RU2354342C1 - Method of surgical treatment of progressive myopia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be used in treatment of progressive myopia. Cuts of conjunctiva and Tenon's membrane are made in four quadrants between rectus muscles parallel to limb, with 6-8 mm indent from it. Conjunctiva and Tenon's membrane are separated from sclera at 5-6 mm depth. In formed canals bioimplants made of collagen isolatd from spongy bone of farm animals and preliminarily kept in viscoelastic from 2 to 5 minites are introduced. Bioimplants are made in form of plates 20 mm long, 10 mm wide and 1.0 mm thick.

EFFECT: stable steady position of bioimplant in sub-Tenon's space and its close contact with sclera, sclera strengthening, improvement if its trophism and elimination of appearing of cosmetic defect.

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Description

The invention relates to ophthalmic surgery and can be used for the surgical treatment of progressive myopia.

In the mechanism of the origin of myopia, two main links can be distinguished: 1) the mismatch between the capabilities of the weakened accommodation apparatus of the eyes and the visual load, and 2) the weakening of the strength properties of the sclera and its stretching under the influence of intraocular pressure. In the first case, a more favorable form of myopia is formed, which is only an optical deficiency of the eye, in the second case, myopia develops as a serious eye disease, prone to progression and complications.

When the sclera is weakened, conditions are created for an inadequate response to the stimulus for eye growth, for its gradual extension under the influence of intraocular pressure. As soon as the posterior pole of the eye takes a more convex shape, in accordance with the laws of hydrodynamics, it becomes the place of least resistance.

At this stage, weakened accommodation, which played the role of a kind of triggering mechanism in the development of myopia, loses its significance and biophysical processes come to the fore. Excessive lengthening of the eye leads to thinning of the sclera and negatively affects primarily the state of the vascular and retinal membranes. For their growth, there is a physiological limit beyond which pathology begins in the form of their stretching and the occurrence of trophic disorders, which serve as the basis for the development of complications observed at high degrees of myopia. The occurrence of trophic disturbances also contributes to the decreased hemodynamics of the eye.

The sclera of the eye refers to fibrous formations, i.e. It is a kind of connective tissue of the body. The main fibrous element of the sclera is collagen. It accounts for about 70% of the dry mass of sclera tissue. The main, supporting function of the sclera is determined by its biomechanical properties, the main of which are mechanical stress, strength and elasticity. Their qualitative and quantitative characteristics are determined, firstly, by the concentration of collagen, the packing density of collagen fibers and their architectonics, secondly, by the composition and spatial structure of proteoglycan complexes, and also by the way they are interconnected with fibers, and thirdly, the stabilizing properties of these biopolymers intra- and intermolecular bonds.

With myopia, structural changes in collagen and scleral tissue occur, which ultimately lead to functional disorders.

The closest to the technical solution of the problem is a method of surgical treatment of progressive myopia, including conducting sections of the conjunctiva and tenon membrane in four quadrants between the rectus muscles parallel to the limb, departing from it by 6-8 mm, separating the conjunctiva and tenon membrane from the sclera with a depth of 5-6 mm and introduction of bioimplants into the formed channels (Gusev Yu.A., Trubilin V.N., Filatova G.P. Use of viscoelastics in surgery of progressive myopia. Clinical and morphological study // Refra surgery surgery and ophthalmology. - 2005 - No. 1, - p. 38-42).

However, scleral implants from donor sclera are used as bioimplants, the surface of which is smooth and which do not have sufficient rigidity to be implanted without preliminary expansion and deepening by the viscoelastic channel formed, in addition, an additional fixation of the bioimplant from this material is required (it is fixed under the muscle) and at the end of the operation - suturing the conjunctiva, but in practice this does not exclude the possibility of its displacement, as a result of which it does not integrate with the base zhaschey sclera, so it does not increase the strength and improves the trophism and the displacement of the front segment bioimplants causes rough eye cosmetic defect which is often the cause of re-operation. In addition, the bioimplant from the donor sclera can be contagious, and the risk of developing infectious diseases in the postoperative period cannot be completely ruled out.

