RU2698619C1 - Method for preventing complications following penetration-type antiglaugomic operations - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. To prevent complications after performing antiglaucoma operations of penetrating type, penetrating antiglaucoma operation is performed, laying of superficial scleral flap in scleral bed and application of removable compression seam. Superficial scleral flap is covered with a compression seam in a cross-wise manner; first, a stroma of the cornea is sutured in the projection of scleral flap 1 mm from the limb at width of 4.5–5.0 mm by needle prick-in with the suture from right to left. Then needle with suture is brought in at free edge of scleral flap also from right to left, right angle of scleral flap is sutured. Further, the left angle of the scleral flap is sutured, the needle is brought out on the sclera near the left angle of the scleral flap and the ends of the sutures are tied without tension. Nylon 10-0 is used for the seam.

EFFECT: method enables reducing the number of postoperative complications and excessive filtration in the area of antiglaucoma surgery.

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Description

The invention relates to medicine, namely to ophthalmology, and is intended for the prevention of complications after performing penetrating type anti-glaucoma operations.

Despite the wide selection of medication for glaucoma that exists today, the most radical method of reducing intraocular pressure is surgery. Penetrating type filtering operations proposed in 1967 by academician M.M. Krasnov and in 1968 J. Cairns, provide the most pronounced antihypertensive effect. However, depressurization of the eye and a sharp drop in intraocular pressure pose an increased risk for the development of complications in the early postoperative period, the most characteristic of which are hypotension, shallow anterior chamber syndrome, ciliochorial detachment (CCO), hyphema, external filtration, and macular edema (Lebedev O.I. ., Stolyarov G.M., Yavorsky A.E., Kovalevsky V.V. Comparison of the safety of sinustrabeculectomy and non-penetrating deep sclerectomy // East - West: materials of conference with international participation (Ufa, 2010. - P. 201-203) .

A known method for the prevention of postoperative complications after performing a sinuustrabulectomy by applying a removable suture. After completing all stages of a sinustrabeculectomy, a superficial scleral flap is placed in the scleral bed with 2 nodal sutures at the corners of the flap. Next, a removable suture is placed in the center of the free edge of the scleral flap, the ends of which are not tied, but are brought out from under the conjunctiva on the cornea. The suture is removed in the postoperative period after normalization of IOP (Caporossi A., et al. A randomized prospective study comparing trabeculectomy with and without the use of a new removable suture. // Int Ophthalmol. 2009. Oct; 29 (5): 359-65 . doi: 10.1007 / s10792-008-9245-z.).

The disadvantage of this method is the lack of compression on the scleral flap due to the lack of tension of the removed suture.

Closest to the claimed method - the prototype, is a method for the prevention of postoperative complications after performing sinustrabekulectomy, which consists in the following. After completing all stages of a sinus strabeculectomy, a superficial scleral flap is placed in the scleral bed with 2 nodal sutures at the corners of the flap. Next, a removable U-shaped compression suture is applied to the scleral flap as follows: on the one side of the scleral flap (left), inject the needle into the corneal part, puncture the needle through 3-4 mm at the level of the scleral flap, then on the other side (right) from scleral flap in the reverse sequence - injection at the level of the scleral flap and puncture through 3-4 mm in the corneal part. Thus, the ends of the thread are on the cornea and tied with tension. After suturing the conjunctiva, the corneal part of the suture remains available for removal. The suture is removed in the postoperative period after normalization of IOP (Savastano MC, et al. Shallow Anterior Chamber After Trabeculectomy: Risk Reduction by Use of Removable Compression Sutures. // J. Glaucoma. 2016. Feb; 25 (2): 223-7. Doi : 10.1097 / IJG.0000000000000151).

The disadvantage of this method is the high risk of postoperative complications, since the corneal part of the suture puts pressure on the cornea, cuts into it and after a day is submerged under the corneal epithelium, creating a risk of corneal erosion and difficulty removing the suture. The knot of the thread is tied to the corneal part of the suture and causes irritation, lacrimation and blepharospasm.

The objective of the invention is to reduce excessive filtration of intraocular fluid, reducing the number of complications in the postoperative period after performing penetrating type anti-glaucoma operations.

The technical result of the proposed method is to reduce the risk of complications in the postoperative period, reducing excess filtering in the area of anti-glaucoma surgery.

The problem is solved by the claimed method, which consists in the following.

A conjunctival incision is performed along the limbus. A superficial scleral flap 4 × 4 mm in size is inserted, extending into the transparent layers of the cornea by 0.5-1.0 mm. In the formed scleral bed, a deep scleral flap of a triangular shape is cut out with the base to the limb. A deep scleral flap is excised with the capture of the trabeculae and Schlemm's canal, basal iridectomy is performed. Through the hole in the schlemm canal, the anterior chamber is filled with viscoelastic. The superficial scleral flap is placed without suturing into the scleral bed. Then, a compression suture is applied with a nylon thread 10-0 “crosswise” with capture of the stroma of the cornea and sclera on both sides of the scleral flap as follows: the cornea is sutured in the projection of the scleral flap 1 mm from the limb to a width of 4.5-5.0 mm (0.5-1.0 mm greater than the width of the base of the scleral flap), the next needle injection is carried out on the same side as on the corneal part near the angle of the scleral flap, the angle of the scleral flap is stitched, then the second angle of the scleral flap is stitched ( the thread is over ck eralnym flap), the needle is withdrawn on the sclera near the second corner of the scleral flap. Tie the ends of the threads without undue tension. The conjunctiva is sutured with two interrupted sutures.

