- MeSH
- dospělí MeSH
- glaukom s uzavřeným úhlem * diagnóza etiologie MeSH
- iridektomie metody MeSH
- iris * abnormality diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
x
x
- Klíčová slova
- femtosekundový laser,
- MeSH
- corpus ciliare chirurgie MeSH
- extrakce katarakty MeSH
- iris chirurgie MeSH
- laserová chirurgie rohovky MeSH
- laserová terapie * metody přístrojové vybavení MeSH
- oftalmologické chirurgické výkony * klasifikace metody přístrojové vybavení MeSH
- optické jevy MeSH
- refrakční chirurgické výkony metody přístrojové vybavení MeSH
- retina chirurgie MeSH
- sklivec chirurgie MeSH
Introduction: Successful non-perforating trabeculectomy (NPT) results in filtration of aqueous humor out of the anterior chamber and into a filtration bleb, without surgical excision of tissue from the anterior chamber angle, and without penetration into the anterior chamber. The complications of perforating trabeculectomy, due to early postoperative hypotony (shallow anterior chamber, hyphema, macular folds, suprachoroidal effusion, and ciliochoroidal hemorrhage) (3, 4, 5, 6, 7, 8, 9) are regarded by many surgeons as significant risks. Nonperforating surgery has been reported to reduce the incidence of early hypotony-related complications (10), because it has the advantage of creating gradual filtration of aqueous humor, through a thin trabeculodescemetic membrane (TDM), which markedly reduces postoperative complications seen after a conventional trabeculectomy (11), and also has been reported to provide better long-term intraocular pressure (IOP) control (12, 13). NPT is reported to be a procedure with a significant learning curve, sometimes necessitating conversion to perforating trabeculectomy, and requiring careful postoperative monitoring (14, 15, 16, 17). Zimmerman et al. reported filtration of aqueous humor under a filtering bleb, by resecting the roof of Schlemm’s canal and removing corneal stroma overlying the trabecular meshwork (18) Mermoud et al. reported filtration of aqueous humor under a filtering, bleb by unroofing Schlemm’s canal and removing corneal stroma overlying the trabecular meshwork as well Descemet’s membrane (19); he found that resistance across the TDM sometimes increased with time. When this resistance to aqueous humor outflow occurred, Mermoud found TDM resistance could be eliminated by performance of goniopuncture (ab interno Nd:YAG laser membranotomy via gonioprism), to enhance aqueous humor outflow into the filtration bleb. Failure to filter adequately through the TDM is a potential complication following NPT which can result in a rise in intraocular pressure (IOP). In this paper we examine the effectiveness of adjunctive Nd:YAG laser goniopuncture (YGP) in patients who underwent NPT, to reduce post-operative IOP rise, secondary to scarring at or poor aqueous outflow through the TDM. Iris prolapse (IP) is another potential complication following NPT which can result in a rise in IOP. In this paper we examine the effectiveness of adjunctive argon laser peripheral iridoplasty (ALPI) in patients who underwent NPT, to reduce post-operative IOP rise, secondary to IP obstructing outflow across the TDM. Background: Nd:YAG laser goniopuncture consists of placing several laser shots on the undersurface of the trabeculodescemetic membrane. The result is a microperforation in this membrane, with flow of aqueous into the filtration bleb, which converts a non-perforating filtration procedure into a partial thickness filtration procedure. In this technique, several high power, multi-burst shots are applied, ab interno, by a Nd:YAG laser via a gonioprism, to the underside of the TDM, to facilitate aqueous outflow out from the anterior chamber. YGP can be effective when increased aqueous outflow is desired postoperatively. After this procedure, patent perforation in the TDM is usually observed gonioscopically, generally accompanied with reduction in IOP, and increase in bleb elevation (in height and in circumferential extent). Argon laser peripheral iridoplasty consists of placing several laser burns on the surface of the peripheral iris to contract the iris stroma, in a centripetal fashion, between the site of the burn and the anterior chamber angle. The result is iris stromal tissue contraction and compaction, movement of IP away from the angle and