RU2806508C1 - Method of surgical treatment of recurrent cystic formation above body of ahmed valve drainage - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used for surgical treatment of recurrent cystic formation above the body of the Ahmed valve drainage. A radial incision of the conjunctiva is made over the cystic formation 5 mm long. Next, a radial incision is made on the surface wall of the cystic formation in the projection of the conjunctival incision, followed by its excision measuring 2/3 of the body area of Ahmed valve drainage. Two punctures are made through the remaining part of the capsule of the cystic formation and the conjunctiva at a distance of 2.5 mm parallel to the projection of the lower fornix of the conjunctiva. A silicone tube with a diameter of 0.7 mm and a length of 15 mm is passed through these punctures as follows: one end of the tube is brought out through one of the punctures into the cavity of the cystic formation. Then the tube is removed from this cavity through another puncture into the lower fornix of the conjunctiva. The ends of the tube are tied in the lower fornix with a non-absorbable thread. The operation is completed by layer-by-layer suturing of the conjunctiva with a continuous suture with absorbable thread.

EFFECT: invention ensures restoration of the previously created path of outflow of intraocular fluid, normalization of intraocular pressure and, as a result, prevents the progression of loss of visual functions.

1 cl, 1 ex

Description

The invention relates to the field of medicine, namely to ophthalmology, and can be used for the treatment of increased intraocular pressure (IOP) in the late postoperative period after anti-glaucoma surgery (AGO) of the filtering type with implantation of Ahmed valve drainage.

Glaucoma is a progressive disease that is one of the leading causes of blindness in the world. Despite the fact that ophthalmologists have a large number of antihypertensive drugs in their arsenal, surgical intervention in the treatment of glaucoma, including the use of drains, is a more effective method for achieving a lasting reduction in IOP. One of the drainage devices implanted during surgery is the Ahmed valve drain.

Despite the effectiveness of its use, this type of surgery has its own postoperative complications. According to various authors, there are a number of complications that accompany the implantation of Ahmed valve drainage, including cystic formation over the body of the drainage. The reason for the appearance of cystic formation and, as a consequence, an increase in IOP is the formation of fibrous strands due to scarring in the area of the filtration cushion, preventing the outflow of fluid.

The closest analogue is the method for treating a cystic formation above the body of the valve drainage Ahmed (RF patent for invention No. 2768189), including separating the conjunctiva above the body of the valve drainage and excision of a section of Tenon's capsule, while making one L-shaped incision of the conjunctiva: 5 mm long parallel to the limbus and 7 mm long perpendicular to the limbus, in the projection of the lateral edge of the valve drainage body, then the conjunctiva is separated from Tenon’s capsule and a section of Tenon’s capsule measuring 6 by 6 mm is excised above the valve drainage body, starting from the lateral edge towards the center, exposing part of the valve drainage body and one of the two sutures fixing the body of the valve drainage, the remaining part of the Tenon capsule is fixed with one interrupted suture to the fixation hole in the body of the valve drainage, then a HealaFlow drainage implant with a volume of 0.2-0 is inserted over the exposed part of the valve drainage body and near it along the incision. 3 ml, after which the edges of the wound are compared and fixed with a continuous suture.

The disadvantages of this method include the possibility of recurrent scarring around the drainage body, followed by the formation of a cystic formation and an increase in IOP due to the formation of scars in the conjunctiva and Tenon's capsule.

The objective of the invention is to develop a safe and effective method for eliminating the recurrence of cystic formation over the body of the Ahmed valve drainage to restore the outflow of intraocular fluid (IOH).

The technical result of the proposed method is the elimination of recurrence of cystic formation above the body of the Ahmed valve drainage, restoration of the previously created outflow path of the intraocular fluid, normalization of IOP and stopping the progression of loss of visual functions.

The technical result is achieved in that the method for eliminating the recurrence of a cystic formation above the body of the Ahmed valve drainage, including making a radial incision of the conjunctiva above the cystic formation 5 mm long. Next, a radial incision is made in the wall of the cystic formation in the projection of the conjunctival incision 5 mm long, followed by excision of the superficial wall of the cystic formation measuring 2/3 of the area of the body of the Ahmed valve drainage. Through the remaining part of the capsule of the cystic formation and the conjunctiva, two punctures are made at a distance of 2.5 mm from each other with a blade parallel to the projection of the lower conjunctival fornix. A silicone tube with a diameter of 0.7 mm and a length of 15 mm is passed through these punctures. One end of this tube is brought out through one of the punctures into the cavity of the cystic formation, then from the cavity of the cystic formation with the same end the tube is brought out through the other puncture into the lower conjunctival fornix. The ends of the tube are tied in the lower fornix with non-absorbable Mopylen 6/0 suture. The method is completed by layer-by-layer suturing of the conjunctiva with a continuous suture using Vicryl 8/0 thread. The method is carried out as follows.

