RU2371149C1 - Method of combination surgery of glaucoma and cataract - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and aims at the combination surgery of glaucoma and cataract. In upper quadrant of eyeball, conjunctival is separated with its base to eyeball fornix. A surface rectangular scleral lap is formed with its base to limb. A through cut of sclera of length 2 to 4 mm from limb and parallel thereto, is made in scleral bed. Besides a triangular deep flap of sclera is formed at 2 mm from limb with its base thereto. Phacoemulsification cut is made under the deep scleral flap. Phacoemulsification follows with positioning a flexible IOL. A tubular implant with its one end placed in anterior chamber and the other end in the through cut of sclera is formed of cut leaf of anterior capsule of lens. A surface scleral flap is fixed with two interrupted sutures herewith displacing distal end 1 mm aside from lmb.

EFFECT: method allows ensuring high visual acuity and evident hypotensive effect, and also provides prevention of fistula blockade.

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Description

The present invention relates to ophthalmology and is intended for the combined surgical treatment of glaucoma and cataracts.

It is known that the combination of glaucoma and cataract according to various authors is observed in 17-38% of cases. Combined intervention, including cataract extraction by phacoemulsification, implantation of an intraocular lens (IOL), anti-glaucomatous surgery, allows for quick medical and social rehabilitation of this category of patients. The main problem of combined interventions is that, on the one hand, it is necessary to ensure good sealing of the wound, and on the other hand, to create reliable ways for the outflow of aqueous humor. As an anti-glaucomatous component, non-penetrating deep sclerectomy is most often used, in which normalization of intraocular pressure cannot be guaranteed with advanced stages of glaucoma.

The closest analogue of the proposed method for the combined surgical treatment of glaucoma and cataract is the method of combined surgical treatment of glaucoma in combination with cataract, proposed by I. Ya. Baranov, L.M. Konstantinova, in which, after cataract extraction, an intrascleral channel is formed from the angle of the anterior chamber under the conjunctiva. In the channel to enhance the hypotensive effect spend drainage thread (RU 2203002 C2, 04/27/2003). In our opinion, the disadvantages of this method are the lack of activation of the trabecular pathway of the outflow of intraocular fluid and the small area of the intrascleral canal formed by the drainage thread, which will not allow for a steady decrease in intraocular pressure in the long-term postoperative period.

At the same time, there is a known method for the surgical treatment of severe forms of glaucoma, in which a sinustrubekulectomy and cyclodialysis are performed, and then a hydrogel drainage is placed through the trabeculectomy hole in the anterior chamber, while the element of the dissected part is suprachoroidal, the other under the superficial scleral flap (V. Yerichev ., Immortal AM, Robustova O.V., Sevastyanov V.I., Perova N.V., Dovzhik I.A. Method of surgical treatment of severe forms of glaucoma. RU 2234902, 08.27.04). The disadvantage of this method of treating glaucoma is that the implantable drainage is a foreign body and can cause an inflammatory reaction.

The objective of the invention is to create an improved method for the combined treatment of glaucoma and cataracts.

The technical result of the proposed method consists in providing high visual acuity while maintaining a hypotensive effect for a long time with an increase in the outflow of moisture from the anterior chamber using drainage formed from the lens’s own capsule with a scleral valve, and simultaneously forming two outflow paths - under the conjunctiva and into the suprachoroid space .

The technical result is achieved by using drainage from the lens’s own capsule, which allows creating subconjunctival and suprachoroidal outflow paths, using a scleral valve, displacing a superficial scleral flap to reduce the likelihood of scar obliteration of the intervention area.

The method is as follows and is illustrated in figures 1-3, where 1 is a superficial scleral flap, 2 is a deep scleral flap, 3 is a through section of the sclera, 4 is drainage from the anterior lens capsule.

In the upper quadrant of the eyeball, as usual, a conjunctival flap is separated with the base to the limb. A surface rectangular flap of sclera is formed (Fig. 1, pos. 1). Then form a triangular deep sclera flap with the base to the limb (figure 1, position 2). A through incision is made at the base of the deep flap. Through it and additional corneal paracentesis, ultrasonic phacoemulsification is carried out according to a standard method. A flexible IOL is implanted. In the scleral bed, a through incision is made parallel to the limbus and a spatula is used for cyclodialysis (Fig. 1, item 3). The removed anterior lens capsule is folded into a tube and placed at one end into the anterior chamber, and the other through the cyclodialysis fissure into the suprachoroid space (Fig. 2, item 4). The superficial scleral flap is fixed with two interrupted sutures with a slight displacement towards the limb (Fig. 3, item 1). The conjunctival flap is fixed in a standard manner with a continuous suture.

Example 1. Patient D., 66 years old. Diagnosis at admission: OD - immature cataract, IIb open-angle glaucoma, OS - initial cataract. Visual acuity: OD - 0.04 n / a, OS - 0.8 n / a. IOP on OD 29 mmHg on mystical mode, on OS - 20 mmHg

The patient underwent surgery on OD according to our proposed method. After separation of the conjunctival flap, one-third of the thickness of the sclera formed a rectangular surface flap measuring 5.0 mm (height) × 4.0 mm (width). A deep scleral flap 2 mm high and with a base to the limb was separated by one third of the sclera thickness. A through incision was made at the base of the flap, through which the standard phacoemulsification and implantation of the IOL was performed. Then, 4 mm from the limb, parallel to it, a through cut of the scleral bed 2 mm long was made. A putty knife is inserted into the incision and cyclodialysis is performed. The front capsule of the patient’s own crystalline lens is folded into a tube and inserted at one end into the anterior chamber, and the other into the cyclodialysis fissure. The superficial scleral flap is fixed by two interrupted sutures with an offset of 1 mm towards the limb. The conjunctiva is fixed by a continuous suture. The operation and the postoperative period proceeded without complications. Visual acuity in the postoperative period of 0.9 n / a. IOP OD the entire observation period (13 months) did not exceed 21 mm Hg

Example 2. Patient 3., 64 years. Diagnosis at admission: OD - IIa operated open angle glaucoma, initial cataract, OS - IIIb open angle glaucoma, immature cataract. Visual acuity: OD - 0.6 n / a, OS - 0.02 n / a. IOP OD 20 mmHg, OS - 28 mmHg The patient underwent surgery on the OS according to the above procedure. Operation, postoperative period without features. Visual acuity of the OS at the last examination after 12 months with a correction of 0.7, IOP - 19 mm Hg

The proposed method only operated on 11 patients with primary open-angle glaucoma and immature cataracts aged 59 to 73 years, 5 men, 6 women. The observation period is from 6 to 15 months. All patients managed to achieve high visual functions and normalize intraocular pressure.

Thus, the use of this method provides stable compensation for intraocular pressure by creating two outflow paths using an autograft, increasing visual acuity by eliminating cataracts.

Claims (1)

A method for the combined surgical treatment of glaucoma and cataracts, characterized in that they form a superficial sclera flap, make a through incision in the scleral bed 4 mm from the limb, and create a triangular flap with a base to the limb with a cut for phacoemulsification, 2 mm from the limb, after which it is cut out the flap of the anterior lens capsule forms a tubular implant, one end of which is placed in the anterior chamber, and the other through a through incision of the scleral bed into the suprachoroid space, after which I fix scleral flap surface with an offset its distal end by 1 mm in the direction of the limb.

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