Intraoperative extracorporeal Schlemm tube positioning method and application of intraoperative extracorporeal Schlemm tube positioning method in glaucoma operation

Abstract

The invention discloses an intraoperative extracorporeal Schlemm tube positioning method and application of the intraoperative extracorporeal Schlemm tube positioning method in a glaucoma surgery, and the intraoperative extracorporeal Schlemm tube positioning method comprises the steps that a conjunctival flap with a dome as a base is manufactured, a full-thickness bulbar conjunctiva is cut off along the corneal limbus radian through a conjunctival shear, and the cut-off length is 8 + / -2 mm; performing blunt separation by clinging to the sclera surface to form a rectangular sclera area; the method comprises the following steps: manufacturing a superficial sclera flap taking limbus corneae as a substrate, forwards sectioning a sclera to a transparent cornea area, placing a mitomycin cotton piece under the sclera flap, staying for 3 minutes, and flushing; a light ring and a shadow ring are observed to be formed on the whole corneal limbus by means of irradiation of the positioning optical fiber device, and lineation marking is carried out; carrying out 1mm * 2mm deep sclera flap sectioning in the direction from 1mm behind the marking line to the limbus corneae until the limbus corneae is transparent; in the sectioning process, 0.3 mm-0. 5 mm in front of the marking line is the rear edge of the outer path Schlemm tube, the outer wall of the outer path Schlemm tube can be opened by conducting conventional fine sectioning on the outer path Schlemm tube at the position, positioning is accurate, and the surgical success rate can be improved.

Description

Technical Field

[0001] The present invention relates to the technical field of intraocular surgical positioning methods, in particular to an intraoperative external Schlemm's canal positioning method, and also to the positioning method and its application in glaucoma surgery. Background Art

[0002] The external Schlemm's canal, also known as the scleral canal, is an important annular canal structure in the eye. It is located at the junction of the cornea and sclera (corneal limbus). It is a key part of the aqueous humor drainage system and has functions such as intraocular pressure regulation, aqueous humor circulation, aqueous humor drainage, corneal nutrition supply, and waste and metabolic product clearance. If functional disorders occur due to other surgeries or diseases (such as primary open-angle glaucoma), the drainage of aqueous humor will be blocked, resulting in increased intraocular pressure and easy damage to the optic nerve. The external Schlemm's canal needs to be opened, such as in anti-glaucoma filtration surgery, so that the aqueous humor can be discharged normally and smoothly, thereby restoring intraocular pressure to normal.

[0003] During external Schlemm's canal surgery, accurate positioning is a crucial factor in ensuring or improving the success rate. Currently, there is no quantitative or precise method for external Schlemm's canal positioning. Inexperienced novice surgeons, in particular, often fail to locate the Schlemm's canal during surgery or undergo premature penetration, forcing them to switch to other procedures. Studies have shown that the intraoperative penetration rate during non-penetrating deep sclerectomy by novice surgeons can be as high as 30% to 50%, which is directly and significantly related to the surgeon's unfamiliarity with the limbal anatomy and inaccurate Schlemm's canal positioning.

[0004] Ophthalmologist Mansour Armaly et al. have found that due to the hidden location of Schlemm's canals and the limitations of localization techniques, understanding of Schlemm's canals by beginners and researchers relies entirely on structural observations in tissue sections. Although advances in imaging technologies, such as various optical coherence tomography (OCT), ultra-blind microscopes (UBM), and two-photon confocal microscopy (2-photon confocal microscopy), have enabled non-invasive Schlemm's canal incision, imaging and measurement of Schlemm's canals in vivo will contribute to a deeper understanding of the dynamics of Schlemm's canals and their role in the pathogenesis of POAG (primary open-angle glaucoma). However, current methods for intraoperative Schlemm's canal localization are crude and often based on coincidence. Therefore, these methods still lack the ability to provide intuitive guidance for precise intraoperative localization of Schlemm's canal. Summary of the Invention

[0005] The technical problem to be solved by the present invention is to provide a method for positioning the Schlemm canal externally during surgery, which can accurately position the Schlemm canal and help improve the efficiency and success rate of the surgery.

