RU2250093C1 - Surgical method for treating dystrophic changes in retina and choroidea in complicated myopia cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making two incisions in conjunctiva and Tenon's capsule. One incision is done in superoexterior quadrant of eyeball and the second one in the inferointerior one. Two tunnels directed towards posterior eyeball pole are formed between sclera and Tenon's capsule and flexible magnetic polymer implant is placed in each of them. Implant is manufactured as 0.15-0.45 mm thick plate with permanent magnetic field of 0.5-1.5 mTesla units and through reverse profiled magnetization type. The implant has openings having area equal to 0.18-0.52 times implant surface area. The implants are sutured to sclera using interrupted sutures in equatorial region. The implants are not removed.

EFFECT: improved microcirculation conditions in choroid and retina; prolonged treatment effect.

3 cl

Description

The invention relates to medicine, to ophthalmology, and in particular to methods of surgical treatment of dystrophic changes in the retina and choroid in complicated myopia.

There is a method of surgical treatment of dystrophic changes in the retina and choroid in complicated myopia, including conjunctiva and tenon membrane sections, the formation of tunnels in the subtenon space, the placement of implants in them (see Prefix EF, Pivovarov NN “A simplified method for the surgical prevention of progression myopia ”, Methodological recommendations, Moscow, 1980, p.1-16).

However, the known method in its use has the following disadvantages:

- does not allow to sufficiently increase the duration of the therapeutic effect,

- does not allow to exclude the gradual replacement of the used implant with its own connective tissue,

- it is possible to involve the implant in the process of pathological changes occurring in the sclera of the recipient,

- fibroblasts of the operated patient migrate into the transplanted biotransplant, obviously synthesizing defective callogen replacing the donor one, which reduces the effect of sclerotherapy in the long-term period. The use of cadaveric sclera and other donor tissues has recently become undesirable due to the risk of infection with HIV and hepatitis viruses.

The objective of the invention is to provide a method for the surgical treatment of dystrophic changes in the retina and choroid in complicated myopia.

The technical result is to improve microcirculation in the choroid and retina, increase blood oxygenation while improving tissue trophism, increase the duration of the therapeutic effect, exclude the replacement of used implants with their own connective tissue and, in addition, exclude the involvement of the implant in the process of pathological changes in the sclera of the recipient, exclude the negative impact of the implant on the processes of collagen biosynthesis of the sclera, while creating a non-resorbing and stable Newly stable complex “sclera-implant”.

The technical result is achieved by performing a revascularizing type of operation and with the direct energy effect of the weak magnetic field of the implants on the tissue structures of the eye.

The method is as follows. Two sections of the conjunctiva and tenon shell are made, with the first cut being made in the upper outer quadrant of the eyeball, the second in the lower inner quadrant of the eyeball, tunnels are formed between the sclera and tenon membrane towards the posterior pole of the eyeball and placed in each of they are a polymer elastic magnetic implant made in the form of a plate with a thickness of 0.15-0.45 mm with the induction of a constant magnetic field of 0.5-1.5 mT with a through profile reversible type of magnetization, in which opposite e sections of parallel to the main surfaces of the implant are magnetized antipolarly, while holes are made in the implant, the area of which is 0.18-0.52 of the implant area, then the implants are sutured to the sclera with interrupted sutures in the equatorial region, while polymer elastic magnetic implants do not delete. In this case, the implants are made of a biostable material based on polypropylene, polyester or polyethylene with powder particles of magnetic material evenly distributed in it based on samarium - cobalt, neodymium - iron - boron or samarium - iron - nitrogen. In this case, the implant is made in the form of a plate of round, oval, elliptical, trapezoidal, rectangular or square shape.

Experimental studies of the proposed method for the surgical treatment of degenerative diseases of the retina in clinical conditions showed that using all the distinguishing features of the proposed technical solution, an increase in the duration of the therapeutic effect, an improvement in microcirculation in the choroid and retina was achieved, the gradual replacement of the used implant with its own connective tissue was achieved, and, moreover, , the involvement of the implant in the process of pathological changes is excluded, roiskhodyaschih in the sclera of the recipient.

The implementation of the proposed method for the surgical treatment of degenerative diseases of the retina and optic nerve is illustrated by the following clinical examples.

Example 1. Patient P., 25 years old, was admitted to the Kaluga branch of GU MNTK “Eye Microsurgery with a diagnosis of“ High complicated OU myopia ”. Before surgery, visual acuity OD - 0.02-10.0 = 0.63 n / a, OS - 0.11-11.5 = 0.5. Data of ultrasound biometry (PZO) OD - 27.00 mm, OS - 27.54 mm. Fundus: OU myopic cone 2 tbsp., In the macular region lack of physiological reflexes, uneven dispigmentation. Surgical operation performed: implantation of two polymer elastic magnetic implants in the lower-inner and upper-outer quadrants towards the posterior pole of the eyeball.

