RU2344800C1 - Method of surgical retina detachment treatment - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be applied in surgical treatment of retina detachment with multiple ruptures, or retina detachment with a single rupture and express peripheral retina dystrophy, with pre-rupture states as well. After conjunctive cut at 3-4 mm distance from limb, all rectus eye muscles are extracted and taken into holder seams. Retina rupture projection are localised on sclera by intraoperation indirect binocular ophthalmoscopy. Further a round bank of scleral depression is made by silicon seal with diametre defined by rupture size. Silicon seal is put through 4 channels formed between sclera and allotransplant strips glued to sclera surface meridionally between rectus eye muscles by medical glue. Channel size should be less than seal size. The method allows for maximum anatomical adjunction of retina to subjacent eye layers by round bank of scleral depression created in projection of ruptures and dystrophic retina alterations by silicon seal without suture fixation to sclera. It eliminates risk of sclera damage during suture forming in cases of retina thinning, silicon seal dislocation risk in post-operation period in case of suture eruption.

EFFECT: improved cosmetic and functional results of surgical retina detachment treatment in early and long-term post-operation periods.

2 ex, 3 dwg

Description

The invention relates to medicine, and more specifically to ophthalmology, and is intended for the surgical treatment of retinal detachment with multiple ruptures or retinal detachment with a single rupture and severe peripheral retinal dystrophy, including the presence of pre-bursting conditions.

Retinal detachment is still one of the main causes of visual disability and blindness, so timely surgical treatment of this pathology is very important to obtain high functional results. A pathogenetically substantiated method of surgical treatment of retinal detachment with tears (regmatogenous detachment) is episcleral filling. With it, depending on the volume of the impression and the location of the fillings, local (radial, sectoral) and circular depression of the sclera are distinguished.

Episcleral filling is widespread because of its relative simplicity and effectiveness. Most often, with this method, a fine-meshed silicone sponge is used as a filling material.

A known method of surgical treatment of retinal detachment by circular episcleral filling by fixing the silicone sponge to the episclera using U-shaped meridians in four quadrants, including forming a conjunctiva incision 3-4 mm from the limbus, isolating and taking all four rectus muscles of the eye , localization of the projection of retinal breaks on the sclera using indirect binocular ophthalmoscopy, the creation of a scleral impression shaft in the zones of projection of breaks with a silicone seal, which fixes uetsya episclera to the U-shaped seams meridian in four quadrants between the rectus muscles of the eye (VD Zakharov Vitreoretinal Surgery -. M., 2003. - s.11-55).

The disadvantage of this method is excessive trauma to the scleral tissue during hemming, the likelihood of perforation of the sclera during suture, which can lead to bleeding from scleral and choroidal vessels and even damage to the retina, which is especially likely for diseases such as high myopia, Marfan syndrome.

The objective of the invention is to provide a method for surgical treatment of retinal detachment with obtaining high functional and anatomical results in cases associated with an increased risk of suture fixation of filling material to the sclera, such as pathologically thin ("blue") sclera, including with high myopia, low elasticity of the collagenous frame of the sclera with a tendency to eruption of sutures during their conduct, loosening of scleral tissue during inflammatory and dystrophic processes in it.

The technical result achieved by using the present invention is to obtain the maximum anatomical fit of the retina to the underlying membranes of the eye using a circular scleral impression shaft created in the projection of the retinal tears by a silicone seal without using its suture fixation to the sclera, eliminating the risk of damage to the sclera during suture in cases its thinning and dislocation of silicone fillings in the postoperative period in the case of teething, which leads to an improvement in braids metic and functional results of surgical treatment of retinal detachment in the early and long-term postoperative periods.

