RU2809072C1 - Method of surgical correction of ahmed valve drainage tube position - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used to correct the position of the Ahmed valve drainage tube after anti-glaucoma surgery. A meridional incision of the conjunctiva is made in the projection of the Ahmed valve drainage tube 5 mm long. Next, the conjunctiva and Tenon’s capsule with an area of 5×5 mm is separated. The Ahmed valve drainage tube is pulled from the anterior chamber 3 mm from under the scleral flap. The tightened tube is bent at an angle of 120° parallel to the sclera and fixed in this position with two interrupted sutures with a non-absorbable thread. The conjunctiva is then sutured in layers with a continuous suture using absorbable thread.

EFFECT: invention improves visual acuity and eliminates complaints of double vision and image distortion due to safe and effective correction of the position of the Ahmed valve drainage tube.

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Description

The invention relates to the field of medicine, namely to ophthalmology, and can be used to correct the position of the Ahmed valve drainage tube after anti-glaucoma surgery (AGO).

Glaucoma is a progressive disease that is one of the leading causes of blindness in the world. This disease is characterized by impaired hydrodynamics of the eye with increased intraocular pressure (IOP) and the development of glaucomatous optic neuropathy and corresponding irreversible changes in the optic nerve and visual field. Despite the abundance of antihypertensive drugs used by ophthalmologists, surgical treatment of glaucoma, including the use of drains, is a more effective way to achieve a stable reduction in IOP. One such device that is implanted during surgery is the Ahmed Valve Drain.

Despite its high efficiency, implantation of Ahmed valve drainage can lead to a number of complications, including displacement of the Ahmed valve drainage tube into the pupil area, which can be accompanied by double vision, distortion and decreased visual acuity.

The above determines the relevance of correcting the position of the Ahmed valve drainage tube after AGO.

The applicant is not aware of methods for surgically correcting the position of the Ahmed valve drainage tube.

The objective of the invention is to develop a safe and effective method for correcting the position of the Ahmed valve drainage tube.

The technical result of the proposed method is to increase visual acuity and eliminate complaints of double vision and distortion by correcting the position of the Ahmed valve drainage tube.

The method is carried out as follows.

In the operating room, under local installation anesthesia with a solution of proximetacaine 0.5%, the patient is given a meridional incision of the conjunctiva in the projection of the Ahmed valve drainage tube, 5 mm long. Next, the conjunctiva and Tenon’s capsule with an area of 5x5 mm are separated. After that, the Ahmed valve drainage tube is pulled from the anterior chamber 3 mm from under the scleral flap, the pulled tube is bent at an angle of 120 degrees parallel to the sclera and fixed in this position to it with two interrupted sutures using a non-absorbable Silk 8/0 thread. The operation is completed by layer-by-layer suturing of the conjunctiva with a continuous suture using an absorbable Vicryl 8/0 thread.

The bending of the tube eliminates the displacement of the Ahmed valve drainage tube into the pupil area without penetrating the anterior chamber, which relieves the patient from complaints of double vision, distortion and decreased visual acuity.

The invention is illustrated in figures 1-2, in fig. 1 shows a view before surgery, Fig. 2 - shows the view after the operation. Position 1 indicates the eyeball, 2 - the body of the Ahmed valve drainage, 3 - the valve drainage tube, 4 - the conjunctival incision, 5, 6 - interrupted sutures.

The method is confirmed by the following example.

Patient M., 67 years old, was diagnosed at his place of residence in 2016 with primary open-angle glaucoma of the right eye. In 2018, surgical treatment was performed on the right eye at the place of residence: Non-penetrating deep sclerectomy followed by laser descemetogoniopuncture. In 2019, at the place of residence, decompensation of IOP was detected on a hypotensive regimen and sinustrabeculectomy was performed with implantation of hydrogel drainage and posterior trepanation of the sclera. At the same time, the OD diagnosed: Complicated cataract; in November 2019, cataract phacoemulsification with intraocular lens (IOL) implantation was performed at the place of residence. However, in January 2020, decompensation of the IOP of the right eye occurred, an Ahmed valve drainage was implanted in the right eye at the place of residence, and the pressure was compensated in the postoperative period. In 2022, the patient was referred to the Eye Microsurgery MNTK in Moscow with complaints of double vision, distortion and decreased visual acuity.

According to the examination: visual acuity OD - 0.1. IOP (pneumotonometry) on one antihypertensive drug: OD 15 mm Hg. According to ultrasound: OU membranes are adjacent, posterior vitreous detachment. The field of vision of the right eye corresponds to the third stage of glaucoma. With OD biomicroscopy: the eye is calm, the filtration cushion is at 12 and 13 o'clock, the cornea is transparent, the anterior chamber is of medium depth, the Ahmed valve drainage tube is in the anterior chamber at 11 o'clock in the pupil area, the iris is subatrophic, surgical coloboma is at 13 o'clock. The IOL is in the correct position , in a capsule bag. Examination of the fundus is difficult due to the location of the valve drainage tube in the pupil area.

Based on the medical history and the results of an ophthalmological examination, a diagnosis was made: OD Primary open-angle glaucoma 3A, operated on. Artifakia.

Surgical correction of the position of the Ahmed valve drainage tube was performed using the proposed method.

There were no complications in the postoperative period. According to the examination: visual acuity OD - 0.4. IOP 16 mm Hg. (pneumotonometry). The field of vision of the right eye corresponds to the third stage of glaucoma.

Claims (1)

A method of surgical correction of the position of the Ahmed valve drainage tube, characterized by the fact that first a meridional incision of the conjunctiva is made in the projection of the Ahmed valve drainage tube 5 mm long, then the conjunctiva and Tenon's capsule with an area of 5x5 mm are separated, then the Ahmed valve drainage tube is pulled from the anterior chamber to 3 mm from under the scleral flap, after which the tightened tube is bent at an angle of 120° parallel to the sclera and fixed in this position to it with two interrupted sutures with a non-absorbable thread, then the conjunctiva is sutured in layers with a continuous suture with an absorbable thread.

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