RU2315586C1 - Surgical method for treating open angle glaucoma cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming curvilinear circular segment-shaped superficial scleral graft turned with its base towards the limb and with its convex part towards sclera, after having formed conjunctival flap. Superficial scleral graft base is segment chord. Then, curvilinear elliptic deep scleral graft is formed. Its chord is graft base and symmetry axis belongs to greater axis of the ellipse. The deep scleral graft and superficial scleral graft have common symmetry axis. The base of the former one is a part of superficial scleral graft base. Ratio between the superficial scleral graft base length and deep scleral graft base length is equal to 1.5. Ratio between the distance from superficial scleral graft convex part top to its base along the symmetry axis and that of the deep scleral graft is equal to 1.5. The deep scleral graft is cut out and removed, and the so created intrascleral bed is coagulated, the superficial scleral graft is returned to its original place and fixed.

EFFECT: reduced risk of eye tissue injuries; optimized intraocular fluid discharge paths; creating directed filtration from conjunctiva incision; enhanced effectiveness of antiglaucoma operation; accelerated healing processes.

3 dwg

Description

The invention relates to medicine, and more particularly to ophthalmology, and can be used for surgical treatment of open-angle glaucoma.

The closest to solving the technical problem is the method of surgical treatment of open-angle glaucoma, including conducting a conjunctival incision, forming a conjunctival, superficial and deep scleral (HS) flaps, excising the deep layers of the sclera, coagulating, returning the superficial scleral flap to its place and comparing the edges of the conjunctival wound, when this, before the formation of a superficial scleral (PS) flap, episcleral vessels coagulate along the perimeter of its planned Niya. (RF Pat. No. 2184514).

However, this method has significant drawbacks: the presence of trauma to the tissues of the eye, insufficient optimization of the outflow pathways of the intraocular fluid, insufficient stabilization of the filtration of the intraocular fluid over time, insufficient directivity of filtration away from the conjunctival incision, insufficient reduction in the violation of hydro- and hemodynamics during the operation.

The technical result achieved according to the invention is to minimize trauma to the eye tissue while optimizing the outflow pathways of intraocular fluid, stabilizing the filtration, creating directional filtration away from the conjunctival incision and reducing the disturbance of hydro- and hemodynamics during the operation.

The specified technical result according to the invention is achieved by the fact that in the method of surgical treatment of open-angle glaucoma, including the conjunctival incision, the formation of the conjunctival flap, PS and GS flaps, excision of the deep layers of the sclera, coagulation, the return of the PS flap in place and matching the edges of the conjunctival wound, while after the conjunctival incision, a curvilinear PS flap is formed, the base facing the limb, in the form of a circle segment, convex to the side ry, wherein the base flap PS is a chord of the segment; then a curved GS flap is formed, the base of which is part of the base of the PS flap and having a common axis of symmetry with it, while the depth of formation of the HS flap lies in the range of 0.2-0.1 scleral thickness, while the HS flap is formed as an ellipse segment, the chord of which is the base of this flap, and the axis of symmetry of the HS flap lies on the major axis of the ellipse, while the ratio of the base length of the HS flap to the base length of the HS flap is 1.5, the ratio of the distance from the top of the convex part of the PS flap to its base of the axis of sym etria to the distance from the top of the convex part of the HS flap to its base along the same axis is 1.5; then the HS flap is cut out and removed, then the formed intrascleral bed is coagulated, the PS flap is returned to its place and fixed with two interrupted sutures.

The authors empirically selected the shape and size of curved PS and GS flaps, necessary and sufficient to achieve a technical result, according to the invention, namely: form a curved PS flap facing the base to the limb, in the form of a circle segment, convex towards the sclera; the base of the PS flap is the chord of this segment; form a curved GS flap, the base of which is part of the base of the PS flap and having a common axis of symmetry with it, while the depth of formation of the HS flap lies in the range of 0.2-0.1 scleral thickness; The HS flap is formed in the form of an ellipse segment, the chord of which is the base of this flap, and the axis of symmetry of the HS flap lies on the major axis of the ellipse, while the ratio of the base length of the HS flap to the average outer diameter of the iris lies in the range 0.15-0.19; the ratio of the base length of the PS flap to the base length of the HS flap is 1.5; the ratio of the distance from the top of the convex part of the PS flap to its base of the axis of symmetry to the distance from the top of the convex part of the HS flap to its base along the same axis is 1.5; then the HS flap is cut out and removed, then the formed intrascleral bed is coagulated, which allows the curved section of the intrascleral bed open to the limb to form and the curved bed in the surface scleral layer, in turn, and ensures the achievement of a technical result: minimizing trauma to the eye tissue while optimizing the outflow paths intraocular fluid, stabilization of filtration, the creation of directional filtration away from the conjunctival incision, reduction of the infringement hydro and hemodynamics during the operation.