The technical result is achieved by the fact that in the method of surgical treatment of retinal detachment, including the formation of a circular section of the conjunctiva 3-4 mm from the limbus, isolation and capture of the holders of all four rectus muscles of the eye, localization of the projection of retinal breaks on the sclera using intraoperative indirect binocular ophthalmoscopy create a circular shaft of scleral depression in the area of the projection of the gaps with a silicone seal, which, according to the invention, is passed through 4 channels formed between the sclera and the strips allograft 13-15 mm long, 4-5 mm wide, glued to the sclera surface meridionally in four quadrants between the rectus muscles of the eye with medical glue. The size (diameter) of the channels should be slightly smaller than the size (diameter) of the seal, so that the glued alloscleral strip has an effect on the seal that is sufficient to form a scleral impression shaft and block retinal tears. In addition to holding the silicone seal through the formed channels, the seal also passes under the rectus muscles of the eye and before the final stitching of the ends is slightly stretched along the course of the formation in order to form a “steeper” scleral impression shaft.

The method allows to exclude damage to the sclera, choroid, retina during filling due to the fact that there is no need for suture fixation of the filling material, the risk of dislocation of the seal along the sclera surface associated with the possible eruption of the joints is also eliminated, which improves the cosmetic and functional result of the operation. The proposed method, in turn, allows to obtain a sufficient shaft of circular depression of the sclera and completely block the existing retinal tears.

As medical glue can be used: polymer composition “Sulfacrylate”, latex fabric glue (LTK). Sulfacrylate adhesive consists of ethyl cyanacrylate (binding component), butyl acrylate (plasticizer) and sulfolane methacrylate (anti-inflammatory, antimicrobial component) and is a colorless liquid with a specific gravity of 1.05-1.07 g / cm ³ and a viscosity of 5-85 cSt ( depending on the temperature of the glue). The developers conducted bacteriological studies of Sulfacrylate glue with cultures of Staph bacteria. Aureus and E. coli, and it was proved that the presence of the adhesive composition inhibits the growth of microbial strains. The glue is autosterilene, presented in ready-to-use form in polyethylene ampoules-tubes with a hermetically sealed neck and contains 1 ml.

Latex tissue glue (LTK) is a viscous homogeneous hydrophilic mass of white color. The adhesive mass includes Acronal V271 latex, polyvinyl alcohol, ammonia solution and medicinal additives (aminocaproic acid, dimeside and aminosteril).

The invention is illustrated by drawings (figure 1, 2, 3). Figure 1 schematically shows the posterior pole of the eyeball from the side, the detached retina with a gap and the position of the allograft strips glued to the sclera, figure 2 - the proper location of the glued strips of the allograft between the rectus muscles of the eye and the silicone seal held under the strips and muscles, in Fig. 3 - model of blocking retinal rupture with a circular filling with the formation of a scleral impression shaft. Position 1 denotes the sclera, 2 — the strip of the allograft 3 — the rectus muscle of the eye, 4 — the filling silicone sponge, 5 — the detached retina, 6 — the retinal tear, 7 — the scleral impression shaft, 8 — the blocked retinal tear, 9 — the retina adjacent after being pressed.

The method is as follows.

Epibulbar anesthesia is performed with 1% dicaine solution.

The operation is carried out in several stages:

1. make a circular incision of the conjunctiva 3-4 mm from the limbus,

2. allocate and take to the seams - holders all four straight muscles of the eye 3,

3. localize the projection of the gap 6 of the retina 5 to the sclera 1 using intraoperative indirect binocular ophthalmoscopy,

4. glued to the sclera 1 strips of allograft 2 meridionally in 4 quadrants between the rectus muscles of the eye 3 using medical glue "Sulfacrylate" or LTK,

5. create a scleral indentation shaft 7 in the area of the projection of the retinal breaks 6 using a silicone seal 4 held through 4 channels formed by a spatula between the sclera 1 and the allograft strips 2 glued to it,

6. conduct a control intraoperative indirect binocular ophthalmoscopy in order to confirm the blocking of breaks 8 of the retina 9,

7. impose a continuous 8/0 on the sections of the tenon membrane and conjunctiva and install a 20% solution of albucide.

