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laser surgery

The purpose of successful laser therapy is restoration of a normal stream of an intraocular liquid by means of direct communication adjustment between a cavity of a vitreous and the forward chamber. At a malignant glaucoma carrying out of several variants of laser interventions [13, 48, 51, 59, 70, 113] is described:

- The iridotomy (additional or correction of an available coloboma) is carried out by a standard technique. Its technics depends on depth of the forward chamber in a coagulation zone. The combined laser technique with use of two sources - argonovogo and neodimogo lasers is preferable. At the first stage argonovym oftalmokoaguljatorom the crateriform excavation in the chosen site of a stroma of an iris is formed. Punching is made neodimovym by the laser, it is better at the minimum power. The maximum effect it is possible to reach by restoration of depth of the forward chamber viskoelastikami after lazerkoaguljatsii;

- lazerkoaguljatsija tsiliarnyh processes through an iris coloboma. Still 1980 J. Herschler has informed on efficiency of this procedure as way of suppression of secretion of an intraocular liquid and restoration of depth of the forward chamber [70]. Such direct applications argonovym are applied by the laser for the purpose of influence on tsiliarnye processes to weakening of the tsilio-lens block and activation of ways for normal circulation of a watery moisture. Procedure is effective, if coagulation of two and more processes is executed. Considering possibility of an edema of a cornea after procedure, for rising of its transparency it is expedient instilljatsija Glycerinum before lazerkoaguljatsiej. At once after end lazerkoaguljatsii the forward chamber becomes a little bit deeper, however medicamental therapy is necessary for continuing, as the full effect is reached only in 4-5 days;

- On afakichnyh and artifakichnyh eyes probably carrying out of a YAG-laser capsulotomia which is effective only in the event that the direct communication between a vitreous and a moisture of the forward chamber (at a primary malignant glaucoma manipulation is exigeant and interfaced to high risk of maturing of a cataract and the further advance glaukomnogo process) is preliminary established. Coagulation is expedient for carrying out both in the field of a pupil, and in a zone of peripheric or basal corectomy [37, 85, 86, 107]

- YAG-laser gialoidotomija, kotroruju it is preferable to spend on afakichnyh or artifakichnyh eyes, allows to "break" a forward hyaloid membrane, providing with that access of an intraocular liquid from a vitreous in the forward chamber [13, 51, 59, 65, 91];

- Laser tsiklofotokoaguljatsija on neodimovom or diodnom oftalmokoaguljatore. The purpose of both procedures consists in reducing volume of a vitreous and to weaken production of an intraocular liquid [47, 51, 68, 123]. The application technique diodlazernoj transskleralnoj contact tsiklokoaguljatsii which allows to spend a vitreous destruction in a sparing regimen Is worthy.
However, authors used this technique only at a glaucoma end-stage [19, 30].

All surgical approaches described above to treatment of a malignant glaucoma, unfortunately, do not solve a problem of its extremely adverse current, complexity in forecasting of result of an operative measure and fatal influence of process on visual functions.

The decision of a problem of conservation of an eye as organ and visual functions at the given serious pathology could dilate considerably a spectrum of possibilities oftalmohirurgov.

1.7. Care of a didymous eye

In a case implication of a malignant glaucoma in one eye, exists high risk of development of this complication in a didymous eye, after a surgical intervention [13, 25, 41, 51, 113] specify, that the patient should be warned about it before signing of the consent to operation on a didymous eye [102].

Preventive measures include cancellation of drops causing a miosis (they cause an edema of a ciliary body and forward rotation of a diaphragm of a lens), long use of atropine (with careful observation over the patient, after the termination of its use), and an avoidance of a shallowing of the forward chamber in the postoperative period.

Some authors recommend to apply as a preventive measure carrying out vitrektomii pars plana in a combination to cataract excision [51, 52] Taking into account works [15, 90, 113] it is obviously necessary to us as preventive maintenance of development postoperative zlokachestvenoj glaucomas to spend not only vitrektomiju in a combination to cataract excision (or a transparent lens), but also carrying out of destruction of a forward hyaloid membrane and carrying out of filtering operation. However in the literature accessible to us we have not taped the description of such operation.

Thus, absence of uniform representations about patofiziologii a malignant glaucoma and the possible pathogenetic role several factors in its development complicates at once a choice of surgical tactics. The most perspective represent those methods of surgical treatment which allow to displace an irido-lens diaphragm kzadi and to open an angle of the forward chamber. At the same time, apparently from the presented data of the scientific literature, the isolated operation - the ex-traction of a cataract or vitrektomija - does not give necessary depression of level of an ophthalmotonus and high-grade aftertreatment of visual functions (especially if it is a question of a swelling of a muddy lens), and a question on implantation intraokuljarnoj a lens, except for individual mentions [51,113, 126], remains opened. At the same time it is shown, that replacement of a natural lens on intraokuljarnuju a lens enlarges depth of forward and back chambers almost in 2 times, eliminating thereby the mechanism of closing of an angle of the forward chamber a lens [98]. Hence, working out malotravmatichnogo pathogenetically referred and it is easy vypolnimogo the method of surgical treatment of a malignant glaucoma providing high probability of cupping of process and stabilisation of visual functions it is represented extremely actual problem at the present stage of development of surgery of a glaucoma.

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Scientific source Tarasov Konstantin Leonidovich. COMPLEX SURGICAL TREATMENT of the POSTOPERATIVE MALIGNANT GLAUCOMA. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow, 2014. 2014

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