In the operating room, under local installation anesthesia with a solution of proximetacaine 0.5% (“Alcaine”), the patient is given a meridional incision of the conjunctiva over the cystic formation 5 mm long. Next, a meridional incision of the wall of the cystic formation is made in the projection of the conjunctival incision 5 mm long, followed by excision of the superficial wall of the cystic formation measuring 2/3 of the area of the body of the Ahmed valve drainage. Through the remaining part of the capsule of the cystic formation and the conjunctiva, two punctures are made with a blade in the projection of the lower conjunctival fornix. A flexible silicone tube with a diameter of 0.7 mm and a length of 15 mm is passed through these punctures. One end of this tube is passed through the first puncture into the cavity of the cystic formation, then from the cavity of the cystic formation with the same end the tube is brought through the second puncture into the lower conjunctival fornix. The ends of the tube are tied in the lower fornix with non-absorbable Mopylen 6/0 suture. The method is completed by layer-by-layer suturing of the conjunctiva with a continuous suture using an absorbable Vicryl 8/0 thread.

Inserting a silicone tube into the lower conjunctival fornix creates a new path for the outflow of intraocular fluid with a decrease in cystic formation above the drainage body, thereby prolonging the hypotensive effect after AGO, which will avoid repeated AGO.

The method is confirmed by the following example.

Patient N., 71 years old, in 2012 at his place of residence was diagnosed with primary open-angle glaucoma of the left eye, and therefore was sent to the Eye Microsurgery MNTK in Moscow, where surgical treatment was performed: Ne penetrating deep sclerectomy followed by laser descemetogoniopuncture and then, due to insufficient IOP compensation, in 2015, sinustrabeculectomy was performed with drainage implantation and posterior trephination of the sclera at the place of residence. However, in 2016, decompensation of the IOP of the left eye occurred, the first Ahmed valve drainage was implanted at the place of residence in the left eye, model FP7, whose body area is 184.0 mm ² , the pressure was compensated. In 2021, the patient was sent to the Eye Microsurgery Center in Moscow with complaints of decreased visual acuity; upon examination, complicated cataracts and epithelial-endothelial dystrophy of the cornea were revealed, and in May 2021, phacoemulsification was performed with implantation of an intraocular lens. Over the next two months, decompensation of intraocular pressure in the left eye was detected at the place of residence on the maximum hypotensive regimen. The MNTK recommended the implantation of a second valve drain Ahmed model FP7 with a body area of 184.0 mm ² in the adjacent segment in relation to the first valve drain. In July 2021, a second valve was implanted in the left eye at the Eye Microsurgery MNTK in Moscow, in the postoperative period without complications. On the second day after surgery, the patient was discharged, IOP was compensated.

When examined 2 months after surgery, an encapsulated cystic formation was revealed around the body of the second Ahmed valve drainage and an increase in IOP to 23 mm Hg. Art. without antihypertensive drops. Needling of the surgical area was performed under local anesthesia to open the cystic formation. IOP decreased to 12 mmHg. Art. However, a month later, the patient again complained of a recurrence of the cystic formation, and therefore a decision was made to revise the surgical area with partial excision of the capsule of the cystic formation and insertion of a HealaFlow drainage implant into the surgical area. In the postoperative period there were no complications, IOP was compensated without antihypertensive drops.

However, six months after the operation, there was a recurrence of a cystic formation above the body of the second Ahmed valve drainage.

According to the survey: OS 0.3 sph -2.0 cyl -0.75 Ax 65=0.4. IOP (pneumotonometry) at the maximum hypotensive mode: OS 27 mm Hg. Art. According to ultrasound: OU membranes are adjacent, posterior vitreous detachment. The field of vision of the left eye corresponds to the third stage of glaucoma. With OS biomicroscopy: the eye is calm, there is a cystic formation above the valve drainage body at 5 o'clock, the filtration cushion is flat at 12 o'clock, the cornea is edematous, the anterior chamber is of medium depth, the valve drainage tubes in the anterior chamber at 1 and 5 o'clock are in the correct position, the iris is subatrophic, surgical coloboma at 12 hours, intraocular lens in the correct position. Fundus: optic disc gray, clear boundaries, ED 0.8, details behind the flair.

Based on the medical history and the results of an ophthalmological examination, a diagnosis was made: OS Primary open-angle glaucoma of the 3rd time operated on. Epithelial endothelial dystrophy of the cornea. Artifakia.

It was decided to carry out treatment according to the proposed method, while the area of excision of the superficial wall of the cystic formation was 123 mm, which corresponds to 2/3 of the area of the valve drainage body.

The postoperative period was without complications. According to the survey: OS 0.4 sph -2.0 cyl -0.75 Ax 65=0.5. IOP 16 mm Hg. Art. (pneumotonometry). The field of vision of the left eye corresponds to the third stage of glaucoma. There was no recurrence of cystic formation during 6-month follow-up.

Claims (1)

A method of surgical treatment of recurrent cystic formation above the body of the Ahmed valve drainage, including a conjunctival incision, characterized in that a radial incision of the conjunctiva is made above the cystic formation 5 mm long, then a radial incision is made on the surface wall of the cystic formation in the projection of the conjunctival incision, followed by its excision of size 2/ 3 body area of Ahmed valve drainage; through the remaining part of the capsule of the cystic formation and the conjunctiva, two punctures are made at a distance of 2.5 mm parallel to the projection of the lower fornix of the conjunctiva, then a silicone tube with a diameter of 0.7 mm and a length of 15 mm is passed through these punctures as follows: one end of the tube is removed through one of the punctures into cavity of the cystic formation, then from this cavity the tube is removed through another puncture into the lower fornix of the conjunctiva, the ends of the tube are tied in the lower fornix with a non-absorbable thread, the operation is completed by layer-by-layer suturing of the conjunctiva with a continuous suture with an absorbable thread.