An indication for the use of the method is retinal detachment with multiple ruptures or retinal detachment with a single rupture and severe peripheral retinal dystrophy, including the presence of pre-fracturing states with severe thinning of the sclera of various genesis.

Example 1. Patient R., 39 years old, diagnosis: total retinal detachment of the right eye with valve ruptures at 17 and 11 hours on the middle periphery. High degree myopia in both eyes. Visual acuity of the right eye / OD / = 0.02 eccentric, no correction; visual acuity of the left eye / OS / = 0.05 sph-7.25 = 1.0. The length of both eyes is 27.5 mm. In the anamnesis - visual impairment of the right eye in the form of the appearance of a “curtain” from below, inside and blurred vision over the past 10 days. The diagnosis of retinal detachment is confirmed by ultrasonic B-scanning, tears are localized by indirect binocular ophthalmoscopy and examination with a three-mirror Goldman lens. On the right eye, an operation of circular scleral depression was performed according to the above method using Sulfacrylate medical glue. The operation and the postoperative period proceeded without complications. During control examinations throughout the observation period (24 months), the eye is calm, the impression shaft is pronounced, the retina is adjacent, there are no allografts and fillings. Visual acuity /OD/=0,05sph-9.0=0,5; / OS / = 0.05 sph-7.25 = 1.0. The data of ultrasound B-scanning, examination by indirect binocular ophthalmoscopy and a three-mirror Goldman lens confirm the complete fit of the retina and blocking of retinal ruptures by the shaft of circular scleral depression.

Example 2. Patient K., 27 years old, diagnosis: total retinal detachment of the left eye with valvular rupture at 19 hours and severe peripheral lattice dystrophy of the retina. Visual acuity of the left eye / OS / = 0.05, no correction; visual acuity of the right eye / OD / = 0.05 sph-6.5 = 0.9. The length of both eyes is 26.78 mm. History - a sharp deterioration in the vision of the left eye over the past 3 days. The diagnosis of retinal detachment is confirmed by ultrasound B-scan, the gap is localized by indirect binocular ophthalmoscopy and examination with a three-mirror Goldman lens. On the left eye, an operation of circular scleral depression was performed according to the above method using medical adhesive "LTK". The operation and the postoperative period proceeded without complications. During control examinations throughout the observation period (16 months), the eye is calm, the position of allografts is correct, the shaft of circular scleral impression is pronounced, the retina is adjacent. Visual acuity / OS / = 0.02 sph-8.0 = 0.2; / OD / = 0.05 sph-6.5 = 1.0. The data of ultrasound B-scan, examination by indirect binocular ophthalmoscopy and a three-mirror Goldman lens confirm the complete fit of the retina and blocking of the retinal rupture by the scleral impression shaft.

According to the proposed method, 22 patients were operated on. In all cases, a complete fit of the retina was achieved due to the closure of retinal defects by a shaft of circular scleral depression.

Thus, the method allows to achieve complete fit of the retina by closing retinal defects with a shaft of circular scleral depression without using suture fixation of the seal to the sclera and to obtain good functional and cosmetic results of the operation.

Claims (1)

A method of surgical treatment of retinal detachment with multiple ruptures or retinal detachment with a single rupture and severe peripheral dystrophy of the retina, including with the presence of pre-fracturing conditions, including the formation of a conjunctival incision 3-4 mm from the limbus, isolation and grasping of the arms of all four rectus muscles eyes, localization of the projection of retinal ruptures on the sclera using indirect binocular ophthalmoscopy, the creation of a scleral impression shaft in the zones of rupture projection with a silicone seal, characterized the fact that the silicone seal is passed through four channels formed between the sclera and allograft strips 13-15 mm long, 4-5 mm wide, glued to the sclera surface meridionally in four quadrants between the rectus muscles of the eye with medical glue, and the size of the channels should be smaller than the size of the seal.

Images