RU2335272C1 - Method of treatment of glaucoma and implant for its realisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmosurgery and can be used for treating glaucoma. "П"-shaped flap of sclera is formed with base to limb. From deep layers of sclera triangular flap of sclera with apex to limb is formed and removed. Transciliar drainage of posterior chamber by opening it at root of the iris with spatula is performed. Plasty of remote section by means of implant of rhomboid form from collagen copolymer is performed; upper corner of implant is introduced into formed slit-like hole of posterior chamber of eye, lower corner - into suprachorioidal space at apex of superficial flap of sclera. After that knot suture is put on scleral "П"-shaped flap, and continuous suture - on conjunctiva. Method ensures controlled reduction of intraocular pressure, elimination of uncontrolled loss of intraocular fluid and beginning of hypotension in remote post-operation period. In addition, migration of cells of connective tissue to zone of operative intrusion is minimised due to low traumatisation of tissues during operation.

EFFECT: ensuring controlled reduction of intraocular pressure, elimination of uncontrolled loss of intraocular fluid and beginning of hypotension in remote post-operation period.

3 cl, 1 ex, 3 dwg

Description

The invention relates to the field of medicine, to the surgical treatment of glaucoma.

A known method of treating angle-closure glaucoma, in which form a conjunctival flap with the base to the limb and a scleral flap of 5 × 5 mm at half the thickness of the sclera also with the base to the limb. From the underlying layers of the sclera, a triangular flap is cut out with the release of a circular ligament, behind which the ciliary body is secreted, a point microfistula is formed in the posterior chamber of the eye by exposure to the ciliary body with diathermocoagulation. The triangular scleral flap is cut off. The operation is completed by suturing the superficial scleral flap and a continuous suture on the conjunctiva. (TP Tahchidi et al. New possibilities for surgical treatment of glaucoma with organic blockade of the anterior chamber angle, Ophthalmosurgery, 1993, No. 3, pp. 15-18).

However, this method of treatment has its drawbacks: with diathermocoagulation, quite extensive damage to the eye cells occurs, which subsequently leads to excessive development of vascular tissue in the surgical area, which further leads to blockage of the formed pathways of the outflow of intraocular fluid.

The objective of the invention is to increase the effectiveness of treatment and reduce the number of complications due to the controlled outflow of fluid.

The essence of the invention lies in the fact that a U-shaped sclera flap is formed with the base to the limb, from the deep layers of the sclera a triangular sclera flap is formed with the apex to the limb and removed, then transciliary drainage of the posterior chamber is performed by opening the posterior chamber at the root of the iris with a spatula, then plastic is performed of the remote site using a rhomboidal implant, the sharp peak of which is inserted into the formed slit-like opening of the posterior chamber to a depth of 1 mm, and its opposite peak is inserted into the supracho ioidalnoe space at the top surface of the flap of the sclera at a depth of 2 mm, followed by the application node seam on the scleral flap is U-shaped and continuous seam on the conjunctiva. The implant used is made of a collagen copolymer and is a rhomboid-shaped quadrangle with two upper sides 5.4 mm long and the lower sides 2.3 mm long, while the angle formed by the upper sides is 55 degrees, and the lower ones - 90.

The configuration of the implant used is fully consistent with the size and shape of the removed scleral flap and plasticizes the drainage zone, which eliminates the uncontrolled loss of HPV and prevents the development of postoperative hypotension.

The formation of a scleral flap with the apex to the cornea provides an extension of the outflow pathways of intraocular fluid (IHL). The outflow of intraocular fluid is carried out from the posterior chamber of the eye along the implant and along its surface into the suprachoroid space and vessels of the conjunctiva, thus, two different ways of outflow of intraocular fluid are simultaneously involved. Injury to eye cells during the proposed intervention is minimized, which ensures a moderate migration of connective tissue cells into the surgical area. The intraocular fluid outflow paths formed during the operation turn out to be stable and constantly functioning due to the presence of an implant in the surgical area and minimal migration of connective tissue cells into this area as a result of low trauma to the eye cells.

The essence of the method is illustrated by drawings, where in Fig.1 is a top view of the eye, in Fig.2 is a side view in section, in Fig.3 is an implant.

