RU2293544C2 - Surgical method for treating phacogenic glaucoma with small anterior chamber of eye - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves deepening anterior chamber with initial intraocular blood pressure being retained unchanged by applying dosed posterior vitrectomy with balanced salt solution being concurrently supplied to the anterior chamber. Cataract is extracted and intraocular lens is implanted.

EFFECT: enhanced effectiveness in reducing intraocular blood pressure; reduced risk of corneal endothelium and iris injury.

4 cl

Description

The invention relates to medicine, in particular to ophthalmosurgery, and can be used in the treatment of phacogenic glaucoma caused by a forward displacement of the iridocrystal diaphragm with a pupil block and anterior chamber angle (phacogenic form) or its swelling (phacomorphic form). In both cases, a shallow anterior chamber, a closed angle of the anterior chamber, the development of functional, and sometimes organic, blocks are observed. The most effective method for the treatment of phacogenic glaucoma is the removal of the lens (Nesterov A.P. Glaucoma., M., 1995, p. 84, 146-147, 161; Amirova FS, "Ophthalmology Issues", Omsk, 1997, vol. .3, p. 174). In this case, the removal of the lens is considered at the same time as the anti-glaucomatous operation (Krasnov M.M. Eye Microsurgery. M., 1980, p.205).

The closest analogue to the method for the treatment of phacogenic glaucoma, for example, the treatment of phacomorphic glaucoma, is the method proposed by V.M. Malov with employees (V.M. Malov, E.B. Eroshevskaya, I.V. Malov. Abstracts at the VII Congress of Ophthalmologists Rossi, I, p.165, M., 2002), in accordance with which phacoemulsification is carried out cataracts and subsequent implantation of the IOL into the capsular bag.

The disadvantages of this method are:

- inevitable damage to the endothelium of the cornea with the introduction of the tip of the phacoemulsifier into the shallow, and sometimes slit-like, anterior chamber;

- the formation of hemorrhages and hyphema due to possible damage to the iris;

- with phacotopic glaucoma, phacoemulsification of the lens is difficult, because the cinnamon ligaments are weakened, the position of the lens is unstable, which can lead to the capsule bag breaking off and displacing it into the vitreous body.

The objective of the invention is to develop an atraumatic, effective method for the surgical treatment of phacogenic glaucoma with a shallow eye chamber.

The essence of the invention lies in the fact that the anterior chamber is preliminarily deepened while maintaining the initial IOP, for which a vitreotomy is metered with a metered dose of saline using a vitreotomy irrigation system at the same time, and then the lens is phacoemulsified for small incisions according to the standard method.

In phacotopic glaucoma with an iris-lens diaphragm moving forward and a shallow anterior chamber, a capsule ring is implanted after vitrectomy and circular capsulorexis due to the weakening and partial destruction of the zine ligaments.

The technical result achieved by using the invention is expressed in the following:

- eliminates the risk of damage to the endothelium of the cornea and iris when the tip of the phacoemulsifier is introduced into the anterior chamber;

- the possibility of complications during surgery, such as suprachoroidal hemorrhage, expulsive hemorrhage, is practically excluded, since there is no drop in IOP after vitrectomy and deepening of the anterior chamber;

- with the phacotopic form of glaucoma, a capsule bag frame is created due to implantation of the capsule ring, which ensures a stable position of the lens during phacoemulsification and prevents postoperative complications;

- intraocular pressure decreases to normotonia due to the opening of the anterior chamber angle and the stable position of the iris-lens diaphragm.

The proposed method is as follows. After traditional anesthesia, a conjunctiva is cut 3 mm 4 mm from the limbus in the region of the flat part of the ciliary body. On a sclera 4 mm from the limbus, a metered incision is made to introduce a vitreotome; at 9 o'clock, paracentesis is performed with a metered knife. The sclera is inserted into the incision with a vitreotome, and a tip with a vitreotome irrigation system is inserted into the anterior chamber. Then a vitrectomy and a balanced supply of saline to the anterior chamber are performed. In this case, the value of intraocular pressure practically does not change, the anterior chamber is deepened to 3.5 mm, after which the vitrectomy and the supply of saline to the anterior chamber are stopped.

Then viscoelastic is introduced into the anterior chamber and a 5 mm circular capsulorexis is performed, a metered tunnel incision is 2.75 mm, then hydrodissection and, in the case of phacotopic glaucoma, the capsule ring is implanted into the capsule bag, followed by phacoemulsification of the lens, removal of the lens masses and implantation of implantation .

The proposed method for the treatment of phacogenic glaucoma is illustrated by the following clinical examples:

Example 1

Patient N., born in 1924, a.k. No. 152562, received November 16, 2004

Survey data:

V OD = 0.04 sph-3.0 = 0.05

V OS = 0.03 sph-7.0 = cyl-3.0ax15 ° = 0.06

IOP, mmHg: OD-30; OS-19.

