RU2258491C2 - Method for treating macular rupture - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with performing vitrectomy, removing the posterior hyaloid membrane and tamponade of ocular cavity with gas. After vitrectomy one should introduce a spatula into ocular cavity to smooth out a macular retina from periphery towards the center by shifting retina towards the area of macular rupture. Then rupture edges should be captured with pincers to be connected together for 1-2 sec. After that ocular cavity should be filled with the mixture of sterile air and gas. The method suggested enables to treat significant ruptures due to shifting patient's retina towards the area of macular rupture.

EFFECT: higher efficiency of therapy.

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Description

The present invention relates to the field of medicine, namely to ophthalmology.

Various methods for treating macular rupture are known. There is a method by which the vitreous is removed, biological glue is applied to the gap (growth factor, autoplasma, platelet concentrate) and tamponade of the eye cavity with a long-term absorbable gas (Smiddy WE, Glaser BM, Pulur A. et al. Transforming growth factor beta: a biologic chorioretinal glue. // Arh / Ophtalmol. - 1989. - Vol. 107. - P.577-580, Paques M., Chastang C., Mathis A. et al. Effect of Autologus platelet concentrate in surgery for idiopatic macular holes . // Ophthalmology. - 1999, Vol. 106. - No. 5 / -P / 932-938. Wells JA Gregor ZJ Surgical treatment of full thickness macular holes using autologous serum. // Eye 1996; 10: 593-599) .

There is also known a method by which the vitreous body and the inner border membrane of the retina are removed without the use of bioglue and gas tamponade is also performed (see Park DW, Sipperley JO, Sneed SR et al. Macular hole surgery with intermal-limiting membrane peeling and intravitreous air. / / Ophthalmology. - 1999. - Vol. 106. No. 7. - P.1392-1397).

The closest and accepted by us for the prototype is a method of treating macular rupture, according to which vitrectomy is performed through the flat part of the ciliary body, removing the posterior hyaloid membrane, epiretinal membranes, applying biological glue to the rupture and tamponade of the eye cavity with a long-term absorbable gas (see Rice T. Internal -limiting membrane removal in surgery for full-thickness macular hole // in "Macular hole", Oxford, Butterworth & Heinemann. 1999 P.125-146).

However, the known methods have the following disadvantages:

- the introduction of additional substances (bioglue) into the cavity of the eye can cause infection, toxic damage and an allergic reaction;

- when the inner boundary membrane of the retina is removed, damage to its other layers occurs over a significant area in the center of the fundus, which subsequently leads to a decrease in functions (see Smiddy WE, Feuer W., Cordahi G. Intermal limiting membrane peeling in macular hole surgery. Ophthalmology.2001.Vol / 108. - P.1471-1476);

- with a significant size of the macular gap, even with the maximum elimination of traction due to deficiency of the retinal tissue, the connection of the edges of the gap does not occur, the morphological basis for improving vision does not appear.

The technical result of the proposed method of treatment is to increase the effectiveness of treatment due to displacement of the retina in the macular gap and the possibility of treating large gaps.

The technical result is achieved by performing vitrectomy, removing the posterior hyaloid membrane and tamponade of the eye cavity with gas.

What is new in achieving this result is that after a vitrectomy, a spatula is inserted into the eye cavity, with which the macular retina is smoothed from the periphery to the center, moving the retina to the area of macular rupture.

It is also new that the edges of the gap are captured with tweezers and connected among themselves for 1-2 seconds in the horizontal direction along the nerve fibers, after which the eye cavity is filled with a mixture of sterile air and gas.

The retinal displacement in the area of macular rupture allows filling the retinal defect with a full-fledged retinal tissue. Preliminary centripetal smoothing makes it possible to bring together the edges of the macular fracture with minimal trauma. The edges of the gap are compressed with tweezers for 1-2 seconds, while there is aseptic inflammation, which allows you to reliably connect the edges of the gap without damaging the retinal pigment epithelium. The connection of the edges of the gap between themselves in the horizontal direction along the nerve fibers can improve the quality of vision. Subsequent tamponade of the eye cavity promotes the formation of strong retino-retinal and retino-choroidal adhesions.

