RU2153309C2 - Method for forming subepiscleral space in performing nonpenetrating antiglaucoma operation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves cutting trabecular endothelium in its middle part, round ligament and adjacent intrascleral tissue in one block. Two strips are formed from them. The strips reach the boundaries of scleral notch. The strips are brought out beyond boundaries of covering episcleral flap. Intraocular fluid drainage is provided with the own eye tissues. Subepiscleral space volume grows, preventing from early occlusion of the created drainage canal. EFFECT: stable hypotensive influence; improved intraocular fluid drainage. 1 tbl

Description

 The invention relates to medicine, in particular ophthalmic surgery, and can be used in the surgical treatment of glaucoma.

 A known method (1) of the formation of subepscleral space during non-penetrating type anti-glaucomatous surgery, which involves the removal of the outer layer of the Schlemm canal and the release of the descemet membrane. At the same time, the conjunctiva is preseparated, the sclera flap of square shape is cut into half its thickness and it is detached to the corneal part of the limb by 1.0 mm into the transparent layers of the cornea. From the underlying layers, the sclera is cut out a triangular flap facing the base of the limb, it is separated to a curve of the ligament, then removed together with the outer wall of the Schlemm's canal and a strip of corneoscleral tissue. The thickness of the corneal part is 0.5-0.8 mm, reaching the descemet membrane. Then the Descemet's membrane is released by a single limbal-scleral flap, after which it becomes moisture permeable.

The disadvantages of this method include:
- insufficient depth of the formed subepiscleral space;
- its early healing in the postoperative period;
- difficulty in filtering intraocular fluid from the subepiscleral space into the subconjunctival cavity;
- removal of circular ligament tissue during surgery;
- not always a sufficient decrease in intraocular pressure.

 The task of the invention was the development of an effective method for the formation of subepscleral space during anti-glaucomatous surgery of non-penetrating type, which allows to obtain a high hypotensive effect without removing eye tissue.

 The essence of the proposed method lies in the fact that during the formation of the subepiscleral strip, the trabecular endothelium, the circular ligament and the adjacent intrascleral tissue are cut in the middle in a single block, they form two strips to the edges of the scleral incision and extend beyond the episcleral flap covering them.

 The technical result is expressed in the fact that drainage of intraocular moisture is provided by the eye’s own tissues and there is no need to use a graft.

Positive effect when using this method:
- an increase in the volume of subepiscleral space;
- creating obstacles to early overgrowth;
- providing a more stable hypotensive effect;
- increased filtration of intraocular fluid into the subconjunctival space.

 The proposed method is as follows (see drawing); after traditional anesthesia, a conjunctival incision is made in the upper part of the eyeball along the meridian from 12 to 15 hours (or from 12 to 9 hours) and the conjunctiva is separated (1), the blood vessels of the vessels are thermocoagulated, the square flap is cut from it (2) with the base to limb 1/3 sclera thick and otseparovyvat it to exposure of corneal tissue. The inner middle third of the sclera is cut out and separated in the same manner and shape as an episcleral flap (3), formed in the zone of scleral tissue transition into the corneal “Descemet's window” (4), then the trabecular endothelium and the circular ligament in the middle are cut (5, 6), and they are peeled off in the form of two strips to the border of the scleral bed, lay them on both sides on the sclera (7), then cover the bed formed with an episcleral flap and fix it with a silk suture (8). A conjunctival suture is applied and an antibiotic with a corticosteroid is administered subconjunctively.

The proposed method is illustrated by clinical examples:
Example 1. Patient M., outpatient card N 77297, 54 years.

Diagnosis: right eye - open-angle primary glaucoma III-B; the left eye is the same, 1-A
Survey data: it has been ill for 3 years, in 1994 it was operated on for glaucoma for the first time, decompensation occurred in the fall of 1996. On admission, the peripheral field of view was narrowed from the nasal side to 10 ^o , uniform narrowing along all meridians, with computer perimetry 80 cattle.

 IOP = 31 mmHg with the use of myotics.

03/12/97 the patient underwent surgery according to the proposed method. At discharge:
IOP - 15 mm RT. Art., the field of view from the bow is expanded by 10 ^o , visual acuity - 1.0. A month after the operation, all indicators were saved, IOP in both eyes - 19 mm Hg.

 Example 2. Patient I., outpatient card N 77713, 86 years.

 Diagnosis: right eye - operated glaucoma complicated by cataract; left eye - primary glaucoma, 2 V.

Examination data of the left eye: corrected visual acuity - 0.8; narrowing of the visual field from the nasal side to 40 ^o , paracentral scotoma of Bjerum, IOP - 29 mm Hg

 2.04.97, the patient underwent surgery of the left eye according to the proposed method. Upon discharge from the hospital, corrected visual acuity is 0.7, IOP -17 mm. Hg, the boundaries of the field of view are close to normal. 1.5 months after surgery, the eye functions were preserved, IOP - 21 mm RT. Art. for the left eye and 17 mm. Hg for the right.

References:
1. S.N. Fedorov, V.I. Kozlov et al. "Ophthalmosurgery" N 3-4, 1989 p. 52 (prototype).

Claims (1)

 A method for the formation of a subepiscleral space in a non-penetrating type anti-glaucomatous operation, comprising the formation of a “descemet window” under an episcleral flap, characterized in that during the formation of the subepiscleral strip, the trabecular endothelium is cut in the middle, the circular ligament and the adjacent intrascleral tissue in one of them form a single block, and lead their edges beyond the episcleral flap covering them.