RU2119784C1 - Device for fixing and rotating eyeball in performing operations on anterior part of the eye - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has carcass having bearing ring with two arc-shaped guiding members and cross-piece connecting them to produce ligature openings provided with fixing hooks placed on internal part of the arc-shaped guiding members to enlarge solid angle of eye rotation and in this way to make easier access to anterior pole of the eye that enables microsurgical devices to be used in full measure. To place the device over the eyeball for performing its rotation and fixation, only one of four musculi recti available. EFFECT: excluded pressure of surrounding tissues; reduced risk of operative and postoperative complications. 1 dwg

Description

 The invention relates to the field of medicine (ophthalmology) and can be used in ophthalmic practice to remove foreign bodies located in the posterior parts of the eyeball, namely in the macular and parapapillary regions.

 The closest in essence is a device for fixing the eyeball during block excision of the tumor in the extra-equatorial part of the eye (A.I. Kirillichev; copyright certificate N 1597188).

 The proposed new device for fixing and rotating the eye is made in the form of a frame containing a support ring with two arcuate guides and a jumper between them with the possibility of forming ligature holes and provided with fixing hooks on the inside of the arcuate guides, which provides an increase in the solid angle of rotation of the eyes and thereby facilitates approach to the posterior pole of the eye, which allows the use of microsurgical techniques in full.

 Unlike the existing frame device, the new device does not require installation during the operation, because made in the form of a single element. To apply the device to the eyeball for rotation and fixation, it is necessary to cut off only one of the four rectus muscles. The rigid frame structure virtually eliminates the pressure of surrounding tissues on the eyeball during rotation and fixation, which leaves intraocular pressure unchanged during surgery.

 The frame device for fixing and rotating the eyeball is made of a single piece of wire (GOST 10994-74; alloy grade 40 KXNM) with a diameter of 0.7 mm. Micro hooks for fixing the structure to the episclera made of wire of the same grade with a diameter of 0.15 mm. The device is divided into several parts (elements), the complete scheme of which is given.

 The frame device is shown in the drawing.

 The support ring (1) is located in the projection region of the ciliary body - diameter 18 mm. Two arcuate guides (2) are rigidly fixed to the support ring (1) by soldering. The diameter of the curvature of each guide (2) is 18 mm, the length is 23 mm. 6 mm from the support ring (1) is an arcuate stiffener (3), which connects the guides (2). The length of the stiffener (3) is 16 mm, the diameter of curvature is 24 mm. The distal ends of the guides (2) have loops (4) for rotational ligatures (5). The diameter of the loops (4) is 1 mm. On the inner side of each guide (2), 3 mm from the distal ends are microhooks (fixation hooks) (6) to fix the structure to the episclera. Micro hooks (6) are installed between the double guide wire guides (2) and are fixed by soldering. Fixation hooks (6) are L-shaped, pricking and directed against the guide rails. The distal elbow of the micro-hook is 1.5 mm long, and the proximal elbow is 0.3 mm. Arcuate guides (2) are parallel to each other. The distance between the guides (2) is 15 mm. The surgical field, limited by two guides (2) and a stiffener (3), has a size of 15 x 15 mm. The distal ends of each guide (2) are 24 mm from the lower point of the support ring (7). The overall dimensions of the frame device - 18 x 20 x 22 mm allow you to freely place and rotate it in the orbit.

 An imaginary line passing between the guides (2) and coinciding with the meridian of 12.00 h at the highest point on the support ring (8) is called the guide meridian of the frame device.

 Work with the device.

