METHOD FOR TREATING ADVANCED PRIMARY ANGLE-CLOSURE GLAUCOMA WITH CATARACT

Abstract

A method for treating advanced primary angle-closure glaucoma (PACG) with cataract includes the steps of: S1, utilizing phacoemulsification cataract extraction combined with intraocular lens implantation (PEI) to remove pupillary block and shallow anterior chamber and reduce a risk of progressive formation of peripheral anterior synechia (PAS); S2, utilizing goinosynchialysis (GSL) to separate the physical adhesion of PAS in the anterior chamber angle with the assistance of a gonioscope and a chopper; and S3, utilizing goniotomy (GT) to incise a dysfunctional trabecular meshwork and a Schlemm canal, so as to remove a dysfunctional trabecular meshwork, enhance outflow of aqueous humor, and reduce intraocular pressure.

Claims

1. A method for treating advanced PACG with cataract, comprising steps of: S1, utilizing phacoemulsification cataract extraction combined with intraocular lens implantation, so as to remove pupillary block and shallow anterior chamber, and reduce a risk of progressive formation of peripheral anterior synechia; S2, utilizing goniosynechialysis to separate anterior chamber angle, with the assistance of a gonioscope and a chopper, so as to remove physical adhesion of the anterior chamber angle; and S3, utilizing goniotomy to incise a diseased trabecular meshwork and Schlemm canal, so as to remove the trabecular meshwork with function loss, enhance outflow of aqueous humor, and reduce intraocular pressure.

2. The method according to claim 1, wherein step S1 comprises steps of: S11, carrying out conventional disinfection and surface anesthesia on a surgical eye; S12, using an eye speculum to open eyelids, making a main corneal incision with a length of 1.8-3.2 mm at an upper or temporal quadrant and making a side port cornea incision in a direction with 90° formed between same and the main corneal incision; S13, injecting a viscoelastic substance into an anterior chamber; S14, carrying out continuous curvilinear capsularhexis for an area of 5.5 mm*5.5 mm, and using a balanced salt solution to carry out hydrodissection and phacoemulsification to suck out a nucleus lentis; S15, sucking, by irrigation and aspiration, residual cortex lentis; and S16, implanting a posterior chamber intraocular lens.

3. The method according to claim 1, wherein step S2 comprises steps of: S21, injecting a viscoelastic substance into an anterior chamber, and coating a surface of a cornea with the viscoelastic substance; and S22, using a chopper with the assistance of the gonioscope, inserting a contralateral anterior chamber angle from the main incision and slightly pressing the root of an iris, so as to separate the adhesive anterior chamber angle by 120° until a lower ⅔ functional trabecular meshwork and a scleral spur are seen.

4. The method according to claim 3, wherein in the step of S22, a head position of a patient and an inclination angle of a surgical microscope are adjusted to clearly and directly view an anterior chamber angle structure under the gonioscope.

5. The method according to claim 1, wherein S3 comprises steps of: S31, inserting a microhook or microblade for goniotomy into the trabecular meshwork and entering the Schlemm canal to incise an inner wall of the Schlemm canal by 120°; S32, carrying out, by irrigation and aspiration, suction to remove a viscoelastic substance and possible hyphema in an anterior chamber; and S33, forming an anterior chamber from a balanced salt solution, and suturing a cornea incision in a watertight manner.

6. The method according to claim 1, wherein a main incision is sutured with a 10-0 nylon suture optionally after step S3 is carried out.

7. The method according to claim 1, further comprising step S4, utilizing an eye pad to bind a surgical eye with tobramycin and dexamethasone ophthalmic ointment, and 1% pilocarpine ophthalmic ointment.

Description

DETAILED DESCRIPTION

[0040] The embodiment discloses a method for treating advanced PACG with cataract. The method includes the steps of:

[0041] S1, utilize phacoemulsification cataract extraction combined with intraocular lens implantation (PEI).

The step of S1 specifically includes:

[0042] S11, carrying out conventional disinfection and surface anesthesia on a surgical eye;

[0043] S12, using an eye speculum to open eyelids, making a main corneal incision with a length of 1.8-3.2 mm at the upper or temporal quadrant and make side port cornea incision in a direction with 90° relative to the main incision;

[0044] S13, injecting a viscoelastic substance into an anterior chamber;

[0045] S14, carrying out continuous curvilinear capsularhexis for an area of about 5.5 mm*5.5 mm, and using a balanced salt solution to carry out hydrodissection and phacoemulsification to suck out a nucleus lentis, where epinephrine may be added into the balanced salt solution as required;

[0046] S15, sucking, by irrigation and aspiration, residual cortex lentis; and

[0047] S16, implanting a posterior chamber intraocular lens.

