RU2809087C1 - Method of surgical correction of length of ahmed valve drainage tube during phacoemulsification of cataracts with implantation of intraocular lens - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used to correct the length of the Ahmed valve drainage tube after anti-glaucoma surgery during cataract phacoemulsification with intraocular lens implantation (PhEC+IOL). A corneal paracentesis is made at 3 o'clock position with a width of 1.2 mm and a tunnel corneal incision with a width of 2.2 mm at 11 o'clock position. Afterwards the anterior chamber is filled with viscoelastic through the corneal incision. Then, through paracentesis, the valve drainage tube is grasped with capsulorhexis tweezers and the tube is cut off by 1–2 mm using Vannas scissors inserted through the corneal incision. The cut part of the tube is removed from the anterior chamber with tweezers through the corneal incision. Next, a PhEC+IOL is produced.

EFFECT: invention ensures safe correction of the length of the Ahmed valve drainage tube in the anterior chamber of the eye, and also makes it possible to prevent displacement of the valve drainage tube from the area of surgical intervention.

1 cl, 2 ex

Description

The invention relates to the field of medicine, namely to ophthalmology, and can be used to correct the length of the Ahmed valve drainage tube after anti-glaucoma surgery simultaneously with cataract phacoemulsification with intraocular lens implantation (FEC+IOL).

Among the known forms of glaucoma, one of the most severe is considered to be refractory, in the treatment of which traditional methods do not lead to the desired result. Refractory glaucoma (RG) combines several varieties of this disease with a persistent decompensated clinical course, which includes a number of primary and secondary forms: decompensated, previously operated, primary open-angle glaucoma (POAG), advanced stage of POAG, neovascular glaucoma of various origins, post-traumatic, uveal and others. Currently, surgical treatment remains the main effective method for compensating intraocular pressure (IOP) and preserving visual functions in RG. Various drainages and implants are used to treat RG.

One of the most common devices for the treatment of RG is the Ahmed valve drain. This device consists of a unidirectional valve system with a silicone outlet tube, which is implanted into the anterior chamber (AC) of the eye, and a drainage body itself, which is sutured to the sclera in the superior temporal segment of the eyeball. The mechanism of operation of valve drainage is based on the removal of intraocular fluid from the anterior chamber through a tube into the sub-Tenon's space with the formation of new outflow pathways.

However, when implanting drainage into an eye with a native lens, the location of the valve drainage tube in the anterior chamber can lead to rapid progression of cataracts, which requires FEC + IOL. If the length of the tube is excessive and it is located in the area where the FEC+IOL is performed, it can cause difficulties for manipulation when entering the area of surgical intervention.

The above determines the relevance of correcting the length of the Ahmed valve drainage tube in the anterior chamber simultaneously with performing FEC + IOL.

The Applicant is not aware of methods for surgically correcting the length of the Ahmed valve drainage tube.

The objective of the invention is to develop a safe and effective method for correcting the length of the Ahmed valve drainage tube in the anterior chamber before performing FEC+IOL.

The technical result of the proposed method is the correction of the length of the Ahmed valve drainage tube in the anterior chamber of the eye, eliminating the displacement of the Ahmed valve drainage tube from the area of surgical intervention.

The method is carried out as follows.

In the operating room, under local installation anesthesia with a solution of proximetacaine 0.5%, the patient undergoes a corneal paracentesis at 3 o'clock, 1.2 mm wide, and a tunnel corneal incision, 2.2 mm wide, at 11 o'clock. After which the PC is filled with viscoelastic through the corneal incision. Then, through paracentesis, the valve drainage tube is grasped with collet tweezers for capsulorhexis and the tube is cut off by 1-2 mm using Vannas scissors inserted through the corneal incision. The method is completed by removing the cut part of the tube from the anterior chamber with collet tweezers through the corneal incision at 11 o'clock. Next, FEC+IOL is performed using standard methods.

Shortening the length of the tube eliminates the displacement of the valve drainage tube into the area where FEC+IOL is performed, which avoids difficulties during manipulation and reduces the risk of complications in the postoperative period.

The method is confirmed by the following examples.

Example 1

Patient M., 50 years old, was diagnosed in his left eye at his place of residence in 2010: Primary open-angle glaucoma 3 s, initial cataract. In 2015, surgical treatment was performed at the place of residence: non-penetrating deep sclerectomy was performed on the left eye, followed by laser descemetogoniopuncture. Target IOP values were temporarily achieved, followed by the addition of antihypertensive drops. In January 2021, during a repeat appointment with an ophthalmologist at the place of residence regarding IOP decompensation on the maximum hypotensive regimen of the left eye, a diagnosis was made: primary open-angle glaucoma 3C, operated on. At the place of residence, an Ahmed valve drainage was implanted in the left eye, and the pressure was compensated in the postoperative period. In May 2021, the patient was referred to the Eye Microsurgery MNTK, Moscow, with complaints of decreased vision in the left eye.