Suture removal is carried out 2-7 days after surgery. The criteria for removal of the suture are the stability of the anterior chamber of the eye, moderate hypotension of the eye, determined by palpation or by the method of contactless pneumonometry. The achievement of IOP of 14 mm Hg according to pneumonometry data serves as a criterion for removing the compression suture. When removing the suture, the knot is pulled out from under the conjunctiva without difficulty.

In FIG. 1-3 shows a scheme for applying a removable compression seam.

The defining hallmarks of the proposed method, compared with the prototype, are:

- when applying a compression suture to the superficial flap, the thread is passed through the stroma of the cornea, which avoids trauma to the corneal epithelium, irritation with a nodule with the formation of a corneal syndrome and the formation of erosion;

- the seam is applied “crosswise”, while the intersection of the threads is above the center of the scleral flap, which allows compression on the flap and prevents excessive filtering;

- the angles of the scleral flap are stitched additionally, while the thread is held over the edge of the scleral flap, which has an additional compression effect and also prevents excessive filtering from under the scleral flap.

The invention is illustrated by the following examples.

Example 1

Patient F., 68 years old. Diagnosis Primary open-angle exfoliative glaucoma stage III, operated on the left. A history of Sinustrabekulectomy, 4 years ago, on the left.

Visual acuity with a correction of 0.2; IOP on the background of additional drug therapy 24 mm Hg; total field of view of 160 degrees. When viewed at 12 hours, the scar from the previous anti-glaucoma surgery, coloboma of the iris.

The patient underwent sinistrabeculectomy of the claimed method.

The conjunctiva section was performed along the limbus at 11 o’clock, departing from the place of the previous operation. A 4 × 4 mm superficial scleral flap was separated. In the created scleral bed, a deep scleral flap of a triangular shape was cut out with the base to the limb and excised with the capture of the trabecula and Schlemm's canal, they performed a basal iridectomy. The anterior chamber was filled with viscoelastic. A superficial scleral flap was placed in the scleral bed. The compression suture was applied crosswise with a nylon thread 10-0: the cornea was sutured in the projection of the scleral flap 1 mm from the limb to a width of 4.5 mm, injecting and pricking the needle with the thread from right to left, then the following was performed at the free edge of the scleral flap needle injection is also from right to left, the right angle of the scleral flap was stitched, then the left corner of the scleral flap was stitched, the needle was pulled out on the sclera near the specified angle of the scleral flap. Tied the ends of the threads without undue tension. The conjunctiva was sutured with two interrupted sutures.

In the postoperative period, the eye is outwardly calm, the filter cushion spilled moderate. Eye tone was determined by palpation as (-) 2. Front camera 3.0 mm deep. The corneal part of the compression suture is visualized, it does not irritate. The rest of the suture is covered with conjunctiva.

The seam was removed on the third day under the control of a slit lamp, when the tonus of the eye was determined as (-) 1 and convinced of the stability of the anterior chamber. Complications in the postoperative period were not observed.

1 month after surgery, IOP 15 mm Hg 6 months after surgery, IOP is 16 mm Hg.

Example 2

Patient K, 79 years old. Diagnosis: primary open-angle glaucoma, stage II, artifact (posterior chamber intraocular lens) of the right eye. In the history of glaucoma, the patient was not operated on.

Visual acuity with a correction of 0.3; total field of view is 290 degrees. IOP 30 mmHg

The patient performed the penetrating type anti-glaucoma surgery "Deep sclerectomy" with the application of a compression suture by the claimed method.

A conjunctival incision was performed along the limbus at 12 hours. After performing the main stages of deep sclerectomy, a superficial scleral flap was placed in the scleral bed. The compression suture was applied crosswise with a nylon thread 10-0 as follows: a cornea was sutured in the projection of the scleral flap 1 mm from the limb to a width of 5 mm, injecting the needle with the thread from right to left, then the following was performed at the free edge of the scleral flap the needle was also inserted from right to left, the right corner of the scleral flap was stitched, then the left corner of the scleral flap was stitched, the needle was pulled out on the sclera near the corner of the scleral flap. Tied the ends of the threads without undue tension. The conjunctiva was sutured with two interrupted sutures.

In the postoperative period, the eye is calm, the filtration cushion is moderate, the anterior chamber is deep - 3.5 mm. According to pneumonometry, IOP was on the 1st and 2nd day - 8 mm Hg, on the 3rd day - 10 mm Hg, on the 4th day - 14 mm Hg. The seam was removed on the 4th day under the control of a slit lamp. The front camera remained stable throughout the observation period.

IOP according to Maklakov after 1 month was 14 mm Hg, after 8 months 16 mm Hg.

The proposed method allows to reduce the risk of postoperative complications, such as shallow anterior chamber syndrome, ciliochorial detachment, hypotension, edema of the macula. The additional removed suture applied to the superficial scleral flap allows not only fixing, but also providing compression on it, which prevents excessive filtration in the area of anti-glaucoma surgery in the early postoperative period.

Claims (2)

1. A method for the prevention of complications after performing penetrating anti-glaucoma surgery, including performing penetrating anti-glaucoma surgery, placing a superficial scleral flap in the scleral bed and applying a removable compression suture to it, characterized in that the compression suture is criss-cross on the superficial scleral flap, for which first stitching the stroma of the cornea in the projection of the scleral flap 1 mm from the limb to a width of 4.5-5.0 mm by injecting a needle with a thread from right to left, yes it is performed with the puncture needle thread at the free edge of the scleral flap as from right to left, right angle sewn scleral flap is sewn more left corner scleral flap, the needle withdrawn to the sclera near the left corner of the scleral flap and link ends filaments without tension. 2. The method according to p. 1, characterized in that for the seam use nylon 10-0.

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