[0006] To solve the above technical problems, the technical solution of the present invention is: a method for positioning the Schlemm canal via an external route during surgery, which is implemented under the conditions of traction and fixation of the corneal limbus and exposure of the eyeball, comprising the following steps: SP A-1 2. Make a conjunctival flap based on the fornix. Use conjunctival scissors to cut the entire bulbar conjunctiva along the curvature of the corneal limbus. The cutting length is 8±2mm. Blunt dissection was performed close to the scleral surface to expose a rectangular scleral area, and hemostasis was performed. SP A-2 2. Create a shallow scleral flap based on the corneal limbus, cut the sclera forward to the transparent cornea area, place a mitomycin pad under the scleral flap for 3 minutes, and then rinse thoroughly with normal saline; SP A-3 2. With the aid of a positioning fiber optic device, the light generated by the device is refracted and reflected in the cornea until a halo and a shadow ring are observed to be formed on the entire limbus and their positions are fixed. The halo is translucent and the shadow ring is opaque. The tissue boundary between the translucent and opaque areas is established as the sectioning baseline and marked; SP A-4 2. Perform a 1mm×2mm deep scleral flap from 1mm behind the marking line toward the corneal limbus until the transparent corneal limbus; during the cutting process, 0.3mm~0.5mm in front of the marking line is the posterior edge of the external Schlemm's canal. Perform conventional fine cutting of the external Schlemm's canal at this position to open the complete outer wall of the Schlemm's canal.

[0007] As a preferred technical solution, the size of the rectangular sclera area is 6 mm×6 mm.

[0008] As a preferred technical solution, the size of the superficial scleral flap is 4 mm×4 mm, and the thickness is 1 / 2 of the sclera thickness.

[0009] As an improvement to the above technical solution, the positioning optical fiber device includes a power conversion plug for connecting to the mains electricity, the power conversion plug is electrically connected to the optical fiber light source through a wire, and a power control switch is connected in series on the wire between the power conversion plug and the optical fiber light source, and a light-guiding optical fiber is detachably connected to the optical fiber light source for use with it.

[0010] The present invention also relates to an application of an intraoperative external Schlemm's canal positioning method in glaucoma surgery, comprising the following steps: SP B-1 , place the patient in supine position; Use povidone-iodine solution to disinfect the patient's eyelid margin and periocular skin. After the iodine solution dries naturally, lay a sterile drape. After laying the drape, apply a disposable surgical dressing and cover the surface of the eyelid and surrounding skin. Cut the dressing at the corresponding palpebral fissure area and place an eyelid speculum to open the eyelid. SP B-2 1. Use 4 ml of a mixture of lidocaine hydrochloride and levobupivacaine for retrobulbar anesthesia or general anesthesia; SP B-3 1. Disinfect the conjunctival sac with povidone-iodine solution for at least 90 seconds, then rinse the conjunctival sac with tobramycin diluted solution at least once and with normal saline at least twice, and use sutures to fix the corneal limbus with sutures to keep the eyeball exposed. SP B-4 2. Make a conjunctival flap based on the fornix. Use conjunctival scissors to cut the entire bulbar conjunctiva along the curvature of the corneal limbus. The cutting length is 8±2mm. Blunt dissection was performed close to the scleral surface to expose a 6 mm × 6 mm scleral area, and hemostasis was performed; SP B-5 A superficial scleral flap with the corneal limbus as the base was made, with a size of 4 mm × 4 mm and a thickness of 1 / 2 the thickness of the sclera. The flap was dissected forward to the transparent cornea area. A mitomycin pad was placed under the scleral flap for 3 minutes and then rinsed thoroughly with normal saline. SP B-6 2. With the aid of a positioning fiber optic device, the light generated by the device is refracted and reflected in the cornea until a halo and a shadow ring are observed to be formed on the entire limbus and their positions are fixed. The halo is translucent and the shadow ring is opaque. The tissue boundary between the translucent and opaque areas is established as the sectioning baseline and marked; SP B-7 2. A 1mm×2mm deep scleral flap is cut from 1mm behind the marking line toward the corneal limbus. The posterior edge of the external Schlemm canal is 0.3mm to 0.5mm in front of the marking line. SP B-8 During the dissection process, clamp the edge of the scleral flap and lift it upward, and gradually dissect forward to the transparent cornea area. At this position, perform conventional fine dissection of the external Schlemm's canal until the scleral bed gradually shows circularly arranged fibers. Then, continue to separate the iris restorer to both sides, and the outer wall of the external Schlemm's canal will be cut open, and the gray-brown inner wall of the external Schlemm's canal will be exposed. SP B-9 , remove the deep scleral flap and connect to the iTrack glaucoma surgery system; SP B-101. Use micro forceps to hold the microcatheter and insert it into the opening of the broken end on one side of the external Schlemm's canal. Slowly move it forward along the curvature of the corneal limbus, dimming the microscope light intermittently. Determine whether the microcatheter is moving in the lumen of the external Schlemm's canal based on the position of the flashing indicator light at the tip of the microcatheter until the microcatheter passes through the opening of the broken end on the other side of the external Schlemm's canal. Fix the suspension wire at the tip of the microcatheter and slowly retract the microcatheter. Use the retraction of the microcatheter to introduce the suspension wire into the external Schlemm's canal until the microcatheter is completely withdrawn from the external Schlemm's canal and the suspension wire is led out from the other end, thus achieving complete introduction of the suspension wire. Cut the suspension wire tied at the microcatheter and tie knots at both ends of the suspension wire that passes through the external Schlemm's canal. The tension of the suspension wire should be such that the inner wall of the external Schlemm's canal is observed to be concave inwards. SP B-11 1. Insert an anterior chamber maintainer at the limbal puncture site, avoid the suspension line with a 15° puncture knife, puncture the anterior chamber through the anterior edge of the Schlemm canal under the superficial scleral flap, and make a 1.0 mm long incision in the deep limbal tissue parallel to the limbus. Use microtrabecular scissors to cut radially forward from both ends of the incision, and then completely remove the deep corneal and scleral tissue of 1.0mm×0.5mm in size parallel to the corneal limbus; SP B-12 2. Use micro forceps to grasp the iris in the limbal incision, lift it up and pull it to both sides, and use micro scissors to make a wide-base peripheral iris excision parallel to the limbus. The excision range should be larger than the limbal incision range. Use an iris restorer to massage from the superficial scleral flap toward the pupil to restore the iris. The peripheral iris resection opening can be seen through the peripheral transparent cornea. Lift the superficial scleral flap and confirm again that the limbus excision site is unobstructed, i.e., there is no iris, ciliary body, or vitreous incarceration; SP B-13 , Use nylon thread to suture the scleral flap intermittently and relatively tightly, and tie the knot and bury the thread; Adjust the height of the perfusion bottle during the maintenance period so that the anterior chamber pressure is close to the normal intraocular pressure. Test the scleral flap permeability. It is appropriate to keep a small amount of leakage at the scleral flap. SP B-14 , Use nylon thread to continuously suture the conjunctival incision; The anterior chamber maintainer was removed, the puncture site was hydrated, the anterior chamber was deepened, and the filter pillow was raised; Cefuroxime 0.1 ml was injected intracamerally, and dexamethasone 2.5 mg was injected subconjunctivally; Remove the corneal limbus traction sutures, remove the eyelid speculum, apply levofloxacin eye drops in the conjunctival sac, apply tobramycin dexamethasone eye ointment, bandage the operated eye, and the operation is completed.

