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According to the latest World Health Organization statistics, one person goes blind every minute as a result of glaucoma. It is possible to cure glaucoma with the help of drug and laser therapy only at the initial stage of development. In other cases, they will have absolutely no effect.
If the pathological process began to progress and intraocular pressure increased, then it is worth immediately performing a surgical operation. In such cases, ophthalmologists prescribe a sclerectomy. After the operation, you can notice how the intraocular pressure for a long time is at the lower limits, which are considered normal. In this case, you can safely say that your vision is safe.
What is the meaning of sclerectomy?
The best effect of sclerectomy is seen in patients with open-angle glaucoma. Doctors in almost all cases resort to this particular technique, since after it there are virtually no chances for the development of traditional trabeculectomy.
Why do such operations at all? Thus, ophthalmologists restore the natural fluid balance in the eye cavity. This, in turn, contributes to: normalization of intraocular pressure; creation of microcirculation favorable for the work of the optic nerves; elimination of the consequences of oxygen starvation in the eye tissues; improvement of nutrition and metabolism of nutrients in tissues.
The main advantage of this surgical intervention is that the restoration of the outflow of intraocular fluid from the eye cavity is carried out without violating the integrity of the trabecular apparatus.
The trabecular apparatus is the basis for the proper functioning of the eye. It is he who acts as a filter for eye moisture.
Possible complications after surgery
Such an operation as a sclerectomy is quite common, and very rarely after it, the patient has serious consequences. But there are always exceptions.
After this procedure, the patient may begin:
- microperforation of the trabeculae;
- hyphema;
- exfoliation of the vascular membranes;
- episcleral and conjunctival fibrosis.
To avoid such consequences, it is necessary to install a special drainage and prescribe cytostatic drugs.
If the hypotensive effect is insufficient, then the patient may again increase intraocular pressure.
How to prepare for the operation?
First of all, the ophthalmologist needs to accurately determine the location of the lesion; for this, gonioscopy is prescribed. The final choice of technique is to determine the form of glaucoma.
There is no special preparation for surgery. The patient is sent for traditional tests (general blood and urine tests) to exclude or confirm the presence of inflammatory processes in the human body.
Doctors should try to ensure that the patient goes to the operation in a normal mental state. For this, drug sleep is often used.
If, in addition to glaucoma, ophthalmologists also diagnosed chronic inflammatory diseases of the conjunctiva and eyelids, then it is important to first treat with antibacterial drugs. If there are no special indications, then antibiotics are not prescribed.
The principle of sclerectomy
As we have already said, the operation is prescribed when it is necessary to restore the natural balance of the intraocular fluid. The main indication for surgery is acute-angled glaucoma.
At the time of sclerectomy, specialists do not open the anterior chamber, and the fluid that forms in it passes through the trabecular apparatus. As a result of the removal of the outer walls, the permeability of the apparatus increases. The outer walls are removed near Schlemm’s canal and Descemet’s membrane is exposed. To normalize the ophthalmotonus, it is necessary to additionally release the limbal edges of the Descemet’s membrane. It is she who takes on the main outflow of eye fluid.
Unlike other procedures, sclerectomy does not break the thin layer of scleral fibers at the moment when ophthalmologists remove deep layers of sclera above the ciliary body. Also, during a sclerectomy, you can access the capillaries. In this case, doctors excise the deep part of the sclera and expose the ciliary body.
Very often, sclerectomy is performed simultaneously with the installation of collagen drainage. This is necessary in order to prevent the formation of scar tissue and not to provoke a second operation.
A greater effect from sclerectomy can be achieved if additional excimer and argon laser treatment is performed. This is necessary in order not to violate the integrity of the eyeball during the operation.
In technical terms, the operation is considered quite complicated. Therefore, ophthalmologists are still working to improve the technique. Thus, specialists will be able to simplify the technique of surgical intervention, stimulate uveoscleral outflow, prevent postoperative scarring of fluid outflow tracts, and, of course, as a prevention of a re-increase in intraocular pressure.
After surgery, the patient should be in bed for some time. The ophthalmologist prescribes special medications in the form of eye drops. Drug prophylaxis lasts a long time.
Sclerectomy is one of the few techniques that can quickly and painlessly get rid of glaucoma and restore normal intraocular pressure. Naturally, this will only be the case when the pathological process was diagnosed at an early stage, and an organic change in the drainage system or optic nerve fibers has not yet begun.
After the patient is already discharged home, he must regularly measure intraocular pressure. To do this, it is enough to make an appointment with an ophthalmologist. In addition to measuring pressure, the doctor will also conduct a preventive examination. This must be done at least once a month. Thus, you will be able to get rid of serious complications and prevent the re-development of the pathological process.