[0048] S2, utilizing goinosynchialysis (GSL) to separate the PAS with the assistance of a gonioscope and a chopper. The step of S2 specifically includes:

[0049] S21, injecting a viscoelastic substance into an anterior chamber, and coating a surface of a cornea with the viscoelastic substance; and

[0050] S22, adjusting a head position of a patient and an inclination angle of a surgical microscope with the assistance of the gonioscope, so as to clearly and directly view an anterior chamber angle structure under the gonioscope; and the chopper inserting a contralateral anterior chamber angle from the main incision and slightly pressing a root of an iris, so as to separate the PAS in the adhesive anterior chamber angle by 120° until a lower ⅔ functional trabecular meshwork and a scleral spur are seen.

[0051] S3, utilizing Goniotomy (GT) to incise dysfunctional trabecular meshwork and a Schlemm canal. The step of S3 specifically includes:

[0052] S31, inserting the microhook or microblade for goniotomy into the trabecular meshwork and inserting the Schlemm canal to incise the inner wall of the Schlemm canal by about 120°;

[0053] S32, carrying out, by irrigation and aspiration, suction to remove the viscoelastic substance and possible hyphema in an anterior chamber; and

[0054] S33, forming an anterior chamber from a balanced salt solution, and suturing the cornea incision in a watertight manner, where epinephrine may be added into the balanced salt solution as required.

[0055] In necessity, the main incision may be sutured with a 10-0 nylon suture optionally. Finally, an eye pad is utilized to bind the surgical eye with tobramycin and dexamethasone ophthalmic ointment, and 1% pilocarpine ophthalmic ointment.

[0056] In step of S1, the PEI mainly solves the problems of pupillary block and shallow anterior chamber of the PACG with cataract. Specifically, by means of PEI, the anterior chamber is deepened to enhance outflow of the trabecular meshwork, so that the risk of formation of the progressive PAS is reduced, thereby achieving the purpose of reducing resistance to outflow of the aqueous humor.

[0057] In step of S2, the GSL mainly solves the problem of adhesion of the anterior chamber angle of the PACG. Specifically, the progressive PAS finally causes closure of the anterior chamber angle and increased intraocular pressure, resulting in irreversible optic nerve damage. The GSL with the assistance of the gonioscope and the chopper may effectively remove physical adhesion of the anterior chamber angle, and the GSL is carried out with the assistance of the gonioscope and a chopper, thereby mechanically separating and opening the anterior chamber angle anew. If a function of a separated exposed trabecula is intact and an outflow passage behind the trabecula is kept perfectly, the outflow resistance of the aqueous humor may be further reduced.

[0058] In step of S3, the GT mainly solves the problem that lesion of the trabecular meshwork and the Schlemm canal obstructs outflow of aqueous humor in the PACG. Specifically, there are also pathological changes in the trabecular meshwork and the Schlemm canal of the PACG, for example, early progressive trabecular fibrosis of the PACG, narrowing or disappearance of a trabecular meshwork, the decreased number of endothelial cells, and pigment particles contained in part of endothelial cell cytoplasm; and obstruction of outflow of the aqueous humor caused by fibrotic degeneration of most of advanced trabeculae, pigmentation, disappearance of a mesh structure and narrow or occluded Schlemm canal. The GT with the assistance of the gonioscope and the microhook or microblade for goniotomy may incise the lesion trabecular meshwork and Schlemm canal tissue. By means of the GT, the dysfunctional trabecular meshwork loss is removed, and the Schlemm canal is opened to enhance outflow of the aqueous humor, thereby further reducing the outflow resistance of the aqueous humor, further increasing drainage of the aqueous humor through an internal passage, and finally achieving the purposes of reducing intraocular pressure and treating the PACG.

[0059] Obviously, the above embodiment is merely an example given for clearly illustrating the technical solution of the present invention, and is not intended to limit the specific embodiment of the present invention. Any modifications, equivalent replacements, improvements, etc. made within the spirit and principle of claims of the present invention should all fall within the scope of protection of claims of the present invention.