RU-2861576-C1 - METHOD FOR COMBINED TREATMENT OF SECONDARY POST-TRAUMATIC GLAUCOMA IN PATIENTS WITH ANIRIDIA

Abstract

FIELD: medicine; ophthalmology. SUBSTANCE: contact transscleral cyclophotocoagulation is performed using a diode laser in micropulse mode with a wavelength of 810 nm, 4 mm from the limbus, with a power of 2500 mW, a duty cycle of 31.3%, a pulse duration of 0.5 ms, a period of 1.1 ms, excluding the horizontal meridian and the area of previous antiglaucoma operations from the exposure zone. The exposure time per cycle is 10 seconds. The first exposure cycle is performed along a 160° arc in one direction. The second cycle is performed along the same arc in the opposite direction. Subsequent cycles are carried out similarly to the first two, with a total of 8 cycles in the upper hemisphere of the eyeball and 8 cycles in the lower hemisphere of the eyeball. One month after surgery, intraocular pressure measurements are taken. If an increase in intraocular pressure is detected one month after contact transscleral cyclophotocoagulation, an antiglaucoma operation with implantation of an Ahmed valve is performed. EFFECT: possibility of obtaining a stable hypotensive effect, no effect on the ciliary body, no reduction in aqueous humour production, low risk of developing eyeball subatrophy, preservation of residual visual functions, reduction of the risk of intra- and postoperative complications, and practically no pain syndrome, achieving a stably reduced IOP with minimal risk of complications, preserving visual functions, and, if necessary, performing further optical reconstructive operations to correct aniridia. 1 cl, 1 ex

Inventors

• KHODZHAEV NAZRULLA SAGDULLAEVICH
• Liubimova Tatiana Sergeevna
• Sobolev Nikolai Petrovich
• Sudakova Ekaterina Pavlovna

Dates

Publication Date

20260506

Application Date

20250922

Claims (1)

1. A method for the combined treatment of secondary post-traumatic glaucoma in patients with aniridia, characterized in that contact transscleral cyclophotocoagulation is performed using a diode laser in the Micropulse mode with a wavelength of 810 at 4 mm from the limbus, with a power of 2500 mW, a duty cycle of 31.3%, a pulse duration of 0.5 ms, a period of 1.1 ms, with the exclusion of the horizontal meridian and the area of previous antiglaucoma operations from the area of action, while the exposure for one cycle is 10 sec, with the first cycle of action carried out along an arc of a circle of 160 ° in one direction, the second cycle along the same arc of a circle in the opposite direction, subsequent cycles are carried out similarly to the first two, a total of 8 cycles are carried out in the upper hemisphere of the eyeball and 8 cycles in the lower hemisphere of the eyeball, a month after the operation, intraocular pressure indicators are measured, and if an increase in indicators is detected Intraocular pressure, one month after contact transscleral cyclophotocoagulation, antiglaucoma surgery with implantation of the Ahmed valve is performed.

Description

The invention relates to ophthalmology and can be used for the combined treatment of secondary post-traumatic glaucoma (PTG) in patients with aniridia. To date, there is no generally accepted treatment algorithm for patients with PTH and aniridia in global practice, and the choice of surgical treatment method is individual, depending on the severity and nature of the damage to the drainage zone, the size of the iris defect, the condition of the ciliary body, the severity of fibroplastic processes, as well as the scope of the performed or planned optical-reconstructive intervention. Traditional penetrating and non-penetrating antiglaucoma surgeries for PTH provide only a temporary effect due to increased scarring of the drainage zone. The fibroplastic processes caused by the injury are incomplete and continue for a long time, leading to recurrent intraocular pressure (IOP) decompensation. The most common treatments for refractory PTH include filtration surgeries using drains to enhance aqueous humor outflow, as well as surgeries that reduce aqueous humor production: endoscopic and transscleral cyclophotocoagulation (CPC) of the ciliary processes using micropulse or continuous modes. (Sobolev N.P., Teplovodskaya V.V., Soboleva M.A., Sudakova E.P. Secondary post-traumatic aniridic glaucoma: pathogenesis and treatment methods. Clinical ophthalmology. 2021;21(4):235-240). Unpredictability of the hypotensive effect and a number of serious complications during continuous-wave cyclo- Photocoagulation limitations limit the use of this procedure in the treatment of glaucoma, leading to the development and widespread use of contact transscleral diode laser cyclophotocoagulation in Micropulse mode (mCPC). This method of transscleral laser treatment of glaucoma is more gentle and safer than the traditional continuous-wave technique. Thanks to the radiation of a diode laser with a wavelength of 810 nm in the Micropulse mode, laser energy is delivered to the ciliary body in a measured dose, allowing the surrounding tissues to cool between pulses, thereby reducing focal overheating and excessive destruction of ciliary body tissue (Sidorova A. V., Khodjaev N. S., Eliseeva M. A., Starostina A. V. Drainage surgery for refractory glaucoma in combination with micropulse cyclophotocoagulation // Saratov Scientific Medical Journal. 2020. No. 1). The closest analogue is a method for combined surgical treatment of secondary glaucoma in post-traumatic aniridia (RU Patent No. 2588396). Transscleral digital photofluorescence is performed using a diode laser in continuous mode with a wavelength of 810 nm and an exposure time of 3.0 seconds. If the ciliary body thickness is less than 0.54 mm, six laser applicators are applied along a 90° arc in the inferior hemisphere of the eyeball, 1-2 mm from the limbus, with a power of 1.2 W and a pulse energy of 3.6 J. If the ciliary body thickness is greater than 0.54 mm, eight laser applicators are applied along a 120° arc in the inferior hemisphere of the eyeball, 1-2 mm from the limbus, with a power of 1.6 W and a pulse energy of 5.4 J. Conjunctival and scleral flaps are formed at 12 o'clock, exposing a strip of the ciliary body distal to the limbus. Under the scleral flap, in the area of the cornea-sclera transition, an entrance hole into the anterior chamber is formed parallel to the iris using a 26 G needle. 0.2-0.3 ml of 1% sodium hyaluronate is injected into the anterior chamber. The needle is removed, and an Ex-PRESS Model P-50 microshunt is implanted into the resulting hole using an injector. A triangular collagen drain is placed under the scleral flap with its base distal to the microshunt. The drain's apex is tucked under the sclera into the suprachoroidal space 2 mm from the limbus. After repositioning the scleral flap, the collagen drain and the drain are secured with a single interrupted suture in the center. A single interrupted scleroscleral suture is placed on each lateral side of the scleral flap proximal to the collagen drain, and the procedure is completed with a conjunctival suture. According to the authors, this method preserves visual function by restoring aqueous humor outflow pathways and achieving a lasting hypotensive effect. The disadvantages of this combined method include a high risk of hypotension in the postoperative period due to suppressed aqueous humor production due to partial ciliary body atrophy. Concomitant CFC and drainage implantation leads to increased inflammation, which increases the risk of scarring and reduces the effectiveness of the surgical procedure. The inflammatory reaction after CFC can activate fibroblast proliferation, which contributes to scarring of the filtration bleb and reduces the effectiveness of Ex-PRESS drainage. Furthermore, it is difficult to predict the degree of intraocular pressure reduction, increasing the risk of both insufficient and excessive reduction. Cyclodestructive procedures can cause significant pain, especially in th