RU2155566C2 - Surgical method for treating open angle glaucoma and cataract with intraocular lens implantation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves forming general operation incision in the corneoscleral zone with nonpenetrating sclerectomy implying valve function and requiring no sutures. The intraocular lens is implanted through this incision after its widening. The external wall of the Schlemm's canal is opened and Descemet's membrane is exposed. EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.

Description

 The invention relates to medicine, namely to ophthalmology, and can be used for simultaneous surgical treatment of glaucoma and cataracts.

 A known method of combining antiglaucomatous surgery with cataract phacoemulsification (Gimbel HV, Meyer D. Small incision trabeculotomy combined with phacoemulsification and intraocular lens implantation // J. Catata Refract. Surgery.- 1993.-Vol.19, N1.- P.92-96 ; Gimbel HV et al. Intraocular pressure response to combined phacoemulsification and intraocular lens implantation // J. Cataract Refract. Surgery.- 1995.- Vol.21, N6.- P. 653-660).

 The disadvantage of the existing technique is that as an anti-glaucomatous component of the operation, a sinustrabekulectomy with iridectomy is used, therefore in the postoperative period there is a relatively high percentage of complications: hyphema, small anterior chamber, choroid detachment, etc. At the same time, the operation of non-penetrating sclerectomy is widely introduced into clinical practice (S.N. Fedorov, V.I. Kozlov, N.T. Timoshkina, etc. Non-penetrating deep sclerectomy in open-angle glaucoma // Otalmosurgery.-1989.- N3-4 .- S. 52-55), which allows to achieve high clinical results with significantly fewer complications.

 The objective of the invention is to develop a safe and highly effective method of phacoemulsification and non-penetrating sclerectomy.

 The technical result achieved by using the invention is to reduce surgical and postoperative complications by combining phacoemulsification and non-penetrating sclerectomy.

 The technical result is achieved by the fact that during the phacoemulsification of cataract with non-penetrating sclerectomy, a single surgical incision is formed in the corneoscleral zone, which has a valve function and does not require subsequent suturing.

 The method is as follows.

 Under the local anesthesia, an eyelid expander is applied, the upper rectus muscle is taken on the stitch-holder. A section of the conjunctiva lasting 5-6 mm is carried out at a distance of 4-5 mm from the limb and concentrically to it. In the upper half of the eyeball (12 hours meridian), the sclera is dissected into 2/3 of the thickness with a dosed diamond knife parallel to the limb and departing from it by 3.0 mm, the section width is 3.5-4.0 mm. Using a diamond exfoliator, a scleral pocket is formed, which, bypassing the limb, extends into the cornea by 1-1.5 mm. The formation of the incision with penetration into the anterior chamber of the eye ends with a spear-shaped knife 3.0-3.2 mm wide. Corneal paracentesis is performed in the meridian of 2 hours, midriatic (0.1% Mesaton) and viscoelastic (Visiton) are introduced into the anterior chamber of the eye. The front lens capsule is opened by an irrigation cystotome, hydrodissection of the nucleus is carried out, followed by its removal with the help of a phacoemulsifier. The remains of the lens masses are removed by an irrigation-aspiration cannula. The incision expands to 5 mm and a posterior chamber IOL is implanted in the capsular bag. Superficial scleral flap retracts to the top. In the deep layers of the sclera, a flap is cut out, which includes the outer wall of the Schlemm canal and the stroma of the cornea, while the Descemet sheath is exposed. After checking the level of filtration, the surface scleral tunnel flap is put in place. There is no suture on the scleral wound; a continuous suture 8/0 is applied on the conjunctiva. The operation ends with the introduction of a subconjunctival antibiotic solution.

Example:
Patient S., 62 years old.

 Diagnosis: OD-open-angle 2-stage glaucoma, immature complicated cataract.

Visual acuity: 0.05 n / a
Ophthalmometry: 5 degrees - 42.00 diopters. 95 degrees - 42.75 diopters.

Tonography: P-29.8 C = 0.06 F = 2.25 P / C = 196
Field of view: narrowed by 10 degrees. from the bow
Eye length: 23.77 mm.

 Endothelial cell density: 2450 cells / mm2

 The patient was offered an operation - phacoemulsification of cataract with implantation of an intraocular lens in combination with non-penetrating sclerectomy.

 After local anesthesia and akinesia of the eyeball with a 2% solution of Lidocaine, an eyelid extender is applied and the superior rectus muscle is fixed on the stitch-holder. Conjunctival incision was made. A diamond section of the sclera is formed by a diamond exfoliator, retreating from the limb by 3.0 mm, length 3.5 mm. The front chamber is opened with a 3.0 mm wide spear-shaped diamond knife. Through corneal paracentesis, a 0.1% solution of Mesatone and Visiton were introduced into the anterior chamber of the eye. Capsulorexis and hydrodissection of the lens nucleus were carried out, followed by its removal with the help of a phacoemulsifier. The remains of the lens masses are removed by an irrigation-aspiration cannula. The section was expanded to 5 mm and a posterior chamber IOL of the T-26 model with an optical power of 21 diopters was implanted in the capsule bag. In the deep layers of the sclera that make up the valve section, a flap is cut, which includes the outer wall of the Schlemm canal, and the Descemet shell is exposed. After checking the filtration level, the superficial scleral tunnel flap is in place. The conjunctiva is sutured with a continuous suture 8/0. Subconjunctively introduced solution of kanamycin and dexazone.

 Visual acuity without correction 1 month after surgery was 0.7. Ophthalmometry: 0 degrees - 42.25 diopters; 90 degrees - 42.50 diopters. Intraocular pressure -15 mm Hg, tonography: P = 19.4 C = 0.24 F = 2.65 P / C = 82 field of view - unchanged, the number of endothelial cells - 2246 cells / mm.sq. - endothelial loss was only 8.2%. The results obtained allow us to conclude about the effectiveness and safety of our method.

 Using the proposed method can significantly reduce the number of intra- and postoperative complications and thereby accelerate the visual and social rehabilitation of patients.

Claims (1)

 A method of surgical treatment of open-angle glaucoma and cataract with implantation of an intraocular lens, including simultaneous phacoemulsification and non-penetrating sclerectomy through a single corneoscleral incision, characterized in that a valve self-sealing incision is formed by dissecting the sclera at 12 hours by 2/3 of its thickness parallel to the limbus by 3 mm and exfoliation of the sclera in the direction of the cornea along the entire incision along a width of 3.5 to 4.0 mm, after which phakoem cataract is removed with an ultrasonicator, then the incision expands to 5.0 mm, an intraocular lens is implanted, and then the external wall of the Schlemm canal is opened along the entire length of the incision and the descemet shell is exposed.