Method for surgical treatment of glaucoma

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with introducing medicinal preparation onto scleral bottom and episclerally at the end of operation. As medicinal preparation one should apply 50%-glycerol solution, onto scleral bottom and episclerally introduced per 1 drop of solution. Exposure of glycerol solution corresponds to 1-2 min. The innovation enables to decrease the quantity of complications in post-operational period.

EFFECT: higher efficiency of therapy.

2 cl, 2 ex

 

The invention relates to medicine, namely to glaucoma surgery.

There is a method of surgical treatment of glaucoma (see Ivanova, E.S., Tumanyan E.R., Gagaev LB, III Eurasian conference on ophthalmic surgery, Ekaterinburg, 2003, p.1-72), which is in operation deep sclerectomy and multiple rear crepancy sclera with intraoperative application of mitomycin-C in both zones.

Also known is a method of surgical treatment of glaucoma, taken as a prototype (see Role of L.A., khvatova A.V., Denisov E.V., journal of ophthalmic surgery, 2002, No. 3, pp.37-40), which is to carry out standard operations sinusotrabeculactomy and introduction 5 mg 5-fluorouracil at the end of surgery and in the postoperative period for the prevention of excessive scarring or used Mitomycin-C in the form of applications for episclera or under the scleral flap at a concentration of 0.4-0.5 mg/ml with an exposure time of 3-5 minutes. In the postoperative period, depending on the severity of filter bags every day or every other day enter 5 fluorouracil (total dose of 5 - fluorouracil from 10 to 60 mg).

The disadvantage of known methods is that the introduction of drugs can cause complications (eg, uveitis, keratopathy, hemorrhage into the vitreous body) due to their toxic effects on tissues.

The aim of our invention is to improve the efficiency of antiglaucomatous operations and reducing complications in the postoperative period.

This objective is achieved in that according to the method of surgical treatment of glaucoma, including the introduction at the end of operation of a medicinal product on the scleral bed and episcleral, as a medicinal substance use 50% solution of glycerin and enter it in the amount of 1-2 drops. In addition, introduce a 50% solution of glycerin in the area of operation under the conjunctiva in the postoperative period from 1 to 6 times daily.

The use of this invention will improve the efficiency of operations by improving the outflow of aqueous fluid from the eye in connection with the attraction of water molecules intraocular fluid 50% solution of glycerol. Continuous fluid flow contributes to the formation of ways of intraocular fluid through which is formed during the operation of the path, preventing them from scarring. Histological studies have shown that glycerol reduces inflammation, infiltration and swelling of the eye tissue, the growth of newly formed vessels, which also contributes to the formation of ways of outflow of aqueous fluid from the anterior chamber of the eye through the scleral bed under the conjunctiva. Mild inflammatory process is not ergodic in proliferative, so do not develop an increased formation of scar connective tissue, clerosterol and sclerocorneal of cicatrices, the outflow of intraocular fluid is free.

All the advantages of our method allow to obtain hypotensive effect antiglaucomatous surgery in the postoperative period there were no such complications as keratopathy, hemorrhage, uveitis and endophthalmitis. It is important to note the availability and economic efficiency of application of glycerol with antiglaucomatous operations. Especially shows the use of glycerin in operations non-penetrating type (non-penetrating deep sclerectomy standard and laser), and when you antiglaucomatous operations in young patients with secondary glaucoma.

The method is as follows.

Local anaesthetic solution dikaina of 0.5%. Concentric limb is cut out a flap of conjunctiva height of 6.0 mm From the surface layers of the sclera is cut out rectangular flap sizes 4×4 mm scleral bed apply 1 drop of 50% solution of glycerol at room temperature (23-25°), exposure time of 1-2 minutes. From the deep layers of the sclera is removed triangular flap base to limb together with the rear wall of schlemm's canal. The superficial flap of sclera filed 2 interrupted sutures, the surface of smazyvaete is 1 drop of 50% glycerin solution temperature of 23-25° the exposure time of 1-2 minutes, superimposed on the conjunctiva of blanket stitch.

In the postoperative period glycerol is injected under the conjunctiva in the area of surgical intervention of 0.2-0.3 ml of 50% solution every day 1-6 times depending on intraocular pressure.

Example 1

Patient P. diagnosed with open-angle developed with high intraocular pressure glaucoma of the left eye was operated non-penetrating deep sclerectomy. The operation was conducted according to the standard technique, after ofseparate superficial scleral flap on the bed caused one drop of a 50% solution of glycerol, and then made the destruction of the deep scleral flap in the form of a triangle with its base to limb. After blending of the two nodal joints on the superficial scleral flap he was treated with one drop of a 50% solution of glycerol t 23-25°S, the exposure time of 1-2 minutes, then put the blanket stitch on the conjunctiva.

After one day after surgery, increased intraocular pressure, filtration pillow flat. Daily for 3 days under the conjunctiva in the area of surgical intervention was administered 0.3 ml of 50% solution of glycerin. Intraocular pressure was normalized, formed spilled filtration bleb.

Example # 2

Patient So with a diagnosis of primary open-angle with moderately elevated inside lsnim pressure glaucoma of the right eye was performed the standard non-penetrating deep sclerectomy. After dissection of the superficial scleral flap bed and episclera greased one drop of a 50% solution of glycerin, then deep sclerectomy, two knotted suture on the surface flap of sclera. On the conjunctiva imposed blanket stitch.

In the postoperative period formed a moderately severe filtration bleb, intraocular pressure of 18 mm Hg

1. The method of surgical treatment of glaucoma, including the introduction at the end of operation of a medicinal product on the scleral bed and episcleral, characterized in that the quality of drug use 50%solution of glycerol on the scleral bed and episcleral enter 1 drop of the solution, while the exposition of the glycerin solution is 1-2 minutes

2. The method according to claim 1, characterized in that it further introduce a 50%solution of glycerin in the area of operation under the conjunctiva in the postoperative period from 1 to 6 times daily.



 

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