RU2348386C2 - Method of nonpenetrating surgical treatment of primary open-angle glaucoma - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: surgical treatment of open-angle glaucoma is ensured with sinusotomy from suprachorioid space. Herewith scleral spur is sharply dissected from appropriate sclera by with immediately removed deep scleral flap. Collagen drainage with its ends protruding from surface scleral flap is inserted thereunder prior to complete the operation.

EFFECT: significantly lowered risk of scleroscleral and scleroconjunctival adhesions with reduced time of treatment.

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Description

The invention relates to medicine, in particular to ophthalmology, and in particular to methods for the surgical treatment of glaucoma

It is known that sinusotomy is a non-penetrating operation and involves opening the cavity of the Schlemm's canal with removal of its outer wall. M.M. Krasnov (1988) described the technique of externalizing the Schlemm canal as follows: form a broad conjunctival flap with a base near the limb. Through open cuts, the sclera (at 2/3 depth) outline a long but narrow area; a long incision passes concentrically to the limbus, 3 mm from it two short incisions are directed from the ends of the long to the base of the conjunctival flap. The sclera exfoliates into superficial and deep plates. At the “bottom” of the thus formed layer-by-layer resection zone, the position of the Schlemm canal lumen is localized. A probe is inserted into the lumen of the Schlemm's canal, along which the outer wall of the canal is dissected. The scleral flap is repaired and sutured to its bed with 2-3 sutures. Continuous suture on the conjunctiva.

C. Lüke et al. (2003) proposed the following technique for non-penetrating surgical treatment of glaucoma with drainage. A conjunctival flap is formed with the base to the arch. Then the superficial scleral flap is separated by 1/3 of its thickness with the base to the limb. Then a deep scleral flap is also separated with the base to the limb, and a thin layer of scleral fibers remains above the surface of the ciliary body. The outer wall of the Schlemm's canal is removed, and high molecular weight viscoelastic is introduced into it. A deep scleral flap is removed. A drainage containing hyaluronic acid is placed under the surface flap, the first is fixed to the sclera with two interrupted sutures. Continuous suture on the conjunctiva.

It is known that the closest prototype according to the claimed method is a sinusotomy with viscoanalodilation and intrascleral microdrainage (S.Yu. Astakhov, Yu.S. Astakhov, N.G. Zumbulidze, 2004). Its essence lies in the fact that under the superficial scleral flap two intrascleral canals are cut in the meridional direction, starting from the “externalization” zone of the Schlemm canal. Through a sinusotomy, viscocanalodilation is performed by introducing high molecular weight viscoelastic, after which the entrances to the schlemm canal are “plugged” with absorbable collagen occluders, the scleral flap is put in place and fixed with absorbable sutures. Suture on the conjunctiva.

The aim of the invention is to reduce the number of complications, reducing the length of stay of the patient in the hospital.

This goal is achieved in that the scleral spur is cut off from the proper sclera sharply and immediately after that the deep scleral flap is removed, and under the surface scleral flap before the end of the operation, collagen drainage is placed, the ends of which extend beyond the surface scleral flap, preventing the formation of scleral-scleral and sclero-conjunctival adhesions.

The proposed method is as follows. A conjunctival flap is formed, 10 mm long, 7 mm from the limb with the base to it. After gentle coagulation of the episcleral vessels, a superficial scleral flap of square shape with a side equal to 5 mm is planned to 1/3 of the thickness, which is then separated to transparent layers of the cornea. Then, three sides of a deep scleral flap of rectangular shape 4 * 3 mm in size are outlined, namely: the sides of a rectangle 3 mm long, perpendicular to the limbus, and the long side connecting them, 4 mm long, which is located 2 mm behind the scleral spur. A deep scleral flap is separated over the entire thickness of the sclera. When the scleral spur is localized, it is cut off from the proper sclera in the acute way. Thus, the venous sinus of the sclera is opened. A deep scleral flap is removed with Vannas scissors. If there is no filtration through the trabecula, the endothelium and juxtacanalicular tissue are removed from its surface. Then, under the superficial scleral flap, collagen drainage 6 * 2 mm in size is laid, the ends of which extend beyond the surface scleral flap. The superficial scleral flap is fixed to the sclera with two interrupted sutures (at the corners of it). Impose a continuous seam on the conjunctiva. Under the conjunctiva, S. Dexasoni 0.3 is administered.

In total, our clinic performed 34 such operations, long-term results - up to 3 years. In all patients, intraocular pressure was compensated.