According to the survey: OS 0.05. IOP (pneumotonometry) on one antihypertensive drug: Visual acuity OS: 16 mm Hg. According to ultrasound: OS membranes are adjacent, posterior vitreous detachment. The field of vision of the left eye corresponds to the third stage of glaucoma. With OS biomicroscopy: the eye is calm, the filtration cushion (FP) is sclerotic at 12 o'clock, the cornea is transparent, the anterior chamber is of medium depth, the Ahmed valve drainage tube is in the anterior chamber at 13 o'clock, the iris is subatrophic. The lens is cloudy in the area of the nucleus and cortical layers. Fundus: not ophthalmoscopically. Also, when examining the PC at 13 o’clock, it was revealed that the valve drainage tube entered the area where the FEC + IOL was performed by 1 mm.

Based on the medical history and the results of an ophthalmological examination, a diagnosis was made: OS Primary open-angle glaucoma FOR operated on. Complicated cataract.

Treatment was carried out according to the proposed method with shortening the length of the tube by 1 mm and performing FEC + IOL.

There were no complications in the postoperative period. According to the examination: visual acuity OS: 0.5. IOP 20 mm Hg. (pneumotonometry). When biomicroscopy OS: the eye is calm, the AF at 12 o'clock is sclerotic, the cornea is transparent, the anterior chamber is of medium depth, the Ahmed valve drainage tube is in the anterior chamber at 13 o'clock in the correct position, the iris is subatrophic. The IOL is in the capsular bag, in the correct position. Fundus: optic disc gray, ED 0.8, clear boundaries. There are no features in the macular area.

Example 2

Patient M., 62 years old, was diagnosed in her right eye in July 2018 at her place of residence: Primary open-angle glaucoma 2s, initial cataract. Between December 2018 and March 2019, sequential treatment was performed at the place of residence: laser trabeculoplasty, non-penetrating deep sclerectomy, followed by laser descemetogoniopuncture was performed on the right eye. The target IOP values were temporarily achieved until November 2019; later, IOP decompensation occurred on the maximum hypotensive regimen, and in March 2022, an Ahmed valve drainage was implanted in the right eye at the place of residence; in the postoperative period, the pressure was compensated. In January 2023, the patient was sent to the Eye Microsurgery MNTK, Moscow, with complaints of a significant decrease in visual acuity of the right eye.

According to the examination: Visual acuity OD: 0.08. IOP (pneumotonometry) on one antihypertensive drug: OD 17 mm Hg. According to ultrasound: OD membranes are adjacent. The field of vision of the right eye corresponds to the second stage of glaucoma. With biomicroscopy OD: the eye is calm, the AF at 12 o’clock is sclerotic, the cornea is transparent, the anterior chamber is of medium depth, the Ahmed valve drainage tube is in the anterior chamber at 11 o’clock, the iris is subatrophic. The lens is cloudy in the area of the nucleus and cortical layers. Fundus: not ophthalmoscopically. Also, when examining the PC at 11 o’clock, it was revealed that the valve drainage tube entered the area where the FEC + IOL was performed by 2 mm.

Based on the medical history and the results of an ophthalmological examination, a diagnosis was made: OD Primary open-angle glaucoma 2A, operated on. Complicated cataract.

Treatment was carried out according to the proposed method with shortening the length of the tube by 2 mm and performing FEC + IOL.

There were no complications in the postoperative period. According to the examination: Visual acuity OD: 0.6. IOP 18 mm Hg. (pneumotonometry). With biomicroscopy OD: the eye is calm, the AF at 12 o'clock is sclerotic, the cornea is transparent, the anterior chamber is of medium depth, the Ahmed valve drainage tube is in the anterior chamber at 11 o'clock in the correct position, the iris is subatrophic. The IOL is in the capsular bag, in the correct position. Fundus: pale optic disc, ED 0.6, clear boundaries. There are no features in the macular area.

Claims (1)

A method of surgical correction of the length of the Ahmed valve drainage tube during phacoemulsification of cataracts with intraocular lens implantation (FEC+IOL), characterized by the fact that the patient undergoes a corneal paracentesis at 3 o'clock with a width of 1.2 mm and a tunnel corneal incision with a width of 2.2 mm at 11 o'clock, after which the anterior chamber is filled with viscoelastic through the corneal incision, then through paracentesis, the valve drainage tube is grabbed with capsulorhexis tweezers and the tube is cut off by 1-2 mm using Vannas scissors inserted through the corneal incision, the cut part of the tube is removed from the anterior chamber with tweezers through the corneal incision, then a FEC+IOL is produced.