toward the pupil, which physically widens the angle and clears the synechial apposition of the peripheral iris against the TDM. In this technique, a series of low power, long duration, and large size burns is applied to the iris periphery to contract the iris stroma, to open the angle, and to clear IP causing synechial obstruction of the TDM after successful NPT. Used previously in acute angle closure glaucoma, ALPI may be effective in controlling IOP and clearing corneal edema when systemic and topical anti-glaucoma treatments fail to control high IOP, and when laser peripheral iridotomy (LPI) is not possible (e.g. in cases of severe corneal edema). Additionally, ALPI can be effective in permanently reopening the anterior chamber angle of iridectomized eyes with plateau iris syndrome; in this technique a full 360 degrees ring of spots is often applied, but a more limited area of treatment may also be effective. Technique: When a post-operative elevation in IOP was detected in a patient’s eye which had undergone NPT, careful indentation gonioscopy was performed to examine the TDM at the surgical site. If the peripheral iris was flat, the anterior chamber angle was open, and the TDM did not appear obstructed by IP, YGP was performed. First, the eyes were pre-treated with aproclonodine 1% and pilocarpine 2% (if needed to allow visualization of the TDM). Next, a Nd:YAG laser was set on triple burst mode and shots were applied to the underside of the TDM at the NPT site, using a Goldman 3-mirror lens in the following manner: Energy – 3–5 mJ; Mode – Triple burst. The power and amount of spots were titrated in order to achieve partial or microperforation of TDM at the NPT surgical site, thus resulting in restoration of aqueous outflow into the filtration bleb. When a post-operative elevation in IOP was detected in a patient’s eye which had undergone NPT and or YGP, careful indentation gonioscopy was performed to examine the TDM at the surgical site. If irreducible synechial IP were detected, which obstructed filtration through the TDM at the NPT surgical site, ALPI was performed. First, the eyes were pre-treated with aproclonodine 1% and pilocarpine 2%. Next, an argon laser was set on blue-green mode and shots were applied to the IP adherent to cornea or to the TDM at the NPT site, using a Goldman 3-mirror lens in the following manner: Spot Size – 500 mM; Duration – 0.5 s; Power – 200 to 400 mW. The power and amount of burns were titrated in order to achieve partial or complete centripetal retraction of the IP from the TDM at the NPT surgical site, causing a clearance of the obstruction to the TDM, thus resulting in restoration of aqueous outflow into the filtration bleb.
- MeSH
- časové faktory MeSH
- iris * chirurgie MeSH
- laserová terapie * MeSH
- lidé MeSH
- nitrooční tlak * MeSH
- oftalmologické chirurgické výkony * metody MeSH
- pooperační komplikace MeSH
- pooperační péče MeSH
- prolaps MeSH
- retrospektivní studie MeSH
- trabekulární síť MeSH
- trabekulektomie klasifikace metody MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
- MeSH
- časové faktory MeSH
- iris * chirurgie MeSH
- laserová terapie * MeSH
- lidé MeSH
- nitrooční tlak * MeSH
- oftalmologické chirurgické výkony * metody MeSH
- pooperační komplikace MeSH
- pooperační péče MeSH
- prolaps MeSH
- retrospektivní studie MeSH
- trabekulární síť MeSH
- trabekulektomie klasifikace metody MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
V práci je popísaný nový irigačný iris retraktor pre operácie kataraty v úzkej zrenici. Je modifikáciou irigačného násadca z bimanuálnej irigácie aspirácie, ktorý má na svojom konci umiestnený háčik gombíkovitého tvaru. Tento umožňuje odhrnutie okraja úzkej zrenice a vizualizáciu zbytkov kortexu v ekvatoriálnej oblasti kapsuly. Puzdro šošovky tak môže byť bezpečne vyčistené pri použití aspiračnej kanyly v chirurgovej druhej ruke.
I describe a new irrigating iris retractor for cataract surgery in small pupils. The retractor, a modified irrigating handpiece has a smooth button-like iris hook in the front. The hook is inserted into the margin of a small pupil and retract the pupil peripherally to allow visualisation of cortical remnant in the equatorial area of the lens capsule. The capsule can then be safely cleaned using the aspirating handpiece in the surgeon’s other hand.
