From Big Medical Encyclopedia

TREPANATION of the SCLERA (fr. trepanation, from Greek trypanon a drill, trepan) — the operation consisting in formation of a through hole in a sclera of an eyeglobe. Two ways of trepanation of a sclera are known: front (corneoscleral) and back.

Front trepanation of a sclera is offered in 1909 by Elliot (R. N of Elliot) as An-tiglaukomatoznoy of operation at an open angle glaucoma (see). Normalization of intraocular pressure after operation is reached thanks to outflow of intraocular liquid in subconjunctival space from where liquid is taken away on conjunctival and episkleralny vessels.

Preoperative medicamentous training of the patient includes purpose of sedative and dehydrational means. Operation is made under local anesthesia. In an upper part of an eyeglobe parallel to a limb create wide (to 8 mm) a rag of a conjunctiva with capture of the tenonovy capsule (a vagina of an eyeglobe, T.), to-ry otpreparovyvat to a transparent part of a limb (fig., a). In the field of a limb make a puncture of a cornea, superficially stratify a limb and on the prepared place put an acute edge of trepan with a diameter of 1,5 — 2 mm, having a little inclined its axis towards the center of a cornea (fig., b). Rotating trepan, try to obtain full excision of the discal site of fabric, a so-called corneoscleral disk. At removal of trepan the corneoscleral disk is pushed out from a trepanation opening by the moisture expiring from the camera; at the same time the root of an iris tampons a trepanation opening from within. For the purpose of reduction of pressure difference in chambers of the eye, a part of chamber moisture is previously released through a puncture of a cornea. To -

ren irises extend from a trepanation opening a little (fig., c) also carry out basal or full sector corectomy (See). On edges of a section of a conjunctiva and the tenonovy capsule impose a continuous tight silk suture (fig., d). Before -

Fig. Diagrammatic representation of the main stages of front corneoscleral trepanation of a sclera: and — in an upper part of an eyeglobe the conjunctival rag which is otseparovyvat to a limb is created; — by means of trepan excise a corneoscleral disk; in — in trepan-dionnoye an opening the root of an iris is removed (it is specified by an arrow); — the removed part of an iris is dissected away, on a conjunctiva the stitch is put (1 — a seam of a conjunctiva; 2 — the national ionic opening translucent through a conjunctiva of chatter in a sclera; 3 — a basal coloboma of an iris).

the neck the camera of an eyeglobe is recovered, filling through a puncture of a cornea with sterile isotonic solution of sodium chloride and partially air. Upon termination of operation in an eye instillirut 0,25% solution of hydrobromide chopped off amine, under a conjunctiva inject corticosteroids (a hydrocortisone, Prednisolonum, dexamethasone, etc.) and antibiotics (gentamycin, Kanamycinum, penicillin, etc.).

Maintaining patients after operation does not differ in essential features (see. The postoperative period, operations on an organ of sight).

As a postoperative complication the iritis can develop and pridotsiklit (see). Often there is an amotio of a choroid of an eye (see) which is shown a syndrome of a small anterior chamber (see). In the remote postoperative period penetration in an eye of an infection through a zone of trepanation is possible. In this case the purulent iridocyclitis or panoftal-Meath develops (see), to-rye can lead to full loss of sight.

In a crust, time use of front T. the page is limited because of quite large number of complications.

Back trepanation of a sclera is offered in 1915 by F. H. Verhoeff for a decompression of an eyeglobe at the developed expulsive hemorrhage (see the Hemorrhage ekspuljsiv-ny) for the purpose of creation of free outflow of blood from suprakhorioidalno-go (okolososudisty, T.) spaces, and also for evacuation of transudate at amotio of a choroid.

Century of G1. Filatov in 1936 suggested to apply back T. page as the auxiliary operation which is carried out before opening of a cavity of an eyeglobe, napr before extraction of a cataract, antiglaukomatoz-ny operations with the purpose of prevention of complications (an expulsive hemorrhage, amotio of a choroid).

Back T. pages, as a rule, carry out in a nizhnenaruzhny quadrant of an eyeglobe or in the place of the greatest accumulation of transudate. After a section of a conjunctiva together with the tenonovy capsule in 5 mm from a limb bare a sclera. Trepan to dia. 2 mm put on a sclera (in 4 — 5 mm from a limb at amotio of a choroid and in 8 — 10 mm prp an expulsive hemorrhage) and produce T. page. The forced removal of blood from suprakhorioidalny space at an expulsive hemorrhage is made by M. M. Krasnov (1959) technique by administration of air in an anterior chamber or a vitreous on condition of sealing of cuts in front department of an eye. Operation of back T. pages finish with imposing on a conjunctiva and a tenonova the capsule of a continuous suture.

T p e p and N about c and to l about d and and l and z — operation of back T. to page in combination with a cyclodialysis (see) — it is shown at an open angle glaucoma, and also at the glaucoma complicating extraction of a cataract (see the Aphakia); it allows to reduce a little before opening of an eye intraocular pressure and through trepan-tsponnoye an opening in a sclera to make a cyclodialysis. As a rule, operation is carried out in a verkhnenaruzhny quadrant. The Trenanatsponny opening is created in 4 — 5 mm from a limb. It is reasonable to make previously a puncture of a cornea at a limb for the purpose of the dosed extraction of intraocular liquid, decrease in intraocular pressure and use by the end of operation of this channel for recovery of an anterior chamber and washing away of a hyphema (see). The stitch on a corneal puncture is not put. Trepanotsiklo-d a cash from finish with imposing of a tight seam on a conjunctiva and a tenonova the capsule. Under a conjunctiva enter antibiotics.

Bibliography: Topical issues of diagnosis, clinic and treatment of glaucomas, under the editorship of,

A. M. Sazonova, etc., page 98, M., 1979;

Alekseev B. N., etc. Kofeino-terapiya according to M. Zh: To Krasnov in treatment of tsiliokhorioidalny amotio, Vestn., oftalm., No. 1, page 11, 1983; The Multivolume guide to eye diseases, under the editorship of,

B. N. Arkhangelsky, t. 5, page 132, M.,

1960; Management of eye surgery, sost. V. P. Odintsov and To. X. Eagles, t. 2, page 764, M. — JI., 1934;

Va A. F. Flush. Eye surgery, page 244, Kiev, 1959; Duke-Elder S. Fundamental concepts in glaucoma, Arch. Ophthal., v. 42, p. 538, 1949; Lehrbuch und Atlas der Augenheilkunde, hrsg. v. T. Axen-feld, S. 576, Jena, 1958; Verhoeff F.H. Scleral puncture for expulsive sub-choroidal hemorrhage following sclerostomy, Ophthal., Rec., v. 24, p. 55, 1915.

B. H. Alekseev.