 After the conjunctiva is cut into 1/2 of the circumference, one of the 4 rectus muscles is stitched and cut off (opposite to the device’s rotation). The guides (2) of the frame device (general view 4) are placed in the subconjunctival space, wound behind the eyeball (5) and fixed to the episclera using fixation hooks (3) by the reverse movement of the frame device. Lowering the device onto the eyeball, the support ring (1) rests on the sclera (in the projection of the dentate line) and is fixed with sutures. The frame device rotates together with the eyeball (12) by tensioning the rotational ligatures (11) inserted into the loops (10), at the angle “alpha” required by the ophthalmic surgeon. In this case, the surgical field (6) (beta angle) is opened to the surgeon’s eye, bounded from below by a stiffener (9), from above by soft tissues, and to the right and left are arched guides (2). After completing the manipulations, the frame device is removed in the reverse order.

 On the bases of the regional clinical hospital of Orenburg and the municipal 1st city clinical emergency hospital in the ophthalmic departments, 14 patients with intraocular foreign bodies located in the posterior part of the eye were operated on.

 On May 28, 1993, an operation with the use of a new frame device for a patient Filoretov Alexander Mikhailovich, 26 years old, case history No. 5199, with a diagnosis of penetrating wound, intraocular foreign body of the left eye, was performed on the basis of the municipal 1st city clinical hospital of the ambulance. Foreign body: metallic, magnetic, 24 mm from the limb, 3 mm from the central axis, meridian of IX hours. Operation: diascleral magnetic removal of a foreign body from the extra-equatorial region of the left eye. Operation progress: the operation was performed under local anesthesia. The eyelids are fixed with a blepharostat, a bulbar conjunctiva was cut 5 mm from the limb from 6 hours to 12 hours. The internal rectus muscle was isolated, stitched and cut off. Adjacent tissue from the sclera is stupidly separated. A frame device is applied to the eyeball and is fixed with 6 sutures and two hooks of the structure (8 fixation points). The eyeball is rotated using a device. Accordingly, the occurrence of a foreign body produced "G" -shaped incision of the sclera. On the first traction, the foreign body is removed (size 0.5 x 0.5 x 1.0 mm). Three sutures were placed on the scleral wound, around one row of diathermocoagulate was produced. Vitreous prolapse was not. The frame device was removed, the rectus muscle was sutured to the same place. The conjunctiva has a continuous suture. Under the conjunctiva, antibiotics, hormones. Binocular dressing, bed rest.

 The postoperative period without complications. Visual acuity of the left eye: before surgery - 0.5 n / a, when discharged from the hospital - 0.9, after 1/2 years - 1.1. No retinal detachment.

 Based on the results of observation of 14 patients who underwent surgery to remove an intraocular foreign body using a new frame device, we propose this device as an invention.

 In the course of operations, in no case were there any complications. In the postoperative period, one patient has the phenomenon of parietal hemophthalmus. Absorption therapy gave positive results. Patients with damage to the lens developed a traumatic cataract, which was subsequently prepared for extraction.

 The use of a new device for fixation and rotation of the eyeball during operations related to the removal of foreign bodies located in the posterior part of the eye will allow during the operation to clarify the location of the foreign body, open the surgical intervention area widely, and make enough cuts to remove foreign bodies of various sizes without loss vitreous body, will allow to obtain optimal conditions for the use of surgical equipment in the inaccessible area of the eyeball in full, thereby increasing the chances removal of a foreign body and the smooth conduct of measures to prevent retinal detachment. At the same time, the use of a new skeleton device will expand the indications for surgical intervention in the posterior part of the eye: diaskleral operations for penetrating wounds of the eye, scleroplastic operations for progressive myopia, revascularization operations for partial atrophy of the optic nerve, block excision, cryodestruction, hemming of “B” applicators for tumors, reconstructive surgery for ophthalmomyases.

Claims (1)

 A device for fixing and rotating the eyeball, made in the form of an annular frame, containing a support ring with two arcuate guides equipped with fixation hooks, characterized in that the two arcuate guides are rigidly fixed on the annular frame, provided with a jumper between them and made in the form of a single element, with the possibility of forming ligature holes at the ends of the arcuate guides remote from the support ring, and the fixing hooks are made on the inside of the arcuate nap ulation.