RU2239399C1 - Drain and method for treating the cases of neovascular glaucoma - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: device has collagen of 2-3 types immobilized in polymer of acryl and/or vinyl row with the following ingredient proportions, in % by mass: collagen of 2-3 types - 0.1-5.0, polymer of acryl and/or vinyl row - the rest. Method involves carrying out subtotal vitrectomy, creating fistula and implanting drain. Panretinal endolaser coagulation of the retina is carried out after the subtotal vitrectomy and then, fistula is created by means of laser cyclodiathermal puncture. The drain is implanted into the created fistula, its distal end being installed in the vitreous cavity and the proximal one being conducted into subconjunctival space.

EFFECT: hindered cicatrization of built discharge paths.

2 cl

Description

The invention relates to medicine, namely to ophthalmology, and is a polymer drainage for the treatment of neovascular glaucoma and a method for the treatment of neovascular glaucoma.

There are various types of drains that are used to treat secondary glaucoma, which help maintain the outflow paths created during surgery and thereby achieve stabilization of the ophthalmotonus.

Known explant from polymer materials. Such drainage has a high percentage of water and an aqueous buffer shell, has softness, elasticity and the ability to filter water, which leads to optimal biological tolerance of the material by body tissues (Cheglakov Yu.A. Abstract of dissertation for the degree of Doctor of Medical Sciences, Moscow, 1989, p. 19).

However, according to the author, a stable normalization of IOP in the long-term postoperative period can only be achieved in 70% of cases.

The cause of failure is mainly hemorrhagic complications and an inflammatory reaction of the eye, inducing scarring processes in the area of surgical intervention, which leads to obliteration of the created outflow pathways and increased IOP.

There are various methods for the treatment of neovascular glaucoma using various modifications of the drainage. In this case, an objective necessity is the correct choice of the place and method of implantation of the drainage. Thus, the implantation of drainage into the anterior chamber may facilitate the contact of the drainage with the posterior surface of the cornea and lead to endothelial decompensation of the latter.

There is a method of treating neovascular glaucoma by implanting a tubular drainage into the posterior chamber, namely through the flat part of the ciliary body with preliminary partial or subtotal vitrectomy. (Pars plana implant and vitrectomy for treatment of neovascular glaucoma. Luttrul J.K., Avery R. L. - Retina - 1995 - Vol. L5 (-5) - P. 379-387).

However, the residual fibers of the vitreous body can be infringed in the inner opening of the tube, create traction and lead to complications in the posterior segment of the eye such as tears and retinal detachment.

The technical result of the present invention is the compensation of IOP due to the presence of drainage, which prevents scarring of the formed outflow paths. The technical result of the invention for drainage is achieved in that the drainage consists of collagen of 2-3 types, immobilized in an acrylic and / or vinyl polymer in the following ratio of components, wt.%:

Collagen 2-3 types 0.1 - 50

Polymers of acrylic and / or vinyl series

The polymer basis of the drainage contributes to the resilience of the drainage to resorption and its resistance over a long period of time. The additional content of collagen, which is gradually and metered in the postoperative period, improves the filtration properties of the drainage, increases the level of filtration of intraocular fluid and prevents obliteration of the created outflow pathways. In addition, the elastic material of the drainage prevents the adhesion of vitreous fibers on it and thereby prevents complications from the posterior segment of the eye. The method of its implantation is supplemented by the performance of panretinal endolasercoagulation as a pathogenetic treatment of proliferative diabetic retinopathy and helps to reduce the allocation of angiogenesis factors.

The technical result of the method is achieved by the fact that after a subtotal vitrectomy and panretinal endolasercoagulation of the retina, laser cyclodiothermopuncture is performed in the projection of the flat part of the ciliary body and drainage is implanted into the vitreous cavity through the formed opening. As polymers, it is preferable to use polyacrylates and / or polyvinyl.

As collagen use collagen obtained from animal raw materials.

The proposed method is as follows. The operation is performed under local anesthesia, supplemented by the intravenous administration of sedatives. After standard processing of the surgical field, three incisions of the conjunctiva are made, three scleral punctures are formed, and the cannula is hemmed to supply a replacement solution. Subtotal vitrectomy is then performed according to a generally accepted technique.

