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techniques of diagnostics and treatment of surveyed patients

The diagnosis of a postoperative malignant glaucoma was put on the basis of complaints of patients, the disease anamnesis, and also data of ophthalmologic inspection.

2.2.1. Complaints and anamnestic data

Patients showed complaints to pains in an eye, irradiirushchie in nadbrovnuju area, sharp depression of sight.

The malignant postoperative glaucoma arose as complication GSE which was carried out to the patient with a primary angle-closure glaucoma. The malignant glaucoma developed, as a rule, for 1-3 day after operation, with sudden lifting VGD which kept on very high
Digits (40-45 mm hg) also did not give in to conservative hypotensive therapy.

2.2.2. Standard methods of inspection

Were carried out visual acuity definition afar at the maximum correction (by means of a projector of signs, fig. 2.1.). At patients with visual acuity more low 0,1 visual acuity defined by means of tables for blizi or suggested to define the account of fingers. Research refractions (refractometer), the control of a peripheric and central field of vision on sferoperimetre G oldmana and the analyzer of field of vision Humphhrey was carried out.

The ophthalmotonus was defined on pneumotonometer Reichert NT 555, the USA (fig. 7).

Fig. 6. A projector of signs EUCARIS, Korea

Fig. 7. Pneumotonometer Reichert NT 555, the USA

Survey of patients was spent on slit lamp SL-30/Zeiss, Germany (fig. 8.)

Fig. 8. Slit lamp SL-30/Zeiss, Germany

Distribution of patients on stages of a glaucoma also is presented in the table

4.

Table 4.

Distribution of patients on glaucoma stages

Patients (group 1 stage 2 stage 3 stage In total people (eyes)
Subgroup I "and" 7 (8) 14 (15) 7 28 (30)
Subgroup I 4 10 (11) 4 18 (19)
2 group 11 24 7 42 (42)
3 group 4 8 - 12 (12)
Total 26 (27) 56 (58) 18 100 (103)

Sick IV stages of a glaucoma in the preoperative period were excluded from

Researches.

17-04-2008 GHT: OUTSIOE NORMAL LIMITS


Fig. 9. Change of fields of vision as a result of observation over the patient in 2008-2012

The biomicroscopical picture was defined by degree of rising VGD and expression of the pupillary block.

Following signs were the most typical:

- Congestive injection of an eyeball;

- Cornea edema;

- The small/shchelevidnaja forward chamber;

- Iris changes (a vasodilatation, a rubeosis, forward and back synechias;

- Pseudo-exfoliations;

- Opacifications in kortekse and-or a kernel of a lens with its swelling.

Distribution of patients with a cataract is presented to tab. 5

Table 5.

Distribution of patients on degree of a maturity of a cataract

Patients (group There is no Cataract The initial The unripe The mature In total
Subgroup I "and" 5 14 (16) 7 2 28 (30)
Subgroup I 3 10 (11) 4 1 18 (19)
2 group 9 23 9 1 42 (42)
3 group 2 10 - - 12 (12)
Total 19 57 (60) 30 4 100 (103)

Gonioskopija did not allow to visualise identification zones of an angle of the forward chamber (full closing of an angle proved to be true by means of ultrasonic biomicroscopy) more often. At korneokompresionnoj to assay it was possible to see only the top part trabekuly, and in case of an appreciable swelling of a lens and the expressed pupillary block this assay appeared not informative.

2.2.3. Special methods of inspection

To the special methods of inspection used in the present work, ultrasonic researches - And - and In - scanning and UBM - microscopy (on an ultrasonic biomicroscope «P60 UBM»/Paradigm, the USA), and also eye researches on korneotopograficheskoj to system "Sirius", (Germany) and optical coherent tomograph OCT Cirrus (Carl Zeiss Meditec, Germany) concern.

By means of A-scanning on scanning system "Sonomed/В-5500" (USA) (fig. 10) defined perednezadnjuju an eye axis, perednezadny the size of a lens and depth of the forward chamber (especially at a cornea edema). By means of V-scanning investigated a parity of intraocular structures of an eye, presence of amotio back gialoida, etc.

Fig. 10. A-V scanning system "Sonomed/В-5500" (USA)

Fig. 11. Amotio of a back hyaloid membrane at ultrasonic In scanning

Research on scanning korneotopograficheskoj to system Sirius allowed to estimate a profile and size of an angle of the forward chamber. Approximately in 2/3 cases (32 eyes) value iridokornealnogo an angle has appeared less than 20 °, in 1/3 cases (14 eyes) this indicator exceeded 20 °.

The principle of work Cirrus OCT (fig. 12 see) consists in use non-invasive, non-contact, nizkokogerentnoj interferometries. Thanks to it it is possible to receive tomograms of section of an eye with the high permission. Light is referred on two optical ways, one of which represents actually scanning, and another - the basic way of an interferometer. As a light source the superluminescent diode (SLD) with a wavelength of 1310 nanometers serves. The beams of light getting through scanning and on the basic way, are imposed on the photodetector. Owing to change of optical length of the basic way the interferometer analyzes a proceeding signal in a scanning point to define axial depth reflected from a tissue
Signal. Thanks to that the scanning beam moves on an eye cross-section, Cirrus OCT receives a little A-skanov and levels them, framing two-dimensional images.

Fig. 12. Optical coherent tomograph Cirrus OCT.

Fig. 13. Research of an angle of the forward chamber on the shajmpfljug-chamber

UBM (fig. 14 see) has received a wide circulation at a condition estimation iridotsiliarnoj zones that is especially actual for a malignant glaucoma. This method represents V-scanning ultrasonic immersionnuju diagnostic procedure with linear scanning which gives the quantitative and qualitative information on structure of a forward segment of an eye. Characteristics UBM are summarised by "a rule of five» - frequency of the gauge of 50 MHz, diameter of a beam in focus of 5 mm, the axial and cross-section permission 50 microns, a focal length 50 microns, depth of penetration of 5 mm. For research the site in the size of 5 5 mm is single-step covered. Advantage of the given technology consists that she allows to receive sharp images with the high permission.

Fig. 14. Ultrasonic biomicroscope P60 UBM.

Scanning carried out in four meridians (3, 6, 9 and 12 hours) with gauge statement perpendicularly to investigated structures - a cornea, an angle of the forward chamber, an iris, tsiliarnomu to a body, tsiliarnym to processes, fibers tsinnovoj ligaments. An angle of the forward chamber in degrees, and also depth of the back chamber measured in mm by the following technique. A thickness tsiliarnogo bodies estimated in mm on a perpendicular to its basis in a zone maximum vystojanija and with a space from skleralnoj eperons on 1 and 2 mm. Iridokornealnyj
Angle defined on crossing of two lines: from a sulcus tsiliarnogo bodies to a point of crossing with an iris in a zone of contact to a lens capsule, and from a point of a contact of an iris with a capsule of a lens to as much as possible remote equatorial edge of a capsule of a lens. Acoustic density of structures analyzed on density of a sclera of an investigated eye which conditionally accepted for 100 %.

By results of inspection on optical coherent tomograph OCT Cirrus and UBM analyzed a profile of an iris (convex/direct), a condition of equatorial area of a lens and its copular apparatus, presence/absence of blockade of an angle of the forward chamber by a root of an iris and iridohrustalikovogo contact (in the central zone and on periphery) and a condition (depth) of the back chamber. Besides, in the course of UBM studied a condition of forward departments of a vitreous.

2.3.

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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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