The invention is illustrated by drawings, which depict

figure 1 - the formation of PS flap;

figure 2 - the formation of the HS flap;

figure 3 - the formation of a curved section of the superficial scleral bed and intrascleral bed.

A method of surgical treatment of open angle glaucoma according to the invention is as follows.

After traditional anesthesia, the conjunctiva is cut 1.5-2 mm and 0.5-1 mm from the limb 1 and the sclera is exposed. A curved PS flap 2 is cut out with the base to the limb 1 (Fig. 1), in the form of a circle segment, while the base 3 of the PS flap is the chord of this segment. Then form a curved HS (Fig. 2) flap 4, the base 5 of which is part of the base 3 of the PS flap 2 and having a common axis of symmetry with it, while the depth of formation of the HS flap lies in the range of 0.2-0.1 scleral thickness, The GS flap is formed in the form of an ellipse segment, the chord of which is the base 5 of this flap, and the axis of symmetry of the GS flap lies on the major axis of the ellipse; the ratio of the length of the base 3 PS flap 2 to the length of the base 5 GS flap 4 is equal to 1.5; and the ratio of the distance from the top of the convex part of the PS flap 2 to its base 3 along the axis of symmetry to the distance from the top of the convex part of the HS flap 4 to its base 5 along the same axis is 1.5.

After that, the HS flap 4 is cut out and removed, forming a curved bed 6 in the surface layers of the sclera, then coagulation of the formed intrascleral bed is carried out (Fig.3); then return the PS flap 2 into place and fix it with two interrupted sutures and compare the edges of the conjunctival wound.

Example 1

Patient N., 54 years old, diagnosis: primary open-angle I With glaucoma of the left eye. Glaucoma was revealed for the first time, the patient complains of pressing pains, blurred vision in front of the left eye.

There were no operations, no eye injuries. Somatically healthy.

Inspection data: the eye is calm, the optical media are transparent, the destruction of the pigment border of the iris, the pupil's reaction to light is positive.

Gonioscopically - the anterior chamber angle is open, medium width, pigmentation 0-I. Fundus: pink reflex, optic nerve disc - pale pink, glaucomatous excavation 0.5.

Instrumental examination data:

Visual acuity with correction - 0.8,

Tonography: Po = 34; C = 0.02; F = 0.46; Po / C = 1725,

Perimetry: expansion of the blind spot, single scotomas in the Bierrum zone.

The operation was performed according to the method described above, while the ratio of the base length 3 PS flap 2 to the length of the base 5 GS flap 4 is 1.5; and the ratio of the distance from the top of the convex part of the PS flap 2 to its base 3 along the axis of symmetry to the distance from the top of the convex part of the HS flap 4 to its base 5 along the same axis is 1.5; the depth of formation of the HS flap is 0.2 scleral thickness;

Complications during the operation and in the postoperative period were not observed. The patient was discharged on the first day after surgery. The discharge pressure is 15 mmHg (pneumometer), visual acuity with correction is 0.8.

3 months after surgery:

Inspection data: the eye is calm, the optical media are transparent, the destruction of the pigment border of the iris, the pupil's reaction to light is positive.

Gonioscopically, the anterior chamber angle is open, medium width, pigmentation 0-T. Fundus: pink reflex, optic nerve disc - pale pink, glaucomatous excavation 0.5.

The filter cushion is flat, spilled. Instrumental examination data:

Visual acuity has not changed. According to computer perimetry, no changes in the fields of vision were recorded.

Tonography: Po = 18; C = 0.25; F = 1.65; Po / C = 72.

According to ultrasound biomicroscopy (UBM) - the presence of an active filtration zone, without excessive proliferation.

As a result of the operation, the patient achieved minimization of tissue trauma, optimization of the outflow pathways of intraocular fluid, stabilization of filtration, creation of directional filtration away from the conjunctival incision, and impaired hydro- and hemodynamics.

Example 2

Patient I., 58 years old, diagnosis: primary operated open operated III C glaucoma of the left eye. Glaucoma was detected in 1996, at the same time an anti-glaucomatous operation was carried out at the place of residence. IOP increased a week ago. Somatic: hypertension II, atherosclerosis.

Inspection Data:

The eye is calm, in the upper sector the zone of antiglaucomatous operation is visualized at 11.30 hours, the filtering pillow does not differentiate, cicatricial changes in tissues for 10 to 13 hours. Optical media are transparent, subatrophy of the iris stroma, destruction of the pigment rim, single pseudoexfoliation along the edge of the pupil and on the surface of the anterior lens capsule. Gonioscopically: the anterior chamber angle is open, medium width, low profile, pigmentation II, at 11.30 hours - the free zone of the previous non-penetrating deep sclerectomy.

