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techniques of surgical interventions

2.3.1. Carrying out vitrektomii with destruction of a forward hyaloid membrane

On eyes with the postoperative malignant glaucoma which has developed after performance GSE in group 1 "and" were carried out vitrektomija with

Destruction of a forward hyaloid membrane, and in group 1 complex operation including fakoemulsifikatsiju with implantation IOL, reconstruction of the forward chamber and carrying out vitrektomii.

Operation was spent as follows.

In 3,5 mm from a limbus established two ports, through port at 10 o'clock connected vitreotom, through port at 11 o'clock - irrigational system. With the help vitreotoma 25G deleted forward departments of a vitreous. Vitreotom translated in an aspiration regimen (vacuum 420-450).

In the field of lens equator blasted a forward hyaloid membrane by it "podsasyvanija" to a handpiece vitreotoma so that between a back capsule of a lens and a handpiece vitreotoma there was a space of 1-2 mm. Vitreotom switched in a regimen vitrektomii and blasted a forward hyaloid membrane and forward departments of a vitreous, trying not to damage tsinnovu ligament and a back capsule of a lens. Thus the report between the back chamber and a vitreous cavity was formed. Vitreotom repeatedly translated in an aspiration regimen, and using an aspiration (vacuum 200-250), carried out the control. At adequate excision of a forward hyaloid membrane the intraocular liquid flowed off from the forward chamber. In case of need did additional vitrektomiju in area ekvatorov a lens. If effectively to check excision of a forward hyaloid membrane it was not represented possible because of small diameter of a pupil, used a polymeric iris-retractor. Having achieved unobstructed outflow

Liquids from the back chamber in a vitreous cavity. Skleralnye ports deleted, skleralnye and conjunctival cuts germetizirovali by means of a diathermocoagulation. Operation finished

Subconjunctival injection of Dexasonum (0,3 ml) and klaforana (0,2 ml).

As patients have entered into research with terms of observation more than 10 years in 2003-2006 it was carried out vitrektomija 20 G. Immediately port technique of operation began to be carried out also since 2006 Before handpieces for fakoemulsifikatsii entered through tunnels formed in a sclera.

2.3.2. The combined operation fakoemulsifikatsii cataracts with implantation IOL, reconstruction of the forward chamber and a lobby partial vitrektomiej with destruction of a forward hyaloid membrane

Under local anaesthesia and an intravenous premedication mikrokeratomom with an edge of 0,8 mm carried out at 2 o'clock corneal paratsentez. Through it into the forward chamber entered 0,1 ml of a phenylephine hydrochloride and 0,1 ml DisCoVisc for the purpose of an excavation of the forward chamber to necessary parametres. At 10 o'clock by means of corneal rasslaivatelja with an edge of 1,8 mm made a tunnel corneal cut. If necessary depth of the forward chamber enlarged additional introduction of solution DisCoVisc. If because of the vitreo-lenticular block effectively it was not possible to deepen the forward chamber carried out a lobby vitrektomiju, using vitraktor 25G which entered into a vitreous cavity through special port in 3,5 mm from a limbus. In the course of a lobby vitrektomii deleted 1 ml of a vitreous, achieving thereby a sufficient excavation of the forward chamber and ophthalmotonus depression. Skleralnyj port germetizirovali "zaglushkoj".

Through a corneal cut carried out continuous circular kapsuloreksis in diameter 5-6 mm with the help tsangovogo a forceps. In some cases before fakoemulsifikatsiej cataracts on a method fako-chop in
kapsulnuju a bag implanted vnutrikapsulnoe a ring of the corresponding size for the purpose of its additional stabilisation. After fakoemulsifikatsii cataracts kapsulnyj filled a bag with solution Provisc and through the corneal tunnel of 1,8 mm by means of an injector implanted IOL MI60 (Bausch &Lomb, the USA) or AcrySof Natural (Alcon, the USA). After implantation a lens aligned a spatula. Viskoelastik carefully deleted from under IOL, forward and back chambers with use of aspiratsionno-irrigational system. The forward chamber restored the balanced solution. In the presence of changes from an iris (the sectoral atrophy, the pupil deformation, a proof mydriasis) on it put in stitches on purpose to achieve rigidity intensifying iridohrustalikovoj a diaphragm, expansion of an angle of the forward chamber, the correct form and normal diameter of a pupil. Corneal cuts germetizirovali a hydration method, if necessary on a corneal tunnel cut imposed a noose suture 10-0, achieving full tightness of the forward chamber.

Further spent vitrektomiju and destruction of a forward hyaloid membrane on described in item 2.3.1. To a technique.

2.3.3. The combined preventive operation fakoemulsifikatsii cataracts, implantations IOL, a lobby partial vitrektomiej

The operation technique is stated in the chapter VI.

2.3.4. A substantiation of efficiency of surgical treatment

Substantiation of efficiency of surgical treatment 1 year in the postoperative period was spent on the basis of the analysis of following signs which were carried out in dooperatsionnom the period, and also for 3 days, 1 month, 6 months:

- The analysis of postoperative complications;

- Visual acuity change;

- The analysis of the central field of vision;

- Ophthalmotonus research;

- Change of depth of the forward chamber;

- Definition of an angle of the forward chamber;

- Quantity of the spent operative measures.

2.4.

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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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