RU2240760C1 - Method for treating glaucoma - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: one should cut scleral fragment of trapezoid shape for the half of its thickness with its bottom towards the limbus. Circumferences should be marked in deep scleral layers. One should perform perforations for two thirds of the length of every marked circumference by forming scleral disks faced by their ungashed section to each other by pairs. Free edges of scleral disks should be unfolded to be sutured by pairs, then a trapezoid fragment should be applied onto them loosely. The method enables to remove postoperational complications and provide better draining effect of operation conducted.

EFFECT: higher efficiency of therapy.

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Description

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

A known method for the surgical treatment of glaucoma [1] by forming the path of the outflow of intraocular fluid into the supraciliary space without opening the anterior chamber.

The disadvantage of this method is the frequent postoperative complications caused by difficulty in the outflow of intraocular fluid, which reduces the therapeutic effect and lengthens the length of stay of the patient in the hospital.

There is also a known method for the treatment of glaucoma [2], which includes forming a pathway for the outflow of intraocular fluid into the supraciliary space without opening the anterior chamber and performing multiple, through perforations of the sclera in the projection of the ciliary body.

However, this method causes frequent postoperative complications, which lengthens the length of stay of patients in the hospital, and obvious cosmetic defects of the eyeball.

The objective of the invention is the reduction of postoperative complications and the elimination of cosmetic postoperative defects of the eyeball.

The problem is solved due to the fact that in the method of treating glaucoma, which includes forming a pathway for the outflow of intraocular fluid into the supraciliary space without opening the anterior chamber and multiple perforation of the sclera in the projection of the ciliary body, according to the invention, the sclera flap is pre-cut to half its thickness, trapezoidal, the base to the limb, and in the deep layers of the sclera with a trepan, draw circles, perforate 2/3 of the length of the intended circle with the formation of scleral discs facing which are not cut in pairs to each other, then the free edges of the scleral discs are folded and stitched in pairs, after which the superficial trapezoidal flap is freely laid on the pairwise stitched scleral discs.

The invention is illustrated in figures 1-6, which consistently depict the stages of the operation.

The method is as follows.

An instillation and conduction retrobulbar anesthesia of the eyeball and akinesia of the circular muscle of the eyelids are performed. In the sector "from 10 to 2 hours" cut the conjunctiva along the limb and radially on one side towards the posterior pole of the eyeball (figure 1).

Then, in the surgical field, the tenon capsule is cut off and it is pushed backwards (Fig. 2). Sclera trapezoidal flap is cut out at half its thickness with the base to the limb. The size of the flap: the lateral faces - 6-7 mm, the limbal part - 12-13 mm, the opposite zone to it - 16 -17 mm. In the deep layers of the sclera with a trepan 2 mm in diameter, 10-14 perforations are marked out, placing them in two rows in a checkerboard pattern (Fig. 3).

Then, 2/3 of the length of the intended circumference of the perforation is incised with a blade to the choroid in such a way that the scleral disks formed in each row are pairwise turned not to have a notched part to each other, after which the free surfaces of the scleral disks are folded and stitched in pairs (Fig. 4) nodal silk seam. Thus, if we take into account that the area of sclera in humans is on average about 700 mm ² , and the area of perforation produced by trepan 2 mm ² is approximately equal to 3 mm ² , therefore, the total area of perforations will be 30-42 mm ² . After that, the superficial trapezoidal, scleral flap is freely laid on pairwise stitched scleral disks (Fig. 5) and nodal sutures (Virginian silk) are applied to the edges of the conjunctiva (Fig. 6).

Disinfectant drops are instilled into the conjunctival cavity. The operation is completed with an aseptic dressing.

Example 1

Patient N., 62 years old, diagnosis: open-angle developed with high intraocular pressure (IOP) glaucoma of the right eye; open-angle initial with normal IOP of glaucoma of the left eye; incomplete complicated cataract of both eyes.

When examined before surgery, IOP on the right eye was 32.7 mmHg, on the left eye - 18.3 mmHg. Visual acuity in the right eye - 0.06 is not corrected, in the left eye - 0.3 without correction, with glass - 2.0 D 1.0.

On the right eye, an operation was performed by the proposed method.

Marked with trepan 2 mm in diameter. 10 perforations in two rows in a checkerboard pattern were cut with a blade 2/3 of the intended circumference to the choroid. The uncut edges of the scleral discs in each row are stitched in pairs. The total area of perforation of the sclera was about 30 mm ² or approximately 0.05 of the area of the sclera. There were no complications during the operation.

In the postoperative period, IOP on the right eye was 10.7 mmHg. Visual acuity of the right eye increased to 0.1 without correction, with glass - 1.0 D 0.2. The field of view has not changed.

Example 2

Patient B., 71 years old, diagnosis: secondary hemorrhagic with high IOP glaucoma of the right eye. Incomplete complicated cataract of both eyes.

During examination before IOP surgery, there was 48.5 mmHg on the right eye and 15.0 mmHg on the left eye. Visual acuity in the right eye is the correct light projection, in the left eye - 0.7 does not correct.

On the right eye, an operation was performed by the proposed method.

The free edges of 10 scleral discs arranged in two rows in a checkerboard pattern are stitched in pairs. The total area of perforation of the sclera was about 30 mm ² .

There were no complications during the operation. In the postoperative period, IOP on the right eye was 14.5 mmHg, and visual acuity of 0.01 is not corrected. The field of view has not changed.

The inventive method of treating glaucoma allows you to get a good therapeutic and fairly high economic effect by eliminating postoperative complications and cosmetic postoperative defects of the eyeball and, as a result, reducing the length of the patient’s hospital stay.

Sources of information

1. USSR author's certificate No. 519194, cl. A 61 F 9/00, 1976

2. USSR copyright certificate No. 1524893, cl. A 61 F 9/00, 1989

Claims (1)

A method for treating glaucoma, including forming a pathway for the outflow of intraocular fluid into the supraciliary space without opening the anterior chamber and multiple perforation of the sclera in the projection of the ciliary body, characterized in that the trapezoidal sclera flap is pre-cut to half its thickness with the base to the limb, and outlined in the deep layers of the sclera circumference, carry out perforations at 2/3 of the length of the intended circumference with the formation of scleral discs facing in pairs not cut to each other, then free nye edge of the scleral disks are folded and mutually cross-linked, and then freely laid on them a trapezoidal flap.

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