RU2116773C1 - Device for performing scleroplastic operations in cases of amotio retinae - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has two parts one of which is carbon fiber reinforced plastic contact plate fixable on sclera and the second one is carbon fiber felt washer placed between sclera and the contact plate. Contact plate size in longitudinal direction is greater than that of the washer in lateral direction. The washer projects beyond the contact plate boundary in lateral direction. The contact plate has various shapes: arc- shaped, T-shaped or irregular form depending on location and size retina rupture zone. EFFECT: stable in volume, local controlled impression conditions. 4 cl, 4 dwg

Description

 The invention relates to ophthalmology, namely to ophthalmic surgery, and is intended for scleroplastic surgery for retinal detachment. Surgical treatment of retinal detachments is aimed at detecting rupture (s) and their blocking.

 Today, there are various methods of extra-, intrascleral and intraocular techniques. Most often, silicone implants are used for the treatment of retinal detachment (silicone tape, sponge of various sizes, as well as monolithic and spongy silicone fillings. Guide to under-eye surgery. / Ed. By M. Krasnov, V. S. Belyaev. - M., 1988). The method of local depression is carried out after the localization of the gap (s) with extrascleral fixation of the seal and the creation of the shaft of the indentation in this area. In this case, the indentation shaft should protrude 2 - 3 mm beyond the edges of the gap and be behind its rear edge. Seals can be located in the radial and circular direction.

 The closest analogue of the invention is a silicone seal, which is made in the form of a contact plate with fixation zones (Guide to eye surgery. / Under the editorship of ML Krasnov, V. S. Belyaev. - M., 1988).

 The disadvantage of this device is the distance above the sclera, the eruption of sutures and the eruption of a silicone implant inside the eye with excessive tightening of the circulating element or U-shaped seams above the seal, rejection due to infection or inadequate closure of the seal (Antelava D.N., Pivovarov N.N. , Safoyan A.A. Primary retinal detachment), reduction of the impression shaft due to depolymerization of silicone.

 The technical result of the proposed device is the ability to create a stable volumetric dosed local depression by placing a strip of carbon felt between the sclera and the contact plate - the supporting element.

 Carbon materials are used in various fields of medicine. In orthopedics, carbon fiber is used for joint replacement, as a fixing plate for bone adjustments. In ophthalmology, carbon felt is used as an implant for the formation of a stump after enucleation, orbital plasty.

 The proposed device is intended for filling sclera for the prevention and treatment of retinal detachment in the presence of gaps in it. The device consists of two parts: a curved contact plate, the curvature of which corresponds to the surface of the eyeball made of carbon fiber (TU 48-4807-231-89). The gasket is a carbon felt (TU 48-4807-186-87), the dimensions of which depend on the size of the blocked retinal break.

 The proposed device has been tested in order to study the reaction of surrounding tissues in an experiment that was carried out on chinchilla rabbits. Histological studies were performed in terms of 7 days, 15 days, 1 month, 3 months and 6 months. After the operation to implant the proposed device, any reaction to it from the surrounding tissues was not observed. Within 6 months after the operation, there was not a single case of infection or rejection. Remote devices in the early 7–15 days were covered with a thin connective tissue film and glued to the surrounding tissues. After 1 month, the growth of connective tissue is already noticeable in the section. The device is fixed and has a strong connection with surrounding tissues. In a section through the entire thickness of the strip, an increase in connective tissue was observed.

 The device is used as follows.

 After cutting and separating the conjunctiva in the corresponding quadrant of the eyeball at the site of the projection of the retinal rupture, the contact plate is hemmed in the radial or meridian direction with two U-shaped sutures. Between the sclera and the contact plate there is a gasket made of carbon felt, the dimensions of which depend on the shape and size of the gap. It can be in the form of a tourniquet (d, f), round (g, h) or curly (s). You can use a contact plate of various shapes: T-shaped (a), curved (b), curly (c, d).

 Figure 1 and 2 presents the seal; figure 3 and 4 - seal, fixed to the sclera.

 Patient G-or, 34 years old, was admitted to the department of injuries of the organ of vision, reconstructive surgery and ophthalmic prosthetics of the Moscow Scientific Research Institute of GB named after Helmholtz 09/13/95. After the examination, the diagnosis was made: the right eye - atraumatic retinal detachment with a gap. Anamnesis: 7 days ago a right eye injury - a punch. 6 days after the injury, a veil appeared in front of the right eye, and vision decreased.

 On examination: the eyelids are moderately edematous, subcutaneous hemorrhage. Anterior segment without pathological changes. Fundus: optic disc pale pink. In the lower half of the fundus, a common retinal detachment with a gap of 4 hours. Visual acuity upon receipt of the right eye of 0.08 n / a, the left eye of 1.0.

 The operation was performed on the right eye: extrascleral filling with the proposed device, the release of subretinal fluid, cryopexy.

 At discharge 09/20/95: the right eye is the anterior segment without pathological changes. The fundus - the impression shaft is pronounced, the gap is blocked, the retina is adjacent. Visual acuity at discharge right eye 0.3 n / a, left eye 1.0. Intraocular pressure is within normal limits.

 Thus, the proposed device can be used to treat retinal detachment. Strong fixation of the device, local volume-stable local depression due to sprouting of the gasket by connective tissue, is noted. Due to the contact plate, the strip does not stand above the sclera surface. During the observation period, there were no cases of rejection, infection and displacement of the device.

Claims (4)

 1. Device for scleroplastic operations, made in the form of a contact plate with fixation zones, characterized in that the contact plate is made of carbon fiber and an additional carbon felt pad is inserted, which is able to contact the sclera in the area of the projection of the retinal break, and the contact plate is made that the transverse dimension of the gasket exceeds the transverse size of the contact plate, the fixation zones of which in the longitudinal direction extend beyond the gasket.  2. The device according to claim 1, characterized in that the contact plate is made T-shaped.  3. The device according to claim 1, characterized in that the contact plate is made curly.  4. The device according to claim 1, characterized in that the contact plate is made arcuate.

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