RU2022541C1 - Ophthalmologic device - Google Patents

Abstract

FIELD: medical engineering; ophthalmologic devices used for removing foreign objects adhered to posterior region of eye. SUBSTANCE: device incorporates coaxially positioned tube and rod having working portion made in the form of grip including three flexible pseudo-lobes having cutting edges mutually overlapping one another at their bases. Rod is positioned for longitudinal movement inside tube partially closing gripping lobes in stowed position. EFFECT: more sophisticated design. 4 dwg

Description

 The invention relates to medicine, in particular to ophthalmic surgery, and is intended to remove intraocular foreign bodies fixed on a mooring in the posterior part of the eye.

 Known collet tweezers for removing intraocular foreign bodies, consisting of a coaxial tube and rod and a three-petal capture. After the diascleral approach of the forceps to the localization site of the intraocular foreign body, the surgeon presses the rod, the latter moves relative to the tube and advances a three-petal grip. Then the surgeon pushes the open grip on the foreign body and releases the rod. The petals are pulled into the tube and fix the foreign body, which is then removed transvitreal.

 A disadvantage of the known tweezers is the high invasiveness of the operation to remove foreign bodies fixed on a mooring in the posterior part of the eye. When trying to remove such a foreign body transvitreal, it pulls on the mooring, which often leads to retinal detachment. As a result, in some cases, the removal of fixed foreign bodies becomes generally impossible. In addition, during transvitreal removal, the trapped foreign body can escape from the tweezers through the space between the thin petals.

 The purpose of the invention is to reduce the morbidity and increase the efficiency of the operation by providing the possibility of cutting off and removing the moored foreign body.

 In FIG. 1 shows a pair of tweezers in a folded form, an incision; in FIG. 2 is a front view of an open tweezers knife; in FIG. 3 - the position of the tool when capturing a foreign body, fixed on a mooring in the back of the eye; in FIG. 4 - a forceps knife with a trapped foreign body.

 The tweezers knife consists of a coaxial tube 1 and a rod 2 with a handle 3, a three-leaf grip 4 (see figure 1). The capture is made in the form of three spoon-shaped petals of elastic alloy steel with sharpened edges around the perimeter.

 In ophthalmic surgery, there are often cases of penetrating eye injuries with the introduction of a foreign body 5 (see figure 3), which is enclosed in a connective tissue or fibrin capsule 6 and fixed in the posterior part of the eye on the mooring 7. In order to remove such a foreign body , it is necessary to cut the mooring, because otherwise, when trying to remove a foreign body, retinal detachment 8 or other side injuries of the organ of vision may occur.

 During the operation, the surgeon makes an incision 9 of the sclera 10 in the area opposite to the fixation site of the foreign body and inserts the tweezers-knife in the folded form (Fig. 1) when the grasp is in the tube. In this state, the tool is compact and does not require a large incision. When bringing the tip of the tweezers to a foreign body, the surgeon presses on the handle 3, holding on to the tube 1, as a result of which the rod 2 extends the three-petal grip 4. Under the action of elastic forces, the knife-blades 4 are moved apart (see figure 3). The surgeon pushes the grip on the foreign body and releases the rod 2. The knives 4 are closed and capture the foreign body 5 in the capsule 6, cutting it off with its sharp edges from the mooring 7 (see figure 4). In this case, the foreign body 5 is in an isolated volume of a three-petal capture and thus eliminates the loss of a foreign body from the capture in the process of transvitreal removal.

 PRI me R 1. Patient P., born in 1956, Moscow, a / c N 11467 was in the Institute of eye diseases named. Helmholtz from 05.03.90 to 12.03.90 with a diagnosis of OD (right eye) - a penetrating scar of the cornea, coloboma of the iris, intraocular foreign body. According to the patient, a penetrating wound with a metal fragment occurred at the production site on 01.30.89. Initial surgical treatment was performed at the place of residence after 5 hours without an attempt to remove a foreign body. In December 1989, laser coagulation was performed.

