RU2197205C2 - Method for treating eyeball subatrophy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves puncturing sclera and ciliary body. The ciliary body is pressed against the internal layers of sclera through the posterior chamber by introducing sterile air, hyalon, perfluororganic compounds or using spatula or injection needle. Laser beam is applied through sclera over the whole ciliary body flat part projection for coagulating the detached ciliary body. EFFECT: improved conditions anatomical adherence; reduced risk of traumatic complications. 5 cl

Description

 The invention relates to medicine, namely to ophthalmology, and can be used for the surgical removal of subatrophy of the eyeball caused by the detachment of the ciliary body.

 Post-traumatic subatrophy of the eyeball is one of the most formidable complications of penetrating wounds and contusions of the eyeball. In the pathogenesis of post-traumatic subatrophy of the eyeball, an important role is played by dysfunction of the ciliary body due to mechanical damage to the choroid.

 Vannas et al suggest coagulation of tissues over the area of the cyclodialysis fissure from the inside through an incision in the limbus, as well as the hemming of the ciliary body to the sclera with silk sutures. However, scleral staphylomas form and because of them this method has been "forgotten" for 20 years (Vannas M. et al. "On hypotony following cyclodialysis and its treatment", Acta Ophthalmol ,, 1952, V.30, 1, P.63 -64.). Mackenson et al. fix the iris root to the sclera at the level of the scleral spur (Mackensen G. et al. "Beitrag zur operativen Behandlung einer Okularen Hypotonie nach Zyklondialyse.", Klin. MBL. Augenheilk., 1972, Bd. 161, S. 10-16.) . The indicated Vannas method is also used at present in the treatment of detachment of the ciliary body against hypotension ("Reattachment of the detached ciliary body with suturing for treatment of contusional ocular hypotension", Ophthalmol Surg., 1991, V22, 6, P.360-362. ) This method is taken as the closest analogue.

 However, the above method has a certain morbidity both on the object of influence and on adjacent tissues, the probability of abutment of detachments is small. After surgical intervention, suture material is left in the ciliary body, which further contributes to neovascularization. The proposed method is characterized in that the proposed surgical laser treatment is optimally sparing and is performed with minimal operational impact on the eyeball (without the risk of shells falling out at the time of manipulation), and the laser is strictly dosed and is carried out under the supervision of a surgeon, ensures the fit and fixation of the ciliary body in the area of anatomical location, without left foreign suture material.

 The technical result of the proposed method is the anatomical fit of the exfoliated ciliary body to the sclera, the normalization of ophthalmotonus and the stopping of the progression of subatrophy of the eyeball while reducing the invasiveness of interventions.

 The technical result is achieved by fixing the ciliary body to the inner layers of the sclera due to the formation of a sclerochoroidal adhesion using laser irradiation and preliminary adequate pressing of the ciliary body to the sclera.

 The method is as follows.

 After conducting a clinical examination and detecting detachment of the ciliary body, the patient undergoes surgery to eliminate detachment of the ciliary body. The sclera is punctured in the quadrant of the location of the highest detachment of the ciliary body. In the opposite quadrant, 4 mm from the limb, the sclera and ciliary body are punctured and the ciliary body is pressed through the back chamber to the inner layers of the sclera by introducing sterile air, hyalon or PFOS, and if necessary, use a spatula or injection needle. The exfoliated ciliary body is coagulated by laser radiation 1-1.5 mm from the limb through the sclera over the entire projection of the flat part of the ciliary body.

 Example 1. Patient R-in, 37 years old, was admitted to a specialized ophthalmology department in January 2001 with a diagnosis of OD - concussion of the eyeball of the 3rd degree, hyphema, traumatic cataract, subluxation of the lens, vitreous hernia, ciliochoroid detachment.

 From the anamnesis: while working with a construction gun, a splinter bounced off and injured his right eye. On the same day he turned to the office of emergency ophthalmologic care. Visual acuity OD = 0.01 n / k, IOP OD = (2-). Objectively; eyelid hematoma, moderate mixed conjunctival injection, anterior chamber small, hyphema, mydriasis 5.0 mm with full iris coloboma at 12 o’clock, iridodonesis, lens subluxation, floating opacities in the vitreous. Optic nerve disc pale pink, retina with patches of ischemia. According to ultrasound, there is a circular slit-like detachment of the ciliary body, in the vitreous body floating opacities. According to x-ray data, a foreign body is not determined.

 3.01.2001 the patient was hospitalized. After analyzing the data and taking into account the results of the study, the patient was offered a course of drug treatment (10% caffeine solution under conjunctiva 5, dicinone and dexazone solution under conjunctiva 5). After a control study (ultrasound), marked changes in the ciliary body were not noted, the hyphema resolved, on January 11, 2001, the patient was prepared for abdominal eye surgery. In the operating room, he confirmed information on the size and standing height of the detachment of the ciliary body with ultrasound devices. Two sections of the conjunctiva were made at the upper limb at 11 and 13 hours, a sclera and ciliary body were punctured with a stylet 4 mm from the limb. Vitreotome tips are inserted into the posterior chamber. The lens and retrolental opacities of the vitreous are excised. The sclera and conjunctiva are stitched. The conjunctiva was cut in the lower outer quadrant. Posterior trepanation of the sclera 3-4 mm from the limbus - 0.2-0.3 ml of xanthochromic fluid flowed out. The conjunctiva is stitched. The conjunctiva was cut in the opposite quadrant 4 mm from the limbus, and the sclera and ciliary body were punctured. The ciliary body is pressed with a spatula and 1.5 ml of air is introduced into the posterior chamber. The conjunctiva is stitched. A circular transconjunctival transscleral diodlaser cyclopexy was produced with a force of up to 1.5 W and an exposure time of 1.0 second 1 mm from the limb with an interval between coagulates of 3-4 coagulates. The total number of coagulates has reached 35. An antibiotic solution has been administered under the conjunctiva. Bandage.

