RU109662U1 - TRABEKULOT IRRIGATION - Google Patents

Abstract

 1. A tool for performing trabeculotomy ab interno, comprising a handle and a working part with double-edged lateral cutting edges, characterized in that the tool is a modified 25 G injection needle with the ability to feed an irrigation solution through it, the distal end of which is blunt, while the faces forming a blunt distal part are rounded, and the needle itself is made with a bend separating it into the handle and the working part. ! 2. The tool according to claim 1, characterized in that the width of the blunt distal end is 0.15 mm ! 3. The tool according to claim 1, characterized in that the bending angle of the working part with respect to the handle is 130-140 °.

Description

The utility model relates to medicine, namely to ophthalmosurgery and can be used to perform anti-glaucoma operations that restore the natural path of fluid outflow by trabeculotomy ab interno.

Trabeculotomy ab interno is used for open-angle glaucoma and consists in dissecting the trabeculae from the angle of the anterior chamber using a cutting tool under direct gonioscopic control. As a tool, for example, a Sato knife is used, the tip of which cuts the trabecular wall of the scleral sinus (Alekseev B.N., Ermolaev A.P. Trabeculotomy ab interno in combination with simultaneous cataract extraction // Bulletin of Ophthalmology - 2003.- №4 .- Volume 119.- S.7-10). The design of this knife does not allow the dissection of the trabeculae in a controlled and efficient manner. The closest to the construction is a trabeculot developed in our center and protected by a patent, the working part of which is a flat spatula with double-edged cutting edges. Using them, the trabeculae is opened, then the trabeculot is inserted into the Schlemm canal until it stops with a blunt distal end into the outer wall of the channel and move along an arcuate trajectory, dissecting the trabecula in one or the other direction (patent for the invention of the Russian Federation No. 2389456 is a prototype).

The disadvantages of the trabeculotoma prototype.

It is safer to use such a trabeculotome design on aphakic eyes, because the technology provides for maintaining the depth of the anterior chamber with a viscometer, the removal of which at the end of the operation can lead to clouding of the lens, postoperative complications may also occur due to incomplete removal of viscoelastic from the anterior chamber.

The task that the surgeon solves when creating a new tool is to develop an irrigation trabeculotome that allows atraumatic and controlled dissection of the trabeculae and at the same time maintain the anterior chamber volume by supplying irrigation fluid through the trabeculotus.

EFFECT: stable normalization of intraocular pressure, reduction of operational and postoperative complications, the ability to perform operations on phakic eyes, low cost in the manufacture of the instrument.

The indicated technical result can be obtained if, as a tool for performing trabeculotomy ab interno, containing a handle and a working part with double-edged side cutting edges, a modified 25 G injection needle is used, with the possibility of supplying irrigation fluid through it, the distal end of which is made blunt, the faces forming the blunt distal part are rounded, and the needle itself is made with a bend separating it into the handle and the working part. Moreover, as a private option, the width of the blunt distal part is 0.15 mm, and the bending angle of the working part with respect to the handle is 130-140 °.

A standard 25 G injection needle is a hollow straight tube whose outer diameter (D) is 0.4 mm and the inner (d) 0.3 mm. Its working end is beveled at an acute angle, and the lateral faces are double-edged and intersect, forming the sharp distal end of the needle.

The developed utility model is based on a modified 25 G injection needle, through the inner channel of which fluid can be supplied to the distal end of the instrument. The modification consists in the fact that the needle is made with a bend separating it into the handle and the working part. The bending angle is obtuse and is 130-140 °. The distal end of the needle is made blunt, while the faces forming the blunt distal part are rounded, and the width of the blunt distal part is 0.15 mm. You can get the distal end blunt either by cutting off the tip of the injection needle, or by grinding it until the required width is obtained.

Figure 1 shows a schematic representation of an instrument for performing ab interno trabeculotomy in isometry, where 1 is the handle, 2 is the working part of the modified 25G injection needle. Figure 2 is a side view. The outer diameter of the trabeculotome is 0.4 mm, the inner 0.3 mm. The bending angle of the trabeculotoma is obtuse and is 130-140 °. The working part of the trabeculotoma has lateral double-edged cutting edges made converging to the distal end. The distal end of the trabeculotoma is made obtuse, has a width of 0.15 mm, and the faces forming the distal end are rounded.

Trabeculot irrigation is used as follows.

Before surgery, Trabeculot is connected to an irrigation system, for example, a phacoemulsifier.

The working part of the trabeculotome (item 2) is introduced through paracentesis (an incision in the cornea 1-1.2 mm wide) into the anterior chamber and immediately through the trabeculotomy, irrigation fluid is fed into the anterior chamber to maintain its depth. These actions are performed under gonioscopic control (Magna goniolins are used). The blunt distal end of the trabeculot is directed towards the angle of the anterior chamber to the trabeculum, opposite to paracentesis. The tip of the side cutting part carries out an initial injection into the trabecular network. They open it and lead the tool all the way with the blunt distal end into the outer wall of the Schlemm's canal and move the tool along an arcuate trajectory in one or the other direction, while cutting the trabecula with the side cutting edge by the required amount. As a result of this design of the trabeculotome and the technology used, the actions for dissecting the trabeculae are controlled by the surgeon, are atraumatic for the surrounding tissues and effective. Irrigation fluid constantly flowing through the opening of the distal end of the trabeculotome not only maintains pressure in the anterior chamber, but also successfully flushes blood from the angle of the anterior chamber (CCP), which can appear when the trabecula is cut, which provides the surgeon with a better visualization of the operation area. During trabeculotomy, the surgeon can leave one zone of the CPC, move to another and there, repeating the described actions, make a dissection of the trabeculae. At the same time, irrigation carried out through a trabeculot is not interrupted.

Example. Patient P., 68 years old, diagnosis: open-angle glaucoma II degree of the right eye. Visual acuity with correction - 0.8. Intraocular pressure - 37 mm Hg An operation was performed on the right phakic eye in the described manner using the developed trabeculotoma irrigation. Trabeculotomy was performed in the upper nasal sector over a length of 3.5 mm. No operational complications were observed. Postoperative pressure was 18 mm Hg, visual acuity with a correction of 0.8. With further observation after 3 and 6 months, postoperative complications were not observed, the pressure is normal.

Using the irrigation trabeculotome, the Yekaterinburg Center of the IRTC “Eye Microsurgery” performed 46 operations on the phakic eyes, which were successful without complications and made it possible to quickly and atraumatically normalize intraocular pressure.

Claims (3)

1. A tool for performing trabeculotomy ab interno, comprising a handle and a working part with double-edged lateral cutting edges, characterized in that the tool is a modified 25 G injection needle with the ability to feed an irrigation solution through it, the distal end of which is blunt, while the faces forming a blunt distal part are rounded, and the needle itself is made with a bend separating it into the handle and the working part. 2. The tool according to claim 1, characterized in that the width of the blunt distal end is 0.15 mm 3. The tool according to claim 1, characterized in that the bending angle of the working part with respect to the handle is 130-140 °.