RU2150920C1 - Surgical method for treating cornea diseases - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing total penetrating trepanation of recipient cornea, cutting out donor transplant by making circular sclera incision having 3-4 mm width and 1/3-1/4 of its thickness in depth, separating a superficial sclera flap in which base trepanation is carried out. The transplant is fitted and fixed with interrupted sutures passing through donor sclera flap and superficial layers of recipient sclera 4-5 mm apart from the limbus. Then, the donor sclera is covered with conjunctiva using purse-string suture. EFFECT: improved operation method; reduced risk of postoperative complications.

Description

 The invention relates to medicine, namely to ophthalmology, and can be used for surgical treatment for severe damage to the eyeball: with purulent fusion of the entire cornea, necrosis of the cornea and sclera, with chemical burns, staphylomas of the cornea of large diameter, gross vascularized sores.

 Currently, there is a known method for the surgical treatment of corneal diseases by performing total end-to-end keratoplasty (see Guide to Ophthalmic Surgery, edited by Prof. ML Krasnov, Moscow, “Medicine”, 1976, p. 104).

 In this case, a total through trepanation of the cornea of the recipient is performed, a donor graft is cut with a diameter corresponding to the diameter of the removed corneal disk of the recipient, and then the graft is fixed with continuous or interrupted sutures through the cornea of the donor and limbal tissues of the recipient.

 The disadvantage of this method is the trauma during the operation of the perilimbal tissues of the recipient, which, as you know, are the immunogenic zone. This leads to an increase in postoperative complications and treatment time.

 In addition, as a result of this operation, there is a rapid growth of vessels in the corneal tissue, its clouding and even its perforation, which requires further surgical correction.

 Closest to the claimed method and selected as a prototype is a method of complete end-to-end transplantation (see Guide to eye surgery, under the editorship of ML Krasnov, Moscow, "Medicine", 1976, p. 108).

 The method is as follows.

 Conduct the usual preoperative preparation of the patient. Then, the cornea of the recipient with the border of the sclera is removed to the choroid within healthy tissues (the direction of the circular incision of the sclera is parallel to the central axis of the eye), a similar section is cut off from the donor and fixed to the eye of the recipient with interrupted sutures.

The disadvantages of this method of treatment are:
1. Injury to the eye during surgery due to damage to the limbal tissues.

 2. An increase in intraocular pressure after surgery, ie during the operation, the own drainage system of the eye is excised.

 3. Expulsive hemorrhage at the time of surgery.

 4. Flattening of the anterior segment of the eye after surgery.

 5. Frequent outcomes in subatrophy of the eyeball.

 These shortcomings lead to postoperative complications and create a technically difficult operation.

 The objective of the invention is to develop the most effective and technically less complex method of total end-to-end keratoplasty, and the reduction of postoperative complications.

 The problem is achieved in that in the method of surgical treatment of corneal diseases by performing total through keratoplasty, according to the invention, the conjunctiva and superficial sclera layers on the limb are removed, total through trepanation of the cornea of the recipient is performed, the donor graft is cut, making a circular cut of the sclera by 1/3 - 1 / 4 of its thickness and separating the surface sclera flap with a width of 3 - 4 mm to the limb, at the base of which trepanation is made with a diameter corresponding to the diameter of the removed th recipient corneal disk stack graft fix its nodal sutures drawn through the scleral flap donor and recipient scleral surface layers 4 - 5 mm from the limbus and then harboring donor sclera, conjunctiva via purse-string suture.

 The proposed method meets the criterion of "novelty", because unknown from the current level of science and technology.

It also meets the criterion of "inventive step", as clearly does not follow from the level of science and technology,
The proposed shape and size of the donor transplant with a width of 3-4 mm of the scleral rim, 1/3 to 1/4 thickness of the sclera, with a diameter corresponding to the diameter of the removed corneal disk, avoids applanation of the anterior segment of the eye after surgery (by deepening the anterior chamber of the eye on the step of the rim of the sclera), and get a good adaptation of the tissues and sealing the eyes, and also prevent the danger of the formation of goniosynechia.