The method is as follows: under local anesthesia, the conjunctiva 1 is cut 4 mm from the limb 2, the conjunctiva 1 is separated to the limb 2, a U-shaped flap 3 sclera is formed at 2/3 of its depth, 4 × 4 mm in size, with the base to limbus 2 sclera, carry out the separation of the surface flap 3 to the limbus. From the deep layers of the sclera in the region of the choroid, a triangular scleral flap is formed with its apex toward the limb 2 and it is removed. Under the base of the circular ligament of the eye, a spatula is inserted and the ciliary body 4 is perforated, as a result of which a slit-like message forms with the posterior chamber of the eye 5, as evidenced by the current of the intraocular fluid from the posterior chamber 5. A sharp apex of the rhomboid-shaped implant 6 is inserted into the posterior chamber 5 to a depth of 1 mm and the opposite, rectangular tip of the implant 6 is inserted 2 mm into the suprachoroidal space 7. The implant 6 is placed strictly in the area of the removed deep sclera flap, replenishing it in shape and size. The implant does not need additional fixation, the surface flap 3 is put into place and fixed with 2 mm 8/0 interrupted sutures at the corners of the flap. On the conjunctiva 1 impose a continuous suture 8/0.

The implant used is made of a collagen copolymer and is a rhomboid-shaped quadrangle with two upper sides of 5.4 mm long and the lower sides of 2.3 mm long, while the angle formed by the upper sides is 55 degrees, and the lower ones - 90. The implant the desired shape is cut immediately before the operation from the workpiece produced in the MNTK them eye surgery. S.N. Fedorova.

Example. Patient K., 63 years old. Dz: Neovascular II - glaucoma of the right eye. Intraocular pressure (IOP) of the right eye - 34 mm Hg, moderate pain. Due to the high risk of complications associated with neovascularization of the iris, the patient underwent surgery TDZK with collagenoplasty rhomboidal implant. No intra- or postoperative complications were noted. In the postoperative period of IOP of the right eye - 16 mm Hg, the pain syndrome was stopped. The observation period is 1 year. IOP of the right eye is normalized, neovascularization of the iris decreased.

In total, 43 patients (48 eyes) with various types of secondary glaucoma were operated on by the proposed method. Normalization of hydrodynamics was observed in 79% of patients up to 1 year. Typical complications, such as choroid detachment, associated with a drop in IOP during surgery, were not observed. There was no bleeding from the iris, since the iris is not injured during the operation.

The application of the proposed method significantly reduces the number of postoperative complications, because:

the outflow of HPV is carried out from the posterior chamber of the eye into the vessels of the conjunctiva and suprachoroid space;

involved two possible mechanisms of fluid outflow;

the anterior chamber does not open, basal iridectomy is not performed, which eliminates the risk of bleeding from the vessels of the iris and postoperative hypotension;

due to the strict correspondence of the size of the opening zone of the posterior chamber and the apex of the implant, the outflow of the intraocular fluid goes only through the implant through its internal structure and along the surface of the implant, which avoids a sharp drop in intraocular pressure during surgery, which can lead to severe hypotension of the eye.

Claims (3)

1. A method for treating glaucoma, including the formation of a conjunctival flap, a U-shaped superficial scleral flap, the formation and removal of a triangular deep scleral flap, transciliary drainage of the posterior chamber by opening it at the root of the iris, the subsequent application of a nodal suture to the scleral U-shaped flap and a continuous suture on the conjunctiva, characterized in that the scleral flap is cut out with the apex to the cornea, the opening of the posterior chamber is carried out using a spatula and the plastic is removed remotely of the sclera flap with the help of an implant, which is a rhomboid-shaped quadrangle with equal lateral angles, the upper corner of which is inserted into the formed slit-like opening of the posterior chamber of the eye, and the lower corner is inserted into the suprachoroidal space at the top of the surface sclera flap. 2. The method according to claim 1, characterized in that the plasty of the deep sclera flap is carried out using an implant from a collagen copolymer, the upper, acute angle of the implant being formed by sides of 5.4 mm in length and equal to 55 °, and the lower one is formed by sides of length 2.3 mm and is 90 °. 3. The method according to claim 1, characterized in that the tips of the implant are inserted into the slit-like opening of the posterior chamber of the eye to a depth of 1 mm, and into the suprachoroid space to a depth of 2 mm.

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