SU1428372A1 - Method of treatment of glaucoma - Google Patents

Abstract

This invention relates to ophthalmology. The purpose of the invention is to reduce postoperative complications and ensure a stable outflow of intraocular fluid into the supra-ciliary and sub-tenon spaces. In the lower quadrant form the flap of the conjunctiva with the tenon capsule. Cut and otseparovyvat superficial scleral flap with the transition to the cornea. On the sides of the bed of the scleral flap from the middle layers of the sclera cut out two autografts for 2/3 of the length of the scleral bed and 0.5 - 1 mm beyond the limits of the top of the scleral bed base to the limb. A strip of deep sclera with trabecula is cut out and removed. Bilateral cyclodialysis is performed. Autotransplants are inserted into the supra-ciliary space on both sides of the scleral bed. The removed sclera strip with trabeculae with a rn apparatus is placed across the scleral jumper. Superficial scleral and conjunctival flaps fix. The method allows to achieve a persistent hypotensive effect. with S (L

Description

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The invention relates to medicine, namely to ophthalmology, and can be used in microsurgery with glaucoma.

The purpose of the invention is to reduce postoperative complications and ensure a stable outflow of intraocular fluid into the supra-ciliary and sub-tenon spaces.

Example. Patient L., 72 years old, was admitted with a diagnosis: open-angle operated glaucoma of the right eye, initial cataract of both eyes. From the anamnesis, it was established that in 1980, trabeculectomy with basal iridectomy was performed on the right eye by a known method. After 1 year, intraocular pressure increased again and did not decrease, despite drug therapy. The intraocular pressure ranged from 28 to 38 mm Hg. Art. (according to Maklakov), the field of view is narrowed concentrically by 15 °.

The condition of the right eye upon admission to the eye clinic: visual acuity of the right eye 0.7 with corr.-1,. The intraocular pressure is 36 mm Hg. (according to Maklakov).

Objectively: the appendages of the eye are not changed; there is a conjunctival scar in the upper sector of the eye block after previous antiglaucomatous surgery. Filtration conjunctival cushion is missing. The cornea is smooth, transparent, the anterior chamber is of medium depth, and the moisture is transparent. The iris is subatrophic, the pupil is round, the narrow, pigment border of the pupillary edge is leached, at 12 o'clock the basal coloboma. In the lens - the initial opacities. In the fundus glaucomatous excavation of the optic nerve 0,8 DD.

Gonioscopy: the angle of the anterior chamber is open throughout the gonosphere, of medium width, moderate endogenous pigmentation of the trabecular apparatus, at 12 o'clock in the trabecula there is a defect as a result of the trabeculectomy operation and, accordingly, the basal coloboma in the iris. Through a defect in the trabeculae, a scleral flap is visible, which is fused with the underlying scleral bed, and there is no seepage filter, a spruce between them.

Electron tonography data: 1 33; , 07; , 54; .

Anti-glaucoma surgery was performed under local anesthesia with a retro-bulbar-2% novocaine solution. A conjunctival flap is formed in the lower quadrant along with a tenon capsule 8 mm wide to the limbus. The surface scleral flap is cut out and cut off by the base to the limb, with a transition to the cornea to 1/3 of the rectangular shape with a size of 6X6 mm in a projection of 6 hours. On the sides of the bed of the scleral flap from the middle layers of the sclera, two autografts were cut out for 2/3 of the scleral length.

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bed and 1 mm beyond the top of the scleral bed base to the limbus. Cut a strip of deep layers of the sclera and remove it along with the trabecula at the base of the superficial scleral flap, remove the deep layers of the sclera, leaving a narrow bridge between the last and trabeculectomus orifice. Conducted bilateral cyclodialysis and refilled autografts in the supraciliary space on both sides of the scleral bed. A sterile air vial was introduced into the anterior chamber, the removed sclera strip together with the trabecular apparatus was laid across the scleral web, 4 nodal sutures were placed on the surface scleral flap and a continuous suture was applied on the conjunctiva with the tenon sheath. Under the conjunctiva, dexazone and gentamicin, 0.3 ml each, were administered prophylactically.

In the postoperative period, corticosteroids, disinfectants, and mydriatics were topically applied. On the sixth day after surgery, the patient was discharged for outpatient treatment.

The sharpness of the vision at discharge was equal to the preoperative one, the field of vision expanded by 10 °. The intraocular pressure according to Maklakov is 15 mmHg. Art.

Objectively: the right eye is flat, the filtration pad is poured, the cornea is transparent, smooth, the anterior chamber is of medium depth, the basal timbers are at 12 and 6 o'clock (after the last operation), the pupil in the center, round, in the crystalline lens - the initial opacities. In the fundus glaucomatous excavation of the optic nerve 0,8 DD.

Gonioscopy: the anterior chamber angle is open, in the lower segment (the place of the second operation) at 6 o'clock there is a basal coloboma, through a defect in the trabeculae it can be seen that the surface scleral flap will evenly stand out from the underlying scleral bed.

The patient continues to receive topical corticosteroids for 10 days. Repeated measurements of intraocular pressure showed stability of the intraocular pressure within 15-17 mm Hg. Art. (according to Maklakov).

After 6 months, the functional parameters remained at the same level as they were before the operation.

Tonographic data: 13.35; F 1.0; ,thirty; .

The proposed method operated on 14 patients and 20 patients on the known. The observation period is up to 1.5 years. At the same time, a stable hypotensive effect was achieved in all operated patients using the proposed method, in contrast to the known method, in which 5 patients 6 months after surgery showed an increase in intraocular pressure.

214283724

Thus, the proposed method for a new space, additionally

treatment of glaucoma allows to achieve a stable side of the bed of the scleral flap with a direct hypotensive effect and reduce the angular shape from the middle layers and the number of postoperative complications. I cut two autografts on

52/3 of the length of the scleral bed and 0.5-1 mm

Claims (1)

The invention claims to go beyond the top of the scleral bed base to the limb is removed uchasSposob treating glaucoma by formyl-current deep layers of the sclera, allowed perovani konnktivalnogo and poverhnostnogoremychku between the latter and trabekuloskleralnogo flaps, removing strips glu-ektomicheskim hole carried bilatebokih layers sclera with trabeku--sectoral cyclodialysis and administered formed lamis followed by fixation on top of the autotransplants in cyiipaiui.uiapnostnogo scleral and conjunctival space on both sides of the scleroscula, characterized in that, with the aim of the oral bed, and the removed strip of diminished postoperative complications of the scleral layers, together with the trapeal syndrome, the fasciculum of the scleral layer and the scleral layer are also attached. perpendicular to the scleral eye fluid is placed in the supraciliary and sub-bridges.