RU2444337C1 - Method for prediction of complications following laser surgeries of trabecular reticulum in open-angle glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and aims at prediction of developing inflammatory and/or hypertensive complications following laser surgeries on a trabecular reticulum in open-angle glaucoma. Before the surgical intervention, a gonioscopy study is used to determine a position of a Schlemm's canal and a type of iris to ciliary body attachment, and if observing simultaneously a posterior position of the Schlemm's canal and a posterior type of iris to ciliary body attachment, developing postoperative hypertensive and/or inflammatory complications are predicted. The posterior position of the Schlemm's anal is stated provided a width of scleral roll makes no more than one width of the Schlemm's canal, while the posterior type of iris to ciliary body attachment - provided a width of a ciliary body zone makes one width of the Schlemm's canal and more.

EFFECT: method provides preoperative prediction of probability of developing postoperative complications - inflammatory and/or hypertensive.

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Description

The invention relates to ophthalmology and is intended to predict the development of hypertensive and inflammatory complications after laser interventions on the trabecular network (TS) in open-angle glaucoma.

It is known that with open-angle glaucoma, the outflow of intraocular fluid (HPW) through the eye TS is impaired, which leads to an increase in intraocular pressure (IOP).

In recent decades, laser methods of exposure to TS have been widely used to treat patients with open-angle glaucoma, during which laser pulses are applied in the projection of the Schlemm's canal (CC), which allows to improve or restore the outflow of the HPW through the trabecular network and achieve compensation of ophthalmotonus. Currently, among the many methods of laser exposure to TS, such as argon-laser trabeculoplasty, diode-laser trabeculoplasty, hydrodynamic activation of outflow, laser activation of trabeculae and others, selective laser trabeculoplasty (SLT) by M. has become widespread due to its greatest efficiency and safety. Latina (Latina MA, Sibayan SA et al. Q-switched 532 nm Nd: YAG laser trabeculoplasty - selective laser trabeculoplasty. // Ophthalmology. - 1998. - Vol.105. - P.2082-2088).

However, according to the literature, 24.2% of patients undergoing SLT showed a reactive increase in IOP by 6-8 mm Hg, as well as inflammation of the type of iritis and iridocyclitis (Latina MA Glaukoma experts discuss new concepts, techniques. MD-Ophthalmology -Times-Febrary 15, 1998, 14 Boston).

Another effective and safe technique for treating TS is selective laser activation of trabeculae (SLAT), which reduces the number of hypertensive and inflammatory postoperative complications by 1.5 times compared to SLT, but nevertheless does not completely avoid them (Tumanyan E .R., Ivanova ES, Lyubimova TS, Subkhangulova EA Selective laser activation of trabecula in the correction of ophthalmotonus in patients with primary open-angle glaucoma // Ophthalmosurgery. - 2010. - No. 2. - P. 18 -23).

The listed postoperative complications can reduce or neutralize the hypotensive effect of laser interventions on TS, which requires additional antihypertensive and anti-inflammatory drug therapy and / or surgical anti-glaucomatous interventions.

In this regard, the problem of predicting hypertensive and / or inflammatory postoperative complications is urgent, and its solution is associated with the development of safety criteria for the selection of patients with open-angle glaucoma for laser interventions on TS.

Methods for predicting complications after laser interventions on TS in open-angle glaucoma, based on a gonioscopic picture, taking into account the position of the CC and the type of attachment of the iris to the ciliary body (CT), have not been found in the literature available to us.

The technical result of the invention is the development of a method for predicting the development of hypertensive and / or inflammatory complications after laser effects on the trabecular network.

The technical result is achieved by the fact that in the method for predicting complications after laser interventions on the trabecular network with open-angle glaucoma, according to the invention, prior to laser intervention during a gonioscopic examination, the position of the schlemm canal and the type of attachment of the iris to the ciliary body are determined, and if the back position of the schlemm canal is simultaneously detected in which the width of the scleral spur is not more than one width of the Schlemm's canal, and the posterior attachment of the iris to the ciliary body, in which the bandwidth of the ciliary body is one width of the Schlemm's canal and more, then the development of postoperative hypertensive and / or inflammatory complications is predicted.

The method is developed based on the results of clinical monitoring of 230 eyes of 175 patients with open-angle glaucoma who underwent laser interventions on the trabecular network to compensate for IOP. Out of 230 cases, reactive hypertension developed in 13 cases; in 17 cases, reactive hypertension in combination with an inflammatory reaction developed. Moreover, in 10 cases of the development of reactive hypertension and in all cases of the development of reactive hypertension in combination with an inflammatory reaction, the posterior position of the HQ and the posterior attachment of the iris to the CT were revealed.

According to the literature, gonioscopically, the position of the HQ can be judged by the width of the scleral spur. In the forward position of the barrage, the scleral spur is wide, in the back position it is narrow, or there is no scleral spur. The middle position of the HQ is a variation of the anterior. The type of attachment of the iris to the CT is gonioscopically suggested to be estimated by the width of the CT band. With front attachment of the iris to the CT, the band of the latter with gonioscopy is narrow or absent; with the back attachment of the iris, the CT band is wide. Moreover, to determine the width of the scleral spur and the bandwidth of the CT, they are offered to compare them with the width of the barcode. However, specific criteria for the quantitative relationship between the sizes of HSC, scleral spur and CT band in these literature are not given (Nesterov A.P., Bunin A.Ya., Katsnelson L.A. Intraocular pressure. - M .: Nauka, 1974. - S.128-130; Fayzieva U.S. Anatomical features of the structure of the eyes in people of Uzbek nationality. - Russian Medical Journal. - 2002. - No. 4. - S.173-175).

