RU2300354C1 - Method for removing silicon oil from vitreous cavity in ablation retinae cases ure-dislocations - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making conjunctiva incisions and carrying out blood vessels diathermocoagulation. Two or three sclerotomy operations are done depending on planned surgical intervention volume, each including two elements like 1-2 mm long and 0.9 mm wide scleral tunnel being half sclera layer thickness deep and arranged concentrically with respect to the limb 3-4 mm far from it; and pierce at the tunnel end arranged in perpendicular to the limb. Infusion cannula is sutured to one of sclerotomy tunnels. The relative positioning of the sclerotomy tunnels depends on their number.

EFFECT: reduced risk of complications; enhanced effectiveness of treatment; accelerated operation.

3 cl, 3 dwg

Description

The invention relates to medicine, namely to ophthalmology, and is a method of removing silicone from the vitreous cavity in the treatment of retinal detachments.

A known method of removing silicone oil from the vitreous cavity in the treatment of retinal detachments, according to which conjunctival incisions are performed, two sclerotomies in the projection of the ciliary body and silicone oil is removed from the vitreous cavity using active vacuum aspiration. At the end of the operation, sclerotomy and conjunctiva are sutured. (C. Falkner, S. Binder, A. Kruger. // Outcome after silicone oil removal. // Br. J. Ophthalmology; 2001; 85 (11); P.1324-1327).

However, this method due to the need for suturing on sclerotomy has a number of significant disadvantages. So, in the process of suturing sclerotomy, the residual portions of the vitreous body are cut in the sections, which leads to insufficient sealing of the wound and traction effects on the retina. When suturing a thinned sclera, damage to the choroid is possible and, as a result, repeated recurrent hemorrhages in the vitreous cavity occur. In addition, suturing provokes the appearance of postoperative astigmatism, increases the duration and invasiveness of the operation, and in the early postoperative period leads to increased scarring of tissues.

The technical problem solved by the invention is the removal of silicone oil in the treatment of retinal detachment, which allows to reduce the incidence of postoperative complications, reduce the morbidity and duration of the operation.

The technical result is a decrease in the frequency of postoperative complications, such as hypotension, infringement of the vitreous fibers in the section, damage to the choroid, increased scarring of tissues, induced astigmatism, and an increase in the efficiency of retinal detachment, expressed in a decrease in the frequency of retinal detachment relapses, recurrent hemorrhages, and a decrease in trauma and the duration of surgery to remove silicone oil from the vitreous cavity in the treatment of retinal detachment.

The technical result is achieved by the fact that in the method of removing silicone oil in the treatment of retinal detachment, including conjunctival incisions, diathermocoagulation of vessels, sclerotomy, hemming of the infusion cannula and removal of silicone oil through sclerotomy, according to the invention, two to three sclerotomies are made, each of which consists of two elements: a scleral tunnel 1-2 mm long, 0.9 mm wide, half the depth of the sclera, located concentrically to the limb 3-4 mm from it, and a puncture at the end of the tunnel located normal to the limb. If necessary, the product of two sclerotomies, one of them is located on the nasal side, and the other, designed to hem the infusion cannula, is placed on the temporal side in the lower segment of the eyeball, while the direction of the tunnels is the same. If necessary, the product of three sclerotomies, one of them is located on the nasal side, the second - on the temporal side in the upper segment of the eyeball, and the third, designed to hem the infusion cannula, is placed on the temporal side in the lower segment of the eyeball, with the direction of the tunnels located temporal lobe, mutually opposite.

Valve seamless sclerotomy can hold intraocular pressure well during and after the operation, prevent pinching of the vitreous fibers in the wound and relapse of intravitreal hemorrhages, reduce postoperative tissue scarring, induced astigmatism and invasiveness of the intervention and shorten the time of the operation.

The invention is illustrated in figures 1-3. Figure 1 shows a General view of the sclerotomy in the sagittal section, where 1 is the sclera, 2 is the tunnel sclerotomy, 3 is the puncture of the sclera, and L is the length of the rectilinear part of the tunnel. Figures 2 and 3 show a top view of tunnel sclerotomy, while figure 1 shows the case of the formation of two sclerotomy, and figure 3 - three sclerotomy, where 4 is the border of the limbus, L1 is the distance from the limbus to the sclerotomy and D is the direction the course of the tunnel.

The method is as follows. Processing of the surgical field is performed according to the usual method. The operation is performed under local anesthesia or if there is evidence under general anesthesia. Conjunctival incisions are made, the conjunctiva and tennon membrane are separated from the underlying sclera, diathermocoagulation of the scleral vessels is performed. After that, two or three tunnel sclerotomy 2 is made 3-4 mm from the limb 4 in the area of the projection of the flat part of the ciliary body at a distance L1 (Figs. 2, 3) with the cannula sewn to one of them to supply a replacement solution.

