RU2704476C1 - Method for surgical treatment of primary closed-angle glaucoma with functional block of anterior chamber angle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For surgical treatment of primary closed-angle glaucoma with functional block of anterior chamber angle, a conjunctival incision is made, episcleral vessels are coagulated, surface and deep scleral flaps are formed, deep scleral flap (DSF) is removed, exposing a flat portion of the corpus ciliare (CC), forming a drainage hole in the CC projection until filtration from the posterior eye chamber appears. Conjunctival incision is 2 mm; 1 mm-long drainage hole is formed by a laser with wavelength of 810 nm until filtration of intraocular fluid from the posterior eye chamber. After the irradiation of the body and the posterior pole of the eye, the DSF is removed before the trabecule-descemet's membrane is exposed and filtration appears, followed by covering the filtration area with the superficial scleral flap (SSF) and sealing the conjunctival incision. SSF is cut with size of 3.0×3.0 mm, DSF is formed in the form of an isosceles trapezoid, larger base of which is directed towards the limb, after removing the DSF from it fragment 1.0×1.0 mm, then pocket 1.5×1.5 mm is formed at the proximal edge of the formed bed, between the choroid and the sclera, in which the fragment isolated from the DSF is placed, fixed with interrupted suture 8.0 to the sclera of the pocket, then the SSF filtration zone is covered, two interrupted sutures 8.0, one for each angle.

EFFECT: method provides creating additional outflow tracts that leads to minimizing the risk of postoperative complications, such as ciliochorioretinal detachment and eye hypotension, as well as prolonging the hypotensive effect.

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Description

The invention relates to medicine, namely to ophthalmology, and is intended for the treatment of primary angle-closure glaucoma with functional blockade of the anterior chamber angle.

The closest analogue is a method for treating angle-closure glaucoma with an anterior chamber angle block, in which a conjunctiva is cut 0.5-1 mm from a limb 2.0 mm long. The episcleral vessels are coagulated along the perimeter of the scleral flap planned for cutting (the procedure is performed after the coagulation site has been freed from the conjunctiva). In this case, a MIRA4000 diathermocoagulator having an end working area of 0.2 mm is used. Then cut a rectangular superficial scleral flap (PSL) 2.5 × 2.5 mm to one third of the thickness of the sclera. The next stage is the formation of a triangular deep scleral flap (GSL) with exposure of a section of the ciliary body (CT). Using an Alkommedical Russia diode laser unit, with a wavelength of 810 nm, an output power of 0.5 W to 0.6 W, and a pulse duration of 3-5 s, a hole with a diameter of 1 mm is formed in the flat part of the CT until the intraocular fluid is filtered (MIC) from the posterior chamber of the eye. After the iridocrystalline diaphragm shifts to the posterior pole of the eye, the anterior chamber is deepened and the angle of the anterior chamber (CLC) expands, GSL is removed until the trabeculo-descemet membrane (TDM) is exposed and filtering appears. Next, cover the PSL filtration zone. A nodal suture is applied to the PSL and the conjunctival incision is sealed by suturing 8.0. (RF patent for the invention No. 2499579). The objective of the invention is to increase the effectiveness of surgical treatment with the achievement of a persistent and pronounced antihypertensive effect. The technical result is the creation of additional outflow paths, which leads to minimizing the risks of postoperative complications, such as ciliochorioretinal detachment and eye hypotension, as well as to prolonging the hypotensive effect. The technical result is achieved by the fact that in the method of surgical treatment of primary angle-closure glaucoma with functional blockade of the anterior chamber angle, including conjunctival incision, coagulation of episcleral vessels, the formation of superficial and deep scleral flaps, removal of GSL, exposure of the flat part of the CT to the scleral spur, the formation of a drainage hole in the projection of CT before filtering from the posterior chamber of the eye, while the conjunctival incision is 2 mm in size, the drainage hole A hole with a diameter of 1 mm is formed by a laser with a wavelength of 810 nm until HPW filtering appears from the posterior chamber of the eye, after the iridocrystalline diaphragm is displaced to the posterior pole of the eye, GSL is removed until the trabeculodecemetic membrane is exposed and filtration appears, then the PSL filtration zone is covered and the conjunctival incision is sealed. , according to the invention, the PSL is cut out with a size of 3.0 × 3.0 mm, the GSL is formed in the form of an isosceles trapezoid, the larger base of which is directed to the limb, after removing the GSL, the fragment is cut from it cop 1.0 × 1.0 mm, then form a pocket 1.5 × 1.5 mm at the proximal edge of the formed bed, between the choroid and the sclera, into which the fragment cut off from the GSL is placed, fix it with a suture 8.0 to the sclera pockets, then cover the PSL filtration zone, put two 8.0 knotted seams on it, one for each corner.

