TRABEKULOTOMIYa (Latin trabecula, diminutive from trabs a beam, a crossbeam + Greek tome a section, a section) — the operation consisting in a section of a trabecula of a corner of an anterior chamber of an eye, applied to improvement of outflow of intraocular liquid at glaucoma.
T. it is shown at an open angle glaucoma (see) with wide or average width a corner of an anterior chamber (an angle of iris, T.) eyeglobe and trabecular localization of defeat (trabecular form of glaucoma).
Indicator of functional safety of graduates of a shlemmov of the channel (venous sine of a sclera, T.) the possibility of retrograde filling with its blood is. It is reached by provocation of stagnation in episkleralny veins, napr, by means of a special gonioskop with a vacuum sucker for a perezhimaniye of episkleralny veins. Retrograde filling of a shlemmov of the channel with blood indicates the free message of its gleam with outside graduates and confirms trabecular defeat of a corner of an anterior chamber. T. it is necessary to make in a zone of retrograde filling of a shlemmov of the channel with blood; it provides free current of intraocular liquid through the formed crack in a trabecula and an internal wall of a shlemmov of the channel directly in the functioning graduates of its outside wall.
Fig. The diagrammatic representation of the main stages of a trabekulotomiya on a sagittal section of a front piece of an eyeglobe:
and — the leg of a trabekulotom is entered into a gleam of a shlemmov of the channel; — helmets the channel is opened, the leg of a trabekulotom is in an anterior chamber of an eye; 1 — the stratified zone of a sclera, 2 — an otseparovanny conjunctival rag, 3 — a cornea, 4 — an iris, 5 — a ciliary body, 6 — the leg of a trabekulotom is entered into a gleam of a shlemmov of the channel; the arrow designated the direction of the movement of a leg of a trabekulotom during the opening of a shlemmov of the channel.
T. make under the local anesthesia reached by a retrobulbar injection of 2% of solution of novocaine.
Operation is usually carried out under an operative microscope (see) at 15 — 20-fold increase. Create a conjunctival rag with the basis at a limb (fig). - Under it not through cuts of a sclera plan the P-shaped site size of 2x3 mm (the bigger size is the share of P.'s crossbeam, the free ends are turned to a limb). Within the planned site the sclera is stratified. At the bottom of the stratified zone open helmets the channel. On the course of the channel at first in one, then carry out the probe-trabekulotom on distance to other party approximately of V6 of a circle of a limb. Apply double trabe-kuloty, offered by Kharms (N. Harms, 1970); his second leg identical by the size and a form of a bend of the first, is located outside. Rotary motions towards a pupil break off an internal wall of a shlemmov of the channel together with a trabecula; often at the same time in an anterior chamber of an eye there is a little blood that is a positive predictive sign. The anterior chamber is recovered administration in it of air or sterile isotonic solution of sodium chloride. The scleral rag is stacked on the place and sewn noose sutures, then put a continuous suture on a conjunctiva. For prevention of amotio of a descemete cover (a back boundary plate of a cornea.
T.) air into an anterior chamber is entered not via the channel opened helmets, and through previously made puncture of a cornea.
A current of the postoperative period and events held at this time do not differ from those after other antiglaukomatoz-ny operations (see. The postoperative period, operations on an organ of sight). In the postoperative period gonnoskopichesky control is obligatory (see Gonioskopiya).
A complication during the performance of T. there can be an amotio of a descemete cover promoting edematization of a cornea and deterioration in sight. For its elimination use the following method: through microincision of a cornea let out the air or liquid which served as the reason of amotio; out of a zone of amotio of a descemete cover through a tangential puncture of a cornea recover an anterior chamber of an eye administration of isotonic solution of sodium chloride or air which press a destsemetova a cover to a stroma (to own substance, T.) corneas. Next day the cornea becomes transparent.
Exclusively seldom after operation tsiliokhorioidal-ny amotio develops (see the Syndrome of a small anterior chamber).
Efficiency of operation depends on safety of the gaping crack in an internal wall of a shlemmov of the channel and a trabecula. At education in this area of a fibrinous clot and its bystry organization there is a tamponade of a crack in a sine and a trabecula that results in unsatisfactory result of operation. In such cases carry out enzymotherapy (see Enzymes).
T. it can be executed repeatedly since it is a little traumatic for a gl for.
Bibliography: Krasnov M. M. Micro
surgery of glaucomas, page 104, M., 1974; The Guide to eye surgery, under the editorship of M. L. Krasnov, page 184, M., 1976; And
1 - 1 e n L. and. In u r i a n H. M of Trabeculotomy ab externo, A new glaucoma operation, technique and results of experimental surgery, Amer. J. Ophthal., v. 53, p. 19, 1962; Burian H. M. A case of Marfan’s syndrome with bilateral glaucoma, With description of a new type of operation for developmental glaucoma (trabeculotomy ab externo), ibid., v. 50, p. 1187, 1960;
Harms H. u. Dannheim R. Erfahrungen mit der Trabekulotomia ab externo beim angeborenen Glaukom, Ber. dtsch. ophthal. Ges., Bd 69, S. 272, 1969.
B. H. Alekseev.