RU2143873C1 - Surgical method for treating open angle glaucoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves creating conjunctival flap and superficial scleral flap, removing corneoscleral limbus including external wall of Schlemm's canal and peripheral cornea stroma layers. Descemet's membrane edge is uncovered without opening the anterior chamber. Cushion is formed from superficial scleral flap prominent relative to the sclera surface. Free scleral flap surface boundary is rigidly fixed on its bed with sutures. The lateral superficial scleral flap bed walls are in addition partially dissected near the limbus. EFFECT: improved and prolonged hypotensive action; active transportation of intraocular aqueous humor. 2 cl, 4 dwg

Description

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

 A known method for the surgical treatment of open-angle glaucoma, including cutting out a superficial scleral rectangular flap with the base facing the limb, to the transparent layers of the cornea, forming inside the formed bed a triangular flap from the middle layers of the sclera, excising the corneoscleral strip including the outer wall of the Schlemm's canal and the peripheral layers of the corneal stroma, with exposure of the limbal edge of the descemet membrane without opening the anterior chamber / a.c. 1565484 /.

 The disadvantage of this method is the small and short in some cases hypotensive effect of the operation.

 The objective of the method is to enhance the hypotensive effect of the operation and its prolongation.

 The technical result achieved by using the invention is to enhance and prolong the hypotensive effect through surgical intervention, which facilitates the outflow of intraocular fluid from the bed of the deep scleral flap into the subtenon space, the creation of active transport of intraocular fluid through the trabecular network and the site of the descemetic membrane due to the suction action of the formed scleral pillows during eyelid movement, trabecula stretching and limbal area membrane, the difficulty of excessive scarring by creating a sufficiently large diastasis of tissues and their constant displacement relative to each other under the action of the eyelids.

 The technical result is achieved by the fact that in the method of treating open-angle glaucoma, including the formation of a conjunctival flap, superficial scleral flap, removal of the corneoscleral strip including the outer wall of the schlemm canal and peripheral layers of the corneal stroma, exposing the limbal edge of the descemet membrane without opening the anterior chamber, according to the invention, a cushion made of a superficial scleral flap that glue over the surface of the sclera, rigidly fixing the free edge of the surface deleterious scleral flap sutures to his bed. One option is one in which the side walls of the bed of the superficial scleral flap at the limb are additionally partially excised.

 The method allows to increase the outflow of intraocular fluid through the Descemetic membrane and trabecular tissue by removing the corneoscleral tissue flap, creating a direct communication between the bed of the deep scleral flap and the subtenon space, facilitating the outflow of intraocular fluid, the formation of active intraocular fluid transport through the trabecular network and the portion of the descemetic membrane eyelid and displacement of the superficial scleral flap relative to its bed and the drainage system in area of operation; stretching the trabeculae and the limbal portion of the descemetic membrane under the pressure of a superficial scleral flap on the corneal tissue; the difficulty of excessive scarring by creating a sufficiently large tissue diastasis and their constant displacement relative to each other under the action of the eyelids, and therefore the effect of the operation is prolonged.

 The invention is illustrated in FIG. 1-4. In FIG. 1 shows the separation of a superficial scleral flap; in FIG. 2 - cutting and removal of a deep-lying flap of corneoscleral tissue, including the outer wall of the Schlemm's canal and peripheral layers of the cornea with exposure of the limbal edge of the descemet membrane without opening the anterior chamber; in FIG. 3 - hemming of the superficial scleral flap to the side walls of its bed; in FIG. 4 - partial excision of the side walls of the bed of the superficial scleral flap.

 The method is as follows.

 Epibulbar anesthesia is performed with 1% dicaine solution, retrobulbar anesthesia and akinesia with 2% novocaine solution. An incision of the conjunctiva and tenon capsule is performed 6-7 mm from the limbus 7-10 mm in size. A scleral surface flap 1 and 1/2 to 2/3 of the sclera thickness is measured and separated by a size of 5.0 by 6.0 mm with the base to the limb with entry into the transparent layers of the cornea. Under it, parallel to the limb, 1.5 - 2 mm from the Schlemm's canal zone, a strip of corneoscleral tissue 2 is drawn and separated in depth 1/3 of the thickness of the sclera without exposure or with partial exposure of the ciliary body 5 mm long. In this case, the Schlemm canal 3 is opened. A strip of corneoscleral tissue is excised together with the outer wall of the Schlemm 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 area of the descemet membrane 4 with a width of 1 mm. The front camera is not opened. Then, the superficial scleral flap is tightly fixed behind the free edge to the side walls of its bed at a distance of 2–3 mm from the Schlemm's canal with a 8/0 thread. The lateral walls of the bed of the superficial scleral flap 5 are partially excised at a distance of 2 - 3 mm from the limb. A continuous suture is applied to the tenon capsule and conjunctiva. Subconjunctival solutions of dexazone and antibiotic are administered.

Example 1
Patient M., 73 years old, diagnosis: open-angle glaucoma III c, complicated cataract of the left eye.

Upon receipt of the left eye:
Visual acuity - 0.03 sph-4,5 = 0.1
Tonography P = 37.2 C = 0.10 F = 2.59 P / C = 372
The field of view is narrowed from the temporal side by 10; depth of anterior chamber 2.78 mm; the angle of the anterior chamber is open, roughly pigmented; optic nerve disc with a grayish tint, glaucomatous excavation of the optic nerve disc E / D 0.8 - 0.9 mm.

The operation of the left eye was performed according to the above method. The postoperative period was uneventful. On the 3rd day after the intervention, the eye is calm. Visual acuity, field of view unchanged, intraocular pressure 6.7mm Hg. Three months after surgery, tonography indicators: P = 13.4 C = 0.25 F = 0.84 P / C = 53
The indication for the method is primary open-angle glaucoma and some forms of secondary glaucoma with an open angle of the anterior chamber.

 Contraindication to the method is angle-closure glaucoma.

Claims (2)

 1. The method of surgical treatment of open-angle glaucoma, including the formation of a conjunctival flap and superficial scleral flap, removal of the corneoscleral strip including the outer wall of the Schlemm canal and peripheral layers of the corneal stroma with exposure of the limbal edge of the descemet membrane without opening the anterior chamber, characterized in that they form a pillow from the superficial surface scleral flap protruding above the sclera surface, rigidly fixing the free edge of the superficial scleral flap suture ami to the edges of his bed.  2. The method according to claim 1, characterized in that additionally excised part of the side walls of the bed of the superficial scleral flap at the limb.

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