RU2336852C1 - Method for surgical treatment of progressive myopia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: conjunctiva is cut in the upper external quadrant or simultaneously in the upper external and lower external quadrants of the eyebulb at a distance 9-11 mm from the limb. Tenon's layer is separated. Then graft in the form of square strip with dimensions 6.0-7.0 mm x 8.0-10.0 mm, thickness 0.8-1.8 mm, is put on sclera in equatorial direction. One end of the graft is affixed to the sclera with sutures, the other end is strained and affixed to the sclera with strained sutures. Then the conjunctival cuts are sealed by continuous silk suture. The method ensures increase of progressive myopia surgical treatment efficiency due to continuous impact of graft to the most expansible sclera zone. Microcirculation in ciliary body and choroids is enhanced.

EFFECT: stabilization of clinical refraction and improvement of visual functions.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of progressive myopia.

A known method of surgical treatment of progressive myopia is that in the conjunctiva of the eyeball between the rectus muscles 6-7 mm from the limb, four holes 3-4 mm long are formed, then a device with a graft is inserted into one of the formed holes, and the working part of the device equipped with a hook, which fixes the scleral graft through a pre-formed hole in it, after which a viscoelastic is introduced, while advancing the device towards the posterior pole of the eye, the formation of the channel between the sclera and the tenon capsule, the channel is filled with a 1% solution of hyaluronic acid, the scleral graft is fixed and the above actions are performed in all other previously formed holes, after which the conjunctival sutures are sealed (RF patent No. 2238706, class A61F 9/007, 2003, .).

The main disadvantages of this method are the insufficiently high efficiency under tight control, the passive effect of the introduced material on the sclera, caused by the time of its resorption.

The closest technical solution is the method of surgical treatment of progressive myopia, which consists in making an incision in the conjunctiva and tenon membrane, forming a pocket in the projection area of the macular and paramacular region, after which the graft is implanted (RF patent No. 2121827, class A61F 9/007, 1995).

The main disadvantages of this method are the lack of fixation and tension of the graft and the fact that strengthening the sclera of the posterior pole of the eye is not a direct result of the operation, but develops gradually, as the scar welded with the sclera forms and is reversible as a result of resorption of scar tissue. This reduces the effectiveness of the surgical treatment of progressive myopia.

The objective of the present invention is to increase the effectiveness of surgical treatment of progressive myopia.

The problem is solved due to the fact that in the method of surgical treatment of progressive myopia, namely, that the conjunctiva is incised followed by graft implantation (the material is used Scleroplant-M manufactured by MacMedi LLC, Russia), the conjunctiva is incised in the upper outer quadrant or in the upper outer and the lower outer quadrants of the eyeball simultaneously at a distance from the limb of 9-11 mm, after which the tenon membrane is separated, then laid on the sclera in the equatorial direction of the trans a plantate made in the form of a rectangular strip measuring 6.0-7.0 mm × 8.0-10.0 mm and a thickness of 0.8-1.8 mm, after which one end of the graft is fixed to the sclera with sutures, and the other end stretched and fixed to the sclera with tension sutures, then conjunctival incisions are sealed with a continuous silk suture. The size of the graft is experimentally selected, the smaller size of the graft gives a less pronounced effect, and the length of the graft more than 10 mm does not allow the transplant to be tensioned between the muscles.

Clinical refraction is stabilized due to the fact that the tensile stress of the most “vulnerable” equatorial region of the sclera of the myopic eye in the upper and lower outer quadrants of the eyeball decreases. Stabilization and increase in visual functions occurs due to increased microcirculation in the ciliary body and choroid caused by shear deformation, and shear deformation stimulates the secretory function of the microvessel endothelium.

Thus, the effectiveness of the surgical treatment of progressive myopia is increased.

The proposed method is illustrated by drawings.

Figure 1 shows the separation of the conjunctiva and tenon membrane in the upper outer quadrant of the eyeball.

Figure 2 shows the laying of the graft on the sclera in the equatorial direction.

Figure 3 shows the fixation of one end of the graft with interrupted sutures, then the tension of the graft, deviating at least 1.5 and no more than 2.0 mm from its free edge, and fixing with interrupted sutures of the other end of the graft.

Figure 4 shows the imposition of a continuous suture on the conjunctiva.