[0011] As an improvement to the above technical solution, in step SP B-13 During the test of scleral flap permeability, if excessive leakage is observed at the scleral flap, the scleral flap sutures need to be added and tested again until a small amount of leakage remains at the scleral flap.

[0012] Due to the adoption of the above technical solution, the present invention has the following beneficial effects: the external Schlemm's canal can be accurately positioned during surgery, thereby improving the success rate of Schlemm's canal-related surgeries. For example, when used in glaucoma surgery, it avoids problems related to filtering blebs, reduces surgical complications, significantly reduces the number of secondary surgeries, makes postoperative care relatively simple, reduces the number of follow-up visits for patients, and saves medical expenses. BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The following drawings are intended only to illustrate and explain the present invention, and are not intended to limit the scope of the present invention. Figure 1 This is a comparison chart of the current development trends of external Schlemm's canal surgery and related secondary surgeries; Figure 2 This is a schematic diagram of the positioning process in the case of poor blood return from an external Schlemm's tube according to an embodiment of the present invention; Figure 3 This is a schematic diagram of the positioning process in an embodiment of the present invention when blood return from an external Schlemm's tube is good; Figure 4 is a schematic structural diagram of an optical fiber positioning device according to an embodiment of the present invention; Figure 5 This is a schematic structural diagram of a fiber optic lamp light source and a light-guiding optical fiber according to an embodiment of the present invention; Figure 6 Schematic diagram of the process of applying the external Schlemm's canal positioning method in glaucoma surgery according to an embodiment of the present invention; In the figure: 1-power conversion plug; 2-fiber optic light source; 21-light source housing; 22-light source end cover; 23-LED lamp bead; 24-fixing bolt; 3-power control switch; 4-light-guiding optical fiber; 41-optical fiber core; 42-opaque light-shielding sleeve. DETAILED DESCRIPTION

[0014] The present invention will be further described below with reference to the accompanying drawings and examples. In the following detailed description, certain exemplary embodiments of the present invention are described by way of illustration only. It is understood that those skilled in the art will recognize that the described embodiments may be modified in various ways without departing from the spirit and scope of the present invention. Therefore, the drawings and description are illustrative in nature and are not intended to limit the scope of the claims.