The threshold of electrical sensitivity:

OD - 150; OS - 16

Electrical lability:

OD - 35; OS - 33

Echobiometry:

OD-ACD-1.5; LT-5.35; AL-23.06

OS-FCD-2.66; LT-5.0; AL-26.8

Ophthalmostatus: eyelids and lacrimal organs are not changed.

Biomicroscopy: eyes calm, OD - the cornea is transparent, the depth of the anterior chamber is 1.5 mm, uniform, moisture is transparent, dystrophy of the pupil border of the iris. The pupil is 2.5-3 mm, round, central, pseudoexfoliation along the edge of the pupil. The pupil does not react to light. There are clouding in the cortex and nucleus of the lens, pseudoexfoliation on the anterior capsule of the lens, pronounced phacodonesis. The reflex is dull pink; fundus details are not visible.

Gonioscopy OD: angle is closed, details of the angle of the anterior chamber are not visible.

Diagnosis: OD phacotopic, III "C" glaucoma, immature cataract, lens subluxation of the II degree, OS - immature cataract.

November 19, 2004, the patient underwent OD surgery according to the proposed method: dosed vitrectomy with anterior chamber recess up to 3.5 mm, capsule ring implantation, lens phacoemulsification, implantation of the IHANITA.

At discharge:

V OD - 0.3 nk

V OS - 0.03 sph-7.0 = cyl-3.0 = 0.06

IOP - 16 mm Hg, the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the position of the IOL is correct, the optic disc is gray, glaucomatous excavation. Gonioscopy OD: the anterior chamber angle is open, medium width, mixed pigmentation of the II degree with echobiometry, the anterior chamber is deepened to 3.32 mm.

Example 2

Patient P., 79 years old, a.k. No. 108995. Received January 13, 2004

Earlier, in 2000, the patient underwent a filtering iridectomy, and then extracapsular cataract extraction for phacomorphic glaucoma in the left eye.

Upon receipt of December 29, 2003:

V OD - hand movement in the face;

V OS - pr.l.certa sph + 14.0 = 0.05;

IOP, mmHg: OD - 51; OS - 20.

Subjective complaints: eye pain, lack of objective vision OD.

Objectively: OD mixed injection, the cornea is edematous, single folds of the descemet membrane. The anterior chamber is slit-like, the pupil is scalloped, 3 mm. In diameter, posterior synechia along the edge of the pupil, pronounced pigment deposits on the iris, dystrophy of the iris, the lens is swollen, cloudy.

Diagnosis:

OD - acute attack of phacomorphic glaucoma;

OS - aphakia operated on with IV A glaucoma;

The patient underwent a course of antihypertensive therapy, then January 14, 2004 - the operation according to the proposed method (claims 1, 2 and 3 of the claims) according to the scheme: dosed vitrectomy with anterior chamber recess up to 3.5 mm, cataract phacoemulsification with a 2.75 incision mm, implantation of the IOL "Hanita". The angle of the anterior chamber was opened using viscoelastic and a spatula. The first day after surgery, the eyes are irritated. The cornea is slightly edematous in the uranium zone, the folds of the descemet membrane, the pupil in the center, oval, sectoral dystrophy of the iris, the position of the IOL is correct, the optic disc is pale, glaucomatous excavation.

At discharge:

V OD = 0.06 n.k.

V OS = pr.l.certa sph + 14.0 = 0.05

IOP mmHg: OD - 17; OS - 22.

The operated eye is calm.

In a year:

VOD 0.7 sph-1.0 = 0.9

V OS - pr.l.certa

IOP mmHg: OD - 19; OS - 20.

The cornea is transparent, the anterior chamber is of medium depth, the pupil is oval, sectoral dystrophy of the iris, the position of the IOL is correct, the optic disc is pale, glaucomatous excavation.

Gonioscopy: angle open, medium width, mixed pigmentation of the second degree.

Claims (4)

1. A method of surgical treatment of phacogenic glaucoma with a shallow anterior chamber of the eye, comprising cataract extraction and IOL implantation, characterized in that the anterior chamber is deepened preliminarily while maintaining the initial value of intraocular pressure by dosed posterior vitrectomy while feeding a balanced amount of saline into the anterior chamber. 2. The method according to claim 2, characterized in that the supply of a balanced amount of saline into the anterior chamber is carried out using a vitreotome irrigation system. 3. The method according to claims 1 and 2, characterized in that the cataract is removed by phacoemulsification through a small incision. 4. The method according to claims 1 and 2, characterized in that before performing phacoemulsification, a capsule ring is implanted in the capsule bag.