From Big Medical Encyclopedia

TRABECULAS of EKTOMYYa (Latin trabecula, diminutive from trabs a beam, a crossbeam + Greek ektome excision, removal) — the operation consisting in excision of the site of a corneoscleral trabecula of an eyeglobe together with the shlemmo-vy channel, applied to treatment of glaucoma. T. — promezhutoch-

a share operation between fistulizi-ruyushchy (see Trepanation of a sclera) and pathogenetic about r iye nt and r about in and nn ym and m ik r about x ir at rg iches to them and and nt needles and at to about - matozny operations (see Glaucoma).

T. it is offered by Kearns (J. E. Cairns) in 1968. It is shown at an open angle glaucoma (see) at different stages of development and at various degree of a decompensation of intraocular pressure.

T. make under local anesthesia. In an upper part of an eyeglobe create a rag of a conjunctiva together with the tenonovy capsule (a vagina of an eyeglobe, T.) up to 8 mm wide, turned by the basis to a limb (fig. 1). Not through cuts of a sclera plan a P-shaped scleral rag at a limb of 4X4 mm in size. In this zone stratify a sclera on V2 of its thickness and otpreparovyvat to a transparent part of a limb. Cut out a strip of deep layers of a sclera of 1X3 mm in size from a bottom of educated thus scleral bed. Pigmentation of an inner surface of a remote scleral rag confirms existence of a shlemmov of the channel in it with a trabecula (a corneal and scleral part of a limb — see an Eye).

As a rule, make corectomy (see) then the scleral rag is reponirut and sew 3 — 6 seams. The conjunctival section is sewn up with a continuous suture. Through previously made puncture of a cornea at a limb enter air or sterile isotonic solution of sodium chloride into an anterior chamber. Under a conjunctiva inje-

Fig. 1. The diagrammatic representation of a drainage zone of an eye on a sagittal section of a front piece of an eyeglobe after a trabekulektomiya: 1 — an iris;

2 — a basal coloboma of an iris; 3 — a ciliary body; 4 — an outside scleral rag; 5 — a rag of a conjunctiva; 6 — a cornea; 7 — a zone of a trabekulektomiya; 8 — helmets the channel.

tsirut solutions of antibiotics (gentamycin, to caps of ii of a tspn, etc.).

Trabekuloektomiya in M. M. Krasnov's (fig. 2) modification consists in formation not of a rectangular,

but triangular rag of a sclera as such rag keeps within into place after the end of operation (enough 3 seams) better. The resection of deep layers of the filtering zone is made by means of special nippers — a vykusyvatel of a sclera (see fig. 27 in the table to St. Ophthalmologic tools, t. 18, Art. 170). It allows to receive defect of precisely given size and a form.

Possible complications during operation: a separation or eruption of a scleral rag at its uneven otpreparovka and thinning, bleeding from vessels of a root of an iris (ciliary edge, T.) after basal corectomy (see).

Fig. 2. The diagrammatic representation of a sector trabekulektomiya according to M. M. Krasnov: and — the scleral rag of triangular shape is found and will turn off on a cornea; make a trabekulektomiya by means of a spring vykusyvatel for a sclera, one of branches of which is entered in helmets the channel; — result of operation; the dotted line designated a zone of a trabekulektomiya.

The come-off scleral rag is sewn; at its eruption it is possible to put one-two stitches. It is better to tampon defect of a scleral rag a fibrinous clot of the patient. The bleeding vessel of a root of an iris is clamped the thin ends of branches of tweezers for several seconds or make thermocoagulation then bleeding, as a rule, stops. The most serious complication during operation and in the early postoperative period — the tsi-liokhorioidalny amotio which is followed by development of a syndrome of a small anterior chamber (see). In similar cases it is reasonable to make back trepanation of a sclera (see).

At an uncomplicated current of the postoperative period locally appoint desinfectants, mpdrpatik (see M idriatichesky means). corticosteroids (see); inside — inhibitors of synthesis it is simple and of l and N d and is new (and tse t and l with and l and c and l about in at yu

to - that, Butadionum, indometacin), the hyposensibilizing means (Dimedrol, Suprastinum, etc.). For the 2nd day after operation to the patient allow to rise; seams from a conjunctiva are removed in 2 weeks.

Bibliography: Krasnov M. M. Micro

surgery of glaucomas, page 126, M., 1974; The Guide to eye surgery, under the editorship of M. JI. Krasnova, page 174, M., 1976;

Cairns J. E. Trabeculectomy, Trans., ophthal. Soc. U. K., v. 88, p. 231, 1969; it, Trabeculectomy for chronic simple open-angle glaucoma, ibid., v. 89, p. 481, 1970. B. H. Alekseev.