[0015] Combine Figure 1 As shown, with the advancement of ophthalmic disease treatment technology, patients' recognition of external Schlemm's canal-related surgical techniques has further increased, and the number of patients admitted for treatment has shown an increasing trend year by year. Taking the glaucoma surgery that the applicant has been exposed to as an example, the number of surgeries performed through external Schlemm's canal has increased from only 15 cases in 2021 to nearly 400 cases by the end of 2024, and is still on a growing trend. Schlemm's canal-related surgery establishes internal drainage, thereby reducing the probability of related bleb complications and secondary surgery, namely secondary anti-glaucoma surgery (needle extraction). By improving the positioning of the external Schlemm's canal during surgery, it is more helpful to reduce the probability of related bleb complications and secondary surgery. Therefore, it is important to accurately position the external Schlemm's canal during surgery.

[0016] Combine Figure 2 As shown in the figure, the intraoperative external Schlemm canal positioning method is mainly used to achieve positioning during surgery when the external Schlemm canal has poor blood return. The positioning is accurate and helps to improve the success rate of Schlemm canal-related surgeries. It is performed under the conditions of traction and fixation of the corneal limbus and exposure of the eyeball, and specifically includes the following steps: SP A-1 2. Make a conjunctival flap based on the dome, that is, use conjunctival scissors to cut the entire layer of bulbar conjunctiva along the curvature of the corneal margin. The cutting length is about 8mm, and the length fluctuation does not exceed 2mm.

[0017] Blunt separation is performed close to the scleral surface to expose a rectangular scleral area, and hemostasis is performed by electrocoagulation or cauterization. The size of the rectangular scleral area is 6 mm×6 mm.

[0018] SP A-2 , make a shallow scleral flap with the corneal limbus as the base, cut the sclera forward to the transparent cornea area, place the mitomycin cotton pad under the scleral flap for 3 minutes, and then rinse it thoroughly with normal saline. The size of the shallow scleral flap is 4 mm × 4 mm, and the thickness is 1 / 2 of the sclera thickness, that is, Figure 2 See picture 2-1 in the figure.

[0019] SP A-3 , with the help of the positioning fiber optic device, the light generated by it is refracted and reflected in the cornea until a halo and a shadow ring are observed to be formed on the entire corneal limbus and their positions are fixed. The halo is translucent and the shadow ring is opaque. The tissue boundary between the translucent area and the opaque area is established as the section baseline. Figure 2 The blue double arrow in Figure 2-2 indicates the position and mark it with a line. Figure 2See pictures 2-3 in the image.

[0020] SP A-4 , a 1mm×2mm deep scleral flap is cut from 1mm behind the marking line toward the corneal limbus until it reaches the transparent corneal limbus; during the cutting process, 0.3mm to 0.5mm in front of the marking line (related to the axial length) is the posterior edge of the external Schlemm's canal. Conventional fine cutting of the external Schlemm's canal at this position can open the outer wall of the complete Schlemm's canal and achieve precise positioning of the Schlemm's canal (such as Figure 2 The red arrows in Figures 2-4 indicate the locations). Figure 2 As shown in Figure 2-4, the sectioning length in this step is positively correlated with the patient's axial length, so the sectioning length can be determined based on the axial length.

[0021] like Figure 3 As shown, this embodiment is also applicable to patients with good blood return in Schlemm tubes, that is, step SP is implemented according to the use requirements. A-1 Go to step SP A-2 However, when the positioning optical fiber device is used for corneal irradiation, the Schlemm's canal is in good blood return condition, and the Schlemm's canal can be visually seen. Figure 3 The yellow arrow in Figure 3-3 indicates the location, and then mark it with a line (i.e. Figure 3 In pictures 3-4, the blue arrow indicates the location of the Schlemm canal, and the red arrow indicates the baseline position) and complete step SP A-4 That’s it, positioning is simpler and more accurate.

[0022] like Figure 4 and Figure 5 As shown, in this embodiment, the positioning fiber optic device includes a power adapter plug 1 for connecting to the mains electricity. The power adapter plug 1 is electrically connected to a fiber optic light source 2 via a wire. A power control switch 3 is connected in series to the wire between the power adapter plug 1 and the fiber optic light source 2. A light guide fiber 4 is detachably connected to the fiber optic light source 2 for use. The power adapter plug 1 connects to the indoor power supply and converts the 220V mains electricity into a 12V DC voltage for the fiber optic light source 2. When powered on, the fiber optic light source 2 emits light and illuminates the end of the light guide fiber 4, which then directs the light to the intended location within the eye, facilitating observation of the surgical field and illuminating and positioning the Schlemm's canal.

