RU2805395C1 - Method for fixing an ophthalmic applicator during brachytherapy of intraocular tumors - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used in brachytherapy of intraocular tumours. To do this, the ophthalmic applicator is fixed by applying two nodal episcleral sutures to the fixing elements. Then, outside the eye, an inert material of a cylindrical shape with a diameter of 3-5 mm and a length equal to the diameter of the ophthalmic applicator is stitched with a continuous suture, leaving the ends of the thread free. The sutured inert material is placed between the ophthalmic applicator and the Tenon capsule in the centre of the ophthalmic applicator, parallel to the conditional line connecting the fixing elements. An episcleral filling or a donor sclera can be used as an inert material. After that, an ultrasonic B-scan is performed, during which the fit of the ophthalmic applicator to the sclera is controlled. In case of its tight fit, the conjunctiva is sutured with a continuous suture. If deviation of the ophthalmic applicator from the sclera surface is detected, the sutured material is advanced distally to the posterior pole of the eye until a snug fit of the ophthalmic applicator with the sclera is achieved according to B-scan data. After that, the conjunctiva is sutured with a continuous suture.

EFFECT: invention ensures achievement of a snug fit of the ophthalmic applicator to the sclera surface and, as a result, a uniform dose distribution along the entire length of the tumour.

2 cl, 2 ex

Description

The invention relates to the field of medicine, namely to ophthalmology, and can be used in the treatment of intraocular tumors.

Today, the standard method for brachytherapy of intraocular tumors is fixation of the ophthalmic applicator using two interrupted episcleral sutures. Considering the configuration of the eye, these sutures ensure tight fixation of the ophthalmic applicator to the sclera only in its proximal part (near the sutures), while the distal part of the ophthalmic applicator (facing the posterior pole of the eye) can deviate from the surface of the sclera, leading to uneven dose distribution and, as a result, , incomplete irradiation of the tumor (Almony A. et al. Tilting of radioactive plaques after initial accurate placement for treatment of uveal melanoma // Archives of ophthalmology. - 2008. - T. 126. - No. 1. - P. 65-70) .

The closest analogue is the method of fixing the ophthalmic applicator during brachytherapy of intraocular tumors, in which a “mattress” suture is applied around the ophthalmic applicator (Damato B. et al. Local tumor control after 106Ru brachytherapy of choroidal melanoma // International Journal of Radiation Oncology* Biology* Physics. - 2005. - Vol. 63. - No. 2. - P. 385-391).

The disadvantage of this method is that it causes additional trauma to the sclera due to the need to puncture the sclera closer to the posterior pole of the eye to apply a “mattress” suture; in addition, it is impossible to apply this suture when the tumor is localized in the central parts of the fundus of the eye (juxtapapillary , macular and paramacular localization).

The objective of the invention is to create a method for fixing an ophthalmic applicator during brachytherapy of intraocular tumors.

The technical result achieved by using the invention is the achievement of a tight fit of the ophthalmic applicator to the surface of the sclera and, as a result, uniform distribution of the dose over the entire length of the tumor.

The method is carried out as follows.

In a sterile ophthalmic operating room, after achieving maximum drug mydriasis and anesthesia of the eye, an incision is made in the conjunctiva and the Tenon capsule is separated from the sclera, after which the boundaries of the tumor are determined and marked diaphanoscopically.

Then, an ophthalmic applicator of a pre-selected size is fixed to the eye by applying two interrupted episcleral sutures to the fixing elements of the ophthalmic applicator, then an inert cylindrical material with a diameter of 3-5 mm and a length equal to the diameter of the ophthalmic applicator is stitched outside the eye with a continuous suture (Vicryl, 7-0), leaving free ends of the thread.

The stitched inert material is placed between the ophthalmic applicator and the Tenon capsule in the center of the ophthalmic applicator, parallel to the conventional line connecting the fixing elements. An episcleral filling or donor sclera can be used as an inert material.

After that, an ultrasound B-scan is performed, during which the fit of the ophthalmic applicator to the sclera is monitored. Then, if it fits tightly, the conjunctiva is sutured with a continuous running suture (Vicryl, 7-0).

If deviation of the ophthalmic applicator from the surface of the sclera is detected, the stitched material is advanced distally to the posterior pole of the eye until a tight fit of the ophthalmic applicator with the sclera is achieved according to B-scan data. After which the conjunctiva is sutured with a continuous suture.

After which, after the time required for irradiating the tumor according to the dosimetric calculation, the ophthalmic applicator is removed with preliminary removal of the material by traction on the ends of the thread.

There is a cause-and-effect relationship between the set of actions performed and the technical result.

Placing the inert material in the center of the ophthalmic applicator, parallel to the conventional line connecting the fixing elements, allows you to move it more distally to the posterior pole of the eye in case of incomplete adherence of the ophthalmic applicator to the sclera, and placing the inert material between the ophthalmic applicator and the Tenon capsule allows you to achieve a tight fit of the ophthalmic applicator to the surface of the sclera due to passive pressure of the tissues of the orbit and Tenon's capsule on the material, which presses the ophthalmic applicator and promotes its tight fit to the surface of the sclera, which makes it possible to achieve irradiation of the entire surface of the tumor and achieve its complete regression.

