RU2809314C1 - Method of surgical treatment of open-angle glaucoma - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: first, corneal paracentesis is performed in the horizontal meridian. Then the anterior chamber of the eye is filled with viscoelastic based on sodium hyaluronate, after which, by injecting a solution of local anesthetic under the conjunctiva in the upper part of the eyeball, 3 mm from the limbus, the conjunctiva is peeled off from the sclera in the direction of the limbus and the superior fornix. Next, at 3 mm from the limbus at 12 o'clock position, a 2 mm long conjunctival incision is made parallel to the limbus and the conjunctiva is shifted to the limbus, after which a 23-gauge injection needle is injected into the sclera 2 mm from the limbus, it is carried out in the layers of the sclera and inserted into the anterior chamber in the area corner of the latter. Then, using collet tweezers inserted into the anterior chamber through corneal paracentesis, the end of a 3/0 thread made of non-absorbable material is inserted into the lumen of the injection needle, after which, with a reverse movement of the needle, the thread is brought to the surface of the sclera at the point of primary injection. After this, the injection needle is similarly inserted into the anterior chamber through a second puncture located 2 mm from the first and 2 mm from the limbus. Next, the second end of the thread is similarly brought out onto the sclera at the second injection point. After this, the ends of the threads are shortened and thickenings are formed on them using a thermocoagulator to prevent the thread from moving, and a single 8/0 nylon suture is placed on the conjunctiva.

EFFECT: method provides a prolonged hypotensive effect in the postoperative period due to the formation of a direct flow of fluid from the anterior chamber of the eye into the subconjunctival space without clogging of the created channel with the possibility of activating the outflow when it decreases.

1 cl, 1 ex, 5 dwg

Description

The invention relates to medicine, namely to ophthalmology, and can be used to reduce intraocular pressure in open-angle glaucoma.

There are known methods of surgical treatment of open-angle glaucoma using drainages designed for the outflow of intraocular fluid intrascleral and subconjunctival: Ex-PRESS shunt (Kaplan-Messas A, Traverso CE, Glovinski Y, et al, and the International ExPRESS Study Group. The ExPRESS miniature glaucoma implant : Intermediate results of a prospective multi-center study. Invest Ophthalmol Vis Sci. 2001;42:S552), leucosapphire microshunt (RF patent No. 53894. 2004 and RF patent No. 134786. 2013), polymer microshunt “Reper-NN "(RF patent No. 146341.2014).

The use of these drainages often leads in the early postoperative period to hyperfiltration of intraocular fluid, hypotension, comminution of the anterior chamber, ciliochoroidal detachment, and in the long term may not provide sufficient outflow of intraocular fluid due to the closure of the drainage outlet with a superficial scleral flap, fusion of the edges of the superficial scleral flap with the edges of its bed.

The objective of the claimed invention is to develop a microinvasive method for the surgical treatment of open-angle glaucoma.

The technical result of the invention is the achievement of a long-term hypotensive effect by preventing the fusion of the created intrascleral channel and the possibility of activating the outflow through this channel while reducing the effect in the long-term postoperative period.

The specified technical result is achieved by the proposed method, which consists in the following.

Corneal paracentesis is performed in the horizontal meridian. The anterior chamber of the eye is filled with viscoelastic based on sodium hyaluronate. By injecting a local anesthetic solution under the conjunctiva in the upper part of the eyeball, 3 mm from the limbus, the conjunctiva is peeled off from the sclera in the direction of the limbus and the superior fornix. At 3 mm from the limbus at 12 o'clock, a 2 mm long conjunctival incision is made parallel to the limbus, and the conjunctiva is shifted towards the limbus. A 23-gauge injection needle is injected into the sclera 2 mm from the limbus, passed through the layers of the sclera and inserted into the anterior chamber in the area of the angle of the latter. Using collet tweezers inserted into the anterior chamber through corneal paracentesis, the end of a 3/0 thread made of non-absorbable material is inserted into the lumen of the injection needle. With a reverse movement of the needle, the thread is brought to the surface of the sclera at the point of initial injection. The injection needle is similarly inserted into the anterior chamber through a second puncture located 2 mm from the first and 2 mm from the limbus. The second end of the thread is similarly brought out onto the sclera at the second injection point. Thus, in the layers of the sclera, two channels are formed that open into the anterior chamber with a thread located in them, along which fluid is filtered. The ends of the threads are shortened and thickenings are formed on them using a thermocoagulator to prevent the thread from moving. A single 8/0 nylon suture is placed on the conjunctiva.

If insufficient fluid filtration is observed in the postoperative period, microincisions are made in the conjunctiva in the area where the threads exit to the surface of the sclera, the thickening at one end of the thread is cut off, and the thread is removed by pulling its other end.

The inventive method is demonstrated in the drawing, where in FIG. 1 (a, b, c, d, e) schematically shows the stages of sequential surgical intervention with the following notations:

1 - cornea,

2 - iris,

3 - limb,

4 - injection needle 23 G,

5 - collet tweezers,

6 - 3/0 thread made of non-absorbable material,

7 - thickenings on the thread,

8 - intrascleral channels.

The proposed method is carried out in the following sequence of steps.

1. Paracentesis of the cornea is performed in the horizontal meridian.

2. The anterior chamber of the eye is filled with viscoelastic based on sodium hyaluronate.

3. By introducing a local anesthetic solution under the conjunctiva in the upper part of the eyeball, 3 mm from the limbus, the conjunctiva is peeled off from the sclera in the direction of the limbus and the superior fornix.

