RU2109497C1 - Method to treat retinal detachment - Google Patents

Abstract

FIELD: medicine, ophthalmology. SUBSTANCE: method deals with applying a temporary blowing balloon as an oval body with a saddle-shaped hole at its terminal part, the former is introduced via developed tunnel of 6-10 mm width. For its fixation absorbable sutures are applied as two or four stitches at 10-18 mm against a limbus which are removed in 17-24 days. EFFECT: higher efficiency of therapy.

Description

 The invention relates to medicine, namely to ophthalmology, and relates to a surgical method for retinal detachment with tears in the posterior pole of the eye in the region of the macula and optic nerve.

 A known method of treatment with these forms of retinal detachment using extrascleral filling.

 The disadvantages of this method are the trauma, technical complexity and the danger of access to the posterior pole of the eyeball due to the need for sutures or chipping of the scleral pocket for immersion of the filling in the area of large vessels and the optic nerve in a narrow and deep, practically well-shaped surgical field. These manipulations are especially dangerous in case of myopic disease, characterized by anteroposterior extension of the eyeball, thinning of the sclera and the formation of staphyla of various sizes and severity. During the operation, there is a high risk of teething, dislocation of the seal, perforation of the sclera, hemorrhages in the lining of the eye, circulatory disorders in the vessels of the optic nerve, retina and choroid. Filling indentation forms a permanent or prolonged deformation of the posterior pole of the eye, leading to impaired function. Cryopexy, diathermic or laser coagulation in the macula area leads to its reduction. Technical difficulties and complicating moments lead to a lengthening of the operation and an increase in its morbidity.

 Closest to the proposed is a method of treating retinal detachments in the post-equatorial zone using a device for temporary extrasclerotic indentation of the membranes of the eye.

 The device includes a rigid tube, curved in an arc, equipped with a hole. An inflated balloon is placed in the tube channel. A rigid tube is connected to a flexible catheter. The device is inserted through the incision of the conjunctiva and tennon membrane into the retrobulbar space and is attached with a seam to the sclera for the peripheral part of the rigid tube. When the balloon is inflated, its part protruding through the opening of the rigid tube abuts against the sclera and presses it. A few days after the operation, the balloon is lowered and the device is removed.

 The disadvantages of the prototype is the use of a rigid tube of a sufficiently large diameter, which is traumatic for the eyeball and tissues of the orbit. The use of this device to block retinal breaks in the immediate vicinity of the optic nerve (macular and peripapillary regions) poses a great danger to the optic nerve due to its possible damage to the end part of the rigid tube. A long stay (several days) of a rigid and three-dimensional structure poses a threat to the formation of pressure sores of tissues in contact with a rigid tube, which will extremely complicate any kind of possible additional surgery on this eye.

 The purpose of the invention is to reduce the invasiveness of the operation, reduce intraoperative and field surgical complications during retinal detachment with tears in the posterior pole of the eye (in the macula and optic nerve).

 This goal is achieved by using a balloon having the shape of an oval body with a saddle-shaped recess in its end part for the zone of contact with the optic nerve. The balloon is introduced through the formed tunnel with a width of 6 - 10 mm, for its fixation, absorbable sutures are used in the form of two or four stitches 10-18 mm from the limb, and removed after 17-24 days.

 The method is as follows.

 After local anesthesia, the conjunctiva is incised 5-7 mm from the limbus in the meridian of the external rectus muscle and in the lower temporal quadrant. A spatula or spatula form a tunnel in the direction of the gap. Paramacularly 1-2 medium cryocoagulates are applied to the sclera. Gap blocking is carried out with extra-scleral inflatable balloons specially made of silicone or latex, when undressing, forming an oval elastic body with a saddle-shaped recess in the end part with a volume of up to 10 ml. The balloon is fixed by pressing the supporting catheter in the gap meridian with a U-shaped or four-stitch absorbable / catgut, collagen, vicryl (a suture through the sclera 10-18 mm from the limb, usually under the attachment point / or at the front edge) of the lower oblique muscle. The balloon is inflated with saline with an antibiotic to a volume of 2-7 ml. During the operation, the formation of an ophthalmoscopically visible indentation starting from the edge of the optic disc is achieved. After suturing the conjunctiva, the catheter is also fixed with the same suture. The state of visual functions is monitored during the operation. In the postoperative period, exophthalmos is typical and within 4-5 days chemosis in the lower arch is noticeable. The duration of the balloon is 17-24 days (average - 21 days).

