RU2332973C1 - Method for surgical treatment of retina amotio - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: said method involves entering hollow cannula in vitreal eyeball cavity with the diameter of less than 0.5 mm; entering a vitreotome, an irrigator and an aspirator; performing retinotomy using a vitreotome with diameter of 0.5-1.0 mm at a gear line in the top zone of a vitreal cavity from 11-00 till 1-00 o'clock . A vitreal cavity is gradually filled with PFOC solution squeezing out subretinal liquid from space under a retina through the formed aperture in the top zone. To fully evacuate subretinal liquid an eyeball is turned from top to bottom till achieving position whereat the level of 12 o'clock in vitreal cavitity is above the level of 6 o'clock by 15°-30° angle. The method further includes carrying out a full tamponade of vitral cavity PFOC to achieve full retina adhering, carrying out laser concretion of retina, deleting irrigational liquid above the level of PFOC and carrying out a tamponade with silicon oil.

EFFECT: full evacuation of subretinal liquid with achievement of full anatomic adhering of retina to eye covers.

2 ex

Description

The invention relates to the field of ophthalmic surgery.

A known method for the surgical treatment of retinal detachments, which consists in introducing a vitreotome, an irrigator and an aspirator, perfluororganic compound (PFOS), laser coagulation of the retina with subsequent tamponade with silicone oil (CM) into the vitreous cavity of the eyeball (Kh. P. Takhchidi. Selected sections of eye microsurgery. Vitreous. body. M., 2002, p. 58).

However, this method has significant drawbacks: the difficulties of complete evacuation of the subretinal fluid and the achievement of a complete anatomical fit of the retina to the membranes of the eye.

The technical result is the evacuation of subretinal fluid and the achievement of a complete anatomical fit of the retina to the membranes of the eye.

The specified technical result is achieved by the fact that in the method of surgical treatment of retinal detachments, which consists in introducing a vitreotome, an irrigator and an aspirator, perfluororganic compound (PFOS) into the vitreous cavity of the eyeball, laser coagulation of the retina followed by tamponade with silicone oil (SM), initially in the vitreous cavity of the eye apples, hollow cannulas with a diameter of less than 0.5 mm are introduced, then a vitreotome, an irrigator and an aspirator are introduced into them, then from the dentate line in the upper zone of the vitreous cavity from 11-00 to 1-00 hours They make a retinotomy with a vitreatom with a diameter of 0.5-1.0 mm, after which the vitreous cavity is gradually filled with PFOS, squeezing the subretinal fluid from the space under the retina through the formed opening in the upper zone, then turn the eyeball to the bottom to completely evacuate the subretinal fluid to reach the position in which in the vitreous cavity the level of 12 hours becomes higher than the level of 6 hours by an angle of 15-30 °, then after a complete tamponade of the vitreous cavity of PFOS and achievement of full fit of the retina to eye bolochkam PFOS medium is carried out to achieve laser coagulation of the retina fixation, then completely removed above the level of the irrigation liquid and produce PFOS tamponade SM.

The proposed method is as follows. Initially, hollow cannulas with a diameter of less than 0.5 mm are introduced into the vitreous cavity of the eyeball, then rectilinear vitreotomes, an irrigator and an aspirator are introduced into them.

Then, from a dentate line in the upper zone of the vitreous cavity from 11-00 to 1-00 hours, a retinotomy with a diameter of 0.5-1.0 mm is made by a vitreatom.

The vitreous cavity is gradually filled with PFOS, squeezing out the subretinal fluid from the space under the retina through the hole formed in the upper zone of the vitreous cavity.

Then, for complete evacuation of the subretinal fluid, the eyeball is turned down to reach the position at which the level of 12 hours in the vitreous cavity becomes higher than 6 hours at an angle of 15-30 °.

After a complete tamponade of the vitreous PFOS cavity has been achieved and full retinal fit to the eye membranes has been achieved, PFOS is laser coagulated to achieve retinal fixation. Then, the irrigation liquid is completely removed above the PFOS level and SM tamponade is produced.

The method is confirmed by the following clinical examples.

Example 1

Patient M., 34 years old.

Diagnosis: OS: Proliferative diabetic retinopathy, tractional retinal detachment, recurrent hemophthalmus.

Visual acuity before surgery: proper light projection, intraocular pressure: 20 mm Hg

Status localis: The cornea is transparent, the anterior chamber depth is average, the anterior chamber moisture is clean, the pupil is of the correct form, the initial clouding of the lens, the blood suspension is in the vitreous cavity. Details of the fundus are not ophthalmoscopic.

According to the B-scan, traction retinal detachment around the optic disc with a maximum height of 3.5 mm is detected. A heme suspension in the eye cavity.

The operation is carried out in accordance with the claims. 1 month after surgery, visual acuity was 0.1 n / k, intraocular pressure was 18 mm Hg.

Status localis: The cornea is transparent, the anterior chamber depth is average, the anterior chamber moisture is clean, the pupil is of the correct shape, the initial clouding of the lens, the vitreous cavity is transparent. The optic nerve disc is a pale pink color, the borders are clear, gliosis. The retina is adjacent throughout. Foci of laser coagulation. Myakroaneurysms, small foci of epiretinal hemorrhages.

According to the B-scan, the vitreous cavity is acoustically transparent.

The retina is adjacent.

Example 2

Patient V., 45 years old.

Diagnosis: OD: Subtotal retinal detachment, high myopia. Visual acuity before surgery: 0.01 n / a, intraocular pressure: 22 mm Hg

Status localis: The cornea is transparent, the anterior chamber depth is average, the anterior chamber moisture is clean, the pupil is of the correct form, the initial clouding of the lens, the destruction of the vitreous. Subtotal retinal detachment is visualized. Rigid retina of gray color with numerous folds, rigid. The rupture due to destruction of the vitreous body is not ophthalmoscopic. DZN of a pale color. Myopic staphyloma.

According to the B-scan, subtotal retinal detachment up to 4.5 mm high is detected. Vitreous destruction.

The operation is carried out in accordance with the claims.

1 month after surgery, visual acuity was 0.05 with sph - 8.0 0.6 n / a, intraocular pressure was 20 mm Hg.

Status localis: The cornea is transparent, the anterior chamber depth is average, the anterior chamber moisture is clean, the pupil is of the correct shape, the initial clouding of the lens, the vitreous cavity is transparent. Optic disc of pale pink color, clear boundaries. Myopic staphyloma. The retina is adjacent throughout.

According to the B-scan, the vitreous cavity is acoustically transparent. The retina is adjacent.

Claims (1)

A method of surgical treatment of retinal detachments, which consists of introducing a vitreotome, an irrigator and an aspirator, a perfluororganic compound (PFOS) into the vitreous cavity of the eyeball, laser coagulation of the retina followed by tamponade with silicone oil (SM), characterized in that hollow cannulas are introduced into the vitreous cavity of the eyeball with a diameter of less than 0.5 mm, then they are injected with a vitreotome, an irrigator and an aspirator, then at the dentate line in the upper zone of the vitreous cavity from 11-00 to 1-00 hours a retinot is produced with a vitreotome a mission with a diameter of 0.5-1.0 mm, after which the vitreous cavity is gradually filled with PFOS, squeezing out the subretinal fluid from the space under the retina through the formed hole in the upper zone, then to completely evacuate the subretinal fluid, turn the eyeball down to the position where the vitreous cavity, the level of 12 hours becomes higher than the level of 6 hours by an angle of 15-30 °, then after a complete tamponade of the vitreous cavity of PFOS and achievement of full fit of the retina to the membranes of the eye in PFOS medium vlyayut laser coagulation of the retina in order to achieve locking, and then completely removed above the level of the irrigation liquid and produce PFOS tamponade SM.