RU2180545C2 - Method for removing foreign body resident under eyeball conjunctiva - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves stretching conjunctiva area above the foreign body. The conjunctiva is cut with YAG-laser radiation. Loose conjunctiva being the case, neodymium YAG-laser radiation is to be used. Marked vascular pattern being found, erbium YAG-laser radiation is to be used. Conjunctiva is stretched using forceps branches. EFFECT: reduced risk of hemorrhage and foreign body dislocation complications. 4 cl

Description

 The invention relates to the field of ophthalmology, namely to medicine, and can be used to remove a foreign body under the conjunctiva of the eyeball.

 It is known that removal of a foreign body from under the conjunctival membrane of the eyeball is an surgical intervention performed using a microsurgical instrument either under a slit lamp or in an operating room (E. Vilshansky - Concerning the need for reconstructive interventions in patients with traumatic eye injuries and its appendages // Reconstructive Ophthalmosurgery, - M. - 1979 - S. 163-165). Use the instrumental section of the conjunctiva above the foreign body: under local anesthesia, the conjunctiva is fixed and raised with tweezers over the foreign body, Sato's knife, blade or scissors open the conjunctiva. If bleeding occurs, hemostasis is performed, after which, if necessary, the conjunctiva is dissected until the foreign body is adequately exposed. A foreign body is removed either with tweezers or a magnet, depending on the nature of the foreign body (Gundorova R.A. - Eye injuries. // M. - Medicine - 1986 - 310 p.). This method is taken as the closest analogue.

 With the mobility of a foreign body under the conjunctiva along the wound canal along the sclera surface or with a sharp restriction of mobility in cases of getting into the subconjunctival "pocket", the removal of a foreign body with the introduction of a magnet or tweezers into the wound canal may not be achieved. Fixation of the conjunctiva and its elevation above the sclera can cause further displacement of the foreign body along the sclera. Conducting hemostasis under a slit lamp is difficult, since it is necessary to plug and dissect conjunctival tissue at the same time.

 The proposed method is based on the fact that the conjunctiva is dissected by a short-pulse neodymium YAG laser or Erbium: YAG laser with preliminary stretching of the conjunctiva above the foreign body to the sclera with diluted forceps branches, which limits the mobility of the foreign body under the conjunctiva of this section and reduces the thickness .

 The technical result of the method is to reduce the thickness of the conjunctiva and the risk of displacement of a foreign body under the conjunctiva and bleeding from it at the time of surgery.

 The technical result is achieved due to preliminary mechanical stretching of the conjunctiva with diluted jaw branches and dissection of the conjunctiva over a foreign body using a laser to expose a foreign body with its subsequent removal.

 The method is as follows: under local anesthesia on a slit lamp combined with a laser unit, the conjunctiva is pre-stretched around the foreign body with diluted forceps branches to limit the foreign body mobility and to conjunctiva tension in order to facilitate laser dissection and reduce the risk of bleeding from the conjunctiva vessels in this zone. The laser focus is brought to the surface of the conjunctiva. In the destruction mode, a YAG laser dissection of the conjunctiva is performed with exposure of a foreign body sufficient to remove it from the conjunctiva. In cases of enhanced vascular pattern, it is advisable to use Erbium: a YAG laser, so its destructive effect has a more pronounced coagulating effect. A foreign body after exposure is removed with tweezers or a magnet, depending on the nature.

 Example. Patient Za-shin, 27 years old, turned to a specialized ophthalmology department with a diagnosis of OD - a wound of the conjunctiva, a foreign body under the conjunctiva. Visual acuity OD / OS: 0.5 / 0.8; IOP OD / OS: 22/22 mmHg According to EFI - inhibition of the activity of the retina OD is not observed; according to x-ray studies - a foreign body in the anterior part of the eye (according to the conditional scheme, partially in the shells of the eye), according to ultrasound scanning - a foreign body outside the shells of the eyeball.

 From the anamnesis: I was injured in the eyeball with the introduction of a metal fragment during the processing of a part on a lathe. In connection with bleeding from the eye, the patient turned to a specialized ophthalmological institution. They diagnosed the presence of a metal fragment under the conjunctiva. The patient is offered the removal of a foreign body from under the conjunctiva. However, upon examination, a significant displacement of the foreign body from the input wound of the conjunctiva was noted. The foreign body showed a positive magnetic probe - an offset to the magnet was noted. However, there was no further advancement of a foreign body under the conjunctiva along the wound canal, as it turned out to be fixed in a subconjunctival “pocket”. The introduction of a magnet into the wound channel caused bleeding from the vessels of the conjunctiva and also did not activate the movement of a foreign body along the channel. In such a situation, specialists of the department suggested dissecting the conjunctiva above the fragment and removing the foreign body. The conjunctiva was fixed with tweezers and raised above the sclera. As a result of this action, a pronounced subconjunctival hematoma was formed, and when the conjunctiva was cut with scissors, bleeding was noted, which did not allow further intervention. After hemostasis, performed by mechanical stretching of the conjunctiva with diluted branches of scissors, marked changes in blood vessels and the thickness of the conjunctiva above the fragment were noted. However, with such a position of the tweezers, instrumental dissection of the conjunctiva will be difficult and then they offered to perform a further autopsy with a YAG laser. After 8 pulses with a strength of up to 8.5 mJ, the foreign body was exposed to 1/3, but the newly arising weak bleeding did not allow the manipulation to be completed. After the change of the neodymium YAG laser to Erbium: YAG laser, the intervention was completed without repeated bleeding, since Erbium: YAG laser intervention has not only shock but also pronounced coagulating effect. Bandage.

 2 days after the operation, the state of OD is satisfactory: slightly irritated, residual phenomena of subconjunctival hemorrhage, the wound is epithelized, the cornea is calm, a single suspension in the vitreous body. On the fundus: j visual acuity of OD - 0.5, IOP OD - 24 mm RT. Art. According to ultrasound, there are no changes.

 After 7 days - OD is almost calm, the conjunctival wound - traces of subconjunctival hemorrhage. Anterior segment and deep ophthalmic environment without pathology. Visual acuity OD = 0.5, IOP OD - normal.

 3 months after surgery - OD is calm. Front segment unchanged. The indications of the method are operations associated with the removal of a foreign body due to the retina and the occurrence of retinal detachment and bleeding.

 The method has no contraindications.

 As a result of using this method, it is possible to avoid displacement of a foreign body under the conjunctiva, dissection of the thinned conjunctiva above the foreign body, reducing the risk of bleeding and removing the foreign body.

Claims (4)

 1. A method of removing a foreign body from under the conjunctiva of the eyeball, including dissection of the conjunctiva and removal of the foreign body, characterized in that previously the portion of the conjunctiva located above the foreign body is stretched, and the conjunctiva is dissected by radiation from a YAG laser.  2. The method according to p. 1, characterized in that in the presence of a loose conjunctiva, a short-pulse neodymium YAG laser is used.  3. The method according to p. 1, characterized in that in the presence of a pronounced vascular pattern using Erbium: YAG laser.  4. The method according to p. 1, characterized in that the stretching of the conjunctiva is carried out by tweezers jaws.