SU1210821A1 - Method of treatment of secondary glaucoma - Google Patents

Description

The invention relates to medicine, more specifically to ophthalmology, and can be used in the surgical treatment of secondary glaucoma.

The aim of the invention is to increase the outflow of intraocular fluid by additional outflow into the supra-space.

FIG. 1-8 is a schematic representation of the method.

Initially, a conjunctival flap 1 is cut out and folded over the cornea 2 (FIG. 1). Next, an incision is made 1/2 of the sclera 3 in the form of an isosceles triangle.

4 (FIG. 2). The scleral flap 5 is separated and transferred to the conjunctival flap 1 (FIG. 3). Deep scleorectomy is performed in the form of an isosceles triangle 6 (FIG. 4). The external drainage end 7 is inserted into the anterior chamber (FIG. 5), Rear cyclodialysis is carried out and drainage end 8 is introduced by spatula 9 into the subchorial space (FIG. 8), drainage end 10 is introduced into the sub-antenna space, Scleral flap

5 is returned to its original place, and its top, together with the end 10 of the drainage, located in the subtenon space, is fixed with an anchor suture 11 (FIG. 7). On the lateral sides of the scleral flap 5, one conjunctival-scleral suture 12 is applied, and conjunctiva 13 - continuous suture (Fig, 8),

Polymethacrylate ethylene glycol is used as a drainage, which does not cause the formation of a coarse connective capsule around the outer end of the drainage and does not block the outflow path of the intraocular fluid. Moreover, the presence of an intraocular fluid near the outer end provides not only a conjunctival outflow, but also supraciliary space.

The data on the hydrodynamic state of the eye in patients operated on by this method are as follows: P. 28.4 jf3, l; C 0.23HhO, 17; F 3.7 + 0.16.

Example 1, Sick And, 32 g (by profession a driver of an electric car), was admitted about secondary uncompensated glaucoma OD, History of Disease: at work she was hit by OD with the end of the wire. Urgently hospitalized in a hundred

The hospital where cataract extraction, iridectomy, anterior vitreoectomy was performed through a penetrating wound of the cornea and the imposition of four

nodal stitches on the cornea OD. For three weeks after surgery, stubborn, difficult-to-treat iridocyclitis was observed. After verses of inflammation for the first time

marked increase in, g, d, up to 36 mm Hg. Made antiglaucomatous operations. The pressure continued to remain high. Made antiglaucomatous operations using

drains from teflon (2 operations) and silicone (1 operation). Two months after the last operation, vg, d, increased again to 40-45 mm Hg. The patient was sent to an eye microsurgery hospital for consultation and

deciding on further treatment.

Eye condition at admission: OD - pronounced appearance of stagnation in the anterior ciliary vessels, Grub, located in all layers of the stroma of the cornea. Postoperative scars on the entire circumference of the limbus. Front camera uneven depth. At 9, 14 and 6 hours, the inner ends of allodrainage are visible along the limb. Massive anterior synechia nets from the pupillary edge of the iris to the scar of the cornea, In the iris there is stagnation. The pupil of irregular shape is tightened to 5 hours

12 hours is almost full with the coloboma of the iris, Aphaki, Vitreous destruction. The optic nerve head (ds, n,) is pale pink, clear boundaries, glaucomatous excavation,

No pathological changes were detected in the macular area. Acuity of vision with a correction of +11, O, the field of view is narrowed in the upper-inner quadrant by 25 °, V. g, d,

while receiving diakarba 36 mm Hg, Electronic topography: no outflow. It was diagnosed: secondary closed-angle 11 in-with non-stabilized operated glaucoma of post-traumatic etiology OD,

Produced deep sclerectomy with allodrenia by the proposed method. During the first week after surgery c, d, d, ranged from

1S to 16 mm Hg. In the next two weeks, c, g, d, rose to 16-20 mm Hg. In connection with the normalization of v.d, d, the patient was made subtotal

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penetrating keratoplasty with synechoic tumors, anterior vitreectomy, iris plasty and IOL implantation. The postoperative period without features. Two months after the operation, the visual acuity increased to 1.0, V, d. at the level of 18-21 mm Hg. She was able to return to her previous job.

Example 2. Sick K, 36 years old is small by profession. Received about secondary uncompensated glaucoma of the OS.

History of disease: while clarifying family relationships, received a fist punch at the OS. After 1.5 g a cataract developed, and therefore the patient was operated on. During the operation, a vitreous prolapse is produced. In the postoperative period, corneal opacification, the development of iridocyclitis and the elevation of the urinal gd were noted Two months after the operation, anterior vitreoectomy was performed through a flat part of the ciliary body with the removal of the vitreous part from the anterior chamber. After the operation, the cornea became transparent, the sharpness of the vision increased, the inflammation phenomena disappeared, however, it continued to remain.

