RU2638765C1 - Method for prevention of intrascleral cavity cicatrisation in open-angle glaucoma microsurgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: to prevent intrascleral cavity cicatrisation in open-angle glaucoma microsurgery, a U-shaped scleral flap is cut out with a base to the scleral sulcus. Impenetrable deep sclerectomy is performed with removal of the middle scrap of the sclera and the outer wall of the Schlemm's canal. Two golden threads are placed in the scleral bed along its lateral sides, the proximal ends of which are placed in the opened Schlemm's canal, and the distal ones are introduced into the intrascleral tunnels formed under the distal edge of the scleral bed.

EFFECT: method ensures stability and duration of the hypotensive process in the postoperative period due to the prevention of intrascleral cavity cicatrisation during glaucoma microsurgery.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in anti-glaucomatous operations to ensure a stable hypotensive process in the postoperative and remote postoperative period.

It is known that during surgery of open-angle glaucoma, as well as its other forms, due to the pronounced fibroplastic activity of the eye tissue, scarring and obliteration of the outflow pathways of intraocular fluid (HPW) formed during antihypertensive surgery occur.

To restore the stable circulation of the intraocular pressure and normalize the intraocular pressure (IOP) in such cases, prolonged hypotensive therapy is required, but most often repeated surgery on the same segment of the eyeball, and with other forms of glaucoma, operations using explant drainage to prevent adhesion of the superficial scleral flap to the scleral bed and, thus, preserving the intrascleral cavity through which the outflow of excess HPW from the anterior chamber of the eye passes.

Drainages are made of polymer films with a thickness of 0.03-0.05 mm. Collagen and its polymers, hydrogel and polytetrafluoroethylene are used as materials. In addition, tubular drainages made of leucosapphire and stainless steel are used.

In operations performed using deep sclerectomy technology, a part of the explant drainage is introduced into the anterior chamber of the eye and is located in the middle of the scleral bed (VP Nikolayenko, Yu.S. Astakhov. Use of polytetrafluoroethylene explant drains during antihypertensive operations. Part I: Technique and results // Glaucoma. 2005, No. 2 - p. 31).

Analysis of antiglaucomatous operations performed in the Orenburg branch of the IRTC "Eye Microsurgery" named after academician S.N. Fedorov, showed that the formation of fibrous tissue begins along the edges of the scleral bed and develops to its middle.

The exclusion of adhesion of the scleral flap to the scleral bed at its edges will prevent or significantly slow down the scarring of the interscleral cavity, which will ensure the stability and duration of the hypotensive process in the postoperative period.

The task is to develop a method for preventing scarring of the intrascleral cavity during glaucoma microsurgery by preventing adhesion of the scleral flap to the scleral bed along its edges.

The solution to the problem is possible with the use of implants located along the lateral sides of the scleral bed provided that the thickness of the implants matches the thickness of the deep scleral flap (0.03-0.05 mm), and the material of the implants should prevent the formation of fibrous tissue, be non-toxic, resistant to cellular elevants , i.e. not susceptible to resorption followed by scarring.

These properties are possessed by gold and stainless steel, which are widely used in dentistry and orthopedics for a long historical period.

In ophthalmology, explant stainless steel Express is used, but in some cases it is rejected with the eruption of the conjunctiva (RU 5389441, 10.06.2006). In addition, with the requirements for the size of the implants and taking into account the physical properties of stainless steel, the risk of injury is increased when solving the problem.

It is known that in ophthalmology, 24 carat gold is used to cover microshunts during microsurgery of refractory glaucoma (M. Figus, S. Lazem, P. Fogognolo et al. Supraciliary shunts in refractory glaucoma // Br. J. Ophthalmol. - 2011. - Vol. 95. - P. 1537-1541). A rectangular shunt with a width of 9.2 mm, a length of 5.2 mm and a thickness of 44 μm with a gold coating during the operation connects the anterior chamber with a supraciliary space. As a result, hypotension, the formation of subconjunctival fibrous tissue, endophthalmitis, encapsulation or inflammation of the filter pad are excluded.

Gold threads 24 carats with a thickness of less than 0.1 mm are used in cosmetology for facelift. After their implantation in the skin, gold ions stimulate microcirculation, saturate the cells with oxygen and, removing free radicals, promote the accumulation of hyaluronic acid (Golden threads for the face. Http://app-cosmetology.ru/procedury/uxod-za-licom/zolotye- niti-dlya-lica.html). The filaments, due to the plasticity of gold after implantation, acquire the curvature of the skin on the face, which also indicates the use of gold filaments in anti-glaucomatous operations, since the implant can be curved to the eyeball.

