RU2252735C2 - Surgical method for treating the cases of ablatio retinae - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves cutting and separating conjunctiva and Tenon's capsule from limb allover its circumference. Specifying detachment area projection to sclera. Silicon ribbon is sutured and antibiotic is introduced. Next to it, limb-type self-sealing paracentesis is made with intraocular fluid being discharged through it under tonometry control. Inraocular pressure reaching 25 mm of mercury column, Tenon's capsule and conjunctiva is sutured.

EFFECT: enhanced effectiveness of treatment.

Description

The invention relates to medicine, namely to surgical ophthalmology.

It is known that the task of surgical treatment of retinal detachment with the presence of its partial spontaneous fit is to create conditions to reduce the force of traction of the retina from the vitreous body and the maximum fit of the retina, for which temporary or permanent local depression of the sclera in the detachment area is used.

To date, the following two methods of surgical treatment of retinal detachment are most widely used.

The first of these methods is shown in the presence of a small number of single discontinuities and is performed as follows:

after localization of the place of detachment using ophthalmoscopy and exposure of the corresponding area of the sclera by cutting and separating the conjunctiva and tenon capsule from the limbus, the fillings of the required size are sutured with the necessary condition of “immersion” at least half its diameter (the so-called “filling”). The method of suturing varies depending on the size and position of the seal (stitches, mattress stitch). The operation is completed by the introduction of an antibiotic solution into the thickness of the porous filling and suturing of the tenon capsule and conjunctiva (Guide to Eye Surgery, edited by Prof. ML Krasnov and Prof. BC Belyaev, second edition, Moscow, “Medicine”, 1988, p. 390).

The disadvantage of this method is its relatively low efficiency in reducing the force of traction of the retina from the vitreous body and its limitations - the method is shown only in the presence of a small number of single breaks.

Closer to the proposed method for the surgical treatment of retinal detachment is the reception of circular mechanical compression, the so-called "circulation" (see the above link).

The method is shown with retinal detachment, capturing 2 or more quadrants, with multiple tears scattered over a large extent, the presence of large and giant tears, a significant height of the bubble of the detached retina and is performed as follows.

After circular separation of the conjunctiva and tenon capsule from the limbus, the localization and projection of gaps on the sclera is clarified using ophthalmoscopy and instrumental impression. A silicone rubber tape (2-4 mm wide, 0.5-0.6 mm thick, 80-90 mm long) is held under the muscles and fastened with mattress sutures to the sclera according to the planned type of circulation (equatorial, “oblique”). The ends of the tape are either tied with silicone thread, or carried through the sleeve towards each other. Tape is tightened (with its shortening) according to special calculations for its immersion in the sclera. The operation ends with the introduction of an antibiotic and suturing of the tenon capsule and conjunctiva (see the above link).

The disadvantage of this method is its relatively low efficiency in reducing the force of traction of the retina from the vitreous body, insufficient scleral depression, which does not provide sufficient visual acuity in the operated patients.

The objective of the invention is a more effective method of surgical treatment of retinal detachment by reducing the force of traction of the retina from the vitreous body, enhancing the effect of sclera depression and maximum retinal fit.

This problem is solved by the method consisting in the fact that after circular separation of the conjunctiva and tenon capsule from the limb around its circumference, clarification of the localization and projection of the detachment onto the sclera, the silicone tape is carried out under the muscles and fastened with mattress sutures to the sclera, the tape is tightened, self-sealing paracentesis is performed in areas of the limb through which intraocular fluid is released, wait for restoration of the anterior chamber of the eye and intraocular fluid is released again, wait for restoration of the anterior chamber, thief antibiotic and sutured tenon capsule and conjunctiva.

The inventive method is based on the ability of the vitreous body to give part of the liquid under conditions of temporary hypotension to compensate and replenish the volume. In the process, the vitreous body volume decreases, contributing to a decrease in retinal traction force, an increase in the effect of depressing an episcleral filling or circulatory tape and an increase in the effectiveness of surgical intervention, providing a relatively higher visual acuity than the known method.

In the process of developing the proposed method, we found that when performing intraoperative tonometry before each of the two releases of intraocular fluid by limbal self-sealing paracentesis, the intraocular pressure is 28-29 mm Hg, and after two releases it decreases to 25 mm Hg . and remains at that level.

Clinical example.

Patient J.V., 54 years old. Diagnosis: left eye (OS) - subtotal retinal detachment, partial hemophthalmus, Vis OS - 0.01 is not corrected. After circular separation of the conjunctiva and tenon capsule from the limb, the localization and projection of gaps on the sclera was refined using ophthalmoscopy and instrumental indentation, a silicone rubber tape 3 mm wide and 0.5 mm thick and 85 mm long was held under the muscles and secured with mattress sutures to the sclera for the equatorial circling. The ends of the tape were passed through the coupling towards each other, the length of the tape was calculated to immerse it in the sclera, the tape was tightened with its shortening, the ampiox was introduced and the tenon capsule and conjunctiva were sutured.

The method was carried out on 30 patients.

Claims (1)

A method for surgical treatment of retinal detachment, including cutting and separating the conjunctiva and tenon capsule from the limb around its circumference, specifying the projection of the detachment on the sclera, suturing the silicone tape, administering an antibiotic and suturing the tenon capsule and conjunctiva, characterized in that the limimer performs itself paracentesis, through which intraocular fluid (IOP) is twice released under the control of tonometry, and upon reaching an IOP of 25 mm Hg. Art., complete the operation.