RU2360652C2 - Way of surgical treatment of retina detachment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns ophthalmology and is intended for surgical treatment of detachment of the retina with single rupture. The conjunctiva cut is formed in 3-4 mm from a limbus in that square where retina ruptures is found out. The holders are allocated and undertaken on seams adjoining on a zone of rupture with two direct muscles of an eye. Localisation of a projection of rupture of a retina on a sclera by means of an indirect binocular ophtalmoscopy is carried out. After that the local shaft of scleral depression in a zone of projection of rupture is created using a silicon seal, which is placed under an allotransplant glued to a sclera in a zone of a projection to it by means of medical glue. Thus, sutural bracing of a seal and an allotransplant is completely excluded.

EFFECT: way provides obtaining of the maximum anatomic adhering of a retina to underlaying covers of an eye by means of a local shaft of scleral depression, rupture of a retina framed in a projection with a silicon seal without use of its sutural bracing to a sclera, exception of risk of damage of a sclera at seam carrying out in cases of its thinning and a disposition of the silicon seal in the postoperative period in the case of seam cutting out that leads to improvement of cosmetic and functional results of surgical treatment of amotio of a retina in early and remote postoperative periods.

2 ex, 2 dwg

Description

The invention relates to medicine, and more specifically to ophthalmology, and is intended for the surgical treatment of retinal detachment with a single gap.

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 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 local (radial and sectoral) episcleral filling by fixing a silicone sponge to the episclera using one or more U-shaped sutures, including forming a conjunctival incision 3-4 mm from the limb in the quadrant where a retinal rupture is detected , isolating and grasping on the seams of the holder adjacent to the rupture zone of the two rectus muscles of the eye, localizing the projection of the retinal rupture on the sclera using indirect binocular ophthalmoscopy, creating a scl shaft oral depression over the fracture projection zone with a silicone seal, which is fixed to the episclera with U-shaped sutures (VD Zakharov, Vitreoretinal Surgery. // M., 2003. - pp. 39-41).

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 local scleral impression shaft created in the projection of the retinal rupture 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 conjunctival incision 3-4 mm from the limb in the quadrant where a retinal tear is detected, isolation and seizure of a holder adjacent to the gap zone of the two rectus muscles of the eye, localization of the projection rupture of the retina to the sclera using indirect binocular ophthalmoscopy, create a local scleral indentation shaft in the area of the projection of the rupture with a silicone seal, 1.5-2.0 times the size (length and width) of the gap VA, which, according to the invention, is placed in a bed, the size of which should be 1.5-2.0 times smaller than the size of the seal (in order to obtain the maximum effect of sclera depression), which is formed by an allograft glued around its perimeter (a small " window "for the establishment of filling material) to the surface of the episclera in the area of the projection onto it of a retinal break with medical glue.

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 possible eruption of the joints is also eliminated, which improves the cosmetic and functional results of the operation . The proposed method, in turn, makes it possible to obtain a sufficient local scleral depression shaft in the area of the projection of the retinal rupture and completely block it.

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 (Fig.1-2). Figure 1 schematically shows the posterior pole of the eyeball, the detached retina with a gap and the position of the graft glued to the episclera, and figure 2 shows the proper placement of the filling material in the bed formed under the graft and the sclera is pressed with the detached retina pressed and the gap is blocked. Position 1 denotes a retina with a gap zone, 2 - an allograft 3 - sclera, 4 - a filling silicone sponge, 5 - a scleral impression shaft, 6 - a blocked retinal break, 7 - an adjacent retina after an impression. The method is as follows.

Epibulbar anesthesia is performed with 1% dicaine solution. The operation is carried out in several stages:

1) make a sectoral section of the conjunctiva 3-4 mm from the limbus in the quadrant where a retinal break 1 is detected,

2) allocate and take on the seams of the holder adjacent to the gap zone 1 two straight muscles of the eye,

3) localize the projection of the retinal break 1 on the sclera using intraoperative indirect binocular ophthalmoscopy and designate it with a surgical marker,

4) glued to the episclera 3 an allograft modeled in size 2 in the zone of the projection of the gap 1 on the sclera along its entire perimeter, leaving a small “window” for the establishment of filling material using Sulfacrylate or LTK medical glue,

5) create a scleral indentation shaft 5 in the zone of the projection of the gap 1 by means of a silicone seal 4, 1.5-2 times larger in size (length and width) of the gap 1, which is placed in the bed, the dimensions of which should be 1.5 -2 times smaller than the size of the filling 4 (in order to obtain the maximum effect of sclera depression), which is formed by an allograft 2 glued to episclera 3,

6) conduct a control indirect binocular ophthalmoscopy in order to confirm the blocking of retinal rupture 1,

7) impose a continuous 8/0 on the sections of the tenon membrane and conjunctiva and instill a 20% solution of albucide. An indication for the use of the method is retinal detachment with a gap with severe thinning of the sclera of various genesis.

Example 1. Patient P., 45 years old, diagnosis: subtotal retinal detachment with valve rupture at 12 hours of the right eye. High degree myopia in both eyes. Visual acuity of the right eye / OD / = 0.05 no correction; visual acuity of the left eye / OS / = 0.05 sph-7.5 = 1.0. The length of both eyes is 27 mm. In the anamnesis - a deterioration in the vision of the right eye in the form of the appearance of a “curtain” from below and blurred vision over the past 2 weeks. 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 right eye, a local scleral impression was performed according to the aforementioned method using Sulfacrylate medical glue. The operation and the postoperative period proceeded without complications. During control examinations throughout the observation period (18 months), the eye is calm, the impression shaft is pronounced, the retina is adjacent, the graft and seal are not dislocated. Visual acuity / OD / = 0.05 sph-8.25 = 0.4; / OS / = 0.05 sph-7.5 = 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 shaft of local scleral depression.

Example 2. Patient K., 27 years old, diagnosis: total retinal detachment of the right eye with valve rupture at 19 hours. Visual acuity of the right eye / OD / = 0.02 eccentric, no correction; visual acuity of the left eye / OS / = 0.05 sph-6.5 = 0.9. The length of both eyes is 26.78 mm. In the anamnesis - visual impairment of the right eye in the form of a sharp blurred vision and the appearance of floating opacities in the last month. 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 right eye, a local scleral impression was performed according to the aforementioned method using LTK medical glue. The operation and the postoperative period proceeded without complications. During control examinations throughout the observation period (14 months), the eye is calm, the position of the graft is correct, the retina is adjacent. Visual acuity / OD / = 0.02 sph-7.0 = 0.2; / OC / = 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 shaft of local scleral depression.

According to the proposed method, 25 patients were operated on. In all cases, a complete retinal fit was achieved due to the closure of the retinal defect by the shaft of local scleral depression.

Thus, the method allows to achieve complete fit of the retina due to the closure of the retinal defect by the shaft of local 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 for the surgical treatment of retinal detachment with a gap, including the formation of a conjunctival incision 3-4 mm from the limb in the quadrant where a retinal break is detected, isolating and grasping on the sutures of the holder adjacent to the gap zone of the two rectus muscles of the eye, localizing the projection of the retinal break on the sclera with using indirect binocular ophthalmoscopy, the creation of a local scleral impression shaft in the area of the projection of the gap with a silicone seal, characterized in that the seal is placed under the allograft, which is glued to the sclera in On the other hand, the projection of retinal rupture on it with medical glue with the complete exclusion of suture fixation of the fill and allograft to the sclera.

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