RU2299050C2 - Surgical method for treating squint cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves exposing earlier recessed extraocular muscle. The muscle is sutured near its sclera attachment place and cut off from the sclera. U-shaped scleral flap is detached and divided into three equal portions with longitudinal incisions directed from base to free edge 1.5-2 mm far from it. Two outer portions are cut off near the base, turned with inside out towards the excised muscle and sutured edge-to-edge.

EFFECT: reduced risk of suture eruption and coarse cicatrices formation.

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Description

The invention relates to medicine, in particular to ophthalmology, and can be used in repeated surgical treatment of strabismus after a previous recession of extraocular muscle.

There is a method that attenuates the effect of extraocular muscle after a previously unsuccessful recession ["Questions of pediatric ophthalmology" edited by prof. P.G. Makarova, Krasnoyarsk 1978, p. 153]. After isolation of the extraocular muscle, the latter is stitched with two sutures with holders at the new attachment point to the sclera and is cut off. The sclera flap is cut out and separated by a width of 5-6 mm at 1/3 of its thickness with the base to the equator. The cut off extraocular muscle and the scleral flap are sutured end-to-end with a continuous suture. However, at large deviation angles, the weakening effect of this method is insufficient.

Closest to the claimed is the method [USSR Author's Certificate No. 1641327], which consists in separating the "P" -shaped scleral flap with attached extraocular muscle, the base to the equator. The inverted, separated flap, the sclera is dissected in the longitudinal direction so as to form three flaps. The middle flap is cut off at the base, two regional flaps are cut off from the tendon. After that, the formed free flaps sew side to side, or end to end.

The disadvantages of this method are:

- teething sutures when stitching flaps of sclera together “side to side”, because the flaps have a width of 2-3 mm;

- the formation of gross scars when tightening the free edges of the muscle tendon after cutting off the marginal scleral flaps;

- stimulation of cicatricial processes as a result of additional surgical trauma to tissues when stitching scleral flaps together;

- the possibility of vertical deviation as a result of attaching at different levels of freely cut off the edges of the tendon.

The objective of the invention is to propose a method for increasing the weakening effect of surgical intervention after a previous recession of extraocular muscle.

The technical result is the elimination of the strabismus angle due to the weakening of the action of the extraocular muscle by increasing the length of the scleral flap by 5-6 mm due to the edge parts of the flap, cut off from the base and turned to the muscle, but at the same time connected to the distal edge of the middle part of the flap, which allows you to eliminate 10-12 degrees. squint.

The technical result is achieved as follows. First, access to the operated extraocular muscle. Muscle 1 (Fig. 1) is isolated from adhesions, taken on a hook, stitched at the site of attachment to the sclera, cut off from the sclera, fixed to the holding seams. Then cut out, otseparovyvat U-shaped scleral flap 2. Two longitudinal sections 3 U-shaped scleral flap is divided into three equal parts. Cuts are performed from the base of the flap and not reaching 1.0-1.5 mm to the free edge (figure 1). The longitudinal sections 3 dividing the U-shaped flap into three parts are not brought to the edge of the flap in order to leave the connection of the extreme parts with the middle one. Subsequently, the extreme parts of the flap 2 are cut off at the base, turned out to the cut off extraocular muscle - 1 and stitched with the last "edge to edge" (figure 2). The surgical wound is sealed.

The advantage of this method is:

- eliminates the possibility of eruption of sutures when stitching parts of the scleral flap with each other because parts of the scleral flap are not completely cut off and remain interconnected (Fig. 1);

- excludes the formation of free edges of the muscle when stitching the edge parts of the scleral flap with the muscle;

- eliminates the need for stitching scleral flaps together and, consequently, additional surgical trauma to the tissues, which can stimulate rough scar processes;

- eliminates the possibility of twisting the free edges of the muscle with the formation of gross scars, as well as the occurrence of vertical deviation as a result of attaching at different levels of free edges of the extraocular muscle, because there are none;

- additional elimination of the strabismus angle by 10-12 degrees. by increasing the length of the scleral flap by 5 - 6 mm.

Example 1

Patient An - s, 20 years old. Diagnosis: operated right-side intropy, high-degree amblyopia of the right eye.

From the anamnesis: at the age of 6, he was twice operated on for convergent strabismus.

On examination: deviation of the right eye 25 degrees. to the nose, abduction is slightly limited. Postoperative scars of the conjunctiva in the inner and outer adhesions of the right eye.

Surgical intervention was performed for a previously operated convergent monolateral strabismus using the proposed method. Accessed to the operated internal extraocular muscle of the right eye. The place of muscle attachment to the sclera was found 10 mm from the limbus. The muscle is isolated from adhesions, taken on a hook, stitched at the place of attachment to the sclera, cut off from the sclera, fixed to the suture-holders. Then a scleral flap 6 mm long was cut out, separated, with a base 12 mm from the limb. With two longitudinal sections, the scleral flap is divided into three equal parts. The incisions were made from the base of the flap and not reaching 1.0 mm to the free edge (Fig. 1); subsequently, the extreme parts of the flap were cut off at the base, turned to the cut muscle and sewn from the last "edge to edge" (figure 2). The surgical wound is sealed. At discharge, the squint angle was not determined, the mobility of the eye in full. When viewed after 6 months. - strabismus angle 0 deg., mobility of the eye in full. Postoperative scars are not cosmetically visible.

Example 2

Patient P - co, 17 years old. Diagnosis: operated alternating intropy, anisodeviation; amblyopia of a weak degree of the right eye, moderate degree of the left eye.

From the anamnesis: at the age of five, TSP-3 of the internal rectus muscle of the right eye was performed, a recession of the internal rectus of the left eye.

On examination: deviation to the nose 10 degrees. right eye, 20 degrees. left eye. Eye movements in full.

Surgery was performed on the internal rectus muscle of the left eye. Accessed to the operated extraocular inner muscle of the left eye. The place of muscle attachment to the sclera was found 9 mm from the limbus. The muscle is isolated from adhesions, taken on a hook, stitched at the place of attachment to the sclera, cut off from the sclera, fixed to the suture-holders. Then a scleral flap 5 mm long was cut out and separated, with a base 11 mm from the limb. With two longitudinal sections, the scleral flap is divided into three equal parts. The incisions were made from the base of the flap and not reaching 1.0 mm to the free edge (Fig. 1); subsequently, the extreme parts of the flap were cut off at the base, turned to the cut muscle and sewn from the last "edge to edge" (figure 2). The surgical wound is sealed. At discharge, the squint angle was not determined, the mobility of the eye in full. When viewed after 6 months. - 0 deg., Eye mobility in full. Postoperative scars are not cosmetically visible.

Claims (1)

A method for surgical treatment of strabismus, which consists in isolating a previously recessed extraocular muscle, suturing it at the attachment point to the sclera, then cutting it off from the sclera, separating the U-shaped scleral flap, dissecting it in the longitudinal direction into three flaps and stitching the marginal flaps with the cut off extraocular muscle, characterized in that the scleral flap is divided into three equal parts by longitudinal cuts in the direction from the base to the free edge without reaching 1.0-1.5 mm, after which two edges s part of the flap is cut off at the base and turn inside a severed muscle and sutured with her "edge to edge".

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