RU2547253C1 - Method of conjunctival wound sealing in case of microinvasive surgery of glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmic surgery and can be applied for sealing a conjunctival wound in case of microinvasive surgery of glaucoma. An L-shaped cut of the conjunctiva with sides of 0.5 mm , concentric to the limbus, and 2.0 mm, radial to the limbus, is performed in the upper segment of the eye ball, the beginning of the meridian side of the cut is located at a 0.5 mm distance from the limbus, the side concentric to the limbus, and the angle of the cut are located at a 2.5 mm distance from the limbus. An L-shaped scleral flap is formed on the line of the cut. A U-shaped suture is applied close to the angle of the conjunctival wound with pulling the scleral flap edges under the wound edges; the suture is tied up under its angle.

EFFECT: method reduces a risk of the scar tissue development.

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Description

The invention relates to medicine, namely to ophthalmology, and is intended for use in microinvasive anti-glaucoma operations.

Microinvasive surgical treatment of glaucoma is different in that in all operations, except trabeculotomy, the conjunctiva is cut at a distance of 0.5-1.0 mm from the limb concentrically with a length of 2 mm (RU 2184514 C1, 07/10/2002; Takhchidi H.P. , Ivanov OI, Bardasarov DB Long-term results of microinvasive non-penetrating deep sclerectomy // Ophthalmosurgery. - 2003, No. 3 - P.15).

After performing manipulations according to a specific operation technique, a conjunctive suture is applied, the knot of which is tied over a scleral flap at the limb.

However, due to the fact that the conjunctiva is cut in the sublimal zone, at the site of anastomosis of the terminal branches of the terminal ciliary arteries that form the anterior conjunctival vessels, the scar that forms at the site of the suture in the postoperative period causes a violation of microcirculation in the blood circulation system of these vessels and the outflow is also disturbed blood, which is committed, in part, through the veins that accompany the arteries. In addition, the presence of nodes on the surface of the conjunctiva causes irritation of its epithelial cover during eyelid movement.

The task is to create a method for performing a conjunctival incision and a conjunctival suture, excluding the formation of scar tissue in place of the anterior conjunctival vessels.

Due to the fact that microinvasive access to the operating area, located at a distance of 0.5-2.5 mm from the limb, is carried out by temporarily moving the conjunctiva with the tool, an incision is performed at a distance of 2-3 mm from the limb outside the location of the anterior conjunctival vessels excludes the possibility of such access.

In this case, to solve the problem of surgery, it will be necessary to increase the size of the conjunctival incision, which does not correspond to the essence of microinvasive surgery.

The prototype of the proposed method is a method of sealing a conjunctival wound with microinvasive non-penetrating deep sclerectomy (RU 2459600 C1, 08.27.2013). It includes the production of a L-shaped section of the conjunctiva in the upper segment at a distance of 0.5 mm from the limb with sides of 0.5 mm concentrically to the limb and 2.0 mm radially to it, the formation of a L-shaped conjunctival flap, application near the angle of the conjunctival wound П- figurative suture with tightening the edges of the conjunctival flap under the edges of the conjunctival wound and tying the suture at an angle of the wound.

Because Since the meridional side of the conjunctival incision does not cross the vessels, the formation of scar tissue along the incision is practically excluded.

Scar tissue is formed along the small side of the incision, the concentric limb, in the postoperative period, due to the intersection of the anterior conjunctival vessels.

The problem to be solved and the expected technical result are achieved by the proposed method for sealing a conjunctival wound during microinvasive glaucoma surgery.

The method includes the production of a L-shaped section of the conjunctiva in the upper segment with sides of 0.5 mm, a concentric limb, and 2.0 mm radially of the limb, forming a conjunctival flap along the section line, applying a U-shaped suture near the angle of the conjunctival wound with tightening the edges of the conjunctival wound .

The method differs from the prototype in that the meridional side of the conjunctival incision begins at a distance of 0.5 mm, and the side concentric of the limbus and the angle of the incision are located at a distance of 2.5 mm from the limb.

With this arrangement of the L-shaped incision and the L-shaped conjunctival flap, the U-shaped suture will be outside the area of the anterior conjunctival vessels.

The method is as follows:

1. Carry out the preparation of the surgical field, anesthesia and akinesia of the eyeball, the application of an eyelid expander.

2. In the upper segment at a distance of 0.5 mm from the limb, a 2.0 mm 1 length section is made meridional to the limb (FIG. 1).

3. From the end of the meridional incision concentric limb produce a conjunctival incision 0.5 mm 2 in length.

4. Scleral flap 3 is formed and separated along the cutting lines of the L-shaped form, take it away and hold it with tweezers (Figure 2).

5. An antiglaucomatous operation is performed according to the intended procedure.

6. By holding the ligature "nylon 10/0" through the edges of the conjunctival flap and the edges of the conjunctival wound, a U-shaped suture is placed on the conjunctiva, with the edges of the conjunctival flap tightened under the edges of the conjunctival wound (Figure 3).

7. The suture is tied at an angle of the conjunctival wound formed by its edges, and the designated angle is held with tweezers.

8. The free ends of the ligature after tying the seam are cut off, the tweezers are removed, and the seam is covered with the conjunctiva.

Thus, the proposed method for sealing the conjunctival wound during microinvasive surgery of glaucoma eliminates cicatricial changes in the postoperative period in the sublimal zone, preserves the anatomical, topographic relationships and microcirculation in the main structures of the eye.

Claims (1)

A method for sealing a conjunctival wound during microinvasive surgery for glaucoma, comprising producing in the upper segment of the eyeball a L-shaped section of the conjunctiva with sides 0.5 mm, concentric limbus, and 2.0 mm radial to the limb; forming along the cut line a L-shaped scleral flap, applying a U-shaped suture near the angle of the conjunctival wound with tightening the edges of the scleral flap under the wound edges and tying the suture at its angle, characterized in that the beginning of the meridional side of the cut is located at a distance of 0.5 mm from the limb, side, concentric limbus, and the cut angle are located at a distance of 2.5 mm from the limb.

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