- Klíčová slova
- Omnic 0.4, Omnic Tocas 0,4, Fokusin, Tamsulosin HCl Pliva 0,4 mg, Tamsulosini hydroch. Yamanouchi, Tamsucap 0,4 mg, Tanyz, Tamsulosin HCL Merck 0,4 mg, Tamsulosin HCL Kiron 0,4 mg, Urostad, Tamsulosin HCL-Teva 0,4 mg, Lannatam, Tamsulosin HCL Actavis 0,4 mg, Damurgin 0,4 mg tvrdé tobolky, Tamsulosin HCL Sandoz 0,4,
- MeSH
- hyperplazie prostaty farmakoterapie MeSH
- iris chirurgie účinky léků MeSH
- lidé MeSH
- sulfonamidy škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé MeSH
Cieľom tejto prospektívnej štúdie bolo zistiť efektívnosť laserovej periférnej iridoplastiky ako liečby prvej línie na zníženie vnútroočného tlaku (VOT) u akút- nych primárnych glaukómoch so zatvoreným uhlom (PGZU). Do štúdie bolo zahrnutých 12 pacientov s prvým záchvatom akútneho glaukómu, u ktorých bol VOT napriek minimálne 12 hodín trvajúcej konzervatívnej liečbe na hranici 5,32 kPa (40,0 mmHg) a vyšší. Pracovali sme s argónovým laserom firmy HGM typ E - 005. Laserové parametre boli, stopa - 300-500 um, čas - 0,2-0,5 s., intenzita - 300-500 mW. Laserové zásahy boli umiestňované do celého obvodu RDU v počte 50-60, za pomoci Goldmannovej trojbokej šošovky. U všetkých pacientov bol VOT meraný aplanačne tesne pred laserovou liečbou a 1 hodinu a 2 hodiny po ALPI. Priemerný VOT pred liečbou bol 6,88 ± 1,46 kPa (51,7 ± 11,04 mmHg). Priemerný VOT 1 hodinu po ALPI bol 2,77 ± 0,44 kPa (20,83 ± 3,31 mmHg), po 2 hodinách bol 2,39 ± 0,26 kPa (18,0 ± 2,0 mm Hg), čo bol 45,8 % pokles VOT. Po 2 hodinách mali všetci pacienti transparentné rohovky. Výsledky tejto štúdie potvrdzujú, že ALPI veľmi efektívne znižuje VOT a napomá- ha k rýchlej obnove transparencie rohovky u akútneho PGZU a k jeho definitív- nemu riešeniu laserovou iridotómiou.
Evaluation of Laser Peripheral Iridoplasty in the Treatment of Acute Angle-clo- sure Glaucoma The aim of this prospective study has been to evaluate effectivity of laser perip- heral iridoplasty (ALPI) as a first choice therapy for intraocular pressure (IOP) reduction in acute primary angle-closure glaucoma (PACG). The study included 12 patients with the first attack of acute glaucoma in whom IOP in spite of continuing medical therapy for 12 hours persisted at the level of 5,32 kPa (40,0 mmHg) and higher. We used Argon laser manufactured by HGM E-005. Laser parameters were: spot size 300-500 um, time 0,2 - 0,5 s, intenzity 300-500 mW. Laser burns were placed to the whole circumference of the iridocor- neal angle numbering 50 - 60 with the use of Goldmann contact lens. Applanation tonometry was used to measure IOP shortly before the laser therapy and 1 and 2 hours after ALPI. The mean IOP prior to treatment was 6,00 ± 1,46 kPa (51,7 ± 11,04 mmHg). The mean IOP 1 hour after ALPI was 2,77 ± 0,44 kPa (20,83 ± 3,31 mmHg) and after 2 hours 2,39 ± 0,26 kPa (18,0 ± 2,0 mmHg) which represents 45,8% reduction in IOP. Two hours after treatment all patients had transparent corneas. The results of this study confirm that ALPI effectively reduces IOP and enhances transparency of the cornea in acute PACG for the definitive treatment by laser iridotomy.
- MeSH
- glaukom s uzavřeným úhlem MeSH
- iris chirurgie MeSH
- laserová terapie metody MeSH
- lidé MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
