RU2343888C1 - Method of elimination of horizontal nystagmus using method of rotation of rectus muscles of eye - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: carry out separation of muscles at place of its attachment to sclera together with the scleral basis. Carry out rotation of a muscle by its torsion in the area of myoscleral bond along its longitudinal axis. After that fix the muscle to the sclera to place of initial attachment two nodulose sutures. As a result of rotation muscle food is broken, the dystrophia of nerve trunks develops, nervously-pulse influence decreases for a muscle.

EFFECT: reduction of amplitude of a horizontal nystagmus.

2 cl, 3 ex, 1 dwg

Description

The present invention relates to medicine, namely to ophthalmology, and can be used to correct horizontal nystagmus.

There is a known method of correcting a jerky nystagmus, proposed by Anderson, Kestenbaum in 1953 (M.L. Krasnov, B.C. Belyaev. - Manual for eye surgery. - M: Medicine, 1988. - P.459). The operation is performed in 2 stages: at the 1st stage, a recession of the muscles of both eyes associated with the slow phase of nystagmus is performed. At the 2nd stage, bilateral resection of the muscles involved in the formation of the fast phase of nystagmus is performed.

This method is not suitable for correcting pendulum-like nystagmus, where the muscle tone on both sides is the same.

The well-known method is Avetisova E.S., 1978 (M.L. Krasnov, B.C. Belyaev. - Guide to eye surgery. - M: Medicine, 1988. - P.459-463), which is used for any type of nystagmus. The essence of the operation is a bilateral resection of the anterior abdominal segment of the oculomotor muscles. Since stretching receptors - muscle spindles are concentrated in this section of the muscle, their removal allows to reduce the neuromuscular effect on the muscle. At the first stage, an operation is performed on one eye; in the second stage, if the nystagmus has not decreased, in the other eye.

The disadvantage of this method is a significant trauma to the muscle due to resection (excision) of its site; in addition, suturing through the thickness of the muscle and its separation from the place of attachment are possible.

The prototype of the proposed technical solution is a method of surgical treatment of horizontal jerky and horizontal mixed pendulum-like and jerky nystagmus (RF Patent No. 2269989, A61F 9/007, 02.20.2006) by weakening the action of the internal rectus muscles of the horizontal action of both eyes of the patient, characterized in that on the internal the straight muscle of both eyes is fixed with sutures to the sclera in the area lying behind the equator of the eyeball, while the sutures are applied, departing 11-15 mm from the place of their physiological attachment eniya. Muscles are fixed to the sclera with two double entwined interrupted sutures of 5–5 merselen. Sutures are applied on 1/3 of the width of the muscle with capture 1/3 of the thickness of the sclera.

The prototype method is not sufficiently technological and effective in connection with the following circumstances.

1. The proposed effect on the muscle at the equator of the eye and beyond the equator of the eye. However, the sclera thickness in the equator is the smallest: 0.3-0.4 mm (at the edge of the cornea - 0.6 mm, around the posterior pole of the eye - 1 mm) (I.I. Kagan, V.N. Kanyukov Clinical anatomy of the organ Vision. - St. Petersburg: Aesculapius, 1999. - P. 42-43). Given the small thickness of the sclera in the area of manipulation, the likelihood of perforation of the sclera is high.

2. The release of muscles from the surrounding tissue for their further fixation with sutures to the sclera at a distance of 11-15 mm from the point of their physiological attachment is quite traumatic for the surrounding tissues.

3. When a muscle is contracted, it is likely to break away from the sclera, since the muscle is stretched and the sclera is captured to a depth of about 0.1-0.2 mm.

The problem to be solved and the expected technical result are to develop a more efficient, technologically advanced and gentle way to eliminate horizontal nystagmus, both jerky and pendulum-like.

The problem is solved in that the proposed method for eliminating horizontal nystagmus, including the imposition on the rectus muscles of the horizontal action of the fixing sutures to the sclera, is characterized in that the muscles are first separated at the point of attachment to the sclera together with the scleral base, then the muscles are rotated along its longitudinal axis and its fixation to the sclera to the place of initial attachment.

The muscle is rotated by twisting it in the area of the myoscleral joint, and the muscle is fixed to the sclera with two knotted sutures.

The authors are familiar with the Malbrana method, similar in execution technique, proposed in 1965 to correct strabismus (Edited by M.L. Krasnov. - A Guide to Eye Surgery. - M: Medicine, 1976, pp. 75-76). The essence of the operation is to cut off the muscle from its attachment to the sclera; then rotation is performed - twisting in the area of the abdomen of the muscle - and sewing it to the place of initial attachment. The rotation of the muscle was aimed at strengthening the weak muscle by shortening it. However, the expected result was not obtained: muscle shortening was not achieved, the strabismus angle did not decrease.

During Malbrana surgery, an additional trauma to the cut muscle occurs when it is fixed with knotted sutures to the sclera; in addition, teething of sutures and tearing of the muscle from the place of fixation are possible.

The claimed technical solution meets the criteria of an inventive step, as it is efficient and technological for eliminating nystagmus. Since the sclera is a stronger tissue than muscle tissue, the fixation of the muscle to the sclera behind the “scleral ears” - the scleral base sections used to fix the muscle to the sclera after its rotation (twisting) - is more reliable; moreover, the muscle itself, if you do not take into account its rotation, remains intact, anatomically preserved completely.

