Method for improving aqueous humor discharge from eye in open angle glaucoma cases

FIELD: medicine.

SUBSTANCE: method involves introducing two draining wires into Schlemm's canal after having removed its exterior wall in zone under operation. Schlemm's canal walls and draining wires are exposed to rotating magnetic field action to evoke wire oscillations.

EFFECT: complete removal of pigment and protein deposit; increasing Schlemm's canal lumen and its walls flexibility.

 

The invention relates to medicine, in particular to ophthalmology, and can be used to improve aqueous outflow in the surgical treatment of open-angle glaucoma.

It is now established that increase the resistance to aqueous outflow from the eye lead changes in the trabecular tissue, filling schlemm's canal pigment and protein deposits and partial blockade scleral sinus (AppStore "Glaucoma". 1995)

There is a way to increase the filter, consisting in the fact that usepreview flap of sclera from circular ligament together with the outer wall of schlemm's canal and strip corneoscleral tissue. After that, the outer wall of schlemm's canal is removed, and the lack of filtration remove additional layer of endothelium with trabeculae (S.n.fyodorov, Vigolo, Nettikasino, Abenova, Nes, SAV. Non-penetrating deep sclerectomy with open-angle glaucoma. "Ophthalmic surgery" No. 3-4, 1989, p.52-55).

The disadvantage of this method of increasing the filter is that the filter through the trabecular tissue is enhanced only in the area of surgical intervention at a distance of about 5 mm On the rest during filtration through schlemmov channel is not increased. Hypotensive effect of the operation is limited to the place of operation and,in the case of scarring in this area, may increase intraocular pressure (IOP).

There is also another way of enhancing filter with open-angle glaucoma - viscoelastometer.

Viscoelastometer is an extension of schlemm's canal using a viscoelastic material.

From the deep layers of the sclera to form a flap, exposing schlemmov channel, then remove the superficial layers of the cornea above the schlemm's canal by 1-1 .5 mm, achieving filtration through a peripheral departments of the endothelial layer. Further, when the cannula to penetrate into the lumen of schlemm's canal and are viscoelastometer, achieving a gradual filling of the lumen of schlemm's canal viscoelastic (Stegmann R.C. Visco-canalostomy // International Congress of Ophthalmology. 18-th. - Amsterdame. 1998. - P. 94.)

The disadvantage of operations viscoelastometer is that the expansion of schlemm's canal is not all over, and, as in previous similar, only in place of the introduction of viscoelastic at a distance of 4-5 mm and it takes time for resorption of viscoelastic, it is possible falling of schlemm's canal after resorption of viscoelastic, which can lead to increased IOP in the postoperative period.

The task of restoring patency of schlemm's canal and improve the filtration of fluid through the trabecular tissue.

The technical result - the extension slamova ka is Ala and remove protein and pigment deposits, in slamova canal and trabecular tissue by oscillatory movements of the drainage of the probe caused by the action of a rotating magnetic field.

The technical result is achieved in the following way: after the main phase of the operation - ofseparate triangular flap from the underlying layers of the sclera and remove outer wall of schlemm's canal - provide drainage of schlemm's canal by introducing two flexible elastic draining of medical steel wires of circular cross section with a diameter less than 50 microns and a length of not less than 20 mm, the working end of which has a rounded shape.

The diameter of the draining of the wire due to the diameter of schlemm's canal, and its length is half the physiological length of schlemm's canal, is equal to 40 mm

Two drain wire alternately injected around the circumference in schlemmov channel at a distance of 15-20 mm on each side. And then implement the FMS rotating magnetic field, for example, by means of the device BIO-MAC - remotely, with the induction of a magnetic field of 250 MT, the distance from the device to a wire is 10-15 mm Distance selected on the basis of experimental observations. The rotating magnetic field causes fluctuations drain wire, and the amplitude of these oscillations is enough to break up the pigment and protein deposits them in the maintenance and restoration filter schlemm's canal. The exposure time is 2-5 minutes. At a distance of more than 15 mm fluctuations are absent, less than 10 mm fluctuations exceed the amplitude sufficient to remove pigment and protein deposits.

Oscillatory motion draining of the wire due to the influence of a rotating magnetic field within schlemm's canal to provide increased clearance. Improved removal of schlemm's canal and trabecular tissue pigment cells, protein deposits, it also improves the elasticity of the schlemm's canal through the FMS of its walls.

About the cleaning of the drainage system of the eye shows no filtration pillows, and, according to gonioscopy, a significant decrease pigmentation schlemm's canal. These gonioscopy, i.e. the assessment of the degree of pigmentation of the anterior chamber angle using goniolens, showed a decrease in the degree of pigmentation in all cases following surgical treatment.

