RU2454208C2 - Method of drug delivery to tenon's space - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely ophthalmology, and aims at drug delivery to Tenon's space. A conjunctiva is dissected. The discussion is displaced with respect to an underlying Tenon's space in parallel to a limb by 3-4 mm. The Tenon's space is dissected, and a drug is introduced. A needle is removed that is followed by spontaneous eye reposition and wound self-sealing.

EFFECT: method allows reducing injures and providing faster postoperative wound healing.

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Description

The present invention relates to medicine, namely to ophthalmology, and is intended for the introduction of drugs into the tenon space of the eye.

It is known that from the second half of the 20th century, for the treatment of most diseases of the posterior segment of the eye, methods of introducing drugs into the tenon space are used. Thus, a high concentration of the drug in the immediate vicinity of the pathological focus is achieved. Existing operations currently allow for uniform distribution of the drug substance in the tenon space, however, their use in outpatient practice is sometimes difficult due to the need for conjunctival sutures.

There is already known a method of introducing dispersed Alloplant biomaterial into the tenon space, which consists in injecting a suspension of the drug through a simultaneous incision of the conjunctiva and tenon membrane of the eyeball (Karushin O.I. Surgical treatment of optic nerve atrophy in primary glaucoma using Alloplant biomaterial: Ph.D. diss. Medical Sciences: 14.00.08. - Krasnoyarsk, 1999. - 24 p.).

Also known is the method of introducing drugs into the tenon space, which consists in injecting the solution through a thin needle by simultaneously piercing the membranes of the eye (Remizov M.S., Balueva L.I. Introduction of drugs into the tenon space // Bulletin of Ophthalmology, 1973. - No. 1 . - S.36-38).

The closest way to introduce drugs into the tenon space is the method proposed by the same author, carried out by simultaneous dissection of the conjunctiva and tenon membrane with the introduction of a drug through a blunt needle into the tenon space, followed by suturing of the surgical wound. This method, also called retrosclerotomy, allowed the introduction of suspended forms of drugs (Remizov MS Method for the surgical treatment of progressive myopia // Vestnik Ophthalmology, 1981. - No. 3. - P.26-29).

However, a very significant drawback of this method, in our opinion, is the need for a suture on the surgical wound. As a result, patients in the first week after surgery complain of a foreign body sensation in the eye, redness of the operated eye and lacrimation. On examination, in most cases, blepharospasm of varying severity, hyperemia of the edges of the surgical wound and mucous discharge in the suture area are detected. Suture removal occurs after 10 days, which requires an additional visit to the ophthalmologist and prolongs the time of postoperative treatment. The terms of wound healing are from 3 to 4 weeks. When the scar is formed, the conjunctiva and tenon membrane are usually soldered, which violates their displacement relative to each other.

The aim of the invention is to reduce the duration of the recovery period and the number of complications after retrosclerotherapy.

This goal is achieved by sequentially dissecting the conjunctiva, shifting its incision relative to the underlying tenon membrane parallel to the limb by 3-4 mm, after which the tenon membrane is dissected and the drug is administered. After removing the needle, spontaneous reposition of the membranes of the eye and self-sealing of the surgical wound occur. Stitches are not overlapping.

The method is illustrated by the following specific examples of its implementation:

Example 1. Patient K., 72 years old. Received in the direction of the city clinic in the Department of Eye Microsurgery with the diagnosis "OU - open-angle 3a glaucoma, glaucoma optic neuropathy, initial cataract." Complained of a progressive decrease in visual acuity of both eyes, a narrowing of the visual fields of the mainly left eye. He receives treatment: OU - R. Arutimola 0.5% - 2 times a day, R. Xalatan 0.005% - at night.

On examination: Vis OD = 0.4, n / a; Vis OS = 0.3, n / a. OU - The iris is subatrophic, the pigment border is leached, the photoreaction is weakened. The initial clouding of the lens is predominantly in the cortical layers. The optic nerve disc is pale, the boundaries are clear. Excavation of the disk OD = 0.7, OS = 0.8. Arteriosclerosis. The macular zone is not changed. IOP OD = 20 mmHg, IOP OS = 21 mmHg

To stabilize the visual functions of the left eye and prevent the progression of glaucoma optic neuropathy, it was decided to introduce a suspension of dispersed OS alloplant biomaterial into the tenon space.

Operation progress: Preparation of the surgical field is usual. Under local anesthesia of the Alkain River, an eyelid expander is installed. Using a surgical tweezers and conjunctival scissors 8 mm from the limbus at 13 hours, a conjunctival incision of 3 mm was performed. With tweezers, the wound is shifted 4 mm parallel to the limb clockwise, the underlying tenon membrane is captured and dissected to the sclera. Holding the displaced conjunctiva, a blunt-pointed needle bent along the curvature of the eyeball is inserted into the tenon space toward the posterior pole of the eye. The conjunctiva is released from capture and, striving to take its initial position, tightly gripped the needle. 2 ml of a suspension of the alloplant biomaterial was introduced into the tenon space. At the time of administration, no regurgitation exit of the suspension through the surgical wound was observed due to the tight coverage of the needle with the edges of the wound. The needle is removed. The conjunctiva independently assumed its original position, sealing the wound. Installation of an antibiotic solution. Aseptic dressing.

