FIELD: medicine.
SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For a differentiated approach to the surgical treatment of closed-angle glaucoma (CAG) with a flat iris, perform phacoemulsification of the cataract, implantation of the IOL. To do this, perform intraoperative gonioscopy, which determines the subsequent differentiated approach to managing patients, depending on its results: in the presence of a closed angle of the anterior chamber (AAC) and the impossibility of visualizing its structures, endoscopic cyclophotocoagulation (ECPC) is performed in the region of the middle and posterior parts of the processes of the ciliary body. Then, repeated intraoperative gonioscopy is performed to evaluate the effectiveness of coagulation, when the AAC is not fully opened and the trabecular network is not visualized, goniosynechialysis is performed using a trabeculotome or scapula for at least 180 degrees in the same hourly meridians as the ECPC. When visualizing the Schlemm canal, an intraoperative evaluation of its functional state is performed: when blood is filled with the Schlemm channel and decompensation of IOP in the postoperative period, perform Yag laser activation of the trabeculae in the absence or weak pigmentation of the AAC structures or selective laser trabeculoplasty in the presence of pronounced pigmentation of the AAC structures. In the absence of blood filling of the Schlemm canal and decompensation of IOP in the postoperative period, microinvasive non-penetrating deep sclerectomy is performed.
EFFECT: method allows to open the AAC and restore the patency of the trabecular network, to eliminate the risks of developing acute attacks of glaucoma and to stabilize the course of the glaucoma process with CAG with a flat iris.
1 cl, 4 ex