The technical result according to the invention is a stable bio-implant position in the subtenon space, which ensures stable close contact of the bio-implant with the underlying sclera, which is necessary for its further integration with the scleral tissue, which leads to the strengthening of the sclera, improvement of its trophism and elimination of the appearance of a cosmetic defect associated with displacement bioimplant in the anterior parts of the eyeball due to the fact that each bioimplant is made of collagen isolated from gu chatoy bone farm animals in the form of a plate which was preincubated in viscoelastics; in addition, the proposed bioimplant is not contagious, which eliminates the risk of infectious diseases in the postoperative period.

The technical result according to the invention is achieved by the fact that in the method of surgical treatment of progressive myopia, including conducting sections of the conjunctiva and tenon membrane in four quadrants between the rectus muscles parallel to the limb, departing from it by 6-8 mm, separating the conjunctiva and tenon membrane from the sclera with a depth of 5- 6 mm and the introduction of bioimplants into the formed channels, and the bioimplants are made of collagen isolated from the spongy bone of farm animals in the form of plates 20 mm long, 10 mm wide, 1.0 mm thick; while bioimplants are pre-incubated in viscoelastic for 2 to 5 minutes.

According to the invention, the introduction of elastic elastic bioimplants made of collagen isolated from the spongy bone of farm animals in the form of plates previously incubated in viscoelastics allows them to be introduced atraumatically into the subtenon space without preliminary expansion and without additional fixation, and at the end of the operation not to stitch the joints conjunctiva. The porous structure of the sponge implant makes it possible for viscoelastic to penetrate into its pores, while the exposure time in viscoelastic from 2 to 5 minutes is necessary and sufficient.

According to the invention, four elastic-elastic bioimplants made of collagen isolated from the spongy bone of farm animals in the form of plates, stably located at the posterior pole of the eyeball, effectively strengthen the sclera, improve the collagen structure of scleral tissue, while improving its trophism, due to integration with scleral tissue , thereby ensuring the stabilization of myopia.

The authors empirically selected the dimensions of the bioimplant plates: length 20 mm, width 10 mm, thickness 1.0 mm to achieve a technical result according to the invention.

The proposed method is as follows.

Processing of the surgical field is common. Local anesthesia is performed by twice installing a 0.4% solution of oxybuprocaine (Inocaine) in the conjunctival cavity. In the four quadrants between the rectus muscles, 0.2 ml of a 2% lidocaine solution is subconjunctively administered. The conjunctiva and tenon membrane are cut in four quadrants between the rectus muscles parallel to the limb, departing from it by 6-8 mm, 5-6 mm long, then the conjunctiva and tenon membrane are separated from the sclera with a depth of 5-6 mm using conjunctival blunt scissors and injected bioimplants made of collagen isolated from the spongy bone of farm animals in the form of plates 20 mm long, 10 mm wide, 1.0 mm thick are formed into the formed channels; while bioimplants are pre-incubated in viscoelastic for 2 to 5 minutes. The operation is completed by subconjunctival administration of 0.2 ml of a solution of Gentamicin and 0.2 ml of a solution of Dexamethasone.

A method for surgical treatment of progressive myopia is illustrated by the following clinical examples.

Example No. 1.

Patient Z., 14 years old. Diagnosis: OU - progressive myopia of a high degree.

Before the operation.

Visual acuity OD = 0.04 sph - 7.5 D = 1.0; Vis OS = 0.03 sph - 8.5 D = 1.0.

Refractometry: OD sph - 7.0 cyl - 0.5 ax 166, OS - 8.25 cyl 00 ax 0 PZO OD 26.67 mm, OC 27.15 mm.

The patient underwent an operation of scleroplasty on OD and OS according to the method according to the invention, while the conjunctiva and tenon membrane were cut in four quadrants between the rectus muscles parallel to the limb, 8 mm apart from it, the conjunctiva and tenon membrane were separated from the sclera with a depth of 6 mm and introduced into formed channels bioimplants made of collagen isolated from the spongy bone of farm animals in the form of plates 20 mm long, 10 mm wide, 1.0 mm thick; while the bioimplants were preliminarily kept in viscoelastic for 2 minutes.

The operation and the postoperative period without complications.