Based on the study of literature data, as well as in the course of clinical monitoring, we proposed to evaluate the position of HSC as posterior in cases when the width of the scleral spur is not more than one HK width. By the rear attachment of the iris to the CT, we propose to consider such an anatomical structure of the anterior chamber angle when the CT bandwidth is one bar width or more.

The inventors predict the development of hypertensive and inflammatory postoperative complications in the posterior position of the barcode and posterior attachment of the iris to the CT. According to the Gauss law, the energy in the laser beam is distributed unevenly: the maximum value of energy is determined in the center of the laser beam, it is scattered closer to the periphery. Since the scleral spur separates the CC from the CT, in the rear position of the CC, during the application of laser pulses in the projection of the CC, the distance between the center of the laser beam and the CT is reduced and laser radiation acts on the CT. At the same time, with the posterior attachment of the iris, the anterior CT sections facing the anterior chamber of the eye become accessible to laser radiation. Thus, the effect of higher values of laser energy on the CT. As a result, the occurrence of hypertensive and / or inflammatory complications after laser exposure to TS is observed.

The method is as follows.

Before the laser intervention, a Goldman-type gonioscopy lens is mounted on the cornea to the patient. Through the side mirrors of the lens, a beam of light is focused on the angle structures of the anterior chamber. The position of the barcode and the type of attachment of the iris to the CT are determined. If at the same time the posterior position of the CC and the posterior attachment of the iris to the CT are revealed, then the development of postoperative inflammatory and / or hypertensive complications is predicted.

The method is confirmed by the following clinical examples.

Example 1

Patient M., 63 years old. Diagnosis: left eye - open-angle 1B glaucoma. Hydrodynamic indicators: Ro - 27.0; C 0.13; F - 1.7; Kb - 208. With gonioscopy:

the angle of the anterior chamber is of medium width, the pigmentation of the TS is moderate, the width of the scleral spur is 1/2 of the width of the barcode, the strip of the ciliary body is 3 of the width of the barcode. The posterior position of the barcode and the posterior attachment of the iris to the CT were revealed.

According to the invention, the development of hypertensive and / or inflammatory complications in the postoperative period is predicted. The patient is recommended not to perform laser interventions on the trabecular network. Prescribed drug hypotensive therapy - timolol 0.5% 1 drop 2 times a day in the left eye. Against the background of antihypertensive treatment, after a week, hydrodynamic indicators within normal limits: Po - 18.3; C 0.17; F - 1.51; Kb - 108. After 3 months, the hydrodynamic indicators remained in the same range.

Example 2

Patient P., 71 years old. Diagnosis: left eye - open-angle glaucoma 2B. When gonioscopy: the anterior chamber angle is of medium width, the pigmentation of the vehicle is pronounced, the width of the scleral spur is 3 times the width of the bar, the strip of the ciliary body is 1/2 the width of the bar. The anterior position of the barcode and the anterior attachment of the iris to the CT were revealed. According to the invention, the absence of hypertensive and / or inflammatory complications in the postoperative period is predicted.

Hydrodynamic indicators: Po - 23.8; C is 0.09; F 1.84; Kb - 353. A laser action was performed on the vehicle (SLAT): spot diameter 400 μm, pulse energy 0.6 mJ. 98 laser applicates were applied along the arc of the vehicle circumference at 100 °, first in one, and then in the opposite direction, returning to the starting point. On the 1st day after the intervention: objectively - the eye is calm, the moisture of the anterior chamber is transparent. The patient has no complaints. Hydrodynamic indicators: Po - 12.9; C 0.35; F - 1.51; Kb - 37. 1 week after the intervention: Po - 16.1; C 0.18; F - 1.51; Kb - 111. Inflammatory phenomena and a reactive rise in intraocular pressure were not noted. 3 months after the intervention, the laser exposure zone is maximally depigmented, hydrodynamic parameters: Po - 18.6; C 0.2; F is 1.61; Kb - 114.

Thus, in a patient with anterior position of CC and anterior attachment of the iris to the CT, laser intervention did not lead to the development of hypertensive and / or inflammatory postoperative complications. The postoperative period was uneventful, IOP compensation was achieved.

A method for predicting hypertensive and / or inflammatory complications after laser interventions on the trabecular network in open-angle glaucoma is technically simple, affordable and allows you to determine the tactics of patient management depending on the anatomical features of the anterior chamber angle.

Claims (1)

A method for predicting complications after laser interventions on the trabecular network in open-angle glaucoma, which consists in determining the position of the Schlemm canal and the type of attachment of the iris to the ciliary body and, if the back position of the Schlemm canal, at which the width the scleral spur is not more than one width of the Schlemm's canal, and the posterior attachment of the iris to the ciliary body, in which the width of the ciliary band ate is a width of Schlemm's canal or more, the development predict postoperative hypertensive and / or inflammatory complications.