RU2385697C1 - Microdrainage technique in glaucoma treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and aims at surgical treatment of open-angle secondary glaucoma. In involves a tunnel incision of sclera and introduction of one end of a polyfilament carbon fibre of the length 20-25 mm into anterior chamber. The other end of the fibre is introduced into subepiscleral space of the eyeball.

EFFECT: technique allows simplifying procedure, reducing operative injuries and increasing period of drain functioning with preserving a controlled hypotensive effect of antiglaucomatous operation.

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Description

The present invention relates to ophthalmology and is intended for the surgical treatment of open-angle glaucoma by implantation of polyfilament carbon microdrainage connecting the anterior chamber of the eye and retrobulbar space.

In severe forms of glaucoma, when traditional surgical interventions do not allow to achieve a stable normalization of intraocular pressure, interventions using drainages are very common. Microdrainages can be in the form of a silicone strip (AF Yumagulova. Drainage of eye cavities in case of post-burn and some other secondary glaucoma: Abstract of thesis ..., Candidate of Medical Sciences. - L., 1981, pp. 5-6), hydrogel microtubules (RU 2001100084/14, 11.20.2002), valve - type Ahmed (Colerman Al., Hill R., Wilson MR Initial clinical experience with Ahmed glaucoma valve implant. / Am. J. Ophtholmol., 1995, v. 120, 23-31).

The closest analogue of the present invention adopted the method of implantation of drainage Molteno (DIA Molteno. Use of Molteno implants to treat secondary glaucoma. Glaucoma. Publishers: Grune & Stratton Ltd, 1986: 211-238).

Molteno drainage consists of a silicone tube and a polypropylene pad. The tube is inserted into the eye cavity (anterior, posterior chamber, vitreous cavity) and drains intraocular fluid from it. The implant pad is hemlocked episclerally in any available quadrant. A thin fibrovascular capsule is formed around it, from which liquid is filtered.

However, this method has significant drawbacks (Takhchidi H.P., Metaev S.A., Cheglakov P.Yu. Comparative evaluation of shunt drainages available in Russia in the treatment of refractory glaucoma. / Glaucoma, 2008 - No. 1, p. 52- 54).

- Such drainage tends to shift and even to exposure and rejection, patients often notice discomfort, a foreign body sensation, diplopia.

- To install this drainage, a rather complicated and lengthy operation is performed, including the formation of a layered scleral flap, deep sclerectomy, and sinistrabekuloectomy.

The Molteno biological valve requires the surgeon to “pull” and stitch the tenon sheath over the valve. The presence or absence of hypotension in the early postoperative period depends on the correct observance of this step in surgery. In this case, much does not depend on drainage, but on the experience of the surgeon.

- It is possible to block shunt drainage in places of narrowing due to blood clots and fibrin deposits. In Molteno drainage, there is one thing - the beginning of the tube, since the area of the biological valve is incommensurably larger than the diameter of the tube.

- The silicone tube, moving into the anterior chamber, can cause endothelial-epithelial dystrophy of the cornea.

“In addition, Molteno drainage is expensive and inaccessible to a wide range of ophthalmologists and patients.

The objective of the invention is to develop a simple and at the same time highly effective method of drainage in the treatment of glaucoma.

The technical result of the invention is to reduce the morbidity of surgical intervention and increase the life of the drainage while maintaining its conductivity against the background of the controlled antihypertensive effect of atiglaucomatous surgery.

The technical result is achieved due to microdraining of the anterior chamber through a tunnel incision of the sclera with a polyfilament carbon thread 25-30 mm long, 100-150 microns in diameter with a maximum sorption capacity.

The method is as follows.

Prepare the patient for antiglaucomatous surgery. Under local anesthesia, the conjunctiva is separated in the upper quadrant with the base at the limb. Departing from the limb by 5-6 mm, a tunnel incision is made with a standard spear-shaped knife with its exit to the anterior chamber.

The drawing shows a method of performing this section.

A 25 mm threadlike microdrainage made of activated carbon fiber at a temperature of 1000 ° C is preliminarily impregnated with a 40% glucose solution (for about 1 minute).

The thread is fixed with a superficial suture on the sclera, the microdrainage length necessary for insertion into the anterior chamber is measured, one end of the thread is inserted into the anterior chamber with a spatula, and the other is drawn into the subthenon space behind the eyeball.

This method of surgical intervention was applied by us on 6 rabbit and three cadaver eyes, as well as in clinical practice, which experimentally confirmed the simplification of the technique and the reduction of the invasiveness of the operation. As tests have shown, the proposed method for the treatment of glaucoma allows you to provide a long hypotensive effect of the operation during implantation of carbon drainage.

Clinical example. Patient V., 43 years old, was admitted to the hospital with a diagnosis of: OD - open-angle operated post-traumatic IIb glaucoma. OS is healthy. Contusion injury of the right eye - 5 years ago. On admission, visual acuity of the right eye 0.2 s -1.5 D = 0.5. The peripheral boundaries of the field of view are concentrically narrowed by 10 °, from the upper nasal side by 20 °, unstabilized. IOP - 28 mmHg Tonographic indicators Po = 26, C = 0.19, F = 2.0.

In 2006, an antiglaucomatous operation (AGO) was performed. An NSES was performed, after 1 year a relapse of hypertension was observed due to the blockade of the formed pathways of the outflow of the HPW with scar tissue with obliteration of the Schlemm's canal at its intersection.

Under local anesthesia, after separation of the conjunctiva in the upper quadrant, the patient underwent intrascleral perforating microdrainage implantation from a carbon filament 25 mm long, 120 microns in diameter. One end of the thread was inserted into the anterior chamber, and the other into the subtenon space behind the eyeball. Operation, postoperative period without complications.

With this minimally invasive intervention, the HPW gets the opportunity to get from the anterior chamber along the multifilament carbon fiber into the retrobulbar space.

In the postoperative period, the patient received disinfectant drops. Discharged from the hospital on the 3rd day in a satisfactory condition. Visual acuity of 0.3 s - 1.25 D = 0.6. The field of view expanded by 3-5 °. IOP-19 mmHg Po = 17, C = 0.25, F = 1.6 without antihypertensive treatment. An objective examination of the eyes is calm. Microdrainage in the correct position, partially visible under the conjunctiva during biomicroscopy.

At the last follow-up examination, 9 months after surgery, the IOP remained within normal limits, and no reaction to drainage was observed.

Thus, the proposed method provides effective drainage of fluid from the anterior chamber with a long hypotensive effect.

Claims (1)

A method of treating open-angle secondary glaucoma, including intrascleral drainage of the anterior chamber with carbon filament, characterized in that a scleral tunnel is cut and a multifilament carbon filament is inserted into the anterior chamber with a length of 25-30 mm, and the peripheral end is sutured to the sclera and brought into the subtenon space.

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