Method of surgical management of primary glaucoma

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and may be used in surgical treatment of primary glaucoma. It involves transconjunctival deep sclerectomy. Paracentesis and basal iridectomy is performed at a base of a surface scleral flap. Cyclodialysis is performed in the scleral bed. A sandglass-shaped drainage is made of a polymer plate. A peripheral end of the drainage is implanted in the anterior chamber, a central end is implanted in the cyclodialysis cleft in the scleral bed.

EFFECT: method enables reducing a number of intra- and postoperative complications, ensuring a stable hypotension effect, reducing a length of medical-social rehabilitation.

2 dwg, 2 ex

 

The invention relates to ophthalmology, and can be used in the surgical treatment of primary glaucoma.

A known method of surgical treatment of open-angle glaucoma (repertoiremap deep sclerectomy), including the cutting surface rectangular scleral flap base facing limbu up transparent layers of the cornea, forming a formed inside the Lodge triangular flap from the middle layers of the sclera excision corneoscleral strips, including the outer wall of schlemm's canal and the peripheral layers of the corneal stroma, with exposure of the limbus region descemets membrane without opening the anterior chamber (SU # 1565484, publication date 23.05.1990).

The closest analogue of the present invention is a method of surgical treatment of open-angle glaucoma, including execution repertoire deep sclerectomy and subscleral implantation of collagen drainage (Kozlov V.I., Bagrov, S.N., Anisimov HE, A.V. Osipov, Mogilev VV non-Penetrating deep sclerectomy with collagenoplasty // Ophthalmosurgery. - 1990. No. 3. - P.44-46). The disadvantages of this method are the low efficiency in advanced and severe stage glaucoma, loss of use with narrow-angle glaucoma, in some cases in the postoperative period requires additional l is sernai treatment (destinationdirectory).

The task of the invention consists in the improvement of antiglaucomatous operations non-penetrating type for the treatment of primary glaucoma.

The technical result of the proposed method lies in the compensation of intraocular pressure with ensuring long-term preservation of hypotensive effect with minimal complications.

The technical result is achieved through the implantation of drainage and ensure a stable aqueous outflow from the anterior chamber in subscleral and supraciliary space.

It is known that in the formation of a fistula may occur the pressure differential between the anterior chamber and the environment, which leads to a sudden hypotension eyeball, consequently, increasing the risk of intraoperative suprachoroidal bleeding or syndrome shallow anterior chamber in the early postoperative period, and decrease the hypotensive effect of the operation. When the proposed method is metered opening of the anterior chamber, thus avoiding a sudden drop of pressure and grinding of the anterior chamber.

Unlike traditional non-invasive interventions, this operation can be used in primary angle closure glaucoma and severe stage of primary glaucoma.

The method implemented is aetsa as follows and is illustrated in figures 1 and 2, where 1 is the superficial scleral flap, 2 - scleral bed, 3 - deep scleral flap, 4 - cyclodienes, 5 - paracentesis, 6 - drainage.

Form a conjunctival flap base to the arch. Usepreview superficial scleral flap at 1/2 the thickness of the sclera to the cornea part of the limb to 1.0 mm in transparent layers of the cornea base to limb (figure 1, item 1). Usepreview deep scleral flap is triangular in shape together with the outer wall of schlemm's canal and excised it (figure 1, item 2). Later in the scleral bed, on the side facing the arch, produced through an incision of sclera and through him produce cyclodienes (1, 3). Perform paracentesis of the anterior chamber (figure 1, pos.4). Produce basal iridectomy. From polymer plates prepare drainage hourglass. Implanted drainage so that the peripheral end is inserted through the paracentesis into the anterior chamber and Central - cicloturismo the slot (figure 2, pos.6).

The method is complete, as is customary, the fixation of the superficial scleral flap to the edge of the bed with two interrupted sutures and the imposition of continuous conjunctival suture.

Clinical example 1. Patient R., 68 years. Diagnosis: OD - o/III in glaucoma. The patient had an operation on the proposed method. In the upper arch of the eyeball up to the limbus tsepelovo conjuncti the actual flap. On 12 hours basis to limb formed U-shaped surface of the flap at 1/2 the thickness of the sclera. Next tsepelovo deep scleral flap is triangular in shape together with the outer wall of schlemm's canal and isseen. In the scleral bed, on the side facing to the code produced through an incision in the sclera and through him made cyclodienes. Performed paracentesis of the anterior chamber and produced basal iridectomy. Prepared hourglass drainage implanted peripheral end in front of the camera, and the Central - collegiality slit. Operation, the postoperative period without complications. During the 6-month follow-up intraocular pressure normalized.

Clinical example 2. Patient N., 60. Diagnosis: OS - C/II in glaucoma. The patient made operative treatment. Useprivacy conjunctival and scleral surface patches, the Foundation turned to limb. The thickness of the superficial flap is 1/2 the thickness of the sclera. Cut and isseen from the deep layers of the sclera of the triangular flap. In the scleral bed made cyclodienes and paracentesis, then the basal iridectomy. Subscleral implanted drainage posted peripheral end in front of the camera, Central - supraciliary space.

At the final stage of the superficial scleral flap is stitched to the edge of the bed with two interrupted sutures, on the conjunctiva superimposed continuous seam. In the postoperative period there have been complications in the form of ciliochoroidal detachment and severe inflammatory reaction. The hypotensive effect was observed during the entire observation period (6 months).

Thus, the application of this method allows to reduce the number of complications in the peri - and postoperative period, to obtain a stable hypotensive effect and to reduce the period of medical-social rehabilitation in patients with primary glaucoma.

The method of surgical treatment of primary glaucoma, including repertoire deep sclerectomy and implantation of drainage in the form of a plate in subscleral space, characterized in that additionally at the base of the superficial scleral flap spend paracentesis, are iridectomy, and for drainage use polymer plate in the form of an hourglass, the peripheral end of which is injected into the anterior chamber through the paracentesis, and the Central - supraciliary space through cyclodienes in the scleral bed.



 

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2 ex

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