The method of surgical treatment of glaucoma

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and can be used for the surgical treatment of glaucoma. Cut out a rectangular flap of sclera base to limb on half of its thickness. Throw it on the cornea. In the middle of the bed formed on the entire width of the concentric limb cut deeper layers of the sclera to the ciliary body. In the center of the cut excised area of the sclera in the form of two triangles. The base of the triangles facing each other. Perpendicular to the line of incision is placed and fixed with single interrupted sutures two strips of biomaterial. The front ends of the strips is inserted through the incision into the anterior chamber angle with Vistana 1 mm Rear ends of the strips injected into suprachoroidal space. Sclera last put in place and fixed with interrupted sutures. The method allows to form a continuous channel for the outflow of aqueous fluid from the anterior chamber in suprachoroidal space. 6 Il.

The invention relates to medicine, namely to ophthalmology, and can be used to treat various forms of glaucoma.

Known surgical methods of treatment I R. F. Kolasinska // proceedings of V all-Russian Congress of ophthalmologists. - M., 1987. - S. 412; C. A. Malagen // abstracts of the VI Congress of ophthalmologists of Russia. - M., 1994. - S. 238) in which to create the outflow of aqueous fluid from the anterior chamber suprachoroidal space, produce preliminary cyclodienes with subsequent implantation of strips autoclave or silicone pipes-drainage in the form of spacers in the anterior chamber angle.

The disadvantages of these methods are quick obliteration cyclodialysis cracks and that the length of input in supraciliary space autolocate is often insufficient, and lengthening it requires an increase in the length of the incision of the sclera, causing more trauma to the eye.

The prototype of the present invention is a method of surgical treatment of glaucoma by operation of iridociliary with Gonio - cyclodialysis and forming the straight path of the outflow of aqueous humor of the anterior chamber (eye fluid) under the conjunctiva due to the introduction of two parallel reeds from autotune in the anterior chamber angle, pushing back the root of the iris from the drainage area and the sclera (M. M. Krasnov. Microsurgery glaucoma: the Second siglasna fluid from the anterior chamber suprachoroidal space and quick Bamyan created the path of outflow due to insufficient power of the intraocular fluid.

The technical result of the invention is the formation of a channel for the outflow of aqueous fluid from the anterior chamber suprachoroidal space in glaucoma.

The technical result is achieved by the fact that you are giving a rectangular flap of sclera base to limb on half of its thickness, throw it on the cornea, in the middle of the bed formed on the entire width of the concentric limbu, cut deeper layers of the sclera to the ciliary body, in the center of this cut on both edges of the excised area of the sclera in the form of two facing each other with the bases of the triangles, perpendicular to the section line, against the edges of the bed is placed and fixed with single interrupted sutures two strips of biomaterial, the front ends of which are inserted through the incision into the anterior chamber angle with Vistana 1 mm, and back in suprachoroidal space scleral flap is laid in position and fixed with interrupted sutures.

In Fig. 1 - 6 shows the steps executed by way of surgical treatment of secondary glaucoma.

The method is as follows. Operation is carried out in any of the free sectors of the eyeball between the straight muscles. On a nearby direct is completed, the incision of the conjunctiva with a length of 8-10 mm, then it usepreview together with subconjunctival tissue to the limb. From the surface layers of the sclera at half of its thickness to form a rectangular flap 2 size 5x5 mm base to limb. Scleral rectangular flap 2 is folded on the cornea, the spatula is produced through the incision deep layers of the sclera 3 to supraciliary space the entire width of the bed. In the center above section 3 excising two equilateral triangles 4, facing each other foundations 1 mm, and with a spatula gently, pressing it to the sclera, pendulum-like movements is cyclo - and genitials so that the angle of the anterior chamber appeared the tip of a spatula. Two rectangular strips allograft 5, a canned biomaterial (TU-42-2-537-97), size HH,5 mm is placed perpendicular to the section line and parallel to the edges of the scleral bed and try on so that the forward end played for the limb to 1 mm, Fixed every one of them to the edges of the cross-section of the sclera 6 one suture anchor. Then the ends of both strips alternately charged under the sclera: the front end in front of the camera with Vistana 1 mm, and the rear end into suprachoroidal space. As rapacious access intraocular fluid directly from the anterior chamber at the rear division, i.e. suprachoroidal space. Edge of the deep scleral wounds sutured with two interrupted sutures 7. The superficial scleral flap is laid in place and secured at the corners with two seams 8. The conjunctival wound restore continuous suture.

Example 1. Patient K., 39 years with a diagnosis of secondary posttraumatic previously operated, the glaucoma of the right eye with high intraocular pressure. After 1.5 years after injury and moved antiglaucoma surgery pain appeared in his right eye. As prescribed by ophthalmologist treated with eye drops that lower the intraocular pressure, but the effect was not observed. After the examination in our clinic was proposed antiglaucoma surgery. Visual acuity of the right eye - 0,005, not corrects, the left eye is healthy. The field of vision of the right eye are not defined. The intraocular pressure of 45 mm RT.article.

