RU2332971C1 - Method of through keratoplasty with graft biocovering - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: excising of an amazed cornea is performed in two stages. At the first stage, after a cut a cornea trepan by 1/3 of its thickness, blankets are deleted; at the second stage, through excising of the remained layers are made. The method further includes placing a through corneal donor graft in a surgery field; stacking a disk of an amnionic cover over a graft, covering it with the excised level-by-level disk of a recipient cornea from above, and fixing it together with a disk of an amnionic cover to an operational wound rim.

EFFECT: prompt cuticularisation of a graft without sphericity disturbance; minimum edema in the postoperative period; better efficiency of treatment.

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Description

The invention relates to medicine, namely to ophthalmology, and relates to the technique of end-to-end keratoplasty with transplant biocoating.

There is a known method of through keratoplasty for cataracts, in which a deep non-through cut of the cornea is made with a trepan and a through cut in one section through which scissors cut the affected corneal disc with scissors using a previously made incision, a through donor corneal transplant is placed in the hole in the cornea and fixed him to the recipient's cornea with sutures [1].

The disadvantage of this method is that after the operation is completed, the transplant remains unprotected in the environment of the recipient’s tissues, and this can lead to delayed epithelization, excessive edema, and decreased transparency.

There is also known a method of end-to-end keratoplasty, in which the affected part of the patient’s cornea is excised, the donor corneal transplant is placed in the surgical field, it is fixed to the patient’s cornea, the graft is coated with the amniotic membrane and the amniotic membrane is fixed to the edge of the surgical wound [2].

The disadvantage of this method is that the fixation of the amniotic membrane on the graft surface to the edge of the surgical wound of the recipient’s cornea is not strong enough, early eruption of sutures and rejection of the amniotic membrane before the epithelization of the graft occurs, which can lead to complications in the postoperative period and reduce the effectiveness of treatment.

The aim of the invention is to reduce the possibility of postoperative complications and increase the effectiveness of the treatment of lesions of the cornea.

This goal is achieved by excising the affected cornea in two stages, at the first stage after cutting the cornea with a trephine 1/3 of its thickness, the surface layers are removed, at the second stage, the remaining layers are cut through, the excised layered corneal disc of the recipient is placed over the amniotic membrane, which together with the amniotic membrane is fixed to the rim of the surgical wound, the amniotic membrane and excised layered corneal disc of the recipient are left on the graft surface for up to 5 days.

Comparison of the proposed method with other methods known in the field of medicine shows compliance with the criteria of the invention.

The method is as follows.

After processing the surgical field and local anesthesia with trepan of the required size, an incision of the cornea is made to 1/3 of its thickness, within which the anterior layers are excised, then the remaining layers are cut through, a donor corneal through graft is placed into the formed hole in the cornea and fixed with a continuous suture 10 -00 to the edge of the surgical wound. First, the canned amniotic membrane is placed on top of the graft, then the excised layered corneal disk of the recipient is placed, which, together with the amniotic membrane, is fixed with 4 interrupted sutures 8-00 to the rim of the surgical wound. The graft bio-coating is left for 4-5 days.

The proposed method leads to the rapid epithelization of the graft without disturbing its sphericity, minimal edema in the postoperative period, with more predictable transparent engraftment, thereby increasing the effectiveness of the treatment.

In a similar way, 12 patients with secondary endothelial-epithelial dystrophy of the cornea (5), primary dystrophy of the cornea (3) and sore throats (4) were operated on. Biocoating from the amnion and excised layered corneal disc of the recipient was retained on the graft surface for up to 5 days. After removal of the biocoating on the 6th day, the transplant was transparent in all patients; its surface was completely covered with epithelium. The sphericity of the graft was not broken. By the time of discharge, all patients had transplants transparent.

Example 1. Patient L., 72 years old, was admitted to the eye clinic with a diagnosis of Secondary endothelial-epithelial corneal dystrophy, artifact of both eyes. From the anamnesis it was revealed that in 1976 he underwent cryoextraction of cataract with implantation of an iris-clip lens on his right eye, and in 1984 - a similar operation on his left eye. Dislocation of support elements repeatedly occurred on each eye, the correction of which was performed surgically. Over the past 3-4 years, there has been a decrease in vision in both eyes, mostly in the right eye. Upon receipt, the visual acuity of the right eye was 0.01 n / a, the left eye - 0.1 n / a. Objectively: the right eye is a light pericorneal injection, pronounced corneal edema with bullous changes in the epithelium, the thickness of the cornea is significantly increased, the underlying structures of the eye are difficult to see, the ICL position is correct, the pupil is 4 mm, centrally located, at 12 o’clock - peripheral iris coloboma, reflex with fundus very dim, fundus not visible; the left eye is calm, the cornea is moderately swollen, slightly thickened, the anterior chamber is deep, the ICL position is correct, the pupil is 3 mm, centrally located, at 12 o’clock - the peripheral coloboma of the iris, the reflex from the fundus is determined, but the details of the fundus are not visible. On March 30, 2004, a through corneal transplant was performed with a medical-optical target with a bio-coating of the graft on the right eye.