[0023] The fiber optic light source 2 is a structure well known to those skilled in the art, specifically comprising a detachably assembled light source housing 21 and a light source end cap 22, wherein an LED lamp bead 23 is fixed within the light source housing 21. The light source housing 21 and the light source end cap 22 can be made of aluminum material and have a certain heat dissipation function so as to quickly diffuse the heat generated by the LED lamp bead 23 during operation to achieve cooling of the LED lamp bead 23. A light-transmitting mirror can also be provided at the end of the light source housing 21 and outside the LED lamp bead 23 to encapsulate and protect the LED lamp bead 23. The LED lamp bead 23 is electrically connected to the wires on the power control switch 3 so as to obtain an operating voltage through the cooperation of the wires with the power conversion plug 1. The light guide fiber 4 is plugged into the light source end cap 22, passes through the light source end cap 22, and is threadedly assembled to a fixing bolt 24 for tightening and fixing the light guide fiber 4. The light-guiding optical fiber 4 includes an optical fiber core 41 and an opaque light-shielding sleeve 42 covering the outside of the optical fiber core 41. The opaque light-shielding sleeve 42 can prevent light from diffusing outward, thereby ensuring that light can only diverge from the end of the optical fiber core 41 toward the eye during use, thereby ensuring the illumination intensity.

[0024] During use, the power conversion plug 1 is connected to the power socket in the operating room, the light guide fiber 4 is sterilized and then plugged into and assembled with the fiber optic light source 2, that is, the end of the light guide fiber 4 is plugged into the light source end cap 22, and the end is placed against the LED lamp bead 23 or the provided light-transmitting mirror, the power is turned on by the power control switch 3, and the LED lamp bead 23 starts to emit light after being energized, and the outer end of the light guide fiber 4 is moved to the irradiation position of the eye; after use, the power is cut off by the power control switch 3, the power conversion plug 1 is separated from the power socket in the operating room, the light guide fiber 4 is separated from the fiber optic light source 2, the power conversion plug 1, the power control switch 3 and the fiber optic light source 2 are stored, and the light guide fiber 4 is sterilized and stored. The light guide fiber 4 can be sterilized by plasma as a whole to achieve sterile use during surgery, and the entire positioning fiber optic device has a simple structure, is easy to use, and has easy-to-purchase accessories and low cost.

[0025] like Figure 6 As shown, the application of the intraoperative external Schlemm canal positioning method in glaucoma surgery utilizes the above-mentioned intraoperative external Schlemm canal positioning method, including the following steps: SP B-1 , place the patient in supine position; Use povidone-iodine solution to disinfect the patient's eyelid margin and skin around the eyes. After the iodine solution dries naturally, lay a sterile drape. After laying the drape, stick a disposable surgical dressing and cover it on the surface of the eyelid and surrounding skin. Cut the film at the corresponding palpebral fissure area and place an eyelid speculum to open the eyelid.

[0026] SP B-2 4 ml of a mixture of lidocaine hydrochloride and levobupivacaine is used for retrobulbar or general anesthesia. The specific anesthesia method should be determined based on a comprehensive assessment of the patient's age, physical condition, and health status. The mixing ratio of lidocaine hydrochloride and levobupivacaine is known to those skilled in the art and will not be described in detail here.

[0027] SP B-3 1. Disinfect the conjunctival sac with povidone-iodine solution for at least 90 seconds, then rinse the conjunctival sac with tobramycin diluted solution at least once and normal saline at least twice, use 7-0 absorbable sutures as sutures for traction and fixation of the corneal limbus and pull and fix it so that the eyeball is fully exposed to facilitate intraocular operations.

[0028] SP B-4 2. Make a conjunctival flap based on the dome, that is, use conjunctival scissors to cut the entire layer of bulbar conjunctiva along the curvature of the corneal margin. The cutting length is about 8mm, and the length fluctuation does not exceed 2mm.

[0029] Blunt dissection was performed close to the scleral surface to expose a 6 mm × 6 mm scleral area, and hemostasis was performed by electrocoagulation or cauterization.

[0030] SP B-5 , make a shallow scleral flap with the corneal limbus as the base, with a size of 4 mm × 4 mm and a thickness of 1 / 2 of the sclera thickness, cut the sclera forward to the transparent cornea area, place the mitomycin cotton pad under the scleral flap and leave it for 3 minutes, then rinse it thoroughly with normal saline. Figure 6 View A in .

