RU2422121C1 - Method of intraoperational localisation of ciliary processes in carrying out cyclophotocoagulation - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, in particular, to ophthalmology and can be used for localisation of ciliary processes in carrying out cyclophotocoagulation. In the beginning of operation test coagulations are performed in upper-external quadrant at the distance from 1.5 to 4.0 mm from to limb. Localisation of tip above ciliary processes is determined by click. Marking is performed in 8 meridians and cyclocoagulation is carried out at the distance from limb similar to that found by click appearance. ^ EFFECT: method makes it possible to increase operation efficiency due to taking into account individual peculiarities of patient's eye. ^ 1 tbl, 2 ex

Description

The invention relates to medicine, in particular to ophthalmology, and can be used in the surgical treatment of glaucoma.

There are methods for the surgical treatment of glaucoma, which include transscleral diode laser cyclophotocoagulation (TDTsFK), which include surgery at a certain distance from the limb - 2.5-3 mm from the limb (Klyuev G.O. // Ophthalmological Journal. - No. 3 . - S.195-196), or 1.5-2 mm from the limb (Zhaboedov G.D., Kovalenko Yu.V. // Ophthalmological Journal. - 2006. - No. 3, p.156-157).

The disadvantage of these methods is that when conducting TDTsFK not taken into account the individual characteristics of the location of the ciliary processes (CO) in a particular patient.

The task is to propose a method for intraoperative localization of CO during TDDCF.

The technical result is an increase in the efficiency of the operation of TDTsFK by determining the location of the ciliary processes taking into account the individual characteristics of a particular patient during surgery.

The technical result is achieved by the fact that for the DPC use a diode laser ALOD-1 (Russia) with a wavelength of 810 nm, power from 1.5 to 2.2 watts. Using a trans-scleral tip (G-Probe), laser coagulates (15-30) are applied through the conjunctiva to the sclera surface concentrically to the limb in a circle from 180 ° to 270 ° in accordance with the localization of the CO determined intraoperatively. The exposure is 2 seconds. Initially, for precise localization with respect to the limb, test coagulations are performed in the upper-outer quadrant at various distances from 1.5 to 4.0 mm. The criterion for correct localization is the appearance of a characteristic click. This indicates the exact location of the tip over the projection of the ciliary processes. Then, at a similar distance on the surface of the conjunctiva, marking with a solution of diamond greens on 8 meridians is carried out, and already taking into account the location of the CO, TDFCF is performed.

The advantage of the proposed method is the effect of TDTsFK directly in the place of localization of the CO - accordingly, the probability of trauma to the surrounding tissues decreases, the antihypertensive effectiveness of the operation increases, the time of postoperative rehabilitation of patients decreases.

Description of table 1: operated on 20 people according to the prototype, out of 20 patients, 16 showed a decrease in intraocular pressure by 10-20% of the initial pressure, 4 people IOP remained unchanged. According to the method of intraoperative localization of the ciliary processes, 20 people operated on, in all patients a more pronounced hypotensive effect was noted - by 30-50% of the initial level.

Example 1

Patient D., 75 years old, diagnosis: "POAG VI" with "glaucoma of the right eye." After processing the surgical field, anesthesia, test coagulation was performed at a distance of 1.5 mm, 2.0 mm, 3.0 mm from the limb. When applying coagulates at a distance of 3.0 mm from the limb, characteristic clicks appeared, indicating the location of the tip over the projection zone of the ciliary processes. Marking was performed using a solution of diamond greens at a distance of 3.0 mm from the limb in 8 meridians, then cyclophotocoagulation was carried out according to the marking.

Example 2

Patient M., 63 years old, diagnosis: "Secondary neovascular VI" c "glaucoma of the right eye." After processing the surgical field, anesthesia, test coagulation was performed at a distance of 1.5 mm, 2.0 mm, 3.0 mm from the limb. When applying coagulates at a distance of 2.5 mm from the limbus, characteristic clicks appeared, indicating the location of the tip over the projection zone of the ciliary processes. Marking was performed using a solution of diamond greens at a distance of 2.5 mm from the limb in 8 meridians, then cyclophotocoagulation was performed according to the marking (see table).

Group Number of persons Antihypertensive effect (number of people) % reduction in IOP from the original Control twenty 16 10-20 Main twenty twenty 30-50

Claims (1)

The method of intraoperative localization of the ciliary processes during cyclophotocoagulation, which consists in performing the operation at a certain distance from the limb, characterized in that at the beginning of the operation, test coagulations are performed in the upper outer quadrant at a distance of 1.5 to 4.0 mm from the limb; the localization of the tip over the ciliary processes is judged by the appearance of a click; markup in 8 meridians and cyclophotocoagulation is carried out at a similar distance from the limb, as found by the appearance of a click.