Operation progress: The preliminary processing of the surgical field was carried out. As anesthetic support, epibulbar anesthesia was administered with the introduction of 1% tetracaine (dicaine, leocaine) in an amount of 0.5 ml, retrobulbar anesthesia with the introduction of 4% novocaine (procaine) in an amount of 2.5 ml and akinesia of the circular muscle of the eye with 2% novocaine (procaine) in the amount of 11.5 ml. Two sections of the conjunctiva and tenon membrane were made, one section in the upper outer quadrant of the eyeball, and the second in the lower inner quadrant of the eyeball. Then, two tunnels were formed between the sclera and the tenon shell towards the posterior pole of the eyeball and a polymer elastic magnetic implant in the form of a plate with a thickness of 0.45 mm and with a constant magnetic field of 0.5 mT was placed in each of them. We used a polymer elastic magnetic implant in the form of a square-shaped plate made of a bioresistant material based on polyester with uniformly distributed powder particles of permanent magnetic material based on samarium-cobalt and with a through profile reversible type of magnetization, in which sections of parallel main surfaces are opposite to each other the plates are magnetized antipolar. The implant was sutured to the sclera with interrupted sutures in the equatorial region.

The operation was completed by suturing the conjunctiva and a monocular dressing with injection under the conjunctiva of dexazone with an antibiotic. The magnetic implant was not removed from the tunnel.

In the control study after a year, visual acuity OD - 0.05-6.5 = 1.0, OS - 0.05-7.0 = 1.0. Data of ultrasonic biometry (PZO) OD - 25.87 mm, OS - 26.20 mm. No changes were detected in the fundus.

Example 2. Patient R., 12 years old, was admitted to the Kaluga branch of GU MNTK “Eye Microsurgery with a diagnosis of“ Progressive myopia of moderate degree OU ”. Before surgery, visual acuity OD - 0.08-4.25 = 1.0 n / a, OS - 0.08-4.5 = 1.0. Data of ultrasound biometry (PZO) OD - 24.14 mm, OS - 24.3 mm. Fundus: OU myopic cone 2 tbsp., In the macular region lack of physiological reflexes, uneven dispigmentation.

Surgical operation performed: implantation of two polymer elastic magnetic implants in the lower-inner and upper-outer quadrants towards the posterior pole of the eyeball.

Operation progress: The preliminary processing of the surgical field was carried out. As anesthetic support, epibulbar anesthesia was administered with the introduction of 1% tetracaine (dicaine, leocaine) in an amount of 2 ml, retrobulbar anesthesia with the introduction of 4% novocaine (procaine) in an amount of 1.5 ml and akinesia of the ocular muscle with 2% novocaine (procaine) in an amount 4.5 ml Two sections of the conjunctiva and tenon membrane were made, one section in the upper outer quadrant of the eyeball, and the second in the lower inner quadrant of the eyeball. Then, two tunnels were formed between the sclera and the tenon membrane towards the posterior pole of the eyeball and a polymer elastic magnetic implant was placed in each of them in the form of a plate with a thickness of 0.15 mm and with the induction of a constant magnetic field of 1.5 mT. We used a polymer elastic magnetic implant in the form of a plate with a round base made of a biostable material based on polypropylene with powder particles of a magnetic material based on neodymium - iron - boron uniformly distributed in it and with a through profile reversible type of magnetization, in which sections opposite each other The parallel main surfaces of the plate are magnetized antipolar. The implant was sutured to the sclera with interrupted sutures in the equatorial region.

The operation was completed by suturing the conjunctiva and a monocular dressing with injection under the conjunctiva of dexazone with an antibiotic. The magnetic implant was not removed from the tunnel.

In the control study after a year, visual acuity OD - 0.1 -4.0 = 1.0, OS - 0.08-4.5 = 1.0. Data of ultrasonic biometry (PZO) OD - 24.11 mm, OS - 24.25 mm. No changes were detected in the fundus.

The proposed method, in addition to the direct sclerotherapy effect, allows to increase blood supply in the vessels of the retina, choroid, and, as a result, stabilize visual functions in the surgical treatment of progressive myopia, with the presence of dystrophic complications of the myopic process.

Claims (3)

1. A method of surgical treatment of dystrophic changes in the retina and choroid in complicated myopia, including sections of the conjunctiva and tenon membrane, the formation of tunnels in the subtenon space, placement of implants in them, characterized in that two sections of the conjunctiva and tenon membrane are made, one section in the upper outer quadrant of the eye the apple, the second in the lower inner quadrant of the eyeball, between the sclera and the tenon membrane, two tunnels are formed towards the posterior pole of the eyeball and placed each of them contains a polymer elastic magnetic implant made in the form of a plate 0.15-0.45 mm thick with the induction of a constant magnetic field of 0.5-1.5 mT, with a through profile reverse magnetization, and holes are made in the implant , the area of which is 0.18-0.52 of the area of the implant, then the implants are sutured to the sclera with interrupted sutures in the equatorial region, while the implants are not removed. 2. The method according to claim 1, characterized in that the implants are made of a biostable material based on polypropylene, polyester or polyethylene with powder particles of magnetic material uniformly distributed in it based on samarium - cobalt, neodymium - iron - boron or samarium - iron - nitrogen . 3. The method according to claim 1, characterized in that the implant is made in the form of a plate of round, oval, elliptical, trapezoidal, rectangular or square shape.