[0031] SP B-6 , with the help of the positioning fiber optic device, the light generated by it is refracted and reflected in the cornea until a halo and a shadow ring are observed to be formed on the entire corneal limbus and their positions are fixed. The halo is translucent and the shadow ring is opaque. The tissue boundary between the translucent area and the opaque area is established as the section baseline and marked, such as Figure 6 View B in .

[0032] SP B-7 2. A 1mm×2mm deep scleral flap is cut from 1mm behind the marking line toward the corneal limbus. The posterior edge of the external Schlemm canal is 0.3mm to 0.5mm in front of the marking line. SPB-8 During the dissection process, clamp the edge of the scleral flap and lift it upwards. The depth of the flap should be such that only a small amount of fibers remain in the scleral bed and the gray-blue choroid can be seen. Then gradually dissect forward to the transparent cornea area. At this position, perform conventional fine dissection of the external Schlemm's canal until the scleral bed gradually shows circularly arranged fibers. Then continue to separate the iris restorer to both sides, and the outer wall of the external Schlemm's canal can be cut open, and the exposed gray-brown inner wall of the external Schlemm's canal can be seen. Figure 6 View C in .

[0033] SP B-9 , cut off the deep scleral flap, connect the iTrack glaucoma surgery system, and prepare to perform glaucoma surgery.

[0034] SP B-10 2. Use micro forceps to hold the microcatheter, insert it into the opening of the broken end on one side of the external Schlemm's canal, and slowly move it forward along the curvature of the corneal limbus. Intermittently dim the microscope light and judge whether it has been moving in the lumen of the external Schlemm's canal according to the position of the flashing indicator light at the head end of the microcatheter until the microcatheter passes through the opening of the broken end on the other side of the external Schlemm's canal. Figure 6 View D in .

[0035] Fix the suspension wire, such as a 10-0 double-strand imported suspension wire, at the head end of the microcatheter, slowly retract the microcatheter, and use the retraction of the microcatheter to introduce the suspension wire into the external Schlemm's canal until the microcatheter is completely withdrawn from the external Schlemm's canal. Synchronously lead the suspension wire out from the other end to achieve complete introduction of the suspension wire into the Schlemm's canal.

[0036] Cut the suspension wire tied at the microcatheter and tie knots at both ends of the suspension wire that passes through the external Schlemm's canal. The tension of the suspension wire should be such that the inner wall of the external Schlemm's canal is slightly concave. Figure 6 View E in.

[0037] SP B-11 , insert the anterior chamber maintainer at the limbal puncture site, use a 15° puncture knife to avoid the suspension line and puncture into the anterior chamber through the anterior edge of the Schlemm canal under the superficial scleral flap, and cut the deep limbal tissue parallel to the limbus to form a 1.0 mm long incision.

[0038] Use microtrabecular scissors to cut radially forward from both ends of the incision. If the peripheral iris is observed to bulge outward, use iris scissors to cut the iris, slowly release the aqueous humor in the posterior chamber, and then completely remove the deep corneal and scleral tissue of 1.0mm×0.5mm in size parallel to the corneal limbus. Figure 6 View F in .

[0039] SPB-12 2. Use micro forceps to grasp the iris in the limbal incision, gently lift it up and pull it slightly to both sides, and use micro scissors to make a wide-base peripheral iris excision parallel to the limbus. The excision range should be larger than the limbal incision range, such as Figure 6 View G in .

[0040] Use an iris restorer to gently massage from the superficial scleral flap toward the pupil to restore the iris. The peripheral iridotomy opening can be seen through the peripheral transparent cornea.

[0041] Lift the superficial scleral flap and confirm that the limbus excision site is unobstructed, that is, there is no iris, ciliary body or vitreous incarceration. SP B-13 , Use 10-0 nylon thread to suture the scleral flap intermittently and relatively tightly, and tie the thread and embed it, such as Figure 6 View H in.

[0042] Adjust the height of the perfusion bottle during the maintenance period so that the anterior chamber pressure is close to the normal intraocular pressure. Test the permeability of the scleral flap, and it is appropriate to retain a small amount of leakage at the scleral flap. When testing the permeability of the scleral flap, if excessive leakage is observed at the scleral flap, add scleral flap sutures and test again until a small amount of leakage is retained at the scleral flap.

[0043] SP B-14 , Use 10-0 nylon suture to continuously suture the conjunctival incision.

[0044] The anterior chamber maintainer was removed, the puncture site was hydrated, the anterior chamber was deepened, and the filter pillow was raised.

[0045] Cefuroxime 0.1 ml was injected into the anterior chamber and dexamethasone 2.5 mg was injected into the subconjunctiva.

