RU2464958C2 - Method of surgical treatment of cicatricial stages of retinopathy of premature babies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and is intended for separation and removal of retrolental membrane. Sequentially carried out are sclerotomy, lensectomy, mechanical separation, cutting and removal of retrolental membrane, retina mobilisation, removal of epiretinal membranes. Removal of epiretinal membranes is realised by two intraocular micropincers. For this purpose from place of retrolental membrane cutting radial cuts of membrane to extreme periphery are performed. Central part of retrolental membrane flap is taken by micropincer, branches of which have curved shape, and internal surface of branches has ribbed surface. After that membrane flap is passed between branches of other microprincer, whose branches have semicircular shape with sharp angle, and from internal side on the end of each branch made is site with ribbed surface. Separation of retrolental membrane is realised from centre to periphery.

EFFECT: method makes it possible to increase quality of retrolental membrane separation and reduce risk of retina injury at the stage of retrolental membrane separation in surgical treatment of cicatricial stages of retinopathy of premature e babies.

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Description

The invention relates to medicine, namely to ophthalmology, to methods for the surgical treatment of cicatricial stages of retinopathy of prematurity, and relates to the stage of isolation and removal of a retrolental membrane.

A known method of surgical treatment of cicatricial forms of retinopathy of prematurity (RN), which includes sequential sclerotomy, lensectomy, mechanical isolation, dissection and removal of the retrolental membrane (RLM), mobilization of the retina, removal of epiretinal membranes. At the stage of separation of the RLM from the retina, the RLM is punctured first with an insulin needle or intraocular scissors at the site of the smallest contact of the RLM with the retina, then with the help of intraocular tweezers or intraocular tweezers and intraocular scissors, the RLM is separated in stages, by traction exposure to the RLM from the center to the periphery after which they are excised. Moreover, during these manipulations, it is possible to use viscoelastic as a retinoprotector (Zakharov V.D. Vitreoretial surgery. - M., 2003. - P.104-108).

However, the known method involves mechanical isolation of the RLM using a blunt method, which does not exclude damage to the retina (rupture or its dialysis) due to the close connection of the retina and the RLM in the areas of adhesion and traction exerted on the retina during its isolation.

The technical task is to improve the quality of isolation of the retrolental membrane and reduce the risk of damage to the retina at the stage of isolation of the retrolental membrane during surgical treatment of cicatricial stages of retinopathy of premature infants, is solved as follows.

In the method of surgical treatment of cicatricial stages of retinopathy of premature infants, including consecutive sclerotomy, lensectomy, mechanical isolation, dissection and removal of the retrolental membrane, mobilization of the retina, removal of the epiretinal membranes, according to the invention, the removal of the epiretinal membranes is carried out using two intraocular reticulum membranes carry out radial incisions of the membrane to the extreme periphery, the central part of the flap retrolent The membranes are captured by micro-forceps, the jaws of which have a curved shape, and the inner surface of the branches has a ribbed surface, after which the flap of the membrane is carried out between the branches of another micro-forceps, the branches of which are semicircular in shape with an acute angle, and a platform is made at the end of each branch with ribbed surface, and carry out the selection of the retrolental membrane from the center to the periphery.

Due to the use of two new-design intraocular micro-forceps that make up a set of tools for removing epiretinal membranes, the quality of fibrous tissue excretion and the safety of this stage of the operation are improved, thereby improving the anatomical and, as a result, functional result of surgical treatment.

The curved edge of the jaws of the first intraocular microspinner allows grasping the separated portion of the membrane immediately near the sclerotomy (as close as possible to sclerotomy) and is more careful about the tissues of the eye at the entrance of the microspinz. The semicircular branches of the second intraocular micro-forceps with a platform at the ends protect the membranes from tight closure and gripping due to thickening, and the membranes are separated more carefully. The ribbing of the inner surfaces of the branches increases the reliability of the capture of tissues. The direction of movement of the micro-tweezers when releasing the retrolental membrane from the center to the periphery allows you to safely select and completely remove the retrolental membrane.

The method is as follows.

A 20 G sclerotomy is performed in the lower-outer, upper-inner and upper-outer quadrants of the eyeball 0.5 mm from the surgical limb zone. An irrigation cannula is installed in one of the quadrants (usually the lower-outer one), through which a balanced saline solution is introduced to maintain ophthalmotonus. Through free sclerotomy, a vitreotome is introduced and an intracapsular lansectomy is performed. The next step is the autopsy of the retrolental membrane in the central zone in the projection of the "entrance to the funnel", i.e. in the area as far from the retina as possible. A viscoelastic based on methylcellulose is introduced into the resulting cavity, and the x-ray membrane is hydroseparated. The remaining viscoelastic performs a retinoprotective function. To implement the mechanical removal of the x-ray membrane, a set of tools is used: two intraocular micro-forceps.

