RU2301644C1 - Method for treating endothelial epithelial eye cornea degeneration cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying flap having pedicle produced from Tenon's capsule as epicorneal coating. The flap is introduced via additional incision in conjunctiva above cornea. The flap is connected to Tenon's capsule near the lower limb via additional incision in conjunctiva and fixed to eye episclera with sutures near the superior and inferior limb.

EFFECT: improved sorption and trophic action and mechanical protection of degeneratively transformed cornea.

Description

The invention relates to medicine and can be used to treat endothelial-epithelial degeneration (EED) of the cornea of the eye. There is a surgical method for the treatment of corneal EED, the essence of which is to replace the altered cornea with a donor, healthy cornea [1]. However, the diffuse nature of corneal lesions during EED promotes the spread of edema on the transplant, the failure of the sutures, the formation of anterior synechia, and the development of secondary glaucoma. The use of a donor cornea poses a threat of immune conflict, which leads to a decrease in the effectiveness of treatment and a delay in recovery.

The closest method of the same purpose to the claimed object according to the totality of the signs is a method of treating corneal EDF with a collagen coating [2], which has a sorption, stimulating effect, performing mechanical protection of the cornea. This method is taken by us as a prototype.

Collagen coating is a product made of a chemical substance that, by its properties and structure, is close to the connective tissue of a living organism.

A disk is cut from a collagen plate with a diameter 1-2 mm larger than the diameter of the patient’s cornea, and with the help of sutures, it is fixed to the conjunctiva around the cornea, covering it epicorneally. Collagen coating is on the cornea for 2 weeks, gradually completely absorbing.

Due to the autonomy of the collagen coating, its sorption and stimulating effects on the cornea are of short duration. At the same time, the accumulation of tissue decay products in the collagen coating and the impossibility of their timely removal can cause undesirable reactions.

Collagen in its composition and structure is not identical to the tissues of the human body, which leads to possible adverse consequences of its use.

All these circumstances lengthen the time of recovery and reduce the effectiveness of the treatment of corneal EED with collagen coating.

The technical result of the present invention consists in changing the course of the degenerative process in the cornea and increasing the effectiveness of the treatment of EDF of the cornea due to the inclusion of a powerful and constantly acting sorption factor, a vascular factor with its enzymatic processes, and the regulation of these processes is carried out by the patient himself.

This result is achieved by the fact that an epicorneal coating of the entire surface of the cornea is made, and a flap on the leg from the tenon capsule of the patient’s eye is used as a coating, the flap is passed through an additional conjunctival incision above the cornea, it is connected at the lower limb with the tenon capsule through an additional conjunctival incision and fixed seams to the episclera of the eyeball at the upper and lower limbs.

The authors do not know that the claimed technical result was achieved by epicorneal coating of the entire surface of the cornea with a flap on the leg of the tenon capsule of the eye.

Tenon's capsule is a kind of additional shell of the eye, which is located between the sclera and conjunctiva, which takes part in the movement of the eye, the outflow of intraocular fluid, while being a poorly differentiated connective tissue with its own blood supply system.

The mechanism of action of the flap on the leg of the tenon capsule of the eye, covering the entire surface of the cornea with its EED, consists of the following elements:

1. Due to the sorption properties of the tenon capsule, there is a continuous dehydrating, detoxifying effect on the altered cornea.

2. The use of autotissue with its own vascular network provides a continuous trophic effect, introducing changes in the metabolic processes of the affected cornea and determining its structural rearrangement.

3. Long-term mechanical protection of the altered cornea is carried out.

A method of treating EED of the cornea is as follows.

From the tenon capsule of the eye, through the conjunctival incision in the upper outer quadrant, a flap on the pedicle is excised, with a width 1-2 mm greater than the diameter of the cornea (approximately 11-12 mm) and a length of about 20-22 mm (so that the flap can be passed through an additional conjunctival incision above cornea and connect it at the lower limb with the tenon capsule also through an additional incision of the conjunctiva). The width and length of the flap may vary somewhat, based on the individual size of the eyeball. The suture flap is fixed to the episcler of the eyeball at the upper and lower limbs. The duration of resorption of the flap depends on the severity of the degenerative process in the cornea.

The essence of the method is illustrated by example.

Patient Z., 63 years old, with the initial manifestations of Fuchs' primary EED, performed an epicorneal coating of the entire surface of the cornea with a rag on the leg from the tenon capsule of the patient’s eye.

As a result of treatment with the proposed method, the patient almost immediately disappeared pain and eye irritation. Under the tenon transplant, the anterior epithelium rapidly restored, which acquired a normal structure, which could be seen in areas located under the edges of the tenon graft, with no bullae being formed.

If on the first day after the operation, the tenon flap was somewhat swollen and moderately vascularized, then with each subsequent day the activity of the transplant blood vessels increased and by the end of the first postoperative week, almost uniform formation of the vascular network was observed throughout the flap.

Due to the relief of pain and corneal syndromes, a satisfactory condition of the tenon flap, the patient was discharged on day 7 for outpatient treatment with recommendations to instill disinfectant drops 3 times a day in the operated eye. About a year after the operation, a gradual reduction in the area of the tenon coating and some thinning began to occur, its transparency intensified. Now the graft occupies approximately one third of the surface of the cornea and is a translucent tissue that adheres tightly to the cornea, but with blood vessels continuing to function actively. As the tenon transplant resorbed, corneal exposure occurred and a significant transformation of the anterior epithelium was noticed; it became translucent and rough. The stroma of the cornea began to acquire some transparency, now it is possible to clearly identify a small amount of small focal opacities in it without reducing its thickness. The posterior layers of the cornea are translucent. Visual acuity of 0.05.

In this way, 5 patients aged 41 to 67 years were treated.

As follows from the foregoing, the epicorneal coating of the entire surface of the cornea with EED with a flap on the leg of the tenon capsule of the eye has a sorption, trophic effect, and provides mechanical protection for the degeneratively changed cornea, which is reflected in the partial restoration of the transparency of the cornea and its functional ability.

An analysis of the long-term results of the treatment showed a lack of progression of corneal degeneration.

Thus, the above information indicates the possibility of implementing the claimed invention.

As a result of the application of the method, the corneal EED is compensated and functional comfort for the patient is created due to prolonged sorption, trophic influence and mechanical protection with a rag on the leg from the tenon capsule of the eye. The treatment method is simple to implement, auto material is available. The postoperative course is "smooth", does not require medical correction. The method can be used as an independent method for the treatment of corneal EDF, and can also be a step for performing keratoplasty with an optical purpose in the future.

Literature

1. Logay I.M., Moroz O.A. End-to-end keratoplasty in the treatment of secondary endothelial-epithelial corneal dystrophy according to an improved technique // Ophthalmic. Journal. - 1996. - No. 5/6. - S. 271.

2. Fedorov S.N., Moroz Z.I., Kromskaya Z.I. et al. Comprehensive conservative treatment of corneal EDF using therapeutic collagen coating. // Bulletin of Ophthalmology 1985. - No. 6. - p. 34-37. (prototype).

Claims (1)

A method of treating endothelial-epithelial degeneration of the cornea of the eye by epicorneal coating of the surface of the cornea, characterized in that as a coating use a flap on the leg of the tenon capsule of the patient’s eye, which is carried out through an additional incision of the conjunctiva above the cornea, connect it at the lower limb with the tenon capsule through an additional incision of the conjunctiva and fix it with sutures to the episclera of the eyeball at the upper and lower limbs.