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.
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.
SUBSTANCE: method involves per os introducing lipoic acid concurrently with beta-carotene at a dose of 0.05 and 10 mg 3 times a day during 1 month, respectively.
EFFECT: enhanced effectiveness of treatment; improved antioxidation activity in eye tissues; improved vision function.
3 dwg, 1 tbl
FIELD: organic chemistry, medicine.
SUBSTANCE: invention relates to 1-ethanolamide PGF2α of formula I useful in relaxation of mammalian intraocular pressure. Claimed substance unlike majority of ocular hypotensive prostaglandins doesn't effect through FP-receptor.
EFFECT: new effective compound for relaxation of mammalian intraocular pressure.
4 cl, 1 ex, 16 dwg, 16 tbl
< / BR>where R denotes ethyl or 2,2,2-triptorelin group; Y is hydroxy or pivaloyloxy; the carbon atom marked with the symbol (R) is the carbon atom in (R)-configuration, or its pharmaceutically acceptable salts
SUBSTANCE: method involves cutting conjunctiva concentrically relative to limb using radiosurgical apparatus electrode in completely rectified wave shape. Sclera emissaries and varicose veins destruction is carried out with partially rectified wave shape. Extraocular muscles are amputated and single-stage edge coagulation with following neurectomia and optic nerve coagulation done by means of radiosurgical apparatus electrode in completely rectified wave shape mode.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: the present innovation deals with treating vascular cutaneous neoplasms, vast hemangiomas, among them. Before surgical dissection of hemangioma one should carry out stage-by-stage laser impact with help of neodymium YAG-laser onto hemangioma's surface by coagulating hemangioma's nourishing vessels. In each stage one should start the impact from hemangioma's edge and, coming nearer towards its center, it is necessary to finish the stage of therapy. Laser impact should be started at energy level being 80 J/sq. cm not less, and in every next stage performed in 3-5 wk after the previous one it is necessary to increase energy against the previous stage to finish laser therapy at energy of not more than 145 J/sq. cm on achieving hemangioma's vascular resistance. The innovation enables to decrease the area of hemangioma that leads to obtaining better functional and cosmetic effect.
EFFECT: decreased traumatism of operation.
FIELD: medicine, ophthalmology.
SUBSTANCE: one should form paracentesis to develop circular capsulorhexis subiridally, introduce aspiration-irrigation and laser tips into anterior chamber to form a cup in lenticular center, remove laser and aspiration-irrigation tips out of anterior chamber to introduce a chopper into capsular sac, turn lenticular nucleus for 180° against vertical axis of symmetry passing through lenticular center, return the tips mentioned into anterior chamber to perform laser impact onto the center of convex part of lenticular nucleus followed by removing the fragments.
EFFECT: higher efficiency of laser cataractous extraction.
FIELD: medicine, ophthalmosurgery.
SUBSTANCE: the present innovation deals with surgical treatment of cataract at different degrees of density. One should form two mutually perpendicular diametral grooves at the surface of lenticular nucleus, followed by nucleus' breaking, fragmentation and aspirating. On breaking the nucleus one should form a crater in the center of nucleus to decrease each nuclear fragment twice. One should perform aspiration of each fragment successively. While forming perpendicular grooves and a crater it is necessary to apply laser radiation at energy of 150-200 mJ, and while breaking each fragment of lenticular nucleus one should decrease radiation energy up to 100 mJ. The method enables to shorten time for laser impact and total duration of operation, and, also, to conduct operation upon eyes with narrow pupils and apply capsulorhexis of lower diameter, as well.
EFFECT: decreased traumatism of operation performed.
FIELD: medicine, ophthalmology.
SUBSTANCE: one should perform corneal incision to form a pouch in its middle layers and implant there 0.1 ml medium 199 that contains about 5-10 mln tumor cells of melanomic hybridomatous strain. Then it is necessary to suture the pouch with one interrupted suture. The innovation suggested enables to obtain the model of malignant corneal melanoma being maximally similar to clinico-biological characteristics of human corneal melanoma by its clinical and biological features.
EFFECT: higher efficiency.