4. At 3 mm from the limbus at 12 o’clock, a 2 mm long conjunctival incision is made parallel to the limbus and the conjunctiva is shifted towards the limbus.

5. A 23-gauge injection needle is injected into the sclera 2 mm from the limbus, passed through the layers of the sclera and inserted into the anterior chamber in the area of the angle of the latter.

6. Using collet tweezers inserted into the anterior chamber through corneal paracentesis at 9 o’clock, the end of a 3/0 thread made of non-absorbable material is inserted into the lumen of the injection needle (see Fig. 1a).

7. With a reverse movement of the needle, the thread is brought to the surface of the sclera at the point of primary injection (see Fig. 1b).

8. The injection needle is similarly inserted into the anterior chamber through the second puncture, located 2 mm from the first and 2 mm from the limbus (see Fig. 1c).

9. The second end of the thread is similarly brought out onto the sclera at the second injection point (see Fig. 1d).

10. The ends of the threads are shortened and thickenings are formed on them using a thermocoagulator to prevent the thread from moving (see Fig. 1e).

11. A single 8/0 nylon suture is placed on the conjunctiva.

We provide a clinical example of the use of the proposed method.

Example 1. Patient 3., 75 years old. Diagnosis: pseudophakia, primary open-angle developed (II) with moderately increased IOP (B) glaucoma of the right eye. Instills azarga 2 times a day, xalatan at night. Maximum corrected visual acuity of the left eye was 0.5, intraocular pressure 30 mmHg. Art. Biomicroscopically: the cornea is transparent, the anterior chamber is deep, the IOL is in the correct position in the capsular bag. Fundus: optic disc is pale, excavation 0.8.

Surgical intervention was performed using the proposed method after preliminary treatment of the surgical field, installation of a blepharostat, sub-Tenon anesthesia and application of a holder suture.

Corneal paracentesis was performed in the horizontal meridian. The anterior chamber was filled with viscoelastic based on sodium hyaluronate. By introducing an ultracaine solution under the conjunctiva in the upper part of the eyeball, 3 mm from the limbus, the conjunctiva was detached from the sclera in the direction of the limbus and the superior fornix. At 12 o'clock, 3 mm from the limbus, a 2 mm long conjunctival incision was made parallel to the limbus. From an injection 2 mm from the limbus, a 23-gauge injection needle was passed into the layers of the sclera and brought into the anterior chamber in the area of the angle of the latter. Using collet tweezers inserted into the anterior chamber through corneal paracentesis, the end of a 3/0 polypropylene suture was inserted into the lumen of the injection needle. Using a reverse movement of the needle, the thread was brought to the surface of the sclera at the point of initial injection. The injection needle was similarly passed into the anterior chamber through a second puncture located 2 mm from the first and 2 mm from the limbus. The second end of the polypropylene thread was brought out onto the sclera at the second injection point. Thickenings were formed at the ends of the threads using a thermocoagulator to prevent the thread from moving. A single 8/0 nylon suture was placed on the conjunctiva.

During a control study 1 day after surgery, the maximum corrected visual acuity was 0.4, intraocular pressure 10 mm Hg. Art. Biomicroscopically: the cornea is transparent, the anterior chamber is somewhat crushed, the moisture is transparent, the filtration pad is clearly spilled.

During a control study 7 days after surgery, the maximum corrected visual acuity was 0.5, intraocular pressure 14 mm Hg. Art. Biomicroscopically: the cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent, position, the filter pad is pronounced diffuse.

During a control study 1 month after surgery, the maximum corrected visual acuity was 0.6, intraocular pressure 18 mm Hg. Art. Biomicroscopically: the cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent, the filter pad is flat and spilled. During gonioscopy, a thread is visible in the corner of the anterior chamber in the projection of the trabecula.

During a control study 3 months after surgery, the maximum corrected visual acuity was 0.6, intraocular pressure 17 mm Hg. Art. Biomicroscopically: the cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent, the position of the acrylic plate is correct, the filter pad is flat and spilled. During gonioscopy, a thread is visible in the corner of the anterior chamber in the projection of the trabecula.

Claims (1)

A method of surgical treatment of open-angle glaucoma, characterized by the fact that first a paracentesis of the cornea is performed in the horizontal meridian, then the anterior chamber of the eye is filled with viscoelastic based on sodium hyaluronate, after which a solution of local anesthetic is introduced under the conjunctiva in the upper part of the eyeball, 3 mm from the limbus, the conjunctiva is peeled off from sclera in the direction of the limbus and the upper fornix, then at 3 mm from the limbus at 12 o'clock, a 2 mm long conjunctival incision is made parallel to the limbus and the conjunctiva is shifted towards the limbus, after which a 23-gauge injection needle is injected into the sclera 2 mm from the limbus, it is passed in layers sclera and inserted into the anterior chamber in the area of the angle of the latter, then using collet tweezers inserted into the anterior chamber through corneal paracentesis, the end of a 3/0 thread made of non-absorbable material is inserted into the lumen of the injection needle, after which, with a reverse movement of the needle, the thread is brought to the surface of the sclera in point of the primary injection, after which the injection needle is similarly inserted into the anterior chamber through the second puncture, located 2 mm from the first and 2 mm from the limbus, then the second end of the thread is similarly brought out onto the sclera at the second injection point, after which the ends of the threads are shortened and thickenings are formed on them using a thermocoagulator to prevent the thread from moving, and a single 8/0 nylon suture is placed on the conjunctiva.

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