The day after the operation, the reaction of the eye is 0-1 tbsp.

During dynamic observation after 6 months and 12 months, visual acuity OD 0.04 sph - 7.5 D = 1.0; Vis OS = 0.03 sph - 8.5 D = 1.0.

Refractometry: OD sph - 7.0 cyl 0 ax 0, OS - 8.0 cyl 00 ax 0

PZO OD 26.70 mm, OS 27.20 mm.

The patient stopped the progression of myopia during the observation period.

Example No. 2.

Patient G. 16 years. Diagnosis: OD and OS - Progressive myopia of moderate degree.

Before surgery, visual acuity OD = 0.1 sph - 5.0 D = 1.0

OS = 0.1 sph - 4.5D = 0.9 n / a

Refractometry OD sph - 4.75 cyl 00; OS sph - 4.37 cyl - 0.62 ax 27

PZO OD 25.34, OS 24.97 mm

The patient underwent an operation of scleroplasty on OD and OS according to the method according to the invention, while the conjunctiva and tenon membrane were cut in four quadrants between the rectus muscles parallel to the limb, 6 mm apart from it, the conjunctiva and tenon membrane were separated from the sclera with a depth of 5 mm and introduced into formed channels bioimplants made of collagen isolated from the spongy bone of farm animals in the form of plates 20 mm long, 10 mm wide, 1.0 mm thick; while the bioimplants were preliminarily kept in viscoelastic for 5 minutes.

The operation and the postoperative period without complications.

The day after the operation, the reaction of the eye is 0-1 tbsp.

During dynamic observation after 6 months and 12 months, visual acuity OD = 0.1 sph-5.0 D = 1.0

OS = 0.1 sph - 4.5D = 1.0

Refractometry OD sph - 5.0 cyl 00; OS sph - 4.25 cyl - 0.5 ax 30

PZO OD 25.40, OS 25.00 mm

The patient achieved stabilization of myopia during the observation period.

Example No. 3.

Patient B. 15 years. Diagnosis: OD and OS - Moderate progressive myopia, myopic astigmatism.

Before surgery

Visual acuity OD = 0.05 sph - 5.0 D cyl - 0.75 ah 172 = 0.9-1.0 OS = 0.05 sph - 4.75 D cyl - 0.75 ah 163 = 0.9-1.0

Refractometry OD sph - 4.87 cyl - 0.62 ah 176

OS sph - 4.75 cyl - 0.75 ax 165

PZO OD 24.89, OS 24.83 mm

The patient underwent an operation of scleroplasty on OD and OS according to the method according to the invention, while the conjunctiva and tenon membrane were cut in four quadrants between the rectus muscles parallel to the limb, 7 mm apart from it, the conjunctiva and tenon membrane were separated from the sclera with a depth of 5 mm and introduced into formed channels bioimplants made of collagen isolated from the spongy bone of farm animals in the form of plates 20 mm long, 10 mm wide, 1.0 mm thick; while the bioimplants were preliminarily kept in viscoelastic for 5 minutes.

The operation and the postoperative period without complications.

The day after the operation, the reaction of the eye is 0-1 tbsp.

During dynamic observation after 6 months and 12 months, visual acuity OD = 0.05 sph - 5.0 D cyl - 0.75 ax 170 = 1.0

OS = 0.05 sph - 5.0 D cyl - 0.5 ah 170 = 1.0

Refractometry OD sph - 5.0 cyl - 0.75 ah 170

OS sph - 4.75 cyl - 0.75 ax 170

PZO OD 24.90, OS 24.90 mm

The patient has stopped the progression of myopia during the observation period.

Claims (1)

A method for the surgical treatment of progressive myopia, including conducting conjunctiva and tenon membrane sections in four quadrants between the rectus muscles parallel to the limb, departing from it 6-8 mm, separating the conjunctiva and tenon membrane from the sclera to a depth of 5-6 mm and introducing bioimplants into the formed channels, characterized in that the bioimplants are made of collagen isolated from the spongy bone of farm animals in the form of plates 20 mm long, 10 mm wide, 1.0 mm thick; while bioimplants are pre-incubated in viscoelastic for 2 to 5 minutes.