 Status upon receipt: VIS OD = 0.3 n / a, VIS OS = 1.0. OD - calm, penetrating scar of the cornea on the meridian of 6 hours. The anterior chamber is of medium depth, the moisture is clean. Iris coloboma on the meridian of 6 hours. Slight opacification of the posterior lens capsule. On the fundus for 4 hours, a foreign body is determined in the form of a piece of wire located on a mooring, one end of which is fixed to the retina.

 An X-ray examination determined the shadow of a foreign body in the right orbit in the form of a wire 4.0 × 0.3 mm between the meridians 9 hours 00 minutes – 3 hours 00 minutes at 16.0–20.0 mm from the plane of the limb and 1.0 mm to the temple , 3.0 mm to the nose from the anatomical axis. Size OD 26, mm. Conclusion: a foreign body is located in the vitreous, intrathecal.

 An ultrasound examination of the retinal detachment did not reveal, the foreign body is located accordingly x-ray localization.

 03/06/90 on OD, an operation was performed to remove a foreign body with tweezers-knife. The conjunctiva was cut under local anesthesia and it was separated from the sclera in the upper-outer quadrant, as well as a sclera cut 4 mm from the limbus. A tweezers knife with three cutting edges is inserted into the sclera incision, the foreign body is captured by tweezers under the control of ophthalmoscopy, the mooring is cut off by the cutting edges of the tweezers knife. Foreign body removed. Imposed nodal sutures on the sclera, a continuous suture on the conjunctiva. Antibiotic and dexazone are administered subconjunctively. The postoperative course is smooth. When extracting VIS OD = d0.3 n / a. The anterior chamber is of medium depth, the moisture is clean. The eye is calm. The fundus reflex is pink.

 PRI me R 2. Patient S., born in 1975, and / b N 2583, was in the Institute of eye diseases named. Helmholtz from 02/01/89 to 02/08/89 with a diagnosis of OS (left eye) - a penetrating scar of the cornea, an intraocular foreign body. According to the patient on 12/30/88, a detail was beaten off at a labor lesson, while a penetrating wound of the left eye occurred with the introduction of a fragment. The primary surgical treatment was performed on the same day with an unsuccessful attempt to remove a foreign body.

 Status upon admission: VIC OD = 1,0; VIC OS = 0.6-0.7. OS - penetrating scar of the cornea on the meridian of 9 hours. In the vitreous body - fixed opacities. On the fundus in the lower part, a foreign body is determined on the mooring, which is attached to the retina.

 An X-ray examination dated January 2, 89 determined in the left orbit the shadow of a foreign body measuring 1.5 x 1.0 x 1.0 mm, located between the meridians 6 hours 25 minutes - 6 hours 50 minutes 15.0-16.0 mm from the limb plane and 8 , 0-9.2 mm from the anatomical axis. OS size - 22.8 mm. Conclusion: the fragment is located in the vitreous body near the membrane.

 An ultrasound examination of the retinal detachment did not reveal, the foreign body is located accordingly x-ray localization.

 02.02.89 an operation was performed on the OS to remove a foreign body using a collet tweezers knife. Under local anesthesia, a conjunctival incision was made in the upper section and its separation from the sclera, a scleral incision. Under the control of ophthalmoscopy, a collet tweezers-knife is brought to the foreign body, the foreign body is cut off from the moorings, captured and removed from the eye. A suture was made on the sclera and a suture on the conjunctiva, dexazone and gentamicin were introduced subconjunctively. A monocular dressing was applied. At discharge, the visual acuity of the left eye was 0.8.

 Thus, the proposed tweezers knife can significantly reduce the invasiveness of the operation by eliminating the side detachment of the retina, and therefore, increase the efficiency of the operation and expand the indications for the removal of foreign bodies located in the posterior part of the eye.

Claims (1)

 OPHTHALMIC DEVICE containing a coaxially mounted tube and a rod with a working part in the form of a petal grip, characterized in that, in order to reduce trauma and increase efficiency by providing the ability to cut and remove a moored foreign body, the grip is made in the form of three elastic false-like petals with cutting edges installed with mutual overlapping of each other at their bases, while the rod is mounted with the possibility of longitudinal movement inside the tube, partially behind undermines capture petals in the closed position.

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