The method is as follows: under general anesthesia in the upper outer quadrant of the eyeball, departing from the limb 9-11 mm, the conjunctiva and tenon membrane are cut 6.0-7.0 mm long, the above mentioned tissues are separated with a spatula from the sclera. Next, a transplant is placed in this equatorial direction, made in the form of a rectangular strip measuring 6.0-7.0 mm × 8.0-10.0 mm, thickness 0.8-1.8 mm, uniformly adapting and fixed with interrupted sutures to the sclera on one side, then the graft is tensioned and its other edge is fixed to the sclera with interrupted sutures. The degree of transplant stretching is set by interrupted sutures that fix it to the sclera in a tension state, departing at least 1.5 and not more than 2.0 mm from its free edge. In the case of a transplant tension of more than 2.0 mm, there is a risk of compression of the vorticose veins and vessels supplying the eyeball, with a tension of less than 1.5 mm, a sufficient effect from surgery is not achieved. The above actions can be performed in the upper outer and lower outer quadrants at the same time when departing from the limb 9-11 mm in these quadrants, the conjunctiva and tenon membrane are cut in lengths of 6.0-7.0 mm, the above-mentioned tissues are separated with a spatula. Further, transplants made in the form of a rectangular strip of 6.0-7.0 mm × 8.0-10.0 mm in thickness, 0.8-1.8 mm thick, are uniformly adapted and fixed with interrupted sutures are placed in this area in the equatorial direction to the sclera on one side, then the graft is tensioned and its other edge is fixed to the sclera with interrupted sutures. The degree of transplant stretching is set by interrupted sutures that fix it to the sclera in a tension state, deviating at least 1.5 and no more than 2.0 mm from its free edge, after which the conjunctival incisions are sealed with a continuous silk suture.

Example 1

Patient K., 15 years old, turned to the Department of Ophthalmology of the Russian Children's Clinical Hospital with complaints of decreased visual acuity, the progressive course of myopia. Myopia from 8 years.

Survey conducted:

Visual acuity OD = 0.03 with sph-8.0 = 0.8; OS = 0.04 with sph-7.0 = 0.9.

Anteroposterior eye size OD = 26.2 mm; OS = 25.8 mm.

Scleroplasty with dosed graft tension was performed.

The postoperative period was uneventful.

Examination after 1 year:

Visual acuity OD = 0.04 with sph-7.0 = 1.0; OS = 0.04 with sph-6.0 = 1.0;

Anteroposterior eye size OD = 26.2 mm; OS = 25.8 mm.

Example 2

Patient P., 13 years old, turned to the Department of Ophthalmology of the Russian Children's Clinical Hospital with complaints of decreased visual acuity, the progressive course of myopia. Myopia from 7 years.

Survey conducted:

Visual acuity OD = 0.05 with sph-7.0 = 0.9; OS = 0.06 with sph-6.0 = 1.0.

Anteroposterior eye size OD = 25.6 mm; OS = 25.5 mm.

Scleroplasty with dosed graft tension was performed.

The postoperative period was uneventful.

Examination after 1.5 years:

Visual acuity OD = 0.07 with sph-5.5 = 1.0; OS-0.08 with sph-5.0 = 1.0.

Anteroposterior eye size OD = 25.6 mm; OS = 25.5 mm.

According to the proposed technology, 10 patients (20 eyes) were operated on. In all cases, stabilization of the size of the eyeball, the magnitude of myopia and increased visual function are noted. In three cases, the size of the eyeball did not change compared to the original, and the magnitude of myopia decreased.

Thus, the proposed method allows you to effectively treat patients with progressive myopia.

Claims (1)

A method of surgical treatment of progressive myopia, namely, that the conjunctiva is incised followed by implantation of a graft, characterized in that the conjunctiva is incised in the upper outer quadrant or in the upper and lower outer quadrants of the eyeball at a distance of 9-11 mm from the limbus, after which they are separated the tenon shell, then the graft is placed on the sclera in the equatorial direction, made in the form of a rectangular strip measuring 6.0-7.0 mm × 8.0-10.0 mm, thickness 0.8- 1.8 mm, after which one end of the graft is fixed to the sclera with sutures, and the other end is stretched and fixed to the sclera with tension sutures, then the conjunctival incisions are sealed with a continuous silk suture.

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