Example 1

Patient K., 63 years old, turned to the Ophthalmological Clinical Hospital with complaints of decreased vision of the left eye. Diagnosis: Open angle II a glaucoma, initial cataract of the left eye. From the anamnesis it was found out that he suffers from glaucoma for about 5 years. Objectively: visual acuity of the left eye 0,3sph + 1,0D = 0,4. IOP of the left eye according to Maklakov 28 mm Hg (instills pilocarpine 1% 3 times a day and arutimol 0.5% 2 times a day). The adnexal device without deviations from the norm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent. The pupil is round, pseudoexfoliation along its edge, the photoreaction is weakened. The lens with initial opacities in the cortical layers. The fundus of the eye: the optic disc is pale, its borders are clear, e / d 0.6. Macular region - redistribution of pigment. A sinusotomy was performed on the patient from the suprachoroidal space with collagen drainage as follows: a conjunctival flap 10 mm long was formed 7 mm from the limb with the base to it. After gentle coagulation of the episcleral vessels, a superficial scleral flap of a square shape with a side equal to 5 mm, 1/3 of the thickness, which is then separated to transparent layers of the cornea, is outlined. Then, three sides of a deep scleral flap of rectangular shape 4 * 3 mm in size were outlined, namely: the sides were rectangles 3 mm long, perpendicular to the limbus, and the long side connecting them, 4 mm long, which was located 2 mm behind the scleral spur. A deep scleral flap is separated to the entire thickness of the sclera. When the scleral spur is localized, it is cut off from the proper sclera in the acute way. Thus, the venous sinus of the sclera was opened. Deep scleral flap removed with Vannas scissors. The endothelium and juxtacanalicular tissue were removed from the trabecula surface. Then, under the superficial scleral flap, collagen drainage 6 * 2 mm in size was laid, the ends of which protruded beyond the superficial scleral flap. The superficial scleral flap is fixed to the sclera with two interrupted sutures (at its corners). A continuous suture on the conjunctiva. Under the conjunctiva, S. Dexasoni 0.3 was injected.

No intra- or postoperative complications were detected. IOP according to Maklakov - 20 mm Hg

Example 2

Patient G., 66 years old, turned to the Ophthalmological Clinical Hospital with complaints of low vision of the left eye. Diagnosis: Open-angle I and glaucoma of the left eye, immature cataract. He suffers from glaucoma for about 2.5 years. Objectively: Vis OS = 0.04 sph -7.0 D = 0.2. Maklakov tonometry of the left eye: 24 mmHg (instills pilocarpine 1% 3 times a day and 0.5% 2 times a day okomed). The adnexal device without deviations from the norm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent. The pupil is round, pseudoexfoliation along its edge, the photoreaction is weakened. A lens with intense opacities in all layers. Fundus: optic disc is pale on the temporal side, its boundaries are clear, e / d 0.4-0.5. Macular region - redistribution of pigment. The patient performed a sinusotomy from the suprachoroidal space with collagen drainage. No intra- or postoperative complications were detected. IOP according to Maklakov - 18 mm Hg

Example 3

Patient Sh., 82 years old, turned to the Ophthalmological Clinical Hospital with complaints of decreased vision of the left eye. Diagnosis: Open-angle III a glaucoma, initial cataract of the left eye. From the anamnesis it was found out that he suffers from glaucoma for several months. Objectively: visual acuity of the left eye is 0.08 sph -1.0 D = 0.1-0.2. IOP of the left eye according to Maklakov 28 mm Hg (instills okumol 0.5% 2 times a day). The adnexal device without deviations from the norm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent. The pupil is round, pseudoexfoliation along its edge, photoreaction saved. The lens with initial opacities in the cortical layers. The fundus of the eye: the optic disc is gray, its borders are clear, e / d 0.8. The macular region is dry dystrophic foci. The patient underwent a sinusotomy from a suprachoroidal space with collagen drainage. No intra- or postoperative complications were detected. IOP according to Maklakov - 16 mm Hg

The present invention is not obvious to specialists working in this field. The claimed method is effective, however, publications on it in the literature available to us have not been found. The invention has important socio-economic and medical significance. The proposed method of non-penetrating surgical treatment of primary open-angle glaucoma is simple and can be applied in any clinic.

Literature

1. Krasnov M.M. Modern sinusotomy technique (externalization of the Schlemm canal) without resection of the sclera. // Bulletin of Ophthalmology. 1988. - No. 1. - S.10-12.

2. S. Lüke, T. S. Dietlein, R. C. Jacobi, W. Konen and G. K. Krieglstein. A prospective randomized trial of viscocanalostomy with and without implantation of a reticulated hyaluronic acid implant (SKGEL) in open angle glaucoma // British Journal of Ophthalmology. - 203. - Vol. 87. - No. 3. - P.599-603.

3. Astakhov S.Yu., Astakhov Yu.S., Zumbulidze N.G. Modern trends in the development of non-penetrating surgery with glaucoma // Bulletin of Ophthalmology. - 2004 - No. 3. - S. 4-7.

Claims (1)

A method of non-penetrating surgical treatment of primary open-angle glaucoma by performing a sinusotomy with collagen drainage, characterized in that they perform a sinusotomy from the suprachoroidal space, wherein the scleral spur is cut off from the proper sclera in the acute way and immediately after that a deep scleral flap is removed, and under the surface scleral surgery, the flap is removed before the end place collagen drainage, the ends of which extend beyond the surface scleral flap.