RU2240761C1 - Method for surgical treatment of open-angle glaucoma - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: one should perform nonpenetrating deep sclerectomy followed by viscocanalostomy. While performing viscocanalostomy it is necessary to carry out implantation of not less than three implants-braces out of hydrated hydrogel along the whole circumference of Schlemm's canal. Implantation should be carried out so that viscoelastic introduced alternatively with implants-braces to steadily move and distribute them in developed canal. The method enables to enhance and prolong hypotensive effect of antiglaucomatous operation and, also, prevent the development of Schlemm's canal functional block.

EFFECT: higher efficiency of operation.

1 dwg, 1 ex

Description

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

There is a method of surgical treatment of open-angle glaucoma, including non-penetrating deep sclerectomy followed by a viscanocanostomy (Gusev Yu.A., Trubilin V.N. Non-penetrating viscoangulorectomy - a new technology in the treatment of open-angle glaucoma // Sat on the materials of the 5th scientific-practical conference “Actual problems of ophthalmology”, - M., - 2002. - S.13-14).

The closest analogue is a method of surgical treatment of open-angle glaucoma, including non-penetrating deep sclerectomy, detachment of the descemet sheath by 0.5-1 mm in the lumen of the Schlemm canal on both sides of the wound and the introduction of porous implants on both sides of the wound into the Schlemm canal to a depth 2-2.5 mm, leaving 1 mm on the outside on both sides (RU No. 2175535, publication 10.11.01. Bull. No. 31).

The disadvantage of this method is:

In some cases, insufficient and short-term effect of the operation.

The objective of the invention is to provide an effective method for the surgical treatment of open-angle glaucoma with the aim of enhancing and prolonging the hypotensive effect of antiglaucomatous surgery, as well as preventing the development of the functional block of the Schlemmm channel.

The technical result according to the invention is achieved by the fact that in the method of treating open-angle glaucoma, including performing non-penetrating deep sclerectomy and performing a viscanocanalostomy, during the performance of a viscocanalostomy, at least three implant spacers are made from hydrated hydrogel around the entire circumference of the Schlemm canal in such a way that viscoelastic is inserted alternately with spacer implants evenly promotes and distributes them in the formed channel.

The method allows to prolong the hypotensive effect of the operation by restoring the outflow of intraocular fluid through the natural drainage paths. Viscoelastic introduced into the lumen of the Schlemm canal dissects the descemet membrane from the stroma of the cornea, expanding the venous sinus of the sclera, which enhances the hypotensive effect of the operation. At the same time, implants introduced into the lumen of the Shlemmov canal increase the distance between the inner and outer walls of the Shlemmov canal along its entire circumference, which prevents the functional blockade of the Shlemmov canal with excessive trabecular retention. The advancement of spacer implants inside the Schlemm canal under pressure from viscoelastic allows them to be less traumatic and evenly distributed over the entire circumference of the venous sinus of the sclera. It should be noted that other methods of implanting implant spacers do not allow atraumatic to place them on the contralateral side of the zone of non-penetrating deep sclerectomy. The relatively small sizes of hydrated spacer implants reduce the likelihood of them blocking the mouths of the collector tubules, and also make it possible to implant them less traumatically into the Schlemmov canal, which is the prevention of various intraoperative complications.

The invention is illustrated in the drawing, which shows a diagram of the operation, where the superficial scleral flap is 1; deep scleral flap - 2; Shlemmov channel - 3; trabecula - 4; Descemet's shell - 5; spacer implants in the lumen of the Shlemmov channel - 6; location in the Schlemm canal viscoelastic - 7; cornea - 8.

The method is as follows.

Under local anesthesia, the conjunctiva and tenon capsule are cut 6 mm from the limbus. A superficial scleral flap is cut out (1) with a base at the limb at 1 / 3-2 / 3 of the sclera thickness with entry into the transparent layers of the cornea. A deep scleral flap (2) with a base to the limbus is outlined and cut out under it. Open Shlemmov channel (3), exposing the trabecula throughout the base of the deep scleral flap. After that, a deep sclera flap (2), including the outer wall of the Shlemmov canal, is removed with exposure of the area of the descemet casing (5) adjacent to the trabecula (4). The front camera remains unopened. Alternately either a hydrated hydrogel spacer implant (6) or a small amount of viscoelastic (7) are introduced into the Schlemm canal in such a way that each subsequent introduction of viscoelastic propels all previously introduced spacer implants. At the same time, viscoelastic located between the spacer implants prevents them from touching each other. After that, the superficial scleral flap (1) is fixed with sutures to the side walls of its bed. A continuous suture is applied to the conjunctiva and tenon shell. The operation ends with the introduction of a conjunctiva of a solution of dexazone and an antibiotic.

Example.

Patient M., 72 years old, diagnosis: open-angle glaucoma III C, complicated cataract of the right eye.

At admission: visual acuity with a correction of 0.3; peripheral borders of the visual field are narrowed by 20 degrees from the bow; topography: P ₀ = 43.6; C = 0.04, F = 1.21; P / C = 1090.

An operation of non-penetrating deep sclerectomy was performed. Then, during a viscocanalostomy, 12 hydrated hydrogel spacer implants were implanted into the lumen of the Schlemm canal.

3 months after surgery: visual acuity and field of view have not changed.

Tonography: P ₀ = 10.3; C = 0.38; F = 1.23; P / C = 27.

Indications for the method is glaucoma with an open angle of the anterior chamber in the presence of a functional block of the Shlemmov channel.

It should be noted that this method can be used on the basis of any anti-glaucomatous operation.

Claims (1)

A method of surgical treatment of open-angle glaucoma, which consists in conducting non-penetrating deep sclerectomy and viscocanalostomy, characterized in that during the execution of viscocanalostomy, at least three implant spacers are made from hydrated hydrogel around the entire circumference of the Schlemm canal in such a way that viscoelastic implanted struts, evenly promotes and distributes them in the formed channel.