RU2197928C2 - Method for preventing increase in intraocular pressure after extracting cataract complicated with pseudoexfoliative syndrome and/or glaucoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making conjunctiva incision concentrically to limb. 1/3 thickness deep sinusoid sclera incision is made in the superior part of the eyeball 1.9-2.2 mm far from the limb. Tunnel incision penetrating into the anterior chamber is made. Anterior capsule of the lens is accessed and nucleus hydrodissection is performed. The nucleus is removed. Intraocular lens is implanted in capsular sack. An additional incision is done above Schlemm canal projection under scleral overhang. Cutting rod of trabeculotome is introduced into the additional incision and dosed sinus trabeculectomy is carried out. EFFECT: reduced risk of postsurgical complications; high degree of vision and social rehabilitation. 2 dwg

Description

 The invention relates to medicine, namely to ophthalmology, and can be used to prevent an increase in intraocular pressure in patients in the early postoperative period after cataract extraction with a small incision, as well as for the prevention of hypertension in patients predisposed to glaucoma.

 A known method for the prevention of this complication after phacoemulsification of cataracts, which consists in introducing an elastic self-absorbable drainage plate into the surgical incision (RF patent 213490. "A method for preventing increased intraocular pressure after cataract phacoemulsification with IOL implantation").

 The disadvantage of this method is that the drainage resolves after a few days and its antihypertensive effect in the long term may be ineffective, and with tunnel extraction this method is unacceptable due to possible insufficient sealing.

 The objective of the invention is to develop a safe, highly effective method for preventing an increase in intraocular pressure and obtaining a stable hypotensive effect in patients with cataract complicated by pseudoexfoliation syndrome and / or glaucoma after cataract extraction in the early and long-term postoperative period.

 The technical result achieved by using the invention is to reduce the number of postoperative complications, prevent hypertension, persistent antihypertensive effect and stabilization of visual functions.

 The technical result is achieved by the fact that during cataract extraction with implantation of the IOL with a small incision, a sinusoidal incision of the sclera is made at 1/3 of its thickness, while the horizontal axis of the sinusoidal incision, having an amplitude of 1-1.2 mm and a period of 5-6 mm, is located in 2-2.5 mm from the limb, a tunnel incision is formed from this incision, penetrating 2-2.5 mm into the transparent layers of the cornea, then cataract extraction is performed with IOL implantation, and in the section of the tunnel incision in its lower wall under the scleral visor, a cut of an additional incision of 1-2 mm above the projection of the Shlemmov canal performs a dosed synustrabeculoectomy.

 Through a micro-hole, continuous additional filtration of chamber moisture is carried out.

 The peculiarity of this method of surgery is that the sinusoidal incision combines all the advantages of small self-sealing incisions, does not create additional difficulties at all stages of cataract extraction, and provides optimal opportunities for dosed sinistrabeculoectomy. The sinusoidal shape of the incision eliminates the possibility of emptying the anterior chamber during a metered sinus strabeculoectomy due to the fact that only part of the upper wall of the tunnel incision is lifted (the scleral "visor"), and the other part of the tunnel incision remains closed for fluid to flow out of the anterior chamber.

 The sinusoidal shape of the incision is less traumatic for the eye, because part of the incision, made closer to the limb, passes through the tissues of the sclera with less blood supply, which reduces the number of damaged vessels and, accordingly, the number of hemorrhagic complications. Carrying out part of the incision along the less vascularized scleral site also reduces the area of subsequent vascular coagulation, which leads to minimal thermal injury to the sclera and ciliary body and excludes the possibility of reactive inflammation in the postoperative period.

 The scleral "visor" formed by a sinusoidal incision provides additional subscleral outflow paths, which excludes the development of hypertension in the postoperative period, and also prevents excessive filtration of intraocular fluid under the conjunctiva and reduces the likelihood of development of choroid detachment in the postoperative period, which ultimately leads to stabilization and prevention of increased IOP.