Fundus: reflex - pink, optic nerve disc - pale with a grayish tint, glaucomatous excavation - 0.9.

Instrumental research data:

Visual acuity with a correction of 0.3, the field of view is narrowed to 10 degrees from the fixation point on the nasal side.

Tonography: Po = 43; C = 0.05; F = 1.57; Po / C = 872.

The operation (NGSE) was performed according to the proposed method, while the ratio of the base length 3 PS flap 2 to the base length 5 GS flap 4 is 1.5; and the ratio of the distance from the top of the convex part of the PS flap 2 to its base 3 along the axis of symmetry to the distance from the top of the convex part of the HS flap 4 to its base 5 along the same axis is 1.5; the depth of formation of the HS flap 5 is 0.15 thickness of the scoery;

Intra in postoperative complications was not observed. The patient was discharged on the second day after surgery. Air pressure meter 17 mmHg

In 6 months:

Visual acuity has not changed.

The filter pad is clearly contoured, flat.

Tonography: Po = 12; C = 0.28; F = 0.95; Po / C = 42;

After vision, it expanded by 5 degrees from the nasal side.

With UBM, a functionally active cavity is determined in the area of the intervention, without excessive proliferation.

As a result of the operation, the patient achieved minimization of tissue trauma, optimization of the outflow pathways of intraocular fluid, stabilization of filtration, creation of directional filtration away from the conjunctival incision, and impaired hydro- and hemodynamics.

Example 3

Patient A., 62 years old, diagnosis: primary open-angle IV C glaucoma, initial complicated left eye cataract. Glaucoma was detected in 2005, antiglaucomatous drugs are dripping according to the maximum antihypertensive regimen. Over the past two weeks, the patient has noted periodic pain, a feeling of fog in front of his left eye.

Inspection Data:

The eye is moderately irritated: Optical media are transparent, subatrophy of the iris stroma, iris rubeosis, pigment border destruction, pseudoexfoliation along the edge of the pupil and on the surface of the anterior lens capsule.

Gonioscopically: the anterior chamber angle is open, medium width, low profile, pigmentation II.

Fundus: reflex - pink, optic disc - marginal excavation.

Instrumental research data:

Visual acuity: light perception with the wrong projection of light.

Tonography: Po = 34; C = 0.03; F = 2.8; Po / C = 336.

Fields of vision light perception (candle).

The operation (NGSE) was performed according to the proposed method, while the ratio of the base length 3 PS flap 2 to the base length 5 GS flap 4 is 1.5; and the ratio of the distance from the top of the convex part of the PS flap 2 to its base 3 along the axis of symmetry to the distance from the top of the convex part of the HS flap 4 to its base 5 along the same axis is 1.5; the depth of formation of the HS flap 5 is 0.1 of the thickness of the sclera;

Complications in the early and late postoperative period were not observed. The patient was discharged on the second day after surgery. Discharge pressure 16 mmHg

In 6 months:

Visual acuity and visual field has not changed.

The filter pad is clearly contoured, flat,

Tonography: Po = 12.2; C = 0.39; F = 1.61; Po / C = 26.

According to the UBM, the filtration zone is actively functioning, there is no excessive proliferation.

As a result of the operation, the patient achieved minimization of tissue trauma, optimization of the outflow pathways of intraocular fluid, stabilization of filtration, creation of directional filtration away from the conjunctival incision, and impaired hydro- and hemodynamics.

Claims (1)

A method of surgical treatment of open-angle glaucoma, including a conjunctival incision, the formation of a conjunctival, superficial scleral (PS) and deep scleral (HS) flaps, excision of the deep layers of the sclera, coagulation, the return of the PS flap in place and matching the edges of the conjunctival wound, characterized in that conducting a conjunctival incision form a curved PS flap, the base facing the limb, in the form of a segment of a circle facing the bulge towards the sclera, while the base of the PS flap is the chord of this segment; then form a curved GS flap, the base of which is part of the base of the PS flap having a common axis of symmetry with it, while the depth of formation of the HS flap lies in the range of 0.2-0.1 scleral thickness, while the HS flap is formed as an ellipse segment, whose chord is the base of this flap, and the axis of symmetry of the GS flap lies on the major axis of the ellipse; the ratio of the base length of the PS flap to the base length of the HS flap is 1.5; the ratio of the distance from the top of the convex part of the PS flap to its base along the axis of symmetry to the distance from the top of the convex part of the HS flap to its base along the same axis is 1.5; then the HS flap is cut out and removed, then the formed intrascleral bed is coagulated, the PS flap is returned to its place.

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