RU2257874C2 - The method for through keratoplasty - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: the method deals with cutting a donor's corneal transplant to be applied and fixed in the opening developed at dissecting pathological corneal segment. Moreover, one should apply visityl preparation onto affected corneal surface, then after corneal incision with a trephine one should apply a bactericidal collagen film on cornea as a disk of the same diameter. Then comes recipient's corneal dissection simultaneously with successive suturing up patient's cornea together with collagen film to the rim of trephination opening with the help of four preliminary sutures. Then one should cover cornea with visityl again above collagen film to place a through donor's corneal transplant above collagen film removable cornea to be fixed to the ends of trephination opening with four interrupted sutures, one of which being at 3 o'clock position should be untightened to remove dissected recipient's cornea together with collagen film from under a transplant through free space developed to be finally fixed with uninterrupted suture.

EFFECT: higher efficiency.

1 ex

Description

The invention relates to medicine, namely to ophthalmology, and relates to the technique of end-to-end keratoplasty with purulent corneal ulcer.

There is a known method of through keratoplasty for cataracts, in which the turbid layers of the cornea are dissected sequentially first to the deep layers, then the deep layers, after which a corneal through graft is placed into the trepanation hole and fixed with sutures (1).

The disadvantage of this method is the lack of full protection of the internal structures of the eye from their loss in the surgical wound, since at the time of preparation of the graft, the trepanation opening remains open.

There is also known a method of end-to-end keratoplasty, in which, after excision of the turbid cornea, the trepanation opening is covered with a soft contact lens with an eccentrically located opening. A through corneal graft is placed in the trepanation opening without removing the lens, fixed with interrupted sutures, then the soft lens is removed and the transplant is finally sutured with a continuous suture (2).

The disadvantage of this method is that a soft contact lens that lies freely on the iris cannot reliably prevent the loss of internal structures of the eye (iris, lens, vitreous body) into the surgical opening. In addition, the technique of end-to-end keratoplasty for cataracts cannot take into account the features of such an operation for infectious purulent keratitis, which requires prevention of not only loss of the internal structures of the eye, but also prevention of their infection with pathogenic flora.

There is also a known method for the treatment of purulent sclerokeratitis, in which conjunctivectomy and diathermocoagulation of the affected part of the sclera are preliminarily performed before keratoplasty, then through total keratoplasty is performed using a corneal scleroconjunctival flap (3).

The disadvantage of this method is the increased invasiveness and the risk of loss and infection of the internal structures of the eye.

The aim of the invention is to reduce the morbidity and increase the safety of the operation.

This goal is achieved by covering the cornea with a protective agent, making an incision with a trepan and covering it with a bactericidal collagen film, gradually dissecting the cornea, applying four preliminary nodal sutures, again covering the cornea over the collagen film with a protective agent, placing a through donor corneal transplant on the surgical bed and fixing it it to the edges of the trepanation hole with four interrupted sutures, one of which is left untied for 3 hours, removed from under the graft through the bottom space at 3 o'clock excised the cornea of the recipient together with the collagen film and finally fix the transplant with a continuous suture.

Comparison of the proposed method with other methods known in the field of medicine shows compliance with the criteria of the invention.

The method is as follows.

After processing the surgical field and local anesthesia, the conjunctival cavity is washed abundantly with an antiseptic solution, the cornea is covered with a protective agent (visited). A trepan of the required diameter is used to make a deep incision of the cornea, and a bactericidal collagen film in the form of a disk of the same diameter as the corneal incision is placed on it. Using the blade and corneal scissors, the recipient's cornea is gradually dissected, sequentially hemming it with the collagen film to the rim of the trepanation opening with four interrupted sutures. A through corneal graft is prepared, which is placed on top of the collagen film pre-coated with the visitor and hemmed with three interrupted sutures to the rim of the cornea of the recipient. Due to hypotension of the eye, the removed corneal disc is easily shifted towards the iris, without interfering with the preliminary fixation of the graft. The fourth preliminary seam at 3 o'clock is left untied. An additional visit was introduced into the anterior chamber and under the graft. The preliminary sutures are fixed, fixing the excised disc of the cornea of the recipient, after which it is slowly removed from under the graft along with the collagen film through the free space for 3 hours and the last suture on the graft is tied. Washed the front chamber in order to remove exudate and visited. The graft is finally sutured to the cornea of the recipient with a continuous suture. Nodal joints are left for 7-10 days. The anterior chamber is reconstituted with physiological saline and a bubble of sterile air.