Thus, the solution of the task is possible through the implantation of gold threads.

The essence of the proposed method consists in the microsurgical treatment of open-angle glaucoma according to the technique of non-penetrating deep sclerectomy (NSGE), followed by implantation of 24 carat gold threads (999 samples) of 5 × 0.5 × 0.05 mm in size in the scleral bed along its lateral sides.

The claimed method is carried out in the following sequence:

1) Make a section of the conjunctiva.

2) At a distance of 1 mm from the limb, a U-shaped surface sclera flap 1 is 1/4 of its thickness, 4 × 3 mm in size, cut out with a base and separated in its direction (Fig. 1).

3) Carrying out a non-penetrating deep sclerectomy with cutting out the middle flap of the sclera 2 to 1/2 of its thickness by separation, excision, removal of it and the outer wall of the Schlemm's canal 3 (Fig. 2).

4) Two intrascleral tunnels 1 mm long and 0.5 mm wide are formed at the corners of the scleral bed under the distal edge.

5) Gold implants 4 are alternately placed in the scleral bed along its lateral sides, placing the proximal ends of the implants in the opened schlemm canal, and the distal ones in the intrascleral tunnels formed under the distal edge of the bed (Fig. 3).

6) The superficial scleral flap is placed in the scleral bed.

7) The conjunctival wound is sealed with a continuous seam of Vicryl 8.0.

The dislocation of implants inside the intrascleral cavity is excluded due to their flat shape and fixation of the distal ends under the upper layer of the sclera under the distal edge of the scleral bed.

In the postoperative period, gold ions of implants saturate the cells of nearby sclera tissues with oxygen, activate metabolic processes in them, removing free radicals, and the resistance of gold to cell elevants creates conditions that prevent scarring of the edges of the scleral bed.

This is confirmed by clinical examples:

Example 1

Patient F. DS: Open-angle IB glaucoma of the right eye, open-angle glaucoma of the left eye + complicated cataract.

VIS: OD - 0.8 with correction; OS - 0.6 does not correct

IOP: OD - 26 mm Hg .; OS - 29 mmHg

The operation of the left eye of the claimed method.

1st day after surgery: IOP - 12 mm Hg

3rd day after surgery: IOP - 14 mm Hg

1 month after surgery: IOP - 17 mm Hg

According to the results of ultrasonic biomicroscopy (UBM): the filter pad (AF) is weakly expressed.

Intrascleral cavity (ICP) - 0.67 mm.

Implants in the scleral bed along the lateral sides, the distal ends of the implants under the upper layer of the sclera, the contours are clear.

3 months after surgery:

IOP - 19 mm Hg, AF is not clearly expressed, ICP - 0.71 mm. The position of the implants in the scleral bed has not changed, the contours are clear.

6 months after surgery:

IOP - 19 mm Hg, ICP - 0.71 mm. The contours of the implants are clear, there are no signs of dislocation.

1 year after surgery:

IOP - 19 mm Hg, ICP - 0.71 mm. Implants with clear contours, without dislocation.

Example 2

Patient M. DS: open-angle IIC glaucoma of the right eye, complicated cataract of the left eye.

VIS: OD - 0.4, with correction - 0.5; OS - 0.03, with a correction of 0.3.

IOP: OD - 32 mmHg; OS - 20 mmHg

The operation of the right eye was performed by the claimed method.

1st day after surgery: IOP - 19 mm Hg

3rd day after surgery: IOP - 19 mm Hg, AF is weak, ICP - 0.91 mm. Implants in the scleral bed without dislocation, the contours are clear.

1 month after surgery: IOP - 17 mm Hg, AF is weak, ICP - 0.85. Implants without dislocation, clear contours.

6 months after surgery: IOP - 19 mm Hg, AF is not clearly expressed, ICP - 0.85, implants without dislocation, the contours are clear.

1 year after surgery: IOP - 19 mm Hg, AF is not clearly expressed, ICP - 0.87. Implants without dislocation, clear contours.

Claims (1)

A method for preventing scarring of the intrascleral cavity during open-angle glaucoma microsurgery including: conjunctival incision, cutting out a base of the U-shaped surface sclera flap with a base 4 × 3 mm in size, non-penetrating deep sclerectomy with removal of the middle sclera flap and the external wall of the schlemmal canal, placement in the scleral bed its sides of gold threads of 24 carats, 5 × 0.5 × 0.05 mm in size, the proximal ends of which fit into the opened Schlemm canal, and the distal ends are inserted into the askleralnye tunnels of 1 × 0,5 mm, formed at the distal edge of the scleral bed at its corners, laying of the upper flap of the sclera at scleral bed, suturing the conjunctiva.

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