Over a period of 5 years, 7 antiglaucomatous operations of various types were performed in different cities of the USSR. Of these, the latter 2 were produced with alloration (Teflon strips). In a month after the last operation of the year. reached 32 mm Hg against the background of taking diacarb.

Eye condition at admission: OS - appearance of stagnation in the anterior ciliary vessels. Around the circumference of the limbus postoperative scar. The cornea is swollen. And / camera 3.0 mm. By

circumference of the limbus whitish strip of anterior synechia - the remains of the vitreous body. At 9 and 17h visible internal ends of the Teflon drainage. Iris bomb. Pupil in the center. Afaki. Coarse destruction of the vitreous body. The optic disc is pale-rosy, glaucomatous excavation. Macular region without features. Islands of vision with a correction of +10.0 0.2. The field of view is narrowed in the upper inner quadrant of the AOR. V.g.d. equal to 56 mm Kg. Electronic tonography: no outflow. Diagnosed: secondary angle 11 with nest21

bilized operated glaucoma of post-traumatic etiology of the OS. Produced deep sclerectomy with allodrenia on the proposed method. The operation and the postoperative period passed without features. V.g.d. in the postoperative period did not exceed 24 mm Hg. Learn low acuity due to changes

in the vitreous body, after 6 months

repeated vitreoectomy was performed. Acuity of vision with a contact lens increased to 1.0. V.g.d. over the past period remained within

physiological norm.

Example 3. Patient K., 17 years old, a schoolboy, was admitted about the absolute best, her OD glaucoma. History of pain: a game with peers

received a penetrating puncture of the cornea with a sewing needle. Three days later, the eye stopped bothering, and he did not contact the doctor. After a month, the visual acuity decreased, the eyes reddened and there was pain. Paramedic diagnosed cataracts and referred to a doctor. For various reasons, the patient came to the doctor only three months after the injury. Diagnosed with phacolitic uncompensated glaucoma. Proi: z.ede, PA cataract extraction with trabeculoectomy and anterior vitreectomy. V.g.d. continued at 36-48 mm Hg. After three more antiglaucomatous operations were performed, the last two of which were performed using silicone drains (tubules), eye condition: eye block increased (axis length 32 mm, healthy eye length 25 mm), buftalm. Pronounced effects of stagnation in the anterior ciliary vessels. In the inferior cornea quadrant, a post-traumatic scar 1.0–1.5 mm long, passing through all layers of the stroma. P / camera 3.5 mm. Pronounced bombardment of the iris.

Pupil in the center. Afaki. Destructive vitreous body. The optic nerve head is pale gray, deep glaucomatous excavation. Visual acuity is zero. V.g.d. 38 mm Hg. Conclusion EFI: complete atrophy of the optic nerve. A diagnosis of secondary open-angle, absolute, severe glaucoma of post-traumatic etiology of OD was made.

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Produced deeply with scleract with allodrenation according to the proposed method. The operation and the postoperative period passed without features. V.g, d. During the past year after surgery, it ranged from 15 to 25 mm Hg. Patient monitoring continues.

From the above examples, it follows that the reduction of the visual functions of the eye was due to the ineffectiveness of surgical treatment, including the use of drains of various Teflon and silicone constructions, which ensure the drainage of chamber moisture only into the subtenon space. In the first two patients, it was possible to preserve the visual fractions of the eye, despite more severe eye injury, longer disease duration, and more antiglaucoma surgery, which did not have the desired effect compared with the third patient. Patients ESHOVE returned to their former profession.

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In the third patient, despite the relatively short duration of the disease, the young age and elasticity of the eye tissue, the function of the visual

5 eyes irretrievably lost. The main reason for the extinction of the visual functions of the eye is the ineffectiveness of earlier ftpo- led operations. The last operation, which caused the drainage of moisture from the anterior chamber to the subchiorodal and subtenon space, was performed to relieve pain and preserve the eye, as an organ, with the cosmetic purpose. Despite the difficult initial position of the eye, the goal of the operation is achieved. All three patients for 6–10 months have been disabled for the past two years.

20 The indication for the use of the proposed method of treatment is secondary open and closed angle-uncompensated operated glaucoma. The method does not have 25 indications.

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Compiled by E, Pavement Editor M. Kelemesh TehredO. Vashchishina Corrector

Order 571 / 8Discount 659 Subscription

VNIIPI USSR State Committee

for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Branch Research Institute Patent, Uzhgorod, st. Project, 4

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Claims (1)

METHOD FOR TREATING SECONDARY GLAUCOMA by forming a conjunctival and superficial scleral flap, removing deep layers of the sclera and implanting drainage from polymethacrylate glycol, one end of which is inserted into the anterior chamber and the other is fixed between the scleral flap and its bed, which differs from that inside liquids, additionally produce the specified cyclodialysis, and drainage is performed with an additional external end, which is introduced into the supraciliary space through cyclodialysis uy crack. FIG. 7 SU..U 1210821 I 21 0821