RU2354338C1 - Method of surgical treatment of recurrent pterigium - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be applied in surgical treatment of recurrent pterigium. Pterigium head and body are separated from cornea and sclera and excised. Bleeding episcleral vessels on internal limb edge are coagulated. Pathologically changed bulbar conjunctiva above pterigium body is excised. Conjunctiva above semilunar fold is slightly excised, separated, turned toward eye corner and sewn with interrupted suture to eyelid fornix. In formed after pterigium removal bed transplant is laid. As transplant ophtalmotransplant "Ufaplant" from kidney capsule is used. Transplant is fixed to sclera on limb and on edges from internal rectus muscle tendon. Lateral sides of transplant are brought 2 mm under conjunctiva. Bulbar conjunctiva is fixed to transplant by applying interrupted sutures on conjunctiva defect edges.

EFFECT: elimination of conjunctiva growth zone, which prevents pterigium recurrence.

4 cl, 2 ex, 5 dwg

Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in medical practice to remove recurrent pterygium.

Pterygium is a degenerative eye disease in which a degeneratively altered vascularized conjunctiva of the eyeball grows into the surface layers of the cornea in the form of a triangular film with its apex facing the center [Jack J. Kanski, 2006]. The etiology and pathogenesis of the disease is not well understood.

One of the main criteria that determine the quality of surgical treatment of pterygium is to reduce the likelihood of relapse. However, the treatment of persistently recurring pterygium more aggressive than the initial lesion always presents significant difficulties. At the same time, repeated surgical interventions lead to an extensive gross cicatricial degeneration of the conjunctiva, often with the formation of symblepharon or corneal cervix, worsening visual acuity.

With persistently recurring forms of pterygium, preference is given to the so-called barrier method of treatment by transplanting on the eyeball various biocompatible tissues that create a barrier that prevents the growth of pterygium. Currently, the most widely used technique is wrapping excised pterygium with subsequent replacement of the bulbar conjunctiva defect with an autograft (RF patent for invention No. 2269988 dated 02.20.2006, Bugaenko I.A., Novikova E.V., Jashi B.G.), mucosa from the lip [Manual on eye diseases edited by Pletnev N.A., M., Medicine, 1959], allotransplantation of biological materials: dura mater (RF patent for the invention No. 2150257, publ. 06.10.2006. Lantukh VV) , amniotic membrane, etc.

Closest to the claimed method is a method for the treatment of recurrent pterygium (Zolotarev A.V., Milyudin E.S. Surgical treatment of recurrent pterygium with plastic surgery by a silicone-dried membrane // Vestn. Oftalmol., 2007, No. 7. - P.39-42), consisting in the following: separation and excision of pterygium, superficial keratectomy, removal of a pathologically altered conjunctiva with the underlying tissue, replacement of the formed conjunctival defect with a silicone-dried amniotic membrane subjected to Flexamer gamma sterilization, fixed to the episclera with interrupted sutures. After the operation, the corneal defect is completely epithelized on the seventh day, the bulbar conjunctiva in the inner part is restored on the 12-18th day by replacing the amniotic membrane.

The considered method allows to reduce the recurrence rate from 55.1% to 7.1% of cases. The disadvantage of this method is the preservation of the growth zone of the conjunctiva in the area of the arches, contributing to the occurrence of relapses of pterygium. In addition, with a significant size of the pathologically altered conjunctiva, the effectiveness of surgical treatment using a silicone-dried amniotic membrane is significantly reduced [Milyudin ES Amnioplastic surgery in the complex treatment of epithelial pathology of the anterior eye: abstract. dis. Dr. med. sciences. - Samara, 2007].

The task of the invention is to provide an effective method for the surgical treatment of pterygium, which helps prevent the recurrence of the disease.

The technical result when using the invention is the elimination of the growth zone of the conjunctiva.

The specified technical result is achieved by the fact that in the method of surgical treatment of pterygium, including excising the latter from the top to the base and closing the defect with an allograft, according to the invention, after removing the pathologically altered bulbar conjunctiva above the pterygium body, the conjunctiva is cut over the lunate fold, and the inner side is severed, wrapped. angle of the eye and fix with interrupted sutures to the arches of the eyelids, the graft is placed in prepared after removal of the pterygium Auger and fixed to the sclera and limbus sequentially along the edges of the tendon internal rectus muscle, the lateral ends of the graft is slid under the bulbar conjunctiva of 2 mm and fixed to the bulbar conjunctiva graft by applying nodal joints at the edges of conjunctival defects. At the same time, the Ufaplant ophthalograft is used as an allograft from the kidney capsule, to increase access to the inner corner of the eye, take the internal rectus muscle on the stitch-holder, and additionally incisions are made on the surface of the graft.

