RU2456970C1 - Method of surgical management of primary glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and may be used in surgical treatment of primary glaucoma. It involves transconjunctival deep sclerectomy. Paracentesis and basal iridectomy is performed at a base of a surface scleral flap. Cyclodialysis is performed in the scleral bed. A sandglass-shaped drainage is made of a polymer plate. A peripheral end of the drainage is implanted in the anterior chamber, a central end is implanted in the cyclodialysis cleft in the scleral bed.

EFFECT: method enables reducing a number of intra- and postoperative complications, ensuring a stable hypotension effect, reducing a length of medical-social rehabilitation.

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Description

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

A known method of surgical treatment of open-angle glaucoma (non-perforating deep sclerectomy), including cutting out a superficial scleral rectangular flap with the base facing the limbus to the transparent layers of the cornea, forming a triangular flap from the middle layers of the sclera inside the bed, excising the corneoscleral strip including the outer wall of the helmet layers of the corneal stroma, with exposure of the limbal edge of the descemet membrane without opening the anterior chamber (SU No. 1565484 , publication date 05/23/1990).

The closest analogue of the invention is a method of surgical treatment of open-angle glaucoma, including performing non-perforating deep sclerectomy and subscleral implantation of collagen drainage (Kozlov V.I., Bagrov S.N., Anisimova S.Yu., Osipov A.V., Mogil'tsev V.V. Non-penetrating deep sclerectomy with collagenoplasty // Ophthalmosurgery. - 1990. - No. 3. - P.44-46). The disadvantages of the method are low efficiency in the developed and far-reaching stage of glaucoma, the inability to use with narrow-angle glaucoma, in some cases in the postoperative period additional laser treatment is required (descemetogoniopuncture).

The task of the invention is to improve non-penetrating type anti-glaucomatous surgery for the treatment of primary glaucoma.

The technical result of the proposed method is to compensate for intraocular pressure with the long-term preservation of the hypotensive effect with a minimum of complications.

The technical result is achieved by implanting drainage and ensuring a stable outflow of aqueous humor from the anterior chamber into the subscleral and supraciliary space.

It is known that in the process of fistula formation, a pressure drop may occur between the anterior chamber and the environment, which leads to severe hypotension of the eyeball, therefore, increasing the risk of intraoperative suprachoroidal bleeding or small anterior chamber syndrome in the early postoperative period, as well as reducing the hypotensive effect of operations. With the proposed method, a metered opening of the anterior chamber is performed, which avoids a sharp pressure drop and grinding of the anterior chamber.

Unlike traditional non-penetrating interventions, this operation can be used in primary angle-closure glaucoma and in the advanced stage of primary glaucoma.

The method is as follows and is illustrated in figures 1 and 2, where 1 is a superficial scleral flap, 2 is a scleral bed, 3 is a deep scleral flap, 4 is cyclodialysis, 5 is paracentesis, 6 is drainage.

A conjunctival flap is formed with the base to the arch. Separate the superficial scleral flap 1/2 of the sclera thickness to the corneal part of the limb by 1.0 mm in the transparent layers of the cornea with the base to the limb (Fig. 1, item 1). Separate a deep scleral flap of a triangular shape together with the outer wall of the Schlemm's canal and dissect it (figure 1, position 2). Next, in the scleral bed, on the side facing the arch, a through section of the sclera is made and cyclodialysis is performed through it (Fig. 1, item 3). Paracentesis of the anterior chamber is carried out (Fig. 1, pos. 4). Produce basal iridectomy. An hourglass drain is prepared from a polymer plate. Drainage is implanted in such a way that the peripheral end is inserted through paracentesis into the anterior chamber, and the central end is inserted into the cyclodialysis slit (Fig. 2, item 6).

The method is completed, as is customary, by fixing the superficial scleral flap to the edges of the bed with two interrupted sutures and by applying a continuous conjunctival suture.

Clinical example 1. Patient R., 68 years old. Diagnosis: OD - o / y III in glaucoma. The patient underwent surgery according to the proposed method. In the region of the superior arch of the eyeball, a conjunctival flap is separated to the limb. At 12 o’clock, the base to the limb formed a U-shaped surface flap 1/2 scleral thickness. Next, a deep scleral flap of a triangular shape was removed along with the outer wall of the Schlemm's canal and excised. In the scleral bed, on the side facing the arch, a through section of the sclera is made and cyclodialysis is performed through it. Paracentesis of the anterior chamber was performed and basal iridectomy was performed. An hourglass prepared drainage is implanted with a peripheral end into the anterior chamber, and a central one into the cyclodialysis slit. Operation, postoperative period without complications. Within 6 months of observation, intraocular pressure is normalized.

Clinical example 2. Patient N., 60 years old. Diagnosis: OS - s / y II in glaucoma. The patient underwent surgical treatment. The conjunctival and superficial scleral flaps, the base facing the limb, are separated. The thickness of the surface flap is 1/2 the thickness of the sclera. A triangular flap is cut and excised from the deep layers of the sclera. Cyclodialysis and paracentesis were performed in the scleral bed, followed by basal iridectomy. A subsclerally implanted drainage was placed at the anterior chamber with the peripheral end and the supraciliary space at the central one.

At the final stage, the superficial scleral flap is sutured to the edges of the bed with two interrupted sutures, a continuous suture is applied to the conjunctiva. In the postoperative period, there was no development of complications in the form of ciliochoroidal detachment and a pronounced inflammatory reaction. The antihypertensive effect was observed during the entire observation period (6 months).

Thus, the use of this method allows to reduce the number of complications in the intra- and postoperative period, to obtain a stable hypotensive effect and to reduce the time of medical and social rehabilitation in patients with primary glaucoma.

Claims (1)

A method for the surgical treatment of primary glaucoma, including nonperforating deep sclerectomy and implantation of a plate-shaped drainage into the subscleral space, characterized in that paracentesis is performed at the base of the superficial scleral flap, iridectomy is performed, and an hourglass-shaped polymer plate is used for drainage, the peripheral end which is introduced into the anterior chamber through paracentesis, and the central one into the supraciliary space through cyclodialysis in the scleral bed.

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