A day after the operation, the patient complains of mild severity behind the eyeball. Complaints of pain and sensation of a foreign body in the conjunctival cavity are absent. On examination: blepharospasm not detected, mild hyperemia of the edges of the postoperative wound. The conjunctival wound is clean, there is no discharge. For prophylactic purposes, the patient underwent local anti-inflammatory and antibacterial therapy for 10 days (Levoecitin R. - 3 times a day, Dexamethasone R. - 3 times a day in the left eye). There were no complications in the postoperative period. Complete healing of the conjunctival wound by primary intention occurred after 2.5 weeks. The free displacement of the conjunctiva relative to the underlying tissues was noted.

Example 2. Patient M., 48 years old. I entered the ophthalmic department for a planned course of treatment with a diagnosis of OU - retinitis pigmentosa. Complained of low objective vision. The disease was detected about 30 years ago. The patient was repeatedly performed revascularizing operations in both eyes. A history of 4 operations was the introduction of a suspension of dispersed alloplant biomaterial into the tenon space of both eyes with conjunctival sutures.

On examination: Vis OD = 0.03, n / a; Vis OS = 0.02, n / a. OU: In the lower conjunctival arches - postoperative scars of the conjunctiva. In the upper temporal sector, the anterior segment is not changed. The optic nerve disc is slightly pale, the boundaries are clear. Vessels without gross changes. The retina of the macular region is thinned, pigment dissociation. Paramacular and on the periphery - multiple diffuse pigmented foci of star-shaped form.

In order to treat retinitis pigmentosa, the patient underwent retroscleroplasty with dispersed Alloplant OU biomaterial (using the technique described in Example 1). A day after the operation, the patient does not show active complaints. On examination: OU - no blepharospasm detected, mild hyperemia of the edges of the postoperative wound. The conjunctival wound is clean, there is no discharge. For prophylactic purposes, the patient underwent local anti-inflammatory and antibacterial therapy for 10 days (Levaecitin R. - 3 times a day, Dexamethasone R. - 3 times a day in both eyes). There were no complications in the postoperative period. Complete healing of the conjunctival wound by primary intention occurred after 2 weeks. The free displacement of the conjunctiva relative to the underlying tissues was noted.

Example 3. Patient S., 67 years old. Diagnosis: OU - Dry form of age-related macular degeneration, artifact. He entered the direction of the city clinic.

He complained of a progressive decrease in visual acuity of both eyes, a distortion of straight lines.

On examination: Vis OD = 0.5, n / a; Vis OS = 0.2, n / a. OU - The iris is subatrophic, the photoreaction is weakened. The IOL in the back chamber is located correctly. The optic nerve disc is pale pink, the borders are clear. Arteriosclerosis. In the macular zone, druses with a tendency to merge. IOP OD = 18 mmHg, IOP OS = 19 mmHg

The patient underwent retroscleroplasty with dispersed Alloplant OU biomaterial using the technique described in Example 1. A day after the operation, the patient does not have active complaints. On examination: OU - no blepharospasm detected, mild hyperemia of the edges of the postoperative wound. The conjunctival wound is clean, there is no discharge. For prophylactic purposes, the patient underwent local anti-inflammatory and antibacterial therapy for 10 days (Levaecitin R. - 3 times a day, Dexamethasone R. 3 times a day in both eyes). There were no complications in the postoperative period. Complete healing of the conjunctival wound by primary intention occurred after 2.5 weeks.

In total, using the proposed method, we operated on 42 patients (53 eyes) with glaucoma optical neuropathy, age-related macular degeneration, and retinitis pigmentosa (table 1). Patients operated on by the method of M.S.Remizov (58 patients, 76 eyes) acted as a control group. Using the operation technique described in Example 1, we achieved a reduction in complaints of a foreign body sensation in the eye, lacrimation. In addition, the terms of postoperative antibiotic therapy decreased (from 17 to 11 days). The healing rate of postoperative wounds increased (from 25 to 16 days). Patients did not need an additional visit to the ophthalmologist to remove conjunctival sutures. Not a single case of postoperative inflammatory complications was recorded in both groups.

The claimed method is not obvious to ophthalmologists working in the field of surgical treatment of dystrophic diseases of the posterior segment of the eye. To date, suturing of the postoperative wound of the eye membranes is considered a necessary part of the operation.

The method is technically simple, does not require highly qualified surgeon.

Tightness of the postoperative wound eliminates the risk of inflammatory complications.

The period of local postoperative prophylactic anti-inflammatory and antibacterial therapy is reduced. The postoperative period proceeds with fewer complaints from the patient.

The absence of sutures helps to reduce the treatment time; an additional visit of the patient is not required to remove the sutures.

The remoteness of the conjunctiva and tenon shell sections from each other after the operation is completed contributes to anatomically more complete healing of the surgical wound with complete preservation of the mobility of the membranes in the area of the formed scar.

Table 1 Comparison of groups of patients operated on by the method of M.S. Remizov and the proposed method. Operation Number of patients / eyes Complaints of foreign body sensation in the eye or lacrimation The average duration of postoperative antibiotic therapy The average time for complete healing of the surgical wound Method M.S. Remizov 58/76 53 patients 17 days 25 days The proposed method 42/53 7 patients 11 days 16 days

Claims (1)

The method of introducing drugs into the tenon space of the eye by dissecting the conjunctiva and tenon shell followed by the introduction of a syringe needle, characterized in that the conjunctiva is first dissected, its incision is shifted relative to the underlying tenon shell parallel to the limb by 3-4 mm, after which the tenon shell is dissected and the introduction of a medicinal substance, remove the needle, followed by spontaneous reposition of the membranes of the eye and self-sealing of the wound.