During muscle rotation (twisting), torsion of nerve trunks, blood vessels, and muscle fibers is performed in the area of the myoscleral junction.

A muscle tendon connects the abdomen of the muscle and the sclera of the eyeball. Since the tendons of the rectus muscles of the eye are very short, when the muscle is twisted in the area of the myoscleral joint, there is also twisted in the region of the anterior segment of the abdominal muscle and muscle tendon.

As a result of rotation, muscle nutrition is disrupted, dystrophy of the nerve trunks develops, and neuromuscular action on the muscle decreases, which leads to a decrease in the amplitude of horizontal nystagmus.

This method is suitable for correcting both jerky and pendulum-like horizontal nystagmus.

In the drawing, the place for separation of the muscle is indicated by a dashed strip; the numbers 1, 2, 3, 4 indicate “scleral ears” - the areas of the scleral base used to fix the muscles to the sclera after its rotation (twisting), and figure 5 indicates the lateral and medial rectus muscles of the eye. The view before and after the arrow means, respectively, before and after rotation (twisting) of the direct horizontal muscles.

The method is carried out by the following sequence of operations and is illustrated in figure 1.

1) Separation of the rectus muscle of horizontal action — the lateral and medial muscles of the eye 5 — at the place of their attachment to the sclera together with the scleral base with the formation of “scleral ears” on the sides of the muscles 1, 2, 3, 4.

2) Rotation (twisting) of each muscle 5 along its longitudinal axis 1 time by 180 ° in the area of the myoscleral joint.

3) Fixation of muscles 5 twisted according to claim 2 to the sclera behind the “scleral ears” 1, 2, 3, 4 to the place of initial attachment with two knotted sutures.

Examples of the method

Example 1

The proposed method for eliminating horizontal nystagmus was performed on 12 rabbits. A horizontal pendulum-like nystagmus was artificially induced before and after the operation by rotating the rabbit around the vertical axis: 26 revolutions in 30 seconds. Duration of observation after surgery 1 week, 2 weeks, 1 month, 3 months.

At 1 and 2 weeks, the amplitude of nystagmus in rabbits decreased slightly, at the same time 1 month and 3 months - 2 times or more, which indicates the effectiveness of the proposed method.

Example 2

Patient C, diagnosis: OU (both eyes) - mid-span pendulum-like horizontal nystagmus, OD (right eye) - weak refractive myopia, OS (left eye) - amblyopia.

Visual acuity before surgery OD = 0.3 sph (-) 2.0 = 0.9; OS = 0.4 n / k. (visual acuity without correction 0.3, with correction sphere minus 2.0 diopters; thus, visual acuity 0.9; left eye 0.4 does not correct).

The amplitude of the nystagmus OU (both eyes) = 10 °.

After surgery, the proposed method of rotation of the rectus muscles of the eye, after 1.5 years: visual acuity OD = 0.3 sph (-) 2.0 = 1.0; OS = 0.4 n / a (visual acuity without correction 0.3, with correction sphere minus 2.0 diopters; thus, visual acuity 0.9; left eye 0.4 does not correct).

The amplitude of horizontal nystagmus 2.5 °, the frequency of nystagmus decreased.

Example 3

Patient B., diagnosis: OU (both eyes), myopic astigmatism, amblyopia, jerky horizontal nystagmus.

high degree axial myopia, severe complex, coarse

Visual acuity before surgery:

OD = 0.1 cyl (-) 2.75 diop.ax 20 ° = 0.2;

OS = .0.1 cyl (-) 2.5 di.ax 13 ° = 0.2

(visual acuity without correction of 0.1; with correction cylinder minus 2.5 diopters, axis 13 °; visual acuity is 0.2).

The amplitude of the nystagmus OU (both eyes) = 20 °.

After surgery, the proposed method of rotation of the rectus muscles of the eye, after 2 years:

visual acuity OD = 0.1 sph (-) 1.0 diopters. cyl (-) 2.5 diopters.ax 20 ° = 0.3 (visual acuity without correction of 0.1, with correction sphere (-) 1.0 diopters, cyl (-) 2.5 diopters, visual acuity is 0, 3)

visual acuity OS = 0.1 sph (-) 0.5 diopters. cyl (-) 1.5 diopters.ax 15 ° = 0.2 (visual acuity without correction 0.1, with correction sphere (-) 0.5 diopters. cylinder (-) 1.5 diopters, axis 15 °; sharpness vision is 0.2).

The amplitude of the jerky horizontal nystagmus is 10 °, the frequency of the nystagmus decreased.

The proposed method is thus effective and technologically advanced to eliminate horizontal nystagmus, both jerky and pendulum-like; it differs by gentle fixation of the muscle to the sclera by the "scleral ears" and not by the abdomen, which reduces not only the invasiveness of the operation, but also the likelihood of eruption of sutures and tearing of the muscle from its fixation to the sclera.

Claims (2)

1. A method of eliminating horizontal nystagmus, including the imposition of horizontal joints on the rectus muscles of the fixing sutures to the sclera, characterized in that the muscle is first separated at the point of attachment to the sclera together with the scleral base, then the muscle is rotated along its longitudinal axis and fixed to sclera to the site of initial attachment. 2. The method according to claim 1, characterized in that the rotation of the muscle is carried out by twisting it in the area of the myoscleral connection, and the muscle is fixed to the sclera with two knotted sutures.