 The proposed method is illustrated by drawings, in which Fig. 1 shows a sinusoidal incision of the sclera with a formed tunnel incision, and in Fig. 2, the microtrabeculotomy cutting rod is inserted into an additional incision in the lower wall of the tunnel.

 The method is as follows.

 Under a local anesthesia, an eyelid expander is applied, the upper rectus muscle is taken on a stitch-holder. A section of the conjunctiva with a length of 5-6 mm is carried out concentrically along the edge of the limb. In the upper half of the eyeball, departing from 1.8-2.22 mm from the limbus, a sinusoidal incision is made of 1 sclera with a 1/3 of its thickness with a dosed diamond knife, through which a tunnel incision 2 is penetrated with a diamond exfoliator, penetrating 2-2.5 mm into the transparent layers of the cornea . When forming the tunnel incision 2, the lower wall of the tunnel and its upper wall, the “visor”, are formed 3. The formation of the incision with penetration into the anterior chamber of the eye is completed with a spear-shaped knife 3.0–3.2 mm wide. Corneal paracentesis is performed in the meridian for 2 hours, midriatic (0.1% Mesaton) and viscoelastic (Visitil) are introduced into the anterior chamber of the eye. The front lens capsule is opened with an irrigation cystotome, hydrodissection of the nucleus is performed, and the nucleus is removed through an extended tunnel incision. The remains of the lens masses are removed by an irrigation-aspiration cannula. A posterior chamber IOL is implanted in the capsular bag. In the section of the tunnel incision 2, in its lower wall under the scleral "peak" 3, an additional incision 4 is made over the projection of the Shlemmov channel. In the additional incision 4, the cutting rod of the microtrabeculotome 5 is inserted and a dosed (depending on the initial state of eye hydrodynamics) sinusstrabeculoectomy of the drainage system is performed. On the conjunctiva impose two nodal sutures 8/0. The operation is completed by the introduction of solutions of an antibiotic and a corticosteroid subconjunctival.

 Example.

 Patient A., 76 years old.

 Diagnosis: right eye - mature cataract. Pseudoexfoliation syndrome.

 Visual acuity: the projection of light is correct, does not correct.

 The threshold of electrical sensitivity is 95 μA.

 Electrical lability - 28 Hz.

Biometry: front camera - 2.26;
lens - 5.00;
the length of the eye is 22.32.

 Intraocular pressure (IOP) - 19 mm Hg

 Tonography: P = 11.1; C = 0.14; F = 0.2; P / C = 79.

 The patient underwent an operation: tunnel extraction of cataract with IOL implantation according to the proposed method.

 On the first day after surgery, when examining the right eye: the cornea is transparent, the anterior chamber is 3.5 mm deep, moisture is transparent, the pupil is in the center, the IOL is in place.

 Vis Right eye = 0.4, does not correct.

 IOP = 20 mmHg

On the sixth day:
Vis Right eye = 0.9 Cyl + 0.75 ax 8 ^o = 1.0
IOP = 22 mmHg

Ophthalmometry: Sph + 0.25; D Cyl-0.75 D
Tonography: P = 11.4; C = 0.29; F = 0.35; P / C = 39.

 The absence of an increase in IOP in the postoperative period allows us to conclude that the proposed method is effective.

 Using the proposed method makes it possible to significantly reduce the number of postoperative complications, such as hypertension and choroid detachment, and, thereby, increase the visual and social rehabilitation of patients.

Claims (1)

 A method for preventing an increase in intraocular pressure after cataract extraction complicated by pseudoexfoliation syndrome and / or glaucoma, including IOL implantation, characterized in that the sinusoidal scleral incision is made 1/3 of its thickness, while the horizontal axis of the sinusoidal incision is located 1.8-2 2 mm from the limb, a tunnel incision is formed from this incision, penetrating 2-2.5 mm into the transparent layers of the cornea, then cataract extraction is performed with IOL implantation and in the section of the tunnel incision in the lower e To the wall under the scleral "peak" through an additional incision above the projection of the Schlemm canal, a metered sinus strabeculoectomy is performed.

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