RU2294721C1 - Surgical method for treating the cases of open angle glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves producing superficial scleral flap and creating intraocular fluid discharge zone. Sinustrabeculectomy is carried out or non-penetrating sclerectomy. Scleral bed is sutured with 7-10 stitches making step of 0.5-1.5 mm in continuous suture from polymer suture material of 7/0-9/0 in longitudinal and transverse direction. The suture goes outside scleral bed boundaries by 5-8 mm on each side. Then, the superficial scleral flap is fixed.

EFFECT: increased anterior and posterior intraocular fluid discharge; enhanced effectiveness in preventing sclero-conjunctival cicatrisation of peripheral filtering cushion.

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Description

The present invention relates to medicine, in particular to ophthalmology, and may find application in the treatment of glaucoma.

A known method for the surgical treatment of open-angle glaucoma, including the formation of a superficial scleral flap, the formation of a deep scleral flap, the corneal paracentesis at the limb at 3 or 9 hours, the excision of a deep scleral flap, the puncture of a microhole in the area of the descemet sheath with a needle nozzle of a thermocoagulator, the introduction of an anterior chamber through the paracentesis air bubble, fixation of the superficial scleral flap to the sclera with two interrupted sutures (RF Patent No. 2201733).

The method allows to establish a dosed outflow of intraocular fluid (IHL) from the anterior chamber through the formed fistula under the superficial scleral flap, to squeeze the iris root from the microperforation hole.

The disadvantage of this method is the rapid scarring of the surgically created outflow paths.

Another known method for the surgical treatment of glaucoma involves the introduction of a Schlemm canal at the intersection of the Schlemm canal at a depth equal to the length of a fragment of the distant wall of the Schlemm canal, a thread 80-90 μm thick, to activate the anterior pathway of the outflow of the IHC (RF Patent No. 2236201). The second end of the thread is removed from the area of the superficial scleral flap into the subtenon space and the thread is fixed to the sclera. To activate the posterior outflow of the HPW after exposure of the ciliary body in the suprachoroidal space, a cyclodialysis channel is formed by a needle curved at an obtuse angle. They take him to the anterior chamber with subsequent implantation and fixation of a thread with a diameter of 100-120 microns in it. In both variants of the method, surgical threads based on titanium nickelide are used. The method allows to increase the drainage effect of the operation, to achieve activation of the anterior and posterior outflow paths, to increase the duration of the drainage.

However, this method does not prevent excessive scleroscleral and sclero-conjunctival scarring. In addition, the method is technically quite complicated.

There is a method of surgical treatment of open-angle glaucoma, which consists in cutting a superficial scleral flap with the base to the limb at 1 / 3-2 / 3 of the sclera thickness, cutting out a deep triangular scleral flap with the base to the limb until the ciliary body is partially exposed, open the schlemm canal throughout a deep scleral flap, a deep flap is removed, including the outer wall of the Schlemm's canal, with exposure of the area of the descemetic membrane adjacent to the trabecula, the superficial scleral flap f CSIRO seams to sidewalls its bed and on its surface is placed an elastic film of a biocompatible material (RF Patent № 2203638).

As the patent owner indicates, the method allows to prolong the hypotensive effect of the operation by eliminating the scarring of the surgical area.

The disadvantages of the method is the relatively low efficiency of prevention of adhesions and a weak drainage effect.

A known method for the surgical treatment of glaucoma is, in which, after a non-HSE, the superficial scleral flap is not sutured to the sclera by a standard technique, and when the conjunctival incision is closed with a continuous suture, the superficial scleral flap is fixed to the conjunctiva (RF Patent No. 2211011).

The disadvantages of the method are the relatively low efficiency of prevention of adhesions and a small drainage effect.

The closest in technical essence and the achieved effect is a method for the surgical treatment of glaucoma, including sinistrubekulectomy and the formation of a slit-like space between the superficial flap and the scleral bed by means of a self-absorbable suture above the surface of the scleral bed with the suture fixed behind its lateral edges (RF Patent No. 2181273).

However, it also does not prevent excessive scleroconjunctival scarring of the peripheral portions of the filter pad.

The objective of the invention is to increase the efficiency of surgical treatment of glaucoma by enhancing the prevention of scleroconjunctival scarring of the peripheral portions of the filtration cushion and enhancing the anterior and posterior outflow of the HPW.

The problem is solved by the method of forming a superficial scleral flap, creating an outflow zone for intraocular fluid and stitching the scleral bed with 7-10 stitches in increments of 0.5-1.5 mm with a continuous seam of polymer suture 7 / 0-9 / 0 in the longitudinal and transverse directions extending beyond the flap by 5-8 mm on each side.

The specified mesh can be pre-made.

A variant of scleral stratification, representing a non-penetrating deep sclerectomy, is depicted in figure 1.

An option for stratification of the sclera, representing a sinusotrabeculectomy, is shown in Fig.2.

The following examples illustrate the invention.

Example 1. Patient S., 74 years old, was admitted with a diagnosis of open-angle glaucoma III C of the right eye. Visual acuity with correction - 0.06. The intraocular pressure of the right eye was 34 mm Hg, the coefficient of ease of outflow of intraocular fluid was 0.03.

The operation is performed in the described manner. After sinusotrabeculectomy was performed on the sclera surface under the scleral flap by applying a continuous suture from the polymer suture material, a mesh was formed located under the scleral flap and extending beyond it by 5 mm. The operation is completed by fixing the scleral flap with two interrupted sutures and by applying a continuous 8/0 nylon suture to the conjunctival incision.

The postoperative period was uneventful. After discharge on the 6th day after the operation, visual acuity did not change, the anterior chamber remained of medium depth, and the filtering pad was flat and spilled. The intraocular pressure was 15.2 mmHg.

The method was carried out on 10 patients.

Example 2. Patient N., 64 years old, was admitted with a diagnosis of open-angle glaucoma II In the right eye. Visual acuity with correction - 0.5. The intraocular pressure of the right eye was 27 mm Hg, the coefficient of ease of outflow of intraocular fluid was 0.04.

The operation is performed in the described manner. After performing a non-penetrating deep sclerectomy on the sclera surface under the scleral flap by applying a continuous suture from the polymer suture material, a mesh was formed that is located under the scleral flap and extends 5 mm beyond it. The operation is completed by applying a continuous suture of nylon 8/0 to the conjunctival incision.

The postoperative period was uneventful. After discharge on the 6th day after the operation, visual acuity did not change, the anterior chamber remained of medium depth, and the filtering pad was flat and spilled. The intraocular pressure was 16.2 mmHg.

The method was carried out on 14 patients.

Figure 1. The location of the mesh with non-penetrating deep sclerectomy.

1 - superficial scleral flap;

2 - descemet's membrane;

3 - mesh elements.

Figure 2. The location of the mesh with sinusotrabeculectomy.

1 - superficial scleral flap;

2 - sinusotrabeculectomy hole;

3 - mesh elements.

Claims (1)

A method of surgical treatment of open-angle glaucoma, including the formation of a superficial scleral flap and the creation of an outflow zone of intraocular fluid, characterized in that to create an outflow zone, a sinistrabeculectomy or non-penetrating deep sclerectomy is performed, then the scleral bed is stitched with 7-10 stitches in increments of 0.5-1.5 mm continuous seam of polymer suture material 7 / 0-9 / 0 in the longitudinal and transverse directions, and the seam extends beyond the scleral bed by 5-8 mm on each side, and then fix on erhnostny scleral flap.

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