A comparative analysis of the proposed method and the prototype shows that the proposed method differs from the prototype in that a spatula is inserted into the eye cavity after vitrectomy, which smooths the macular retina from the periphery to the center, moving the retina to the area of the macular gap, then the edges of the gap are captured with tweezers and connected together for 1-2 seconds in the horizontal direction along the nerve fibers, after which the eye cavity is filled with a mixture of sterile air and gas, which meets the criteria of the invention of "novelty".

A new set of features allows to increase the effectiveness of treatment, reduce the risk of developing cataracts and infection of the eye cavity, eliminate central scotoma, increase visual acuity, fill the gap area with a functioning retina, which meets the criteria of the invention "industrial applicability".

A method for treating macular rupture is as follows.

The operation is performed under local anesthesia in the horizontal position of the patient. After three punctures in the area of the flat part of the ciliary body, an irrigation system, a light guide and a vitreotome are introduced into the eye cavity. Perform vitrectomy, including removal of the posterior hyaloid membrane. Epiretinal membranes, if any, are removed with a spatula and then excised. Then, a retinal spatula is inserted into the cavity of the eye, with the help of which the macular retina is smoothed from the periphery to the center. In this case, the retina is displaced toward the center and the gap size decreases. After this, the edges of the gap are captured with tweezers and slightly squeezed for 1-2 seconds between each other in the horizontal direction along the nerve fibers. This achieves the initial closure of the gap. After that, the eye cavity is filled with a mixture of sterile air and a long-term absorbable gas, which fixes the retina to the choroid. A delicate adhesion is formed between the edges of the gap, due to which a reliable final closure of the macular gap is achieved.

The proposed method of treatment is illustrated by the following clinical example. Patient X., medical record No. 141577. Diagnosis: Idiopathic macular gap 4 stages of the right eye.

The operation was performed under local anesthesia with a solution of lidocaine. After 3 punctures, an irrigation system was installed in the region of the flat part of the ciliary body, the tip of the fiber and the vitreotome of the Premier ophthalmic surgical harvester from Stonz (Germany) were introduced. The vitreous, epiretinal membranes were removed. Then, a retinal spatula was inserted into the eye cavity, with the help of which the macular retina was smoothed from the periphery to the center. After the retina was displaced to the center and the gap was reduced in size with special tweezers, grip and gentle compression of the edges of the gap between them was carried out. After that, the eye cavity was filled with a mixture of sterile air (85%) and perfluoropropane (15%). 8/0 nodal sutures were placed on the sclera and conjunctiva. Under the conjunctiva, 0.5 ml of gentamicin solution was administered. During an ophthalmological examination the next day, the edges of the gap remained interconnected. After resorption of the gas-air mixture 2-3 weeks after the operation, the edges of the macular rupture were securely bonded to each other biomicroscopically and according to optical coherence tomography. After 1 month, the gap was not determined. Visual acuity improved by 0.2-0.3. The absolute central scotoma has disappeared. On an optical coherence tomogram, retinal tissue edema decreased. In the area of the former gap, a layer of photoreceptors was diagnosed.

Thus, the proposed method for the treatment of macular rupture increases the effectiveness of treatment, increases visual acuity, and reduces the risk of complications.

Claims (1)

A method for treating macular rupture by performing vitrectomy, removing the posterior hyaloid membrane and tamponade of the eye cavity with gas, characterized in that a spatula is introduced into the cavity of the eye after vitrectomy, which smooths the macular retina from the periphery to the center, moving the retina to the area of the macular gap, then grasp the edges of the gap tweezers and connect with each other for 1-2 s, after which the eye cavity is filled with a mixture of sterile air and gas.