RU2283636C1 - Surgical method for treating open angle glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves cutting out superficial scleral rectangular flap turned with its base towards the limb to transparent cornea layers and deep triangular scleral flap. Corneoscleral strip is excised including external wall of the Schlemm's canal with limbal edge of Descemet's membrane being exposed without opening the anterior chamber. Two strips are cut out from corneal stroma tissue above the limbal edge of Descemet's membrane in operation zone. The strips are connected to the lateral walls of the deep triangular scleral flap bed. The Schlemm's canal bougienage is carried out 3 mm on each side from operation zone with Descemet's membrane being separated from corneal stroma. The cut-out strips are implanted between the Descemet's membrane and corneal stroma immediately before the Schlemm's canal treated with bougie to both sides from operation zone.

EFFECT: increased hypotension effect.

4 dwg

Description

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

A known method of 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 a triangular flap from the middle layers of the sclera inside the bed, excising the corneoscleral strip including the outer wall of the Schlemm canal and the peripheral layers of the corneal stroma, with exposure of the limbal margin of the descemetic membrane without opening the anterior chamber (a.s. 1565484).

The disadvantage of this method is, in some cases, excessive scarring of the surgical area and, as a consequence, insufficient and short-term effect of the operation.

The objective of the method is to enhance and prolong the hypotensive effect of antiglaucomatous surgery.

The technical result achieved by using the invention is the partial restoration of the outflow of intraocular fluid in natural ways, the expansion of the lumen of the Schlemm canal, the decrease in the likelihood of developing functional blockade of the Schlemm canal, the facilitation of the outflow of intraocular fluid from the venous sinus of the sclera into the zone of non-penetrating deep sclerectomy, and the reduction of the effect of reparative processes on hypotensive effect of the operation.

The technical result is achieved by the fact that in the method of surgical treatment of open-angle glaucoma, consisting in cutting out a superficial scleral rectangular flap with the base facing the limb to the transparent layers of the cornea, forming a triangular deep flap inside the bed formed, excising the corneoscleral strip including the outer wall of the Schlemm's canal, with exposure the limbic edge of the descemet membrane without opening the anterior chamber, while two strips of corneal stroma tissue are cut out the limbal edge of the descemet membrane in the operative zone, connected to the side walls of the bed of the triangular deep scleral flap, is 3 mm on each side of the Schlemm canal from the zone of non-penetrating deep sclerectomy with the descemet membrane exfoliated from the stroma of the cornea, then the cut strips from the stroma of the cornea are implanted membrane and stroma of the cornea immediately in front of the bougievillea schlemm canal on both sides of the zone of non-penetrating deep sclerectomy.

The method allows to enhance the hypotensive effect of non-penetrating deep sclerectomy due to the partial restoration of the outflow of intraocular fluid through natural drainage paths. In this case, the implantation of corneal autotissue strips between the stroma of the cornea and the descemet membrane directly in front of the bougie schlemm canal can significantly expand the lumen of the venous sinus of the sclera. At the same time, the probability of a functional blockade of the Schlemm canal sharply decreases. In addition, a free, wide communication is created between the zone of non-penetrating deep sclerectomy and the lumen of the Schlemm's canal on both sides of the operation zone. This facilitates the outflow of intraocular fluid from the lumen of the Schlemm canal along the newly created pathways for the outflow of intraocular fluid.

It should be noted that this technique can dramatically reduce the area of the zone of non-penetrating deep sclerectomy, and therefore, minimize the effect of excessive reparative processes on the hypotensive effect of the operation.

Thus, the method allows to enhance and prolong the hypotensive effect of non-penetrating deep sclerectomy.

The invention is illustrated by drawings, which depict:

Figure 1 - cutting a superficial scleral flap, cutting and removal

deep scleral flap.

Figure 2 - cutting strips of autologous tissue stroma of the cornea.

Figure 3 - zone bougieument Schlemm's canal and exfoliation descemet membrane

from stroma of the cornea.

Figure 4 - implantation zone of the formed strips of corneal autotissue.

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 of 1 / 3-2 / 3 thickness with entry into the transparent layers of the cornea. Under it, a triangular deep scleral flap (2) is outlined and cut out with the base to the limb, until the surface of the ciliary body is partially exposed. The Schlemm canal is opened, exposing the trabecula (3) along the entire base of the triangular deep scleral flap (2). This flap, including the outer wall of the Schlemm's canal, is removed (Figure 1). At the same time, a strip of corneal stroma tissue remains over the area of the descemetic membrane adjacent to the trabecula (4). This strip of corneal stroma tissue is raised with tweezers and dissected approximately in the middle perpendicular to the limb to the base of the superficial scleral flap. Then, incisions are made of a strip of corneal stroma tissue parallel to the limbus at the base of the superficial scleral flap. The front camera remains open (Figure 2). After this, bougieument of the Schlemm canal (5) is performed, 3 mm on each side of the zone of non-penetrating deep sclerectomy with exfoliation of the corneal stroma from the descemet membrane (6) (Figure 3). Then, the cut strips of stroma of the cornea (4) are implanted between the descemet membrane and the stroma of the cornea directly in front of the bougie schlemm canal (5) on both sides of the operation area (Figure 4). Further, the superficial scleral flap is fixed with sutures to the side walls of its bed. A continuous suture is applied to the mucous membrane of the eye. The operation ends with the introduction of a conjunctiva of a solution of dexazone and an antibiotic.

Example.

Patient K., 62 years old, with a diagnosis of primary open-angle glaucoma IIIC of the right eye. Received complaints of decreased visual acuity in the right eye. Instill 3 times 1% pilocarpine solution in the right eye.

Right eye. IOP = 34.5 mm Hg. Art. Visual acuity = 0.8 s corr.

P ₀ = 34.5 mm Hg Art. C = 0.02 F = 0.46 P ₀ / C = 1725

The boundaries of the fields of vision are concentrically narrowed to 15-20 degrees from the fixation point. The eye is calm. The angle of the anterior chamber is open at III, the degree of pigmentation 2. The length of the eye is 23.59 mm, the depth of the anterior chamber is 2.78 mm.

After a non-penetrating deep sclerectomy, implantation of corneal autotissue strips in front of the bougie schlemm canal was performed on both sides of the operation area using the described technology.

The postoperative period was uneventful. 3 months after surgery: IOP = 16 mm Hg Visual acuity = 0.8 s corr. P ₀ = 12.1 C = 0.28 F = 0.95 P ₀ / C = 42.9. The field of view expanded by 5-10 degrees from the fixation point.

Claims (1)

A method of surgical treatment of open-angle glaucoma, which consists in cutting a superficial scleral rectangular flap with the base facing the limb to transparent layers of the cornea, forming a triangular deep scleral flap inside the bed formed, excising the corneoscleral strip including the outer wall of the schlemm canal, exposing the limbal edge without a descemet membrane opening of the anterior chamber, characterized in that they cut out two strips of corneal stroma tissue over the limbal edge of the descemetic membrane in the operative zone, connected to the side walls of the bed of the triangular deep scleral flap, 3 mm are drilled from each side of the Schlemm's canal from the zone of non-penetrating deep sclerectomy with exfoliation of the descemetic membrane from the corneal stroma, then cut out strips from the corneal stroma are implanted between the desseta corneas directly in front of the bougieuvian schlemm canal on both sides of the zone of non-penetrating deep sclerectomy.

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