SYNDROME OF THE SMALL ANTERIOR CHAMBER — the complication which is developing more often in the postoperative period after nek-ry operations on an eyeglobe and characterized by the progressing reduction of space between a back surface of a cornea and a front surface of an iris, hypotension or hypertensia of an eyeglobe.
The syndrome of a small anterior chamber can be result of the cyclolenticular block (so-called malignant glaucoma), the relative pupillary block, tsiliokhorioidalny amotio.
Cyclolenticular block can develop both during execution of anti-glaucoma-toznykh of operations, and in the nosleope-ratsionny period at patients from closed-angle glaucoma (see). The block arises because of infringement of a crystalline lens in a crown of shoots of a ciliary body. At the same time the shoots of a ciliary body producing intraocular liquid (watery moisture, T.), appear behind a crystalline lens therefore intraocular liquid gets to zakhrustalikovy space and a vitreous that is followed by increase intraocular pressure (see). At the same time the cyclolenticular block amplifies in connection with the vitrealny block (increase in volume of a vitreous). In the postoperative period (see) the cyclolenticular block, as a rule, leads to total disappearance of an anterior chamber, swelling and bystry opacification crystalline lens (see) and to lack of a tendency to decrease in intraocular pressure. Purpose of midriatik, napr, solution of atropine, suction of a vitreous is led only to temporary insignificant deepening of an anterior chamber. Lech. tactics at the cyclolenticular block shall be directed to early removal of a crystalline lens (see the Cataract).
The relative pupillary block can develop in the postoperative period owing to difficulty of transition of intraocular liquid from the back camera in a lobby through a pupil or a peripheral coloboma of an iris (see. Coloboma ), made during operation. At the same time intraocular pressure, as a result of close contact of pupillary edge or edges of a peripheral coloboma of an iris with a front surface of a crystalline lens (after antiglaukomatozny operations) or with a front hyaloid membrane of a vitreous increases (after intrakap-sulyarny extraction of a cataract). These phenomena are often aggravated with filling of an anterior chamber with a sterile pressured air during the unwinding. Such dissociation of cameras conducts to the fact that intraocular liquid accumulates in the back camera and in space behind a crystalline lens. In process of a rassasyvaniye of air or a small amount of liquid the anterior chamber is narrowed therefore the iris and a crystalline lens are displaced forward, and at its absence — only an iris. At the prolonged pupillary block the space of an anterior chamber can disappear completely. As a result of it epithelial and endothelial dystrophy of a cornea, secondary glaucoma develops that can bring to to a blindness (see). The relative pupillary block takes place and at the cyclolenticular block.
Lech. actions at the relative pupillary block shall be directed to weakening of contact of pupillary edge of an iris with fabrics of a crystalline lens or a vitreous by instillations of midriatik with preferential impact on the dilator of an iris. At impossibility to expand a pupil because of the created back synechias also additional microsurgical is shown laser, and in some cases corectomy (see).
Educated at the same time peripheral coloboma of an iris allows to recover circulation of liquid from the back camera in a lobby and to normalize intraocular tension and to the hydrodynamics engineer of an eye (see) then the iris and a crystalline lens adopt the normal anatomic provision.
Tsiliokhorioidalny amotio develops after the band operations on an eyeglobe which are followed by outside filtering between seams (extraction of a cataract, through keratoplasties) or the strengthened filtering of intraocular liquid under a conjunctiva, formation of fistulas between ruptures of a conjunctiva and not adapted edges of a section of a conjunctiva after antiglauko-matozny operations. The outside or strengthened podkonjyunktival-ny filtering lead to deficit of intraocular liquid that is followed also by a fluid loss and a vitreous. In turn, reduction of volume of internal contents of an eye at a rigid sclera leads to emergence under it relative vacuum as the ciliary body and a choroid have no with a sclera of strong bonds and easily exfoliate from it. In this space through fenestra of vessels of a ciliary body there is a transudate and tsiliokhorioidalny amotio develops, edges increases in process of a fluid loss a vitreous and reduction of depth of an anterior chamber of an eyeglobe.
The most objective method of assessment of extent of development and regression of tsiliokhorioidalny amotio is the contactless and drop ultrasonic ekhografiya (see. Ultrasonic diagnosis, in ophthalmology ).
At tsiliokhorioidalny amotio hypotonia of an eyeglobe therefore the anterior chamber of an eyeglobe becomes more small develops and can even disappear completely. Contact of an iris with a back epithelium of a cornea as well as at the cyclolenticular block and the relative pupillary block, can lead to endothelial and epithelial dystrophy of a cornea, unions in a corner of an anterior chamber (an angle of iris, T.), to secondary increase in intraocular tension and finally — to a blindness.
At detection of outside filtering between seams after extraction of a cataract or after a through keratoplasty imposing of additional seams is necessary. During operation it is necessary to control tightness of a seam with the help flyuorestseinovy test (see) in the light of the cobalt filter of the lighter of an operative microscope. After antiglaukomatozny operations it is reasonable to cover a fistula in a conjunctiva with a silicone tape or a seal, fixing them by means of a supramidny seam to an episclera (to an episkleralny plate, T.) away from a filtrational pillow. Under control of flyuorestseinovy test resolve an issue of terms of a removal of sutures. It is at the same time reasonable to carry out the complex pathogenetic medicamentous therapy including subconjunctive injections of 10% of solution of caffeine, application from 0,1% solution of adrenaline, intake of Dicynonum (etamsylate), vasodilating drugs (Cavintonum, trental, Stugeronum).
In case of lack of positive effect from the specified actions the supratsiliarny sclerotomy with a preliminary corneal tangential puncture a knife needle is shown. It is reasonable to make the Supratsiliarny sclerotomy in a nizhnenaruzhny quadrant of an eyeglobe after a section of a conjunctiva and a tenonovy fascia (a vagina of an eyeglobe, T.) at distance of 4 — 5 mm from a limb. Do a through section of a sclera of one point, forming a rag in the form of a corner with the party of 1,5 — 2 mm. At completion of evacuation of subsklerny liquid the anterior chamber of an eyeglobe is recovered by administration of sterile isotonic solution of sodium chloride through a corneal puncture. On a conjunctiva and those-nonovu a fascia impose a continuous silk suture. Under a conjunctiva with the preventive purpose enter antibiotics and corticosteroids. Lech. tactics in the postoperative period same, as well as at other band operations on an eyeglobe (see. Postoperative period ).
Bibliography: Alekseev B. N. Tspklo-hrustalikovy the block at glaucoma, Vestie, oftalm., No. 3, page 32, 1972; Krasnov M. M. Microsurgery of glaucomas, M., 1974; Microsurgery of an eye, under the editorship of M. M. Krasnov, page 20, M., 1976; The Guide to eye surgery, under the editorship of M. L. Krasnov, page 200, M., 1976.
B. N. Alekseev.