FIELD: medicine, ophthalmology.
SUBSTANCE: one should perform incision for access into anterior chamber being perpendicular to strong meridian, detect the disposition of IOL supporting elements to perform paracenthesis from the side of more remote supporting element against the incision, separate posterior synechia, IOL and capsular sac should be removed as a single block. Through paracenthesis with an instrument by making efforts to lenticular body in direction from paracenthesis one should replace the lens together with a sac should be shifted in horizontal plane by leaving fibers of zonule of Zinn along the both sides against the area of paracenthesis projection. Due to going on the movements of an instrument but in back direction one should apply the sac's segment onto the iris. Through incision with the help of an instrument one should make efforts to the second supporting element at the site of its fixation with optic part by performing rotation of supporting element in horizontal plane, first, towards the incision side for 80-110°, and then in back direction. One should bring the first supporting element towards incision where it should be captured with instruments to withdrawn. Then comes vitrectomy. The method enables to shorten the time for operation and decrease its traumatism due to IOL removal together with capsular sac as a single unit, decrease the chance of endophthalmitis relapse and post-operational astigmatism.
EFFECT: higher efficiency of therapy.
1 cl, 2 ex
FIELD: medical engineering.
SUBSTANCE: device has handle and operation part being double-blade sharp-tip blade. Transverse grooves are available on the lateral surface for providing conformance to limb. The grooves are 3.0 mm and 4 mm far from blade tip.
EFFECT: accelerated operation process.
FIELD: medical engineering.
SUBSTANCE: system has shunt introduceable transparent cornea and device for delivering and arranging the shunt in transcorneal position. The shunt has body with head on one end and base on the opposite end, and canal giving passage for aqueous fluid to be discharged from the anterior chamber to the external cornea surface. Removable filter is set for controlling aqueous fluid discharge. The shunt, device for delivering it and method for using them are adapted for setting draining system through transparent cornea. Aqueous fluid discharge is controlled with filtering system without involving mechanisms for healing wound. The filter forms meandering path hindering bacteria to penetrate.
EFFECT: high accuracy in calculating discharge rate; avoided hypotension risk and insufficient discharge volume risk.
30 cl, 7 dwg
SUBSTANCE: method involves treating skin defect zone with 0.15-0.35% water photosensitizer solution or photosensitizing gel on hyaluronic acid viscoelastic base selected from a group containing chealon, viscoate, or hyatulon containing 0.1-0.2% of chlorine row photosensitizer selected from a group containing photolon, radachlorine or photoditazine. Then, free or transferred transposed skin transplant is laid over defect zone and suturing it along the boundary with following draining. 20-40 min long exposure is carried out away from light action. Transcutaneous scanning laser radiation of covered defect zone is applied at wavelength of 661-666 nm for 3-5 min with total irradiation dose being equal to 30-40 J/cm2.
EFFECT: enhanced effectiveness of treatment; improved adjacency and attachment to underlying tissues; excluded secondary distortion of postoperative zone.
FIELD: medicine, ophthalmology, pediatrics.
SUBSTANCE: method involves irrigation therapy (IT) by retrobulbar catheterization. Before carrying out IT the preparation "Ginkgo biloba" in capsules and age dosage and nasal drops "Semaks" by 1-2 drops for 1 month is prescribed to patient. Then in IT is carried out for 10 days in hospital by administration of cerebrolysin, riboflavin, agapurin, taufon and emoxipine in the dose 0.4 ml of each of them. Preparations are administrated successively, by fractional doses with interval for 2 h in combination with laser-pleoptic treatment at wavelength 0.63 mcm using device "SPEKL" for 10 min, by one procedure per a day for 10 days. After treatment in hospital glutamine and lecithin is prescribed by ambulatory treatment in age doses for 1 month. Method provides the prolonged remission of disease and reduced hospital period due to the complex effect of indicated curative factors on metabolism normalization in nervous cells, their resistance to stress injures, improvement of regenerative and microcirculating processes in eye tissues, frequency-contrast characterization of visual analyzer.
EFFECT: improved treatment method.
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.
EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.
3 cl, 5 dwg