SINUSOTOMY

From Big Medical Encyclopedia

SINUSOTOMY (Latin sinus a cavity + Greek tome a section, a section) — opening of a shlemmov of the channel by a section of its outside wall for the purpose of decrease in intraocular pressure. Operation is developed in 1964 by M. M. Krasnov and is one of pathogenetic methods of microsurgical treatment of various forms glaucomas (see).

Fig. 1. The diagrammatic representation of the site of an eyeglobe in the field of a corner of an anterior chamber (on a section) after the made sinuyeotomiya: 1 — a conjunctiva; 2 — a cornea; 3 — the defect of a sclera formed after a resection of its site making an outside wall of a shlemmov of the channel; 4 — a sclera; 5 — a gleam of a shlemmov of the channel; 6 — a trabecular zone of a corner of an anterior chamber of an eyeglobe; 7 — an iris.

To page it is shown at glaucoma with an open corner of an anterior chamber of an eyeglobe (an angle of iris, T.) when hypertensia of an eye is caused by a delay of outflow of intraocular liquid (watery moisture, T.) on the intrascleral collector tubules connecting helmets the channel (a venous sine of a sclera, T.) with venous vessels of covers of an eyeglobe. Opening of a shlemmov of the channel (fig. 1) allows intraocular liquid to follow freely under conjunctiva (see), passing the struck intrascleral tubules of a frgltruyushchy zone of an eyeglobe. By data A. P. Nesterova, hypotensive effect of S. can be caused also by unblocking of a shlemmov of the channel at those forms of glaucoma when the gleam of the channel in whole or in part disappears as a result of its fall. At disturbance of passability of an internal wall of a shlemmov of the channel — in a so-called trabecular zone (a trabecular reticulum or a gear sheaf, T.) a corner of an anterior chamber of an eyeglobe — S. can also have a favorable effect at the expense of stretching of intertrabecular spaces.

Before operation it is reasonable to be convinced that the obstacle complicating outflow of intraocular liquid is in a zone of an outside wall of a shlemmov of the channel. It is indicated by the expressed internal pigmentation of a shlemmov of the channel, a zatrudnenrra of a retrograde blood flow in its gleam (e.g., at a compression of jugular or episkleralny veins), defined with the help gonioskopiya (see).

Fig. 2. The diagrammatic representation of a stage of a resection of the site of a sclera in the field of an outside wall of a shlemmov of the channel at a sinusotomy: and — a habit view of an eyeglobe; — a sagittal section of a front piece of an eyeglobe in the field of a corner of an anterior chamber; 1 — the rag of a conjunctiva (is unbent); 2 — the resected site of a sclera (in fig. and will delay tweezers, in fig. it is unbent in the direction specified by an arrow); 3 — a gleam of a shlemmov of the channel; 4 — a corner of an anterior chamber; 5 — an iris.

Opening of a shlemmov of the channel can be outside carried out in various ways. At the standard equipment (fig. 2) after formation wide (8 mm) a rag of a conjunctiva two not through cuts of a sclera between meridians of 10 hours 30 min. make and 13 hours are 30 min. old: one ahead from a projection of a shlemmov of the channel, the second behind. The strip of a sclera delimited thus with width apprx. 1 mm is deleted so that deep layers of a wall of an eyeglobe remained unimpaired. In the course of this resection the gleam of a shlemmov of the channel is opened that is the purpose of operation. If indications to S. were defined correctly, from a gleam of the opened shlemmov of the channel continuous outflow of intraocular liquid is observed. It demonstrates that its internal wall is rather passable. If the channel opened helmets is «dry», it is necessary to make a trabekulotomiya or a trabekulektomiya (see. Trabekulotomiya , Trabekulektomiya ). Damage of deep layers of a sclera with opening of an anterior chamber of an eyeglobe is an intraoperative complication though it, as a rule, does not conduct to serious consequences; in these cases it is necessary to make corectomy (see) through the damaged site of an internal wall of a shlemmov of the channel. At the end of operation the conjunctival rag is reponirut, and the section of a conjunctiva is carefully sewn up. A postoperative current, as a rule, very easy, local inflammatory reaction is insignificant or is absent.

With development eye microsurgery (see) steel technically more perfect options C are possible. With the help operative microscope (see) through a dot cut of a sclera in helmets the channel can be entered the special probe, on Krom cut the layers of a sclera making its outside wall.

The most important practical dignity of S., in addition to a pathogenetic orientation, is that it is made without opening of a cavity of an eyeglobe and thanks to it the risk of complications at this operation is very small. According to L. A. Malakhova, normalization of intraocular pressure after S. is observed in 83% of cases. At insufficient effect operation can be repeated repeatedly as an eye after it remains almost unimpaired. The page can be combined with other antiglaukomatozny operations (see. Glaucoma ), if also blockade of a corner of an anterior chamber of an eyeglobe is a root of an iris or goniosinekhiya the reason of increase in intraocular pressure.



Bibliography: Krasnov M. M. Microsurgery of glaucomas, M., 1980.


M. M. Krasnov.

Яндекс.Метрика