Among the essential features of this method are distinctive:

Cutting out first PSL 3 × 3 mm, and then trapezoidal GSL with the base facing the limb, leads to the expansion of the TDM area, which contributes to a more active filtering of HPW.

The formation of a pocket between the choroid and the sclera with the GSL fragment placed in it creates an additional uveoscleral outflow path, which allows prolonging the effect of the operation.

As a result of activation of the outflow in three ways: through the uveoscleral path, through the TDM and through the drainage opening, there is a more uniform distribution and outflow of intraocular fluid from the anterior and posterior chambers, the iris-lens diaphragm occupies a more stable position, which prevents the development of ciliochoroid detachment and hypotension.

The method is as follows.

Produce standard processing of the surgical field, anesthesia. The conjunctiva incision is performed 1 mm from the limb 2.0 mm long. The place of the planned PSL is exempted from the conjunctiva, the coagulation of episcleral vessels is performed along the perimeter of the planned PSL using the MIRA4000 diathermocoagulator, which has an end working area of 0.2 mm. Then cut PSL 3 × 3 mm to one third of the thickness of the sclera. Then, the HFS is formed in the form of an isosceles trapezoid, which has the following dimensions: a larger base, facing the limb - 2.5 mm, a smaller base - 2 mm, height - 2.5 mm, with exposure of the CT section to the scleral spur. Using an Alkommedical Russia diode laser unit, with a wavelength of 810 nm, an output power of 0.5 W to 0.6 W, and a pulse duration of 3-5 s, a hole with a diameter of 1 mm is formed in the flat part of the central heating line until the filtering back camera eyes. After the iridocrystalline diaphragm shifts to the posterior pole of the eye, the anterior chamber deepens and the CPD expands, removing GSL until the TDM is exposed and filtering appears. A fragment of 1.0 × 1.0 mm is cut off from the removed GSL with a blade. The next step is an exfoliator, 1 mm wide at the proximal edge of the formed bed, between the choroid and sclera, a pocket of 1.5 × 1.5 mm is formed, into which a fragment of GSL is implanted with tweezers. The GSL fragment is fixed by a 8.0 nodal suture to the sclera of the formed pocket. Then cover the PSL filtration zone, the corners of which are fixed with two 8.0 knotted sutures (one nodal seam per angle). Then, the conjunctival incision is sealed. Sealing of the conjunctival incision is performed by suturing 8.0.

The invention is illustrated by the following examples.

Example 1. Patient K .; 64 years suffers from hypertension 2 tbsp. for 8 years; hospitalized with a diagnosis of OS Primary angle-closure 3 V glaucoma. Complicated cataract. Weak hypermetropia. Visual acuity at admission 0.1; IOP 30 mm RT. Art. (according to Maklakov); Gonioscopy: the CPC is closed by the root of the iris throughout, the Forbes test is positive. According to the proposed method, an operation was performed to treat angle-closure glaucoma with functional blockade of the CPC. Operation progress: Produced standard treatment of the surgical field, anesthesia. Formed GSL in the form of an isosceles trapezoid. Using an Alkommedical Russia diode laser unit, with a wavelength of 810 nm, an output power of 0.6 W, and a pulse duration of 3 s, a hole with a diameter of 1 mm was formed in the flat part of the central heating line until filtering appeared, then the HFS was removed until TDM was exposed and filtering appeared . A fragment was cut off from the remote GSL with a blade. Then a pocket was formed, in which a GSL fragment was implanted with tweezers and fixed with a 8.0 nodal suture to the pocket sclera. Sealing of the conjunctival incision is performed by suturing 8.0. In the long term follow-up (10 months) IOP 16 mm RT. Art. (according to Maklakov), stable, compensated without additional use of antihypertensive drugs.