The proposed method reliably prevents the fall into the trepanation hole of the cornea of the internal structures of the eye (iris, lens, vitreous body), as well as infection by their pathogenic flora.

In a similar way, 17 patients with purulent corneal ulcer were operated on. None of them had prolapse of the internal structures of the eye and in the postoperative period there was no infection in the eye cavity. In all patients, the transplants survived, the inflammatory process was stopped, and the eyes were saved.

Example. Patient Sh., 40 years old, was treated for a purulent ulcer of the cornea of the left eye caused by epidermal staphylococcus. The right eye is healthy. Upon receipt, the visual acuity of the right eye was 1.0, the left eye - the count of fingers in the face, n / a. Objectively: the left eye is a pronounced mixed injection, purulent discharge in the conjunctival cavity, a purulent ulcer with a diameter of 7 mm on the cornea, and a hypopion of 2 mm in the anterior chamber. Antibacterial therapy was started, which was unsuccessful. 05/19/02, through therapeutic keratoplasty with a diameter of 8 mm was performed.

After intravenous sedation, local anesthesia was performed with 2% novocaine solution (retrobulbar 2.0 ml, akinesia 5.0 ml). Bridal sutures were applied to the vertical rectus muscles, and the eyelids were held by a blepharostat. The eyeball is rinsed abundantly with a solution of furatsilin (1: 5000), a solution of sulfacyl sodium 20% is dripped onto the cornea. Visited on the affected surface of the cornea, after which a circular incision was made with an 8.0 mm trephine. With the same trepan, a disk was cut out of a collagen film soaked in gentamicin. A collagen film is laid on the cornea and hemmed with it to the edge of the trepanation opening at 12 o’clock. The lesion of the cornea is gradually dissected with a blade and scissors and is gradually stitched together with the collagen film to the corneal rim with interrupted sutures at 12, 9, 6 and 3 hours. A 8.25 mm trephine was made from a donor eye, a corneal graft was transferred to the patient’s eye, over the collagen film and the removed cornea, previously covered by the visitor, where it was hemmed with interrupted sutures to the edge of the trepanation opening at 12, 9 and 6 hours. At 3 o'clock, the seam was left untied. In addition, he visited under the graft and in the anterior chamber, after which the nodal sutures fixing the affected cornea and collagen film were removed. Gradually, from the temporal side, where the preliminary suture was left untied, the affected cornea was removed from under the graft along with the collagen film. The last nodal suture is tied, the anterior chamber is washed with physiological sodium chloride solution in order to remove exudate and visited. The transplant is finally fixed with a continuous suture 10/0. Nodal seams left. The anterior chamber is reconstructed by an air bubble and physiological saline solution. A 20% solution of sulfacyl sodium was instilled into the eye, 20 mg of gentamicin was administered under the conjunctiva.

In the postoperative period, inflammation quickly subsided. Nodal sutures removed on the 7th day. When discharged, the left eye is almost calm, the graft has engrafted transparently, and lies well. The anterior chamber is of medium depth, the moisture is transparent. The pattern of the iris is clear, the pupil is round, moderately dilated medically, the lens and vitreous are transparent. The fundus is clearly visible - without pathology. Visual acuity of the left eye is 0.3 n / a. After 2 years in the long term, the visual acuity of the left eye increased to 0.7, the transplant is perfectly transparent.

Sources of information

1. A.S. No. 1273100, M. Cl. A 61 F 9/00, 1986.

2. A.S. No. 1715345, M. Cl. A 61 F 9/00, 1992.

3. A.S. No. 1468527, M. Cl. A 61 F 9/00, 1989.

Claims (1)

A method of end-to-end keratoplasty by cutting a donor corneal graft, laying and fixing it into an opening formed by excision of a pathological section of the cornea, characterized in that a visit is applied to the affected surface of the cornea, a bactericidal collagen film in the form of a disk of the same diameter is laid on the cornea after it is cut with a trephine that the incision of the cornea, excision of the cornea of the recipient is carried out simultaneously with sequential hemming of the cornea together with the collagen film to the rim of the trepanac through four preliminary sutures, again cover the cornea over the collagen film by the visitor, place a donor corneal transplant over the collagen film and the removed cornea previously covered by the visitor and fix it to the edges of the trepanation opening with four interrupted sutures, one of which is on 3 ex the watch is left untied, removed from the transplant through the free space at 3 o'clock the excised recipient cornea along with the collagen film and finally fix transplant the graft with a continuous suture.