RU2302843C1 - Method for eliminating squint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves removing anterior ciliary arteries from longitudinal middle part of separated muscle. The longitudinal middle part being 1/3 of muscle width large is caught with forceps and sutured 4-7 mm far from the muscle attachment place depending on required intensification degree. Scleral suture of 0.5-2 mm is placed before the muscle using the same needle and thread. The sutured muscle portion is pulled forward holding the thread towards the muscle attachment place forming two lateral folds. The thread is tied into three knots.

EFFECT: enhanced effectiveness of treatment; reduced risk of sutures separation and nodular thickening formation under conjunctiva.

3 dwg

Description

The invention relates to medicine, namely to ophthalmology, and is intended to eliminate strabismus.

There is a method of eliminating strabismus, which consists in resection and recession of the rectus oculomotor muscles. To perform a resection, a muscle is isolated, a ligature suture is applied to it, the supposed resection site is measured, the muscle is sutured with two threads at this point, the muscle tendon is crossed, the sutures are inserted through the tendon strip and episclera, the muscle is pulled by the ligature, the suture is tied, and the remaining stump muscles are cut off (Avetisov ES, Squintered strabismus. - M.: Medicine, 1977, p. 280-283). In a recession, the rectus muscle is isolated and it is cut off after preliminary suturing both on it and on the sclera (the same, p.286).

The main disadvantage of this method is its complexity due to the need to impose two nodal sutures at each stage of the operation and, in addition, the ligature suture during resection.

The closest to the claimed method - the prototype - is a way to eliminate strabismus, which consists in the formation of muscle folds to enhance muscle action (the same, p.280).

However, when using this method, complications such as divergence of sutures, nodular thickening under the conjunctiva, difficulty in strengthening the folds of the sutures, and also when the muscle is completely crossed or completely stitched, the neurovascular bundle is disturbed, which also has negative consequences.

An object of the invention is to simplify the method and reduce side complications.

The technical problem is achieved by the proposed method, which consists in the following.

The method is illustrated in figures 1-3.

After preparation of the surgical field and local anesthesia, the conjunctiva is cut, the rectus muscle is planned to be strengthened, it is separated, with the help of tweezers the middle longitudinal part of the muscle is freed from the anterior ciliary arteries, tweezers capture the middle longitudinal part, which is 1/3 of the muscle width, is sutured 4-7 mm from the place of muscle attachment, depending on the required volume of reinforcement (Fig. 1) and with the same needle and thread, impose a scleral suture of 0.5-2 mm in front of the muscle (Fig. 2), pull the stitched section m shtsy anteriorly, to place the muscle attachment, forming two lateral folds muscle, three nodes thread knotted and cut (Figure 3). Nodal sutures are placed on the conjunctival incision.

The determining essential distinguishing features of the proposed method, in comparison with the prototype, are:

1. They release the middle, longitudinal part of the muscle, which they plan to strengthen, from the anterior ciliary arteries, which eliminates trauma to the neurovascular bundle.

2. Capture the middle longitudinal part (1/3 of the width) of the muscle, stitch it 4-7 mm from the place of muscle attachment, depending on the required volume of reinforcement, which allows to simplify the method and reduce its invasiveness, since the muscle is not cut, it is not stitched to the full width forming a crease (prototype).

3. A scleral suture of 0.5-2 mm in front of the muscle is applied, the stitched section of the muscle is pulled anteriorly by the thread, forming two lateral muscle folds, and the thread is tied with three knots, which reduces side complications in the form of a noticeable roller from the limb under the conjunctiva -for volumetric muscle three-layer folds (prototype), as well as improve the cosmetic effect of the operation.

The proposed method is illustrated by the following examples of specific performance

Example 1

Patient B., 8 years old, was admitted to the FGU MNTK “Eye Microsurgery” with a diagnosis of inconsistent divergent strabismus, mainly of the left eye. Myopia of a weak degree in both eyes.

Visual acuity:

OD 0.15 sph (-) 1.5 = 1.0

OS 0.15 sph (-) 1.5 = 1.0

Biometry OD 23, 32;

OS 23.48.

The nature of vision is simultaneous.

The strabismus angle according to Hirschberg is 0 degrees with a carpet test (-) 10-12 degrees. The eye periodically deviates outwards. Optical media are clean. The fundus is unchanged.

Under intravenous anesthesia, surgical treatment of the left eye was performed. After the preparation of the surgical field, the external rectus muscle was recessed according to the standard technique. The internal rectus muscle was strengthened by the claimed method: the conjunctiva was cut, the internal rectus muscle was separated, it was separated, the middle, longitudinal part of the muscle was freed from the anterior ciliary arteries with tweezers, it was captured (1/3 of the muscle width), stitched 4 mm from the site attaching the muscle with the same needle and thread, imposed a scleral suture of 0.5 mm in front of the muscle, pulled the stitched section of the muscle anteriorly, forming two lateral muscle folds and tied with three knots, the thread was cut off. Nodal sutures were placed on the conjunctiva.

The postoperative period was uneventful. After the operation, the strabismus angle is 0 degrees.

Example 2

Patient V., was admitted to the NF FSI MNTK "Eye Microsurgery" with a diagnosis of Converging convergent squint of the left eye. High degree amblyopia of the left eye with macular fixation.

Visual acuity:

OD 1.0;

OS 0.15 is not corrected.

Biometry OD 23.12;

OS 22.27.

The nature of the view is right-handed.

The strabismus angle according to Hirschberg with a carpet test (+) of 15-17 degrees. Constantly mows, to the nose, the left eye. Optical media are clean. The fundus is unchanged.

Under intravenous anesthesia, surgical treatment of the left eye was performed. After the preparation of the surgical field, the internal rectus muscle was recessed according to the standard technique. Strengthening of the external rectus muscle was carried out by the claimed method: a conjunctiva was cut, the external rectus muscle was separated, it was separated, with the help of tweezers they released the middle, longitudinal part of the muscle from the anterior ciliary arteries, captured it (1/3 of the muscle width), stitched 7 mm from the spot muscle attachment, the scleral suture 2 mm in front of the muscle was made with the same needle and thread, the stitched section of the muscle was pulled anteriorly to form two lateral muscle folds, tied with three knots, the thread was cut off. Nodal sutures were placed on the conjunctiva.

The postoperative period was uneventful. After the operation, the strabismus angle is 0 degrees.

In total, the claimed method operated on 27 patients with a good functional result. The method is simple to implement and allows to achieve good results with less invasiveness of the intervention.

Using the proposed method will allow, in comparison with the prototype, to simplify, reduce the invasiveness of the method and improve the cosmetic effect of the operation due to the absence of nodal thickening under the muscle.

Claims (1)

A method for eliminating strabismus, including conducting a conjunctival incision, isolating the rectus muscle, separating it, forming a fold and suturing, characterized in that the middle, longitudinal part of the separated muscle is freed from the anterior ciliary arteries, and tweezers capture the middle longitudinal part, which is 1/3 of the muscle width , sutured 4-7 mm from the place of muscle attachment, depending on the required volume of reinforcement and with the same needle and thread, impose a scleral suture of 0.5-2 mm in front of the muscle, pull the stitched thread the muscle section anteriorly, to the point of muscle attachment, forming two lateral muscle folds, tie the thread with three nodes.

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