RU2267310C1 - Surgical method for treating the cases of glaucoma distinguished by normalized intraocular pressure - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule. Blunt cannula needle repeating eyeball curvature is introduced into subtenon's space towards the posterior eye pole. Suspension containing 30 mg of Alloplant biomaterial powder is introduced as vasculogenesis stimulant via the cannula needle by means of single use syringe. The needle is withdrawn and the incision is sutured with single interrupted suture.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; improved esthetic results.

4 dwg

Description

The invention relates to medicine, namely to ophthalmology, and can be used for the surgical treatment of glaucoma with normalized intraocular pressure.

Known surgical methods for the treatment of glaucoma with normalized intraocular pressure, based on increased blood flow to the eyeball by ligation of various branches of the internal and external carotid arteries; on the introduction of various medicinal substances into the subtenon space (G.A.Shilkin, A.I. Andreytsev, N.P. Volodin // Prevention, medical rehabilitation of blindness and low vision. - Ufa, 1979. - P.55-57; A. -AD Aliev, N.A. Muhamed Hyp, M.I. Ismailov and others // Ophthalmosurgery. - 1999. - No. 2. - P.81-83), in which with the aim of developing additional collaterals and improving ligation of the superficial temporal artery, as well as catheterization of the subtenon space with continuous dosed administration of medicinal "cocktail" is used to supply the posterior segment of the eyeball yule. "

The disadvantages of these methods are the short duration of the effect of the operation, a cosmetic defect with the formation of a scar on the skin of the temporal region of the face, the complexity of technical manipulations, impaired comfort in the operated eye, associated with the sensation of a foreign body under the upper eyelid, the need to wear a catheter on the skin of the forehead for the introduction of drugs in the process course treatment.

The prototype of the invention is a method for the surgical treatment of lesions of the posterior segment of the eye and the anterior optic nerve by forming a channel in the subtenon space in one of the quadrants of the eyeball and then introducing an implant (collagen sponge) into it to the posterior pole of the eyeball, to which the silicone tube is fixed, bred on the skin of the forehead, for dosed administration of drugs (A.P. Nesterov, S.N. Basinsky. A new method of administering drugs to the back subtenon department // Journal of Ophthalmology -. 1991. - №5 -. S.49-51).

The disadvantages of this method are the technical complexity of the operation, the feeling of discomfort under the upper eyelid due to the forced wearing of the silicone tube from the infusion system, removed and fixed on the skin of the forehead, during the entire course of treatment, the need for repeated administration of drugs into the subthenon space during the course of treatment, violation aesthetic appearance of the patient.

The technical result of the invention is to reduce the morbidity by simplifying the method and increasing the efficiency of the results of the operation.

The technical result is achieved by the fact that in the upper outer or lower inner sectors of the eyeball, the conjunctiva and tenon capsule are cut through which a blunt-pointed needle cannula curved along the curvature of the eyeball is introduced into the subtenon space to the posterior pole of the eye, through which a suspension of biomaterial is fed using a disposable syringe Alloplant ”stimulator of vasculogenesis, remove the needle and suture the conjunctival incision with one nodal suture.

Figure 1-4 shows the stages of the method of surgical treatment of glaucoma with normalized intraocular pressure.

The method is as follows. The operation is performed in the upper external or lower inner sectors of the eyeball between the adjacent direct eye muscles. Conjunctiva and tenon capsule 1, 1-2 mm long, are cut 10 mm from the limbus. A blunt-pointed needle-cannula 2, curved along the curvature of the eyeball, is inserted into the formed hole 1, to the posterior pole of the eye, through which a suspension of the Alloplant biomaterial stimulator of vasculogenesis 3 is fed using a disposable syringe (TU-42-2-537-2002). For this, immediately before the operation, Alloplant powdery biomaterial, a vasculogenesis stimulator (30 mg), is diluted in 2 ml of physiological saline and 0.5 ml (2 mg) of dexazone solution. The needle is removed from the wound, the conjunctival incision is sutured with one interrupted suture 4.