After intravenous premedication and local anesthesia with 2% novocaine solution, the eyeball is fixed with two ligatures superimposed on both vertical rectus muscles. A trepan of 8.0 mm produced an incision of the cornea to 1/3 of its thickness, within which the surface layers of the cornea, which were placed on a wet gauze, were removed. With the same trepan, the remaining deep layers of the cornea are excised. One nodular suture 10-00 was applied to the pupil border of the iris, after which the pupil narrowed to 2.5 mm in diameter. Introduced in the front camera visited. From the donor eye, an 8.25 mm through-corneal disc was excised from the donor eye, which was transferred to the surgical field in the recipient's eye, where it was fixed with a continuous suture 10-00. A disk with a diameter of 8.25 mm is cut from a canned amniotic membrane, which is laid on the surface of the graft. A dissected layered corneal disc of the recipient is placed on top of the amniotic membrane, which, together with the amniotic membrane, is fixed by four interrupted sutures 8-00 to the edge of the corneal wound of the recipient. The anterior chamber is washed with physiological saline. A 20% solution of sulfacyl sodium was instilled into the eye, 0.5 ml of a 0.1% solution of dexamethasone was administered under the conjunctiva, the eye was closed with an aseptic cotton-gauze cloth.

The postoperative period was uneventful, the biopoating from the graft was removed on the 6th day, the graft is transparent, its surface is spherical, completely covered with epithelium, the anterior chamber is deep, the ICL is central, the reflex from the fundus is pink, the fundus was visible, visual acuity increased to 0.1 n / a. The treatment was continued for 7 days, the transplant became perfectly transparent, visual acuity at the time of discharge increased to 0.5 n / a. The patient was traced for 2.5 years, the eye is calm, the graft remains transparent, visual acuity is 0.6 n / K. During this period, he underwent a similar operation on the other eye, as a result of which the visual acuity in the left eye improved to 0.7 n / a.

Example 2. Patient S., 57 years old, was admitted to the eye clinic with a diagnosis of Belmo IV category after keratitis in both eyes. Visual acuity of the right eye is 0.03 n / a, the left eye is the count of fingers in the face by 20 cm n / a. Objectively, the cornea of both eyes is cloudy with abundant vascularization, mostly in the left eye. The underlying structures are difficult to see, the reflex from the fundus is not determined. On February 25, 2003, end-to-end keratoplasty was performed according to the described technology with bio-coating of the graft with the disk of the amniotic membrane and fixation of its excised layered corneal disk of the recipient. The biocoating was removed after surgery on the 6th day, by this time the graft was completely covered with epithelium, retained its transparency and sphericity. Visual acuity increased initially to 0.08 n / a, subsequently to 0.3 n / a. The patient was tracked for 3 years, the transplant partially lost its transparency due to the vessels that grew into it, visual acuity decreased to 0.2 n / k. 1 year after the first operation, he underwent a similar operation on his right eye, the graft healed transparently, visual acuity increased to 0.3 n / a.

INFORMATION SOURCES

1. Puchkovskaya N.A. et al. // Basics of corneal transplantation. Kiev, 1971, pp. 93-123.

2. Kasparov A.A. et al. // Method of keratoplasty for vascular corneal sore throats. Patent for invention No. 2275888.

Claims (1)

The method of end-to-end keratoplasty with a bioparticle of the graft by excision of the affected cornea of the recipient, placement of a through donor corneal transplant in the surgical field, fixing it with a continuous suture to the cornea of the recipient, covering the graft with a disk of the amniotic membrane and fixing it to the edge of the surgical wound, characterized in that the excision is performed by excision in two stages, at the first stage after an incision with a trephine of the cornea 1/3 of its thickness, the surface layers are removed, at the second stage, through To excise the remaining layers, a dissected layered corneal disc of the recipient is placed over the amniotic membrane, which together with the amniotic membrane is fixed to the rim of the surgical wound, the amniotic membrane and excised layered corneal disk of the recipient are left on the graft surface for up to 5 days.