 After 5 days, the state of OD is satisfactory: mild irritation of the conjunctiva, the joints are clean, the anterior segment is calm, the anterior chamber is deep, its moisture is transparent. According to ultrasound, there is a slit-like detachment of the ciliary body in the upper section, the membranes are thickened mainly in the lower section. Visual acuity of OD - 0.04, IOP OD = 1-. The patient was given a repeated injection of 10% caffeine solution 10. IOP OD - normal.

After 2 weeks, the state of OD is satisfactory: mild irritation of the conjunctiva, the joints are clean, the anterior segment is calm, the anterior chamber is deep, its moisture is transparent. When ophthalmoscopy - optic nerve disc pink, clear boundaries, slight swelling of the macula, foveolar reflex is absent, detachment of the ciliary body was not detected. Visual acuity of OD - 0.02 s + 6.5 ^d = 0.1, IOP OD - normal.

 Example 2. Patient GK, 42 years old, was admitted to a specialized ophthalmology department in January 2001 with a diagnosis of OS - conjunctival burn of the 2nd degree, contusion of the eyeball of the 2nd degree, hyphema.

 From the anamnesis: the battery exploded when working with the machine at home. The eyes were washed immediately with water. On the same day he turned to the office of emergency ophthalmologic care. Visual acuity OS = 0.1 n / a, IOP = (1-). Objectively: edema and mixed conjunctival injection, descemetitis, anterior chamber is small, hyphema, pupil of irregular shape, D-6.0 mm, initial opacities in the cortical layer of the lens, floating opacities in the vitreous. Doctor of Science pale pink, clear borders, macular reflex preserved. According to ultrasound, the shells are thickened, a slit-like circular detachment of the ciliary body.

 01/18/2001 the patient was hospitalized. After analyzing the data and taking into account the results of the study, the patient is offered a course of drug treatment (solution of dicinone, emoxypip and dexazone parabulbar 5). After the control study (ultrasound), pronounced changes in the ciliary body were not noted, the hyphema resolved. 01/22/2001 the patient is prepared for abdominal ophthalmic surgery. In the operating room, he confirmed information on the size and standing height of the detachment of the ciliary body with ultrasound devices. A conjunctiva incision was made in the lower-outer quadrant. Posterior trepanation of the sclera 3-4 mm from the limbus - 0.2-0.3 ml of xanthochromic fluid flowed out. The conjunctiva is stitched. The conjunctiva was cut in the opposite quadrant 4 mm from the limbus, and the sclera and ciliary body were punctured. The ciliary body is pressed by an injection needle and 0.4 ml of hyalon is introduced into the posterior chamber. The conjunctiva is stitched. A circular transconjunctival transscleral diodlaser cyclopexy was produced with a force of up to 1.5 W and an exposure time of 1.0 second 1.5 mm from the limb with an interval between coagulates of 3-4 coagulate. The total number of coagulates has reached 35. An antibiotic solution has been administered under the conjunctiva. Bandage.

 After 5 days, the state of OD is satisfactory: mild irritation of the conjunctiva, the joints are clean, the anterior segment is calm, the anterior chamber is of medium depth, its moisture is transparent. According to ultrasound, detachment of the retina and ciliary body is not determined. Visual acuity of OD - 0.2, IOP OD - the norm.

 After 2 weeks, the state of OD is satisfactory: mild irritation of the conjunctiva, the joints are clean, the anterior segment is calm, the anterior chamber is of medium depth, its moisture is transparent. With ophthalmoscopy - optic nerve disc pink, clear borders, macula without features, ciliary body detachment was not found. Visual acuity OD = -0.3, IOP OD - normal.

 The method allows to achieve anatomical fit of the exfoliated ciliary body by pressing it to the scleral membrane, and then fixing it to the sclera, while reducing the invasiveness of the intervention.

Claims (5)

 1. A method of treating eyeball subatrophy, including evacuating the fluid from under the exfoliated ciliary body, fixing the ciliary body to the inner layers of the sclera, characterized in that before the fixation, the ciliary body is pressed against the inner layers of the sclera through the back chamber, and the fixation is carried out by coagulating laser radiation, while coagulants are applied through the sclera over the entire projection of the flat part of the ciliary body.  2. The method according to claim 1, characterized in that a hyalon is used to press the ciliary body to the inner layers of the eye.  3. The method according to claim 1, characterized in that sterile air is used to press the ciliary body to the inner layers of the eye.  4. The method according to claim 1, characterized in that PFOS is used to press the ciliary body to the inner layers of the eye.  5. The method according to p. 1, characterized in that a spatula or injection needle is used to press the ciliary body to the inner layers of the eye.