RU2478354C1 - Method of removing silicone oil from eye cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology and can be used for removal of silicone oil from eye cavity. After performing local anesthesia, making 3 transconjunctival sclera punctures and installing in them ports 25G through the port for irrigation carried out is introduction of physiological solution by means of ophthalmological surgical system Assistant in mode of silicone introduction under controlled pressure not higher than 1 bar. Physiological solution displaces silicone oil, which goes out through free ports. After removal of silicone oil, light guide for examination of vitreous cavity is introduced, after which ports are removed.

EFFECT: method makes it possible to increase efficiency of carrying out stage of vitroretinal surgery first of all due to application of ports 25G for necessary and obligatorily installed in vitroretinal surgery aspiration-irrigation system and light guide; when ports 25G are used, no suture application is required, which essentially reduces surgery trauma, due to application of the claimed method time of replacing silicone oil with physiological solution is considerably reduced and constitutes in the average from 3 to 10 minutes depending on vitreous cavity volume and silicone viscosity.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used to remove silicone oil from the eye cavity.

A known method of removing silicone oil from the eye cavity (see User guide for the MILLENNIUM microsurgical system from BAUSCH & LOMB, p. 4-124-4-125) using the microsurgical systems Millenium, Assistant, which consists in aspirating silicone oil through a 19G cannula and replacing it saline solution. To implement this method, at least one incision of the conjunctiva and sclera must be performed to accommodate the 19G suction cannula. At the end of the operation, suturing on the scleral and conjunctival sections is necessary. In addition, the silicone removal time is about 50 minutes.

With the general desire of ophthalmologists to perform incisions without suturing in this known device, the invasiveness of surgical intervention is increased due to the performance of incisions requiring suturing due to the use of a 19G cannula. The duration of surgery to remove silicone also refers to the disadvantages of the known operation, since the longer the operation, the more the patient needs pain relief, the likelihood of postoperative complications increases, and the risk of metabolic disturbances in the eye structures increases.

A known method of removing silicone oil from the eye cavity, which is widely used in ophthalmic practice, which consists in anesthesia, connecting an aspiration-irrigation system, for which 3 transconjunctival scleral punctures are performed with 25G ports installed for the fiber and irrigation and replacing the silicone oil with physiological saline after its removal. A container with physiological saline is placed above the surgical intervention zone and under the influence of the natural pressure of the solution silicone oil is displaced from the eye cavity and, accordingly, silicone oil is completely replaced with physiological saline.

However, the effectiveness of this method is extremely small, since the complete replacement of silicone oil, especially with a viscosity of 5000 cSt, 5700 cSt, with physiological saline occurs over a long period of time. This increases the time of surgery, which is extremely undesirable for the patient and increases the likelihood of possible complications in the postoperative period.

The present invention solves the problem of developing a new method for removing silicone oil from the eye cavity. The technical result obtained in this case consists in increasing the efficiency of the vitreoretinal surgery stage, primarily through the use of 25G ports for the necessary and necessarily installed during vitreoretinal surgery aspiration-irrigation system and optical fiber. When using 25G ports, no suturing is required, which significantly reduces the morbidity of surgical intervention. In addition, through the use of our proposed method, the time for replacing silicone oil with physiological saline is significantly reduced and averages from 3 to 10 minutes, depending on the volume of the vitreal cavity and the viscosity of the silicone.

The specified technical result is achieved by the fact