Each sclerotomy 2 consists of two elements: a scleral tunnel 1-2 mm long (L in Fig. 1), 0.9 mm wide and half the thickness of the sclera located concentrically to the limbus, and a sclera 3 puncture at the end of the tunnel located normal to the limb 4. In this case, the relative position of the sclerotomy tunnels depends on the number of sclerotomies. If it is necessary to perform two sclerotomies, one of them is located on the nasal side, and the other, designed for hemming the infusion cannula, is located on the temporal side in the lower segment of the eyeball, while the direction of the tunnels is the same (D in figure 2). If it is necessary to perform three sclerotomies, one of them is located on the nasal side, the second on the temporal side in the upper segment of the eyeball, and the third, designed to hem the infusion cannula, is also on the temporal side in the lower segment of the eyeball, with the direction of the tunnels located the temporal side, mutually opposite (D in figure 3). The number of sclerotomies depends on the estimated amount of surgery. If an isolated removal of silicone oil is planned, two sclerotomies are performed.

If additional manipulations are necessary (removal or dissection of the epiretinal membranes, endolasercoagulation of the retina), an additional third sclerotomy is formed for the possibility of introducing instruments.

The technique of forming tunnel sclerotomy is as follows. The standard vitreoretinal peak of 20 gauges is set 3-4 mm from the limb with a slope at an angle of 30 degrees to the place of intended entrance into the eyeball. After that, the rectilinear part of the tunnel is formed with a depth of half the thickness of the sclera, with a length of 1-2 mm, and then the cavity is entered into the vitreous cavity by puncture of the sclera. The length of the rectilinear part of the tunnel cannot be less than 1.5 mm and more than 2 mm, as this will interfere with reliable sealing of sclerotomy. After hemming the infusion cannula and starting the delivery of physiological saline, the silicone oil is removed. If necessary, removal or dissection of epiretinal membranes, additional endolasercoagulation of the retina is performed. At the end of the operation, sutures on sclerotomy are not superimposed, and if necessary, only hydration of sclerotomy is performed and sutures are applied to the conjunctiva.

Example 1

Patient B., 22 years old.

Diagnosis: OS High degree myopia, operated regmatogenous retinal detachment, condition after subtotal vitrectomy, silicone in the vitreous cavity.

Visual acuity of the left eye before surgery: 0.08, with hyperopic correction +5.5 diopters - 0.3.

On the left eye under local anesthesia, silicone oil was removed from the vitreous cavity using the proposed method with the formation of three tunnel sclerotomies. During the operation, additional endolasercoagulation of the edges of the retinal ruptures was performed. At the end of the operation, sutures on the sclerotomy were not superimposed.

4 weeks after surgery, the retina was adhering, no recurrent hemorrhage was observed, sclerotomy was reliably sealed.

Visual acuity after surgery was 0.5 without correction.

Intraocular pressure - 15 mm Hg

Example 2

Patient S., 45 years old.

Diagnosis: OD: Proliferative diabetic retinopathy, operated tractional retinal detachment, condition after subtotal vitrectomy, silicone in the vitreous cavity.

Visual acuity of the right eye before surgery: 0.02, with hyperopic correction +4.0 diopters - 0.1.

On the right eye, silicone oil was removed from the vitreous cavity using the proposed method for the formation of two tunnel sclerotomies. At the end of the operation, sutures on the sclerotomy were not superimposed.

In the distant postoperative period, the retina was adhering, no recurrent hemorrhages were observed, sclerotomy was reliably sealed.

Visual acuity of the right eye was 0.3.

Intraocular pressure - 18 mm Hg

Claims (3)

1. A method for removing silicone oil from the vitreous cavity in the treatment of retinal detachment, including conjunctival incisions, diathermocoagulation of vessels, sclerotomy, hemming of the infusion cannula and removal of silicone oil through sclerotomy, characterized in that two or three sclerotomies are performed depending on the intended volume of surgical intervention, each of which consists of two elements: a scleral tunnel 1-2 mm long, 0.9 mm wide, half the depth of the sclera, located concentrically limbus 3-4 mm from it, and a puncture at the end of the tunnel normal to the limb. 2. The method according to claim 1, characterized in that, if necessary, the product of two sclerotomies, one of them is located on the nasal side, and the other, designed to hem the infusion cannula, is placed on the temporal side in the lower segment of the eyeball, while the direction of the tunnels is the same. 3. The method according to claim 1, characterized in that, if necessary, the product of three sclerotomies, one of them is located on the nasal side, the second on the temporal side in the upper segment of the eyeball, and the third, designed to hem the infusion cannula, is placed on the temporal side the lower segment of the eyeball, while the direction of the tunnels located on the temporal side is mutually opposite.

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