RU2106128C1 - Method for treating closed angle glaucoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out descemetotrabeculotomy with microiridectomy forming microfistula from posterior chamber for superficial scleral flap. EFFECT: enhanced effectiveness of operation. 5 dwg

Description

 The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of angle-closure glaucoma.

 A known method of treating glaucoma, including: cutting out a superficial U-shaped scleral flap, a deep scleral flap with exposure of the ciliary body, opening the anterior chamber, basal iridectomy.

 The disadvantages of the method are: the danger of using it with angle-closure glaucoma with a shallow anterior chamber, due to the fact that a pronounced outflow of intraocular fluid can lead to the appearance of a shallow anterior chamber syndrome and the development of malignant glaucoma; the appearance of hyphema caused by the flow of blood from the vessels of the iris after iridectomy.

 The objective of the invention is to obtain a sufficient hypotensive effect of the operation with a minimal risk of complications.

 The technical result achieved by using the invention is to obtain a hypotensive effect, due to the formation of a microfistula from the posterior chamber under the superficial scleral flap, due to descemetotrabeculotomy with microirrectomy, reduction of surgical and postoperative complications.

 The technical result is achieved by the fact that in the method of treating angle-closure glaucoma, including cutting out a superficial scleral flap and a deep ciliary body and iridectomy, according to the invention, by excising a deep scleral flap, the peripheral layers of the cornea to the descemet sheath are removed without opening the anterior chamber, an avascular region of the rainbow is selected shells and over it make a cruciform incision of the descemetic shell and trabeculae, 1.5 mm in size, and an iridectomy is done by removing the the protruding iris splint until a fistula forms in the posterior chamber.

 The method allows for closed organic angle of the anterior chamber to establish the outflow of intraocular fluid from the posterior chamber through the formed microfistula under the superficial scleral flap. Removal of corneal tissue above the descemetic membrane allows you to select a site of the iris without vessels or with the smallest vessels, to coagulate the vessels of the iris through the Descemetic membrane, which prevents the appearance of hyphema during surgery and in the postoperative period from the iris vessels after iridectomy.

 Since an outflow path is formed directly from the posterior chamber, the anterior chamber is emptied during the operation and, as a rule, does not become smaller.

 In FIG. 1-5 depict the steps of the operation.

 The method is as follows.

 Under local anesthesia, the conjunctiva is cut 6 mm from the limbus. A surface section of 1/2 thickness of the sclera is cut out with a U-shaped flap 1, 5x5 mm in size, with a base to the lobe and entering into the transparent layers of the cornea. Under it, the remaining sclera layers are excised in the form of a trapezoid 2, with the dimensions at the apex of 2 mm and the base of 4 mm and remove them together with the outer wall of the Schlemm's canal and stroma of the cornea (1 mm from the trabecular zone to the center of the cornea). This opens the area of the trabeculae and the strip of descemet shell, 1 mm wide.

 The front camera is not opened.

 Through the Descemetic membrane and trabecular tissue, the adjacent root of the iris and the vessels passing through it are clearly visible.

 A site with no visible vessels or a site with smaller vessels is selected and the iris root is coagulated through the Descemet shell in the area of the proposed section. A cruciate incision 3 is made at the border of the trabecular tissue with the descemet sheath. In the area of the intersection under the influence of intraocular pressure, the iris tissue swells. The top of the bulging part 4 is excised. (The pigment leaf is destroyed). A functioning fistula is formed from the posterior chamber. Two interrupted sutures on the superficial scleral flap.

 To prevent bonding in the operation area, in the first days, 2 mm from the limb, a nodal suture 5 is imposed, which captures the surface layers of the U-shaped flap with the node being brought out to the conjunctiva. The suture can serve as a holder for traction of the superficial scleral flap in the postoperative period if there is no slight hypotension on the 1-2 day after the operation.

 Continuous suture on the conjunctiva.

 Example 1. Patient K., 78 L., diagnosis: angle III with glaucoma, immature complicated cataract of the right eye; angle II with glaucoma, immature complicated cataract of the left eye.

Правый глаз.Admitted with complaints of peripheral pain, decreased vision in both eyes. Constantly instills solutions of pilocarpine 1% in 2 cap. x 4 times, takes diacarb 1-2 tablets. in a day. Intraocular pressure

Right eye.

 Visual acuity = 0.03 not corr.

P ₀ = 43.4 C = 0.06 G = 1.57 V _Δ = 3.11 P _{o / c} = 868
The field of view is narrowed inside to 0, outside to 60 ^o .

 The eye is calm. The angle of the anterior chamber is closed, while compression on the cornea does not open.

 Eye length 22.66 anterior chamber depth 2 mm.

 Left eye.

 Visual acuity = 0.25 not corr.

P ₀ = 46.9 C = 0.02 G = 0.68 V _Δ = 1.55 P _{o / c} = 2345.

The field of view is narrowed inside to 45 ^o , outside to 75 ^o . The eye is calm. The angle of the anterior chamber is closed, with compression on the cornea, the upper part of the trabeculae, the synechia, opens slightly. Eye length 22.73 mm, anterior chamber depth 2 mm. Surgery was performed on both eyes according to the specified method with an interval between them of 12 days.

 Was discharged on the 2nd day after operations on each eye for outpatient aftercare.

 3 months after surgery.

Visual acuity of the right eye = 0.05 s corr. - 3.0 ^d = 0.2 of the left eye = 0.3 s corr. su - 1.5 ^d ah 7 ^o = 0.6
The field of view expanded by 5-10 ^o outside.

Right eye = P ₀ = 15.3 C = 0.18 G = 0.95 P _{o / s} = 85.

Left eye = P ₀ = 6.3 C = 0.19 G = 2.45 P _{o / s} = 34.

Claims (1)

 A method for the treatment of angle-closure glaucoma, including cutting out a superficial scleral flap and a deep ciliary body and an iridectomy, characterized in that when the deep scleral flap is excised, the peripheral layers of the cornea are removed to the descemet sheath without opening the anterior chamber, an avascular region of the iris is selected and a cruciate cross is made over it a 1.5 mm incision in the descemet sheath and trabeculae, and an iridiactomy is done by removing the tip of the protruding iris to form a fistula ly in the back camera.

Images