 Fixation of a donor transplant with nodal sutures conducted through a scleral flap and superficial scleral layers 4–5 mm from the limb helps to avoid unnecessary trauma to the limb zone and reduce the frequency and severity of postoperative uveitis.

 The use of a thin flap for fixation of the graft with simultaneous covering of the conjunctiva contributes to the rapid fusion of the flap with the sclera of the recipient; moreover, there is no growth of vessels in the tissue of the cornea of the donor, which allows to obtain not only therapeutic, but also the optical effect of the operation, reduces the patient’s time in hospital in a hospital. The graft is easily fixed, highly resistant to bacterial infection.

 The method is as follows.

 Conduct the usual preoperative preparation of the patient.

 A corneal disk is cut out on the eye of a recipient with a diameter of 1 - 12 mm, the conjunctiva and (superficial layers of the sclera) are removed on the limb. The donor graft is cut out, having previously removed the conjunctiva from the sclera and limbus. By making a circulating incision of the sclera to 1/3 - 1/4 of its thickness, the surface sclera flap is cut off with a width of 3-4 mm to the limb, at the base a through transplantation of the donor eye with a diameter corresponding to the removed recipient disk is performed.

 Place the graft on the eye and fix it with nodal sutures conducted through the scleral flap of the donor and the superficial layers of the sclera of the recipient 4-5 mm from the limbus.

 A purse string suture is applied to the conjunctiva, completely covering the area of the donor sclera (limb).

 Example 1

 Patient Ilyinykh A.A. 21 years old was admitted to the ophthalmic department with a diagnosis of corneal abscess OD as a result of wearing a contact lens 4 days after the onset of the disease, visual acuity - incorrect light projection, there is no data on endophthalmitis during ultrasound examination. Through keratoplasty with a rim of the sclera was made. In the postoperative period, the infection was stopped, visual acuity one month after surgery, 0.3 transplant is transparent.

 Example 2

 Patient Andreev V.I., 56 years old, was admitted 7 days after the onset of the disease with a diagnosis of purulent corneal ulcer on the background of a postoperative scar, aphakia 0, visual acuity - the correct projection of light. 3 days after active antibiotic therapy, a corneal transplant with a rim of the sclera was transplanted.

 The postoperative course without complications, the transplant is transparent, single deep vessels, visual acuity of 0.01 does not correct.

 Example 3

 Patient Vasiliev N.P. 52 years old was admitted with a diagnosis of Regional corneal ulcer with perforation against a background of recurrent keratouveitis of unknown etiology 0, visual acuity - incorrect projection of light.

 A day later, end-to-end total keratoplasty with a rim of the sclera was performed.

 In the postoperative period - long-lasting phenomena of uveitis. 1.5 months after the operation, the transplant is transparent, pupil fusion without secondary glaucoma, visual acuity of 0.03 n / a.

The proposed method for the surgical treatment of diseases of the cornea, in comparison with the known, allows:
1. Improve the effectiveness of treatment.

 2. Reduce the duration of treatment.

 3. Reduce the likelihood of complications.

 4. Save the eye as an organ.

 5. Improve visual function.

Claims (1)

 A method for surgical treatment of corneal disease by performing total end-to-end keratoplasty, comprising performing total end-to-end trepanation of the cornea of the recipient and placing the graft on the region of the distant corneal disc of the recipient, characterized in that the conjunctiva and superficial scleral layers on the limb are removed before the through trepanation of the cornea; the donor graft is cut out, having previously removed the conjunctiva, making a circular incision of the sclera 3–4 mm wide by 1/3 to 1/4 of its thickness, the surface sclera flap is separated to the limb, in the area of which through corneal trepanation is performed; the donor transplant is fixed with nodal sutures conducted through the scleral flap of the donor and the superficial layers of the sclera of the recipient 4-5 mm from the limbus, then the donor sclera is covered with the conjunctival recipient using a purse string suture.