The invention is illustrated by the following examples.

Example 1.

The patient, 49 years old, noticed a gradual deterioration in the vision of the left eye 3 months ago, with the above complaints she contacted MNTK MG. Diagnosis: OS Choroidal melanoma T2N0M0.

Examination data: Visual acuity - 0.3 (0.5 with correction). Ophthalmoscopically, on the superotemporal side of the optic nerve head (OND), a prominent pigmented neoplasm of a round shape, with unclear boundaries, adjacent to the macula, without involving it, is determined. Ultrasound B-scan data revealed a prominent choroidal neoplasm with increased echogenicity measuring 3.4×14.2 mm.

After achieving maximum drug mydriasis and anesthesia of the eye, a conjunctival incision was made and Tenon's capsule was separated from the sclera, after which the tumor boundaries were determined and marked diaphanoscopically.

An ophthalmic applicator of a pre-selected size was fixed to the eye by applying two interrupted episcleral sutures to the fixing elements. Then, according to the invention, a donor sclera of a cylindrical shape with a diameter of 5 mm and a length equal to the diameter of the ophthalmic applicator is stitched outside the eye with a continuous suture (Vicryl, 7-0), the ends of the thread are left free. The stitched inert material is placed between the ophthalmic applicator and the Tenon capsule in the center of the ophthalmic applicator, parallel to the conventional line connecting the fixing elements.

An ultrasound B-scan was performed, according to which a deviation of the ophthalmic applicator was detected by 0.7 mm from the surface of the sclera, the stitched material was advanced distally to the posterior pole of the eye, according to a repeated B-scan, a tight fit of the ophthalmic applicator with the sclera was achieved. The conjunctiva is sutured with a continuous running suture (Vicryl, 7-0).

Two days later, according to the dosimetric calculation, the ophthalmic applicator was removed with preliminary removal of the material by traction on the ends of the thread.

After 4 months, a follow-up examination revealed complete regression of the tumor with the formation of a chorioretinal scar with residual slightly prominent pigmented tissue without signs of activity (according to B-scan data, the height of the residual prominence was 1.8 mm).

Example 2.

Patient, 1 year old. According to the mother, the tumor was discovered during a random examination by an ophthalmologist at her place of residence. Sent to MNTK MG for further examination and determination of further tactics.

Diagnosis: OD - Retinoblastoma, T1N0M0, group A.

Visual acuity - follows objects. Ophthalmoscopically, medially from the optic disc, one disc diameter away from it, there is a prominent whitish lesion with newly formed vessels on the surface measuring 3.5 disc diameters.

According to B-scan data: medially from the optic disc, a prominent lesion is height = 2.4 mm, length = 4.8 mm.

After achieving maximum drug mydriasis and anesthesia of the eye, a conjunctival incision was made and Tenon's capsule was separated from the sclera, after which the tumor boundaries were determined and marked diaphanoscopically.

An ophthalmic applicator of a pre-selected size was fixed to the eye by applying two interrupted episcleral sutures to the fixing elements. Then, according to the invention, a cylindrical episcleral filling with a diameter of 3 mm and a length equal to the diameter of the ophthalmic applicator is stitched outside the eye with a continuous suture (Vicryl, 7-0), the ends of the thread are left free.

The stitched inert material is placed between the ophthalmic applicator and the Tenon capsule in the center of the ophthalmic applicator, parallel to the conventional line connecting the fixing elements.

An ultrasound B-scan was performed, according to which a tight fit of the ophthalmic applicator with the sclera was achieved. The conjunctiva is sutured with a continuous running suture (Vicryl, 7-0).

After 26 hours, according to the dosimetric calculation, the ophthalmic applicator was removed with preliminary removal of the material by traction at the ends of the thread.

After 2 months, a follow-up examination revealed complete regression of the tumor with the formation of a zone of chorioretinal atrophy without signs of active tumor tissue.

Claims (2)

1. A method for fixing an ophthalmic applicator during brachytherapy of intraocular tumors, including its fixation by applying two interrupted episcleral sutures to the fixing elements of the ophthalmic applicator, characterized in that after applying interrupted episcleral sutures outside the eye, an inert cylindrical material with a diameter of 3-5 mm and a length is stitched with a continuous suture, equal to the diameter of the ophthalmic applicator, leaving the ends of the thread free; the stitched inert material is placed between the ophthalmic applicator and the Tenon capsule in the center of the ophthalmic applicator parallel to the conventional line connecting the fixing elements, after which, using ultrasound B-scanning, the fit of the ophthalmic applicator to the sclera is monitored and, if it fits tightly, the conjunctiva is sutured with a continuous continuous suture, and in If deviation of the ophthalmic applicator from the surface of the sclera is detected, the inert material is advanced distally to the posterior pole of the eye until a tight fit of the ophthalmic applicator with the sclera is achieved, after which the conjunctiva is sutured with a continuous continuous suture. 2. The method according to claim 1, characterized in that an episcleral filling or donor sclera can be used as an inert material.