 Example. Patient L., 52 years old. Diagnosis: extensive stale retinal detachment with a macular rupture in the right best eye with myopia of 30.0 diopters, myopic disease of each eye. For two years, in various medical institutions, each eye was operated on twice to strengthen the sclera.

 Visual acuity - 0.02 with sphere correction - 30.0 diopters to 0.1. Under local anesthesia with a 2% solution of novocaine, the conjunctiva was cut in the outer quadrant 7 mm from the limbus along the old surgical scars. Taken on the holders of the outer and lower rectus muscles. Bypassing the old scleral flaps, a tunnel (about 10 mm wide) was made to the posterior pole of the eye and moderate cryocoagulates were applied 3-4 mm from the projection of the macula. In the meridian of 8–9 hours, a balloon of silicone measuring 16 • 3.5 mm was drawn to the posterior pole of the eye (in the inflated state, it forms a saddle depression in the end part). The balloon is fixed to the sclera by hemming the catheter with a four-stitch catgut suture 10-16 mm from the limb. Using a syringe, the balloon is filled with sterile saline with antibiotic in a volume of 3.5 ml. An indentation of the pole of the eye was obtained with a macular rupture blocked by the end section of the balloon.

 The position of the balloon and the circulation in the vessels are monitored ophthalmoscopically. An assessment was made of the preservation of visual functions, a suture was made on the conjunctiva. The catheter is additionally fixed as the last suture.

 The very next day, the retina lay flat, a powerful balloon indentation was maintained, starting from the edge of the optic disc and capturing the macula. On the 13th day, 10 point laser coagulates were applied in the area of the upper and lower slopes of the indentation indentation. On the 17th and 19th days after the operation, taking into account the fit of the retina and closing (“blocking”) the gap, 1.5 and 1 ml of liquid (physiological saline) were phased out from the balloon, and on the 21st day the balloon was removed. The retina is adjacent. Visual acuity of the right eye is 0.02 with correction by a sphere of -20.0 diopters = 0.2 - 0.3.

 Compared with the known method of treating retinal detachment, the proposed method of treatment allows patients to achieve a higher level of visual acuity while reducing trauma and simplifying the method of operation. The method allows not to injure the optic nerve and blood vessels around it, there is no threat of perforation of the eye wall, especially likely in the area of the posterior staphile and sclera sources, as a result of which serious complications occur. Thanks to the proposed method, it was possible to make a smaller incision of the conjunctiva, it is not necessary to make incisions of the eyelids or their adhesions, to place stitches-holders on all muscles (and even more so to cross them), it is enough to fix only the lower and external rectus muscles, you do not need a forced eye turn, reliable exit to the affected area. Sutures fix the catheter carrying the balloon. Carrying out superficial scleral sutures is in an easily accessible area of the sclera.

 Retinopexy with effects on the sclera in the projection of the macula is not used. A sparing version of paramacular cryo- or laser coagulation with the conservation of the central departments (primarily the macula and optic nerve) of the fundus is used, independent closure (“soldering”) of the gap is achieved. After removing the balloon, the fundus relief is completely restored.

 This is ensured by the original technique for setting up the balloon and its shape with a recess for the optic nerve, covering the optic nerve (flow around it) and the reliability of fixation of the balloon.

Claims (1)

 A method of treating retinal detachment by pressing the sclera in the posterior pole of the eye using a temporary inflated balloon, characterized in that they use an oval-shaped balloon with a saddle-shaped recess in the end part, which is inserted through the formed tunnel with a width of 6-10 mm to fix it use absorbable sutures in the form of two or four stitches 10 to 18 mm from the limb, and remove after 17 to 24 days.