Example 1.

Patient A., 68 years, is operated about primary open-angle 3 In the glaucoma of the right eye.

The operation is as follows: from the underlying layers of the sclera cut the flap is triangular in shape, with the base facing the limbu, tsepelovo from circular ligament together with the outer wall of schlemm's canal and strip corneoscleral tissue, the outer wall slamova Kahn is La removed.

In the region of schlemm's canal, with two sides from the transactions entered draining wire made of medical steel with rounded working end, a round cross-section with a diameter of 50 microns, a length of 20 mm Drain wire introduced from one end of schlemm's canal at a distance of 20 mm around the circumference. After this second wire is introduced from the other side of schlemm's canal at a distance of 16 mm, Thus draining the wire is passed around the circumference throughout schlemm's canal. Then spent the remote influence of the rotating magnetic field on the drain wire and schlemmov channel, within 3 minutes, a distance of 12 mm, the magnetic field of 250 MT. After the impact of draining the wire was removed.

Overhasty flap was fixed to the sclera one seam. Suture on the conjunctiva. The operation completed subconjunctival injection of antibiotic and steroid.

Operative and postoperative period was uneventful. On the first day after surgery IOP - Maklakova - was 14 mm Hg After 7 days and 1 month after the operation IOP remained consistently normal (15 mm Hg).

Filtration bleb was absent, this is a normal IOP, suggests that filtering takes place throughout the schlemm's canal.

Example 2.

Patient P., 75 years, is operated about primary open-angle 3 With glaucoma of the left eye.

The operation is as follows: from the underlying layers of the sclera cut the flap is triangular in shape, with the base facing the limbu, tsepelovo from circular ligament together with the outer wall of schlemm's canal and strip corneoscleral tissue, the outer wall of schlemm's canal has been removed.

In the region of schlemm's canal, with two sides from the transactions entered draining wire made of medical steel with rounded working end, a round cross-section with a diameter of 50 microns, a length of 20 mm Drain wire introduced from one end of schlemm's canal at a distance of 19 mm in circumference. After this second wire is introduced from the other side of schlemm's canal at a distance of 15 mm, Thus draining the wire is passed around the circumference throughout schlemm's canal. Then spent the remote influence of the rotating magnetic field on the drain wire and schlemmov channel, within 5 minutes, the distance is 15 mm, the magnetic field of 250 MT. After the impact of draining the wire was removed.

Overhasty flap was fixed to the sclera one seam. Suture on the conjunctiva. The operation completed subconjunctival injection of antibiotic and steroid.

Opera is ionic and the postoperative period was uneventful. On the first day after surgery IOP - Maklakova - was 15 mm Hg After 7 days and 1 month after the operation IOP remained consistently normal (16 mm Hg).

Filtration bleb was absent, this is a normal IOP, suggests that filtering takes place throughout the schlemm's canal.

Example 3

Patient S., 56, - operated, about primary open-angle 2 In the glaucoma of the right eye.

The operation is as follows: from the underlying layers of the sclera cut the flap is triangular in shape, with the base facing the limbu, tsepelovo from circular ligament together with the outer wall of schlemm's canal and strip corneoscleral tissue, the outer wall of schlemm's canal has been removed.

In the region of schlemm's canal, with two sides from the transactions entered draining wire made of medical steel with rounded working end, a round cross-section with a diameter of 50 μm, a length of 20 mm Drain wire introduced from one end of schlemm's canal at a distance of 18 mm in circumference. After this second wire is introduced from the other side of schlemm's canal at a distance of 17 mm, Thus draining the wire is passed around the circumference throughout schlemm's canal. Then spent the remote influence of the rotating magnetic field on drene the existing wire and schlemmov channel, within 2 minutes, the distance is 10 mm, the magnetic field of 250 MT. After the impact of draining the wire was removed.

The superficial flap was fixed to the sclera one seam. Suture on the conjunctiva. The operation completed subconjunctival injection of antibiotic and steroid.

Operative and postoperative period was uneventful. On the first day after surgery IOP - Maklakova - was 14 mm Hg After 7 days and 1 month after the operation IOP remained consistently normal (16 mm Hg).

Filtration bleb was absent, this is a normal IOP, suggests that filtering takes place throughout the schlemm's canal.

The way to improve aqueous outflow from the eye in open-angle glaucoma, including the removal of the outer wall of schlemm's canal, characterized in that schlemmov channel alternately introducing two drain wire in the region of operations around the circumference at a distance of 15-20 mm on each side, and then impinges on the drain wire and the walls of schlemm's canal rotating magnetic field with an induction of 250 MT from a distance of 10-15 mm in 2-5 min with subsequent removal of the wire.



 

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