[0046] Remove the corneal limbus traction sutures, remove the eyelid speculum, place levofloxacin eye drops in the conjunctival sac, apply tobramycin dexamethasone eye ointment, and bandage the operated eye. After the operation, conventional medications can be used for postoperative care.

[0047] After implementation, this embodiment has the following advantages: 1. Accurate positioning and high efficiency have significantly increased the number of patients who choose to undergo Schlemm canal-related surgery.

[0048] 2. Surgical complications are reduced and the number of secondary surgeries is significantly reduced.

[0049] 3. Postoperative care is relatively simple, which reduces the number of follow-up visits for patients, saves medical expenses, and improves patient satisfaction.

[0050] 4. The application of Schlemm tube positioning technology can significantly improve the success rate of surgery and shorten the surgical learning curve.

[0051] The description of the present invention has been presented for purposes of illustration and description and is not intended to be exhaustive or to limit the invention to the form disclosed. Many modifications and variations will be apparent to those skilled in the art. The embodiments were chosen and described in order to better illustrate the principles of the invention and its practical application and to enable those skilled in the art to understand the invention and design various embodiments with various modifications as are suited for specific applications.

Claims

1. The intraoperative external Schlemm canal positioning method is implemented under the conditions of pulling and fixing the corneal limbus and exposing the eyeball, characterized by: The following steps are involved: SP A-1 2. Make a conjunctival flap based on the fornix. Use conjunctival scissors to cut the entire bulbar conjunctiva along the curvature of the corneal limbus. The cutting length is 8±2mm. Blunt dissection was performed close to the scleral surface to expose a rectangular scleral area, and hemostasis was performed. SP A-2 2. Create a shallow scleral flap based on the corneal limbus, cut the sclera forward to the transparent cornea area, place a mitomycin pad under the scleral flap for 3 minutes, and then rinse thoroughly with normal saline; SP A-3 2. With the aid of a positioning fiber optic device, the light generated by the device is refracted and reflected in the cornea until a halo and a shadow ring are observed to be formed on the entire limbus and their positions are fixed. The halo is translucent and the shadow ring is opaque. The tissue boundary between the translucent and opaque areas is established as the sectioning baseline and marked; SP A-4 2. Perform a 1mm×2mm deep scleral flap from 1mm behind the marking line toward the corneal limbus until the transparent corneal limbus; during the cutting process, 0.3mm~0.5mm in front of the marking line is the posterior edge of the external Schlemm's canal. Perform conventional fine cutting of the external Schlemm's canal at this position to open the complete outer wall of the Schlemm's canal.

2. The method for locating the Schlemm's canal via an external approach during surgery according to claim 1, wherein: The size of the rectangular sclera area is 6 mm×6 mm.

3. The method for locating the Schlemm's canal via an external approach during surgery according to claim 2, wherein: The size of the superficial scleral flap is 4 mm×4 mm, and the thickness is 1 / 2 of the sclera thickness.

4. The method for locating the Schlemm's canal via an external approach during surgery according to claim 1, wherein: The positioning optical fiber device includes a power conversion plug for connecting to the mains power, the power conversion plug is electrically connected to the optical fiber light source through a wire, and a power control switch is connected in series on the wire between the power conversion plug and the optical fiber light source, and a light guide optical fiber is detachably connected to the optical fiber light source for use.