Figure 1 presents an intraocular micro forceps with curved edges. The micro tweezers include a handle 1 for micro tweezers universal 20G MICRO FORCEPS, manufactured by Medin-Ural (http://www.medin-ural.ru) and a metal tip: 2 - base (length 22 mm, outer diameter 9.5 mm); 3 - hollow tube (length 28.5 mm, outer diameter 0.9 mm (20 gauge), thickness 0.1 mm); the working part, consisting of two branches - 4, having a curved shape (the length of the branch is 2.6 mm, a bend with a radius of 3.5 mm, thickness 0.55 mm). Tweezers jaws open up to 1.3 mm when the piston is extended. The piston is located inside the base 2, the translational movements of which are carried out by the piston of the universal handle 1.

Figure 2 presents the intraocular micro forceps with semicircular branches. The micro tweezers consist of a handle 1 for universal micro-forceps 20G MICRO FORCEPS, manufactured by Medin-Ural (http://www.medin-ural.ru) and a metal tip: base 2 (length 22 mm, outer diameter 9.5 mm); hollow tube 3 (length 28.5 mm, outer diameter 0.9 mm (20 gauge), thickness 0.1 mm); the working part, consisting of two jaws, 4, of a semicircular shape with a flat platform at the end - 0.2 mm long and 0.1 mm thick (when folded, the jaws are 3.4 mm long, the thickness of each jaw is 0.55 mm). Tweezers jaws open up to 1.6 mm when the piston is extended. The inner surface of the jaws of both tweezers has a ribbed surface.

Radial incisions of the membrane to the extreme periphery are performed from the opening site of the radiolabeled membrane. The central part of the flap of the radiological membrane is captured by micro-forceps with curved edges (Figure 1), after which the flap of the membrane is carried out between the semicircular jaws of the second micro-forceps (Figure 2), (from the tight closing and gripping of the membrane, the thickenings at the end of the jaw are protected in the form of pads with ribbed surface). An X-ray membrane is extracted from the center to the periphery, while the semicircular shape of the jaw with an acute angle of the second micro-tweezers and the direction of its movement from the center to the periphery make it possible to safely isolate and completely remove the retrolental membrane.

During the subsequent operation, the residues of viscoelastic are washed out with a fluid flow and the risk of developing secondary ophthalmic hypertension (due to the blocking of the anterior chamber angle by viscoelastic) is minimal.

The proposed method using two intravitreal micro forceps operated on 29 children with pH. All patients with stage V disease. The average age was 12 months. As a result of surgical treatment, there was not a single case of iatrogenic damage to the retina at the stage of RLM isolation; complete (qualitative) isolation and removal of RLM was achieved.

Clinical example: patient P. (10 months), I. B. No. 428 (2007). Received inpatient treatment for: Retinopathy premature 5 tbsp. both eyes. 1.03.2007, the operation was carried out according to the proposed method: Lensvitrashvartectomy for OD and the introduction of viscoelastic before isolation of the RLM using two intravitreal micro-forceps. As a result of the surgical treatment, a good anatomical result was achieved - the retina was completely flat, including the macular region after one stage of surgical treatment.

Thus, the use of the proposed method allows to improve the quality of the allocation of the retrolental membrane and to reduce the risk of damage to the retina at the stage of isolation of the x-ray membrane in the surgical treatment of cicatricial stages of retinopathy of prematurity.

Claims (1)

A method for the surgical treatment of cicatricial stages of retinopathy of prematurity, including sequential sclerotomy, lensectomy, mechanical isolation, dissection and removal of the retrolental membrane, mobilization of the retina, removal of the epiretinal membranes, characterized in that the removal of the epiretinal membranes is carried out using two intraocular micro-forceps, for which purpose of the retrolental membrane, radial incisions of the membrane are made to the extreme periphery, the central part of the flap is retrolental the membranes are captured by micro-forceps, the jaws of which have a curved shape, and the inner surface of the jaws has a ribbed surface, after which the flap of the membrane is carried out between the jaws of another micro-forceps, the jaws of which are semicircular in shape with an acute angle, and a platform with ribbed surface, and carry out the selection of the retrolental membrane from the center to the periphery.

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