Example 2. Patient G .; 59 years old; hospitalized with a diagnosis of OS primary angle-closure 3 C glaucoma. Complicated cataract. Visual acuity at admission 0.4; IOP 33 mmHg Art. (according to Maklakov); Gonioscopy: the CPC is closed by the root of the iris throughout, the Forbes test is positive. According to the proposed method, an operation of angle-closure glaucoma with functional blockade of the CPC was performed. Operation progress: Produced standard treatment of the surgical field, anesthesia. Formed GSL in the form of an isosceles trapezoid. Using an Alkommedical Russia diode laser unit, with a wavelength of 810 nm, an output power of 0.5 W, and a pulse duration of 5 s, a hole with a diameter of 1 mm was formed in the flat part of the central heating line until filtering appeared, then the HFS was removed until TDM was exposed and filtering appeared . A fragment was cut off from the remote GSL with a blade. Then a pocket was formed, in which a GSL fragment was implanted with tweezers and fixed with a 8.0 nodal suture to the pocket sclera. Sealing of the conjunctival incision is performed by suturing 8.0.

In the long term follow-up (10 months) IOP 17 mm RT. Art. (according to Maklakov), stable, compensated without additional use of antihypertensive drugs.

Example 3. Patient C; 65 years old hospitalized with a diagnosis of OS primary angle-closure 2 C glaucoma. Complicated cataract. Pseudoexfoliation syndrome. Visual acuity at admission 0.6; IOP 34 mmHg Art. (according to Maklakov); Gonioscopy: the CPC is closed by the root of the iris throughout, the Forbes test is positive. According to the proposed method, an operation of angle-closure glaucoma with functional blockade of the CPC was performed. Operation progress: Produced standard treatment of the surgical field, anesthesia. Formed GSL in the form of an isosceles trapezoid. Using an Alkommedical Russia diode laser unit, with a wavelength of 810 nm, an output power of 0.5 W, and a pulse duration of 4 s, a hole with a diameter of 1 mm was formed in the flat part of the central heating line until filtering appeared, then the HFS was removed until TDM was exposed and filtering appeared . A fragment was cut off from the remote GSL with a blade. Then a pocket was formed into which a GSL fragment is implanted with tweezers and fixed with a 8.0 nodal suture to the pocket sclera. Sealing of the conjunctival incision is performed by suturing 8.0. In the long term follow-up (10 months) IOP 14 mm RT. Art. (according to Maklakov), stable, compensated without additional use of antihypertensive drugs.

According to the proposed method, 7 patients with primary angle-closure glaucoma with functional blockade of the CPC were treated. In all cases, IOP compensation was achieved; no operational and postoperative complications were observed. The healing process took place over 2 weeks. The remote observation period was 10 months.

Claims (1)

A method for surgical treatment of primary angle-closure glaucoma with functional blockade of the anterior chamber angle, including the conjunctival incision, coagulation of the episcleral vessels, the formation of superficial and deep scleral flaps, removal of the deep scleral flap (GSL), exposure of the flat part of the ciliary body (CT), the formation of a drainage hole with a diameter 1 mm laser with a wavelength of 810 nm in the projection of the CT until filtering from the posterior chamber of the eye, with conjunctival incision 2 mm in size, after the iridocrystalline diaphragm is displaced to the posterior pole of the eye, GSL is removed until the trabeculodescemetic membrane is exposed and filtration appears, then the filtration area is covered with a superficial scleral flap (PSL) and the conjunctival incision is sealed, characterized in that PSL is cut out with a size of 3.0 × 3.0 mm, the GSL is formed in the form of an isosceles trapezoid, the larger base of which is directed to the limb, after removal of the GSL, a 1.0 × 1.0 mm fragment is cut from it, then a pocket 1.5 × 1.5 mm near the proximal of the formed bed, between the choroid and the sclera, into which the fragment cut off from the GSL is placed, fix it with a 8.0 interlocking suture to the pocket sclera, then cover the PSL filtration zone, put two 8.0 interlocking sutures on it, one at each corner .