A retinal panretinal endolasercoagulation of 150 mW is performed; the number of coagulates varies from 500 to 750.

Scleral punctures are temporarily sealed with plugs. After this, they begin to form a fistulizing hole. To do this, scleral flap 4x4 mm in size is cut out at 12 o'clock with the base to the limb. A section of the ciliary body is exposed. The microfistula is formed by applying to the ciliary body laser radiation with a wavelength of 532 nm with a power of 450 mW. Then the proposed drainage is implanted in the form of a plate 7-9 mm long, 2-4 mm wide and 1-1.5 mm thick.

The distal end of such drainage is installed in the vitreous cavity through the formed fistula, and the proximal end is carried out into the subconjunctival space, the drainage is fixed to the sclera with one nodal suture. The operation is completed by suturing the superficial scleral flap, scleral punctures and conjunctiva.

Example 1

Patient T. suffers from insulin-dependent diabetes mellitus in the stage of decompensation for 14 years. Diagnosis: proliferative diabetic retinopathy, partial hemophthalmus in the organization stage, iris rubeosis, secondary operated neovascular glaucoma 3 s on the right eye myotics.

Visual acuity - finger count at a distance of 10 cm IOP - 42 mm Hg in the intensive mode of antihypertensive instillations. The fundus is not visible due to a suspension of blood in the vitreous cavity.

The operation of the right eye was performed for neovascular glaucoma according to the above method, and a polymer drainage in the form of a plate was implanted, consisting of, wt.%: Collagen of 2-3 types - 9; polyhydroxyethyl acrylate - 91.

On the 3rd day after the operation, the filter cushion is moderately expressed, the IOP level was 23 mm Hg. When examining the fundus with an indirect binocular ophthalmoscope, the retina lies along the entire length, in the vitreous cavity an insignificant suspension of shaped elements.

12 months after surgery, IOP 18 mm Hg without antihypertensive instillations, visual acuity of 0.08, the retina is adjacent, and UBM showed the safety of the created outflow paths and the correct position of the drainage.

Example 2

Patient B. suffers from non-insulin-dependent diabetes mellitus in the stage of subcompensation for 6 years. Diagnosis: proliferative diabetic retinopathy, total fresh hemophthalmus, iris rubeosis, secondary neovascular glaucoma 3 s on the left eye myotics.

Visual acuity is 0.05. IOP - 37 mmHg in the intensive mode of antihypertensive instillations. The fundus is not visible due to total hemophthalmus.

The operation of the left eye was performed for neovascular glaucoma according to the above method, and a polymer drainage in the form of a plate was implanted, consisting of, wt.%: Collagen of 2-3 types - 27; polyvinylpyrrolidone - 73.

On the 2nd day after the operation, the filter cushion is moderately pronounced, the IOP level was 25 mm Hg. When examining the fundus with an indirect binocular ophthalmoscope, the retina lies along the entire length, in the vitreous cavity an insignificant suspension of shaped elements.

7 months after surgery, IOP 14 mm Hg without antihypertensive instillations, visual acuity of 0.3, the retina is adjacent. According to the UBM data, the formed HPW filtration paths are consistent, the drainage position has not been changed.

Claims (2)

1. Drainage for the treatment of neovascular glaucoma, including a polymer, characterized in that it additionally contains collagen of 2-3 types, immobilized in an acrylic and / or vinyl polymer in the following ratio, wt.%: Collagen 2-3 types 0.1-50 Polymers of acrylic and / or vinyl series 2. A method for the treatment of neovascular glaucoma, including subtotal vitrectomy, fistula formation and drainage implantation, characterized in that after subtotal vitrectomy, retinal panretinal endolasercoagulation is performed, then a fistula is formed by laser cyclodiothermopuncture; A drainage is implanted into the formed fistula, setting its distal end in the vitreous cavity, and the proximal end is carried out into the subconjunctival space, while the drainage consists of 2-3 types of collagen immobilized in an acrylic and / or vinyl polymer.