These electroholography:

P0= 35,6 mm RT.article.,

C = 0.02 mm3/min/mm RT.article.,

F = 0.46 mm3/min.

Produced by operation of the right eye. After dissection of the conjunctiva length of 8 mm in the upper outer sector of the eyeball is fixed at the outer and upper rectus muscles. Hemostasis. Vikram on the cornea. The deeper layers of the sclera 2.5 mm from the limbus opened on the spatula slit concentric limbu. In the center of this section excised two scleral equilateral triangular bases 1 mm, facing each other. Produced by cyclo - and genitials. Two rectangular Alloplant sizes HH,5 mm laid perpendicular to the section line to the edges of the scleral bed and fixed him a single interrupted sutures 8/0. The front ends of Alloplant alternately tucked into the angle of the anterior chamber with Vistana 1 mm, and the rear - suprachoroidal space. Scleral flap is laid in position and fixed at the corners with two interrupted sutures. The conjunctival wound is sutured with a continuous suture.

The postoperative course smooth. The patient is examined after 5 months. Eyes calm. Intraocular pressure was normalized (17 mm RT.cent.).

Electroholography:

P0= 16,0 mm RT.article.,

C = 0,32 mm3/min/mm RT.article.,

F = 1,88 mm3/min.

Upon examination by slit lamp in the upper outer sector of the eyes from 10 to 11 h in the anterior chamber angle was determined by two Alloplant westasia in the anterior chamber angle by 1 mm Gonioscopic picture: the angle of the anterior chamber srednechirchik, introduced between the spacers is conjunctival plaskolite, avascular. Identical results were maintained after 1 year after surgery.

Example 2. Patient D. , 62 years with a diagnosis of primary open-angle developed glaucoma of the left eye with high intraocular pressure operated. On the left eye previously produced two antiglaucomatous operation filter type (sinusotrabeculactomy) with an interval of 1.5 years. Over the last year celebrated periodic aches and blurred vision in the operated eye. Ophthalmologist at the place of residence referred for surgical treatment in the hospital. Visual acuity of the left eye of 0.3, the right eye is healthy. The field of vision of the left eye 380 degrees. The intraocular pressure of 36 mm RT.article.

These electroholography:

P0= 34,0 mm RT.article.,

C = 0.07 mm3min/mm RT.article.,

F = 1,62 mm3/min.

In our clinic had an operation on his left eye by the proposed method as in example 1. After dissection of the conjunctiva length of 8 mm in the upper outer sector of the eyeball is fixed at the outer and upper rectus muscles. Hemostasis. Cut a rectangular scleral surface of the flap 7 mm from the limbus size 5x5 mm, base to limb, and moved on the cornea. The deeper layers of the sclera 2.5 mm from the limbus vs triangle grounds 1 mm, facing each other. Produced by cyclo - and genitials. Two rectangular Alloplant sizes HH,5 mm laid perpendicular to the section line to the edges of the scleral bed and fixed him a single interrupted sutures 8/0. The front ends of Alloplant alternately tucked into the angle of the anterior chamber with Vistana 1 mm, and the rear - suprachoroidal space. Scleral flap is laid in position and fixed at the corners with two interrupted sutures. The conjunctival wound is sutured with a continuous suture.

The postoperative course smooth. Patient examined at 6 months. Eyes calm. Intraocular pressure was normalized (19 mm RT.cent.).

Electroholography:

P0= 18,0 mm RT.article.,

C = 0.19 mm3/min/mm RT.article.,

F = 1.5 mm3/min.

Upon examination by slit lamp anterior chamber of the mean depth, in ninananajna sector of the left eye with 4 to 5 h in the anterior chamber angle was determined by two Alloplant. Gonioscopic picture: the anterior chamber angle is open, narrow profile, introduced between the struts angle has expanded considerably, clearly visible gap between the sclera and the iris. Filtration bleb under the conjunctiva plaskolite, avascular. Identifying ademu the time operated on 12 patients. Of them, 7 patients diagnosed with secondary glaucoma with high intraocular pressure, 5 - primary, previously operated, glaucoma with high intraocular pressure. All patients showed a positive result of the operation in the form of the normalization of intraocular pressure. The advantage of the proposed method of surgical treatment of secondary glaucoma with the use of Alloplant biomaterial is to create a permanent channel for direct outflow of aqueous fluid from the anterior chamber at the rear division suprachoroidal space.

The method of surgical treatment of glaucoma, including incision of the sclera to supraciliary space, cyclo - and genitials, the introduction of biological grafts in the anterior chamber angle of the eye, characterized in that cut out a rectangular flap of sclera base to limb on half of its thickness, throw it on the cornea, in the middle of the bed formed on the entire width of the concentric limb cut deeper layers of the sclera to the ciliary body, in the center of this cut on both edges of the excised area of the sclera in the form of two facing each other, the bases of the triangles, perpendicular to the section line, against the edges of the bed of kladiva is via an incision in the anterior chamber angle with Vistana 1 mm, and back in suprachoroidal space scleral flap is laid in position and fixed with interrupted sutures.

 

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SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

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EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

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