3.2.2. The Surgical intervention at carrying out of the combined operation
Patient S, 67 years, 10.10.12 has arrived in a day hospital of clinic "æ" concerning the primary angle-closure not stabilised glaucoma II from the right eye; primary angle-closure I and glaucomas of the left eye.
An initial cataract of both eyes. The accompanying diagnosis: Chronic obstructive illness of lungs of II degree, a diffusive pneumosclerosis? DN II. The Diabetes of II type of moderate severity level.At survey the Right eye: Vis OD = 0,2, not korrigiruet, the admixed injection of an eyeball, at 11 o'clock in 2 mm from a limbus of 2 knots (silk 10/0), the filtrational pillow is absent, a basal coloboma, an easy edema of a cornea, the forward chamber fine, depth of 1,8 mm, PZO - 22,2 mm, iridokornealnyj an angle narrow, 17 °; the pupil is dilated, the wrong form, back synechias, moderate opacifications of a stroma of a lens, the forward-back size of a lens of 4,5 mm; back amotio of a vitreous. A retina prilezhit in all departments. VGD 36 mm hg, a field of vision - at standard automatic perimetria under the program 24/2 Humphrey are defined plural microscotomas, MD - 10 Db. Eyeground details not oftalmoskopirujutsja because of a cornea and cataract edema.
Fig. 15. UMB iridokornealnogo an angle before operation
The left eye: Vis = 0,4 n/k. The forward chamber of an eye depth of 2,0 mm. Iridokornealnyj an angle 20 °. From features: individual vacuoles, moderate phacoscotasmuses under a forward and back capsule. An optic disk acyanotic, E/D = 0,4, at standard automatic perimetria under the program 24/2 Humphrey are taped plural microscotomas, MD - 6 db.
Under local and intravenous anaesthesia, after preliminary depression VGD, on the right eye to it 11.10.12. Complex operation is executed: microinvasive fakoemulsifikatsija cataracts with IOL (+) 19,0 dptr., a lobby vitrektomija with destruction of a forward hyaloid membrane, a deep sclerotomy and basal corectomy of the right eye. After operation the patient felt well, disturbed insignificant pains in the right eyeball. At survey 11.10.12. The right eye: the easy injection of an eyeball, individual cords of a descemete cover, the forward chamber of average depth, a pupil to 4 mm, IOL costs correctly. Palpatorno - a moderate hypotension. Treatment: instilljatsii - tobradeks 4 times a day, tropikamid 0,5 % - 2 times a day. Injections under a conjunctiva dexamethasone of 0,4 % - 0,3 ml and gentamycin of 4 % of 0,5 ml. - once a day. A postoperative current smooth.
The patient is written out from a day hospital 14.10.12. At an extract of ODES: Vis=0,2; ВГД=19 mm hg the Cornea the transparent, forward chamber of average depth, a pupil round, IOL costs correctly. The forward chamber depth of 3 mm. PZO - 22,2мм, iridokornealnyj an angle 32 °. On an eyeground a disk acyanotic (glaukomatoznaja nejropatija DZN), E/D 0,6. Retinal arteries are narrowed, veins are dilated izvity. At standard automatic perimetria under the program 24/2 Humphrey are taped plural microscotomas, MD - 6 db. The left eye without dynamics.
Survey in three months the Right eye: Vis=0,4; ВГД=19 mm hg the Cornea the transparent, forward chamber of 3 mm, iridokornealnyj an angle 32 ° the pupil round, IOL costs correctly. On an eyeground a disk acyanotic, E/D 0,6. Retinal
Arteries are narrowed, veins are dilated, izvity, at standard automatic perimetria under the program 24/2 Humphrey - without negative dynamics. In a year - indicators of visual acuity, a field of vision, an ophthalmotonus,
The forward chamber, iridokornealnogo an angle, an eyeground without dynamics.
Fig. 16. A kind of patient S after operation.
Fig. 17. Appreciable expansion iridokornealnogo an angle by data
UBM.
Other medical related information 3.2.2. The Surgical intervention at carrying out of the combined operation:
- the clinical characteristic of groups of children after carrying out of preventive correction
- dynamics of a painful index at premedication carrying out in group of surveyed children.
- THE MAINTENANCE
- INTRODUCTION
- a general characteristic of groups of patients
- techniques of surgical interventions
- the Chapter III. The SUBSTANTIATION of the COMBINED SURGICAL TREATMENT of the POSTOPERATIVE MALIGNANT GLAUCOMA
- the analysis of outcomes of surgical treatment of patients with the developed postoperative malignant glaucoma
- 3.2. Clinical examples of surgical interventions at carrying out vitrektomii and the combined operation at the developed postoperative malignant glaucoma
- 3.2.1. The Surgical intervention at carrying out vitrektomii
- 3.2.2. The Surgical intervention at carrying out of the combined operation
- 3.3. Fakoemulsifikatsija, executed by us within a year at patients 1 "and" groups
- 3.4. Quantity of operative measures at patients of 1 group
- the Chapter V. The SUBSTANTIATION of EFFICIENCY of the COMBINED PREVENTIVE OPERATION of the POSTOPERATIVE MALIGNANT GLAUCOMA
- the analysis of outcomes of surgical treatment of patients in the investigated groups
- 5.2. An intervention at carrying out of the combined preventive operation
- the Chapter VI. DISCUSSION of the RECEIVED DATA
- 2.2.2. A technique of carrying out of additional radial methods of research (roentgenography, a computer tomography, a magnitno-resonant tomography)
- 5.4 Role of ultrasonic research in planning of treatment of patients with tumours and opuholepodobnymi formations of soft tissues in the conditions of a day surgical hospital