5. Application of the intraoperative external Schlemm canal positioning method in glaucoma surgery, characterized in that: The method for positioning the Schlemm's canal via an external route during surgery as claimed in claim 3 is utilized, comprising the following steps: SP B-1 , place the patient in supine position; Use povidone-iodine solution to disinfect the patient's eyelid margin and periocular skin. After the iodine solution dries naturally, lay a sterile drape. After laying the drape, apply a disposable surgical dressing and cover the surface of the eyelid and surrounding skin. Cut the dressing at the corresponding palpebral fissure area and place an eyelid speculum to open the eyelid. SP B-2 1. Use 4 ml of a mixture of lidocaine hydrochloride and levobupivacaine for retrobulbar anesthesia or general anesthesia; SP B-3 1. Disinfect the conjunctival sac with povidone-iodine solution for at least 90 seconds, then rinse the conjunctival sac with tobramycin diluted solution at least once and with normal saline at least twice, and use sutures to fix the corneal limbus with sutures to keep the eyeball exposed. SP B-4 2. Make a conjunctival flap based on the fornix. Use conjunctival scissors to cut the entire bulbar conjunctiva along the curvature of the corneal limbus. The cutting length is 8±2mm. Blunt dissection was performed close to the scleral surface to expose a 6 mm × 6 mm scleral area, and hemostasis was performed; SP B-5 A superficial scleral flap with the corneal limbus as the base was made, with a size of 4 mm × 4 mm and a thickness of 1 / 2 the thickness of the sclera. The flap was dissected forward to the transparent cornea area. A mitomycin pad was placed under the scleral flap for 3 minutes and then rinsed thoroughly with normal saline. SP B-6 2. With the aid of a positioning fiber optic device, the light generated by the device is refracted and reflected in the cornea until a halo and a shadow ring are observed to be formed on the entire limbus and their positions are fixed. The halo is translucent and the shadow ring is opaque. The tissue boundary between the translucent and opaque areas is established as the sectioning baseline and marked; SP B-7 2. A 1mm×2mm deep scleral flap is cut from 1mm behind the marking line toward the corneal limbus. The posterior edge of the external Schlemm canal is 0.3mm to 0.5mm in front of the marking line. SP B-8 During the dissection process, clamp the edge of the scleral flap and lift it upward, and gradually dissect forward to the transparent cornea area. At this position, perform conventional fine dissection of the external Schlemm's canal until the scleral bed gradually shows circularly arranged fibers. Then, continue to separate the iris restorer to both sides, and the outer wall of the external Schlemm's canal will be cut open, and the gray-brown inner wall of the external Schlemm's canal will be exposed. SP B-9 , cut the deep scleral flap and connect the iTrack glaucoma surgery system; SP B-10 1. Use micro forceps to hold the microcatheter and insert it into the opening of the broken end on one side of the external Schlemm's canal. Slowly move it forward along the curvature of the corneal limbus, dimming the microscope light intermittently. Determine whether the microcatheter is moving in the lumen of the external Schlemm's canal based on the position of the flashing indicator light at the tip of the microcatheter until the microcatheter passes through the opening of the broken end on the other side of the external Schlemm's canal. Fix the suspension wire at the tip of the microcatheter and slowly retract the microcatheter. Use the retraction of the microcatheter to introduce the suspension wire into the external Schlemm's canal until the microcatheter is completely withdrawn from the external Schlemm's canal and the suspension wire is led out from the other end, thus achieving complete introduction of the suspension wire. Cut the suspension wire tied at the microcatheter and tie knots at both ends of the suspension wire that passes through the external Schlemm's canal. The tension of the suspension wire should be such that the inner wall of the external Schlemm's canal is observed to be concave inwards. SP B-11 1. Insert an anterior chamber maintainer at the limbal puncture site, avoid the suspension line with a 15° puncture knife, puncture the anterior chamber through the anterior edge of the Schlemm canal under the superficial scleral flap, and make a 1.0 mm long incision in the deep limbal tissue parallel to the limbus. Use microtrabecular scissors to cut radially forward from both ends of the incision. When the peripheral iris is observed to bulge outward, use iris scissors to cut the iris, release the posterior chamber aqueous humor, and then completely remove the deep corneal and scleral tissue of 1.0 mm × 0.5 mm in size parallel to the corneal limbus. SP B-12 2. Use micro forceps to grasp the iris in the limbal incision, lift it up and pull it to both sides, and use micro scissors to make a wide-base peripheral iris excision parallel to the limbus. The excision range should be larger than the limbal incision range. Use an iris restorer to massage from the superficial scleral flap toward the pupil to restore the iris. The peripheral iris resection opening can be seen through the peripheral transparent cornea. Lift the superficial scleral flap and confirm again that the limbus excision site is unobstructed, i.e., there is no iris, ciliary body, or vitreous incarceration; SP B-13 , Use nylon thread to suture the scleral flap intermittently and relatively tightly, and tie the knot and bury the thread; Adjust the height of the perfusion bottle during the maintenance period so that the anterior chamber pressure is close to the normal intraocular pressure. Test the scleral flap permeability. It is appropriate to keep a small amount of leakage at the scleral flap. SP B-14 , Use nylon thread to continuously suture the conjunctival incision; The anterior chamber maintainer was removed, the puncture site was hydrated, the anterior chamber was deepened, and the filter pillow was raised; Cefuroxime 0.1 ml was injected intracamerally, and dexamethasone 2.5 mg was injected subconjunctivally; Remove the corneal limbus traction sutures, remove the eyelid speculum, apply levofloxacin eye drops in the conjunctival sac, apply tobramycin dexamethasone eye ointment, bandage the operated eye, and the operation is completed.

6. Use of the intraoperative external Schlemm's canal positioning method in glaucoma surgery according to claim 5, characterized in that: In step SP B-13 During the test of scleral flap permeability, if excessive leakage is observed at the scleral flap, the scleral flap sutures need to be added and tested again until a small amount of leakage remains at the scleral flap.

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