Example 1. Patient D., 65 years old, with a diagnosis of primary open-angle glaucoma of the right eye, II "a", with normalized intraocular pressure after antiglaucomatous surgery; terminal operated glaucoma IV "a" of the left eye. Previously repeatedly conducted courses of conservative treatment were ineffective. After the examination in our clinic, the operation of the right eye was performed by the proposed method. Visual acuity of the right eye is 0.3, the left eye is 0.0. Fields of vision of the right eye - a total of 8 meridians 235 degrees, the left - are not determined. Intraocular pressure of the right eye 23 mm Hg, left - 20 mm Hg

The operation of the right eye was performed using a suspension of Alloplant biomaterial, a vasculogenesis stimulator. In the upper external sector of the eyeball, 10 mm from the limb, between the adjacent rectus muscles, an incision of the conjunctiva and tenon capsule 1-2 mm long was made. A blunt-pointed needle-cannula bent along the curvature of the eyeball is inserted into the hole, to the posterior pole of the eye, through which a suspension of the Alloplant biomaterial stimulator of vasculogenesis is applied using a disposable syringe. For this, immediately before the operation, the powdered Alloplant biomaterial stimulator of vasculogenesis (30 mg) is diluted in 2 ml of physiological saline and 0.5 ml (2 mg) of dexazone solution. The needle is removed from the wound, the conjunctiva incision is sutured with one interrupted suture.

The postoperative course is smooth. The patient was examined after 6 months. The right eye is calm. Visual acuity of the right eye of 0.8, left 0.0. Intraocular pressure is normalized and amounts to 24 mmHg. The visual fields of the right eye in total along the 8 meridians expanded from 235 to 260 degrees, an improvement in the electrophysiological parameters of the retina and optic nerve.

When conducting light biomicroscopy of the conjunctiva in the upper outer sector of the eye, 10 mm from the limbus at 11 hours, a delicate point scar of the conjunctiva is visible, not fused with the underlying tissue. The conjunctiva is calm, the growth of newly formed vessels in the area of operation is not observed.

Example 2. Patient J., 63 years old, with a diagnosis of primary open-angle glaucoma of the right eye, I "a"; primary open-angle glaucoma of the left eye, III "a", with intraocular pressure normalized by drugs. Despite repeated courses of conservative treatment at the place of residence, the vision of the left eye continued to deteriorate, the field of view narrowed. Visual acuity of the right eye is 0.9, the left is 0.9. The visual fields of the right eye are 8 meridians in total 485 degrees, the left - 220 degrees (eccentric - outside). Intraocular pressure of the right eye according to Maklakov 18 mm Hg, left - 25 mm Hg After the examination in our clinic, an operation of the left eye was performed by the proposed method.

An operation of the left eye was performed using a suspension of Alloplant biomaterial, a vasculogenesis stimulator. In the upper external sector of the eyeball, 10 mm from the limb, between the adjacent rectus muscles, an incision of the conjunctiva and tenon capsule 1-2 mm long was made. A blunt-pointed needle-cannula bent along the curvature of the eyeball is inserted into the hole, to the posterior pole of the eye, through which a suspension of the Alloplant biomaterial stimulator of vasculogenesis is applied using a disposable syringe. For this, immediately before the operation, the powdered Alloplant biomaterial stimulator of vasculogenesis (30 mg) is diluted in 2 ml of physiological saline and 0.5 ml (2 mg) of dexazone solution. The needle is removed from the wound, the conjunctiva incision is sutured with one interrupted suture.

The postoperative course is smooth. The patient was examined after 6 months. Visual acuity of the right eye is 0.9, the left is 1.0. Intraocular pressure is normalized and amounts to 21 mm Hg. right eye and 25 mm Hg - left, the field of view of the left eye along the 8 meridians expanded from 220 to 270 degrees (eccentric - outside), there is an improvement in the electrophysiological parameters of the retina and optic nerve.

When conducting light biomicroscopy of the conjunctiva in the upper outer sector of the left eye, 10 mm from the limbus, between 1 and 2 hours a tender point scar of the conjunctiva is visible, not soldered to the underlying tissue. The conjunctiva is calm, the growth of newly formed vessels in the area of operation is not observed.

Using the proposed method to date, 42 patients have been operated on with primary glaucoma with normalized intraocular pressure. Of these, 19 diagnosed with advanced stage of the disease, in 23 patients - far advanced. All patients had a positive result of the operation in the form of maintaining or increasing visual acuity, stabilizing or expanding visual fields along the 8 meridians, improving the metabolism of the posterior part of the eyeball, which manifests itself in the preservation of the functional state of the retina and optic nerve according to electrophysiological indicators.

The proposed method for the surgical treatment of primary glaucoma with normalized intraocular pressure is technically simple, less traumatic, there is no discomfort in the eye after the operation, and the patient’s aesthetic appearance is disturbed.

Claims (1)

A method for surgical treatment of primary glaucoma with normalized intraocular pressure, including a conjunctiva and tenon capsule incision followed by a graft to the posterior pole of the eyeball, characterized in that a blunt needle cannula is inserted into the subtenon space, curved along the curvature of the eyeball, to the posterior pole of the eye, through which, using a disposable syringe, a suspension of 30 mg of Alloplant biomaterial powder is stimulated with a vasculogenesis stimulator, the needle is removed and the conjunctomy incision is sutured s one nodal suture.

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