The proposed method is as follows: under local anesthesia by means of infiltration of a 2% lidocaine solution in the traditional way, the head and body of the pterygium are separated and dissected from the cornea and sclera. Bleeding episcleral vessels along the inner edge of the limb thermocoagulate. To increase access to the medial corner of the eye and ease the fixation of the graft to the sclera, the internal rectus muscle is taken on a stitch-holder. After excision of the pathologically altered bulbar conjunctiva above the pterygium body, the remaining part of the conjunctiva above the lunate fold (in the case of operated pterygiums is often absent) is cut with scissors, separated and wrapped in the direction of the corner of the eye, then sewn with interrupted sutures to the arches of the eyelids. In a bed prepared after removal of the pterygium, a “Ufaplant” shaped allograft made of a kidney capsule according to the patented technology is placed in a bed (Patent RF 2290899 C1 of 01/10/2007). The material has high histocompatibility and low antigenicity. The strength and ductility of the graft facilitates the operation. The graft is fixed to the sclera in the following sequence: along the limb, along the edges of the tendon of the internal rectus muscle, the lateral ends of the graft are placed under the conjunctiva by 2 mm. Fixation of the bulbar conjunctiva to the graft is carried out by imposing nodal sutures over the last. Additionally, incisions are made on the surface of the graft for passage of the episcleral vessels. The main advantage of this method is the prevention of recurrence of pterygium by eliminating the conjunctival growth zone.

The proposed method is illustrated by the following figures: figure 1 shows the eye of patient B. before surgery, figure 2 - separation of the pterygium from the cornea, figure 3 - taking the internal rectus muscle on the stitch-holder, in figure 4 - the state of the eye after stitching the graft to the sclera and conjunctiva, figure 5 is a view of the inner corner of the eye on the 7th day after surgery.

We give examples of clinical use of the proposed method.

Example 1. Patient M., 45 years old. Received with a diagnosis of Relapse of internal pterygium II degree of the right eye, III degree of the left eye. Mixed astigmatism of the left eye. From the anamnesis: surgical treatment of pterygium OD in 2001, OS - 2002. In the last 5 years, relapse of the disease of the left eye with decreased vision. When viewed from the medial side of both eyes, there is a spread of the pterygoid hymen on the cornea, on the left to the pupillary zone. The conjunctiva above the body of the pterygium is scarred, folded. The folds at one end are attached to the cornea; when moving, they deform its surface. Visual acuity OS - 0.5 s / c - 1.25 cyl. + 1.25 axis 20 ° = 0.9.

The patient was operated on by the proposed method: under local anesthesia (2% lidocaine solution under the conjunctiva), the pterygium body with adjacent conjunctival tissue was separated and dissected, starting from the apex to the lunate fold. Using a suture-holder, the eyeball was deflected as laterally as possible, the rest of the pterygium body was removed in the inner corner under the conjunctiva. Then the conjunctiva was incised above the lunate fold, wrapped in the direction of the inner corner of the eye and sewn to the eyelids with interrupted sutures at 8:00, thereby eliminating the growth area of the conjunctiva. Held hemostasis. Then, a graft (Ufaplant) 13 mm wide and 7 mm long was placed in the prepared bed, turning the lateral edges under the conjunctiva, fixed to the sclera with interrupted sutures. Then the graft was connected to the conjunctiva, suturing along the edges of the conjunctival defect above the graft. The postoperative period was uneventful. On the 8th day, the patient was discharged from the clinic with good functional (visual acuity was restored to 0.9 without correction) and cosmetic result.

Example 2. Patient B., 48 years old. Received with a diagnosis of pterygium III degree, symblepharon of the inner corner of the left eye (figure 1).

Operated by the proposed method (Fig.2-5).

After the operation, the movement of the eyeball in full was restored, visual acuity improved from 0.6 s / c + 1.75 D = 0.9 (ex) to 0.9 without correction.

In total, the proposed method eliminated recurrent, often repeatedly operated pterygium in 87 patients. Long-term results showed the high efficiency of the proposed method. Relapses of pterygium were not observed.

Claims (4)

1. A method for surgical treatment of pterygium, including excising the latter from the apex to the base and closing the defect with an allograft, characterized in that after removal of the pathologically altered bulbar conjunctiva above the pterygium body, the conjunctiva is incised over the lunate fold, detached, fixed to the inner corner of the eye with interrupted sutures to the arches of the eyelids, the graft is placed in the bed prepared after removal of the pterygium and fixed to the sclera sequentially along the limb and along to the sides of the tendon of the internal rectus muscle, the lateral ends of the graft are brought under the conjunctiva by 2 mm and the bulbar conjunctiva to the graft is fixed by applying nodal sutures along the edges of the conjunctival dejection. 2. The method according to claim 1, characterized in that the Ufaplant ophthalmograft from the kidney capsule is used as an allograft. 3. The method according to claim 1, characterized in that in order to increase access to the inner corner of the eye, they take the inner rectus muscle on a suture - a holder. 4. The method according to claim 1, characterized in that the notches are additionally applied to the surface of the graft.

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