RU2333739C1 - Method of preventive treatment of retinal detachment at penetrating wound of eyebulb with intaocular debride impacted into operculum of posterior pole of eye - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to oculistics, and aimed at preventive treatment of retinal detachment at penetrating wounds of eyebulb with intraocular debride (D) impacted into the operculum of posterior pole of eye, as the stage before elimination of debride as well as in cases when debride (D) elimination is impossible or there is a high risk of complication if it's eliminated. Transpupillary thermotherapy of eyeground is carried out in the zone of dedride localisation while clinching unaffected surrounding tissues on 0.5 mm by laser radiation, the wave length of which is 810 Nm and power is 450-800 mW, at the exposition 60 seconds per one laser field.

EFFECT: risk reduction of retinal detachment progression, inflammatory process, proliferative vitreoretinopathy and metalloze.

2 cl, 2 ex

Description

The invention relates to medicine, and more specifically to ophthalmology, and is intended for the prevention of retinal detachment with penetrating wounds of the eyeball with the presence of an intraocular foreign body hammered into the membranes of the posterior pole of the eye, as a step before removal of a foreign body, as well as in cases of impossibility of removing IT or high the risk of complications during its removal.

Traumatic lesions of the organ of vision occupy one of the leading places in the practice of an ophthalmic surgeon. Their complexity is due to the combined nature of the lesion of the eyeball, as well as possible complications that develop in the post-traumatic period.

Retinal detachment of traumatic origin is one of the most serious complications of penetrating eye injuries with the introduction of a foreign body (IT) and occurs in 19-21% of cases in patients with this pathology. In penetrating shrapnel wounds, the main retinal damage is traumatic defects in the form of single or multiple tears located in the areas of implantation, ricochetting, occurrence and removal of IT, which are diverse in shape and size. A long stay of IT in the eye often leads to the development of an inflammatory reaction and metallosis, which results in preretinal fibrosis, the formation of additional breaks.

There are a number of methods, the use of which is aimed at preventing the development of retinal detachment with penetrating wounds of the eyeball with the presence of an intraocular foreign body, hammered into the membranes of the posterior pole of the eye:

1) cryoretinopexy in the incision zone of the fibrous capsule of the eye (GG Bordyugova, A set of measures to prevent retinal detachment in case of damage to the eyeball. New in the diagnosis and treatment of penetrating organ injuries. - Saratov, 1977. - P.156-159);

2) diode-laser transscleral retinopexy in the incision zone of the fibrous capsule of the eye (Stepanov A.V. et al. Use of lasers for diaskleral removal of intraocular foreign bodies. Mat. Conf. "Modern technologies in the diagnosis and surgical treatment of fragmentary wounds of the eye and orbit." - Moscow, 2001. - P.57-58);

3) carrying out transpupillary barrier laser coagulation of the retina (RF patent No. 2223074). This method is adopted as a prototype.

The above methods of preventing the development of retinal detachment with penetrating wounds of the eyeball with the presence of an intraocular foreign body have found their place in clinical practice. However, their use is often not enough to create a strong chorioretinal adhesion that can block a retinal defect, in addition, the risk of developing an inflammatory process is not excluded.

The objective of the invention is to provide an effective method for the prevention of retinal detachment with penetrating wounds of the eyeball with the presence of an intraocular foreign body, hammered into the membranes of the posterior pole of the eye.

The technical result of the proposed method is to reduce the risk of retinal detachment, the inflammatory process, proliferative vitreoretinopathy and metallosis. The technical result is achieved due to the fact that:

1. Carrying out transpupillary diode-laser thermotherapy with given parameters:

- promotes the formation of a dense chorioretinal scar, which eliminates the occurrence of retinal detachment during and after IT removal, as well as in cases of impossibility of IT removal or a high risk of complications during its removal;

- has a bactericidal effect;

- Prevents the formation of a dense capsule around IT;

- Prevents hemorrhage during IT removal.

The method is as follows.

Preliminary ophthalmoscopically clarify the localization of the intraocular foreign body.

Carry out transpupillary fundus thermotherapy in the area corresponding to the localization of a foreign body with the capture of intact surrounding tissue by 0.5 mm, laser radiation with a wavelength of 810 nm, with a power of 450-800 mW, with an exposure of 60 seconds per field of laser radiation; field diameter - 2-3 mm. The number of laser radiation fields depends on the size of the irradiation zone.

The invention is illustrated by the following examples.

Example 1. Patient S. Was admitted to the Kaluga branch of the Federal State Institution Scientific and Technological Center "Eye Microsurgery" with a diagnosis of "Penetrating corneoscleral wound, with the presence of an intraocular metal foreign body, hammered into the shell of the posterior pole of the right eye." Before surgery, the sharpness of the right eye is 0.3. In the preoperative binocular ophthalmoscopic, a metal foreign body was determined located in the lower nasal quadrant perimacularly at a distance of 2 disk diameters in the temporal direction from fovea centralis. The dimensions of the foreign body according to ultrasound (B-scan) were 0.9 mm by 2.0 mm.

The patient is treated according to the proposed method.

Conducted transpupillary thermotherapy in the area of the foreign body with the capture of surrounding tissue by 0.5 mm, laser radiation with a wavelength of 810 nm, with a power of 600 mW, with an exposure of 60 seconds, one field with a diameter of 3 mm.

After 2 weeks, the foreign body was removed transvitreal. During the operation, when removing a foreign body from the posterior membranes of the eye, hemorrhages did not occur, a flat focus of the chorioretinal structure with moderate pigmentation was determined around the foreign body, and there was no capsule. At discharge, visual acuity in the operated eye was 0.4. In the long-term postoperative period (observation period of up to 18 months), inflammatory phenomena, retinal detachment, metallosis, and proliferative vitreoretinopathy were not observed.

Example 2. Patient 3. He was admitted to the Kaluga branch of the Federal State Institution IRTC “Eye Microsurgery” with a diagnosis of “Penetrating corneoscleral wound, with the presence of an intraocular foreign body punctured in the membranes of the posterior pole of the left eye”. Before surgery, the sharpness of the left eye is 0.2. During preoperative binocular ophthalmoscopic and ultrasound examination, a metal foreign body was found in the inferior temporal quadrant at a distance of 4 diameters of the disk from the optic nerve disk 0.7 mm by 1.0 mm in size.

The patient is treated according to the proposed method.

Conducted transpupillary thermotherapy in the area of the foreign body with the capture of conditionally healthy surrounding tissue by 0.5 mm, laser radiation with a wavelength of 810 nm, with a power of 450 mW, with an exposure of 60 seconds, one field with a diameter of 2 mm.

After 2 weeks, the foreign body was removed transvitreal. During the operation, when removing a foreign body from the posterior membranes of the eye, hemorrhages did not occur, a dense chorioretinal focus was determined around the foreign body, and there was no capsule. At discharge, visual acuity is 0.3. In the long-term postoperative period (observation period up to 12 months), inflammatory phenomena, retinal detachment, metallosis and proliferative vitreoretinopathy were not noted.

The proposed method was used to prevent retinal detachment as a stage before removing a foreign body, as well as in cases of impossibility to remove IT or a high risk of complications when it is removed in 6 patients with penetrating wounds of the eyeball with an intraocular foreign body inserted into the membranes of the posterior pole of the eye . Transpupillary thermotherapy was carried out with a power of 450 to 800 mW, the diameter of the laser radiation field was from 2 to 3 mm, the number of fields was from 1 to 4. The observation period was from 3 to 18 months. In all cases, the claimed technical result was achieved.

Thus, the claimed method prevents the development of retinal detachment, inflammatory complications, proliferative vitreoretinopathy and metallosis.

Claims (2)

1. A method for the prevention of retinal detachment with penetrating wounds of the eyeball with the presence of an intraocular foreign body, injected into the membranes of the posterior pole of the eye, characterized in that they conduct transpupillary thermotherapy of the fundus in the area corresponding to the localization of the foreign body with the capture of intact surrounding tissue by 0.5 mm , with laser radiation with a wavelength of 810 nm, with a power of 450-800 mW, with an exposure of 60 s per one field of laser radiation. 2. The method according to claim 1, characterized in that the diameter of the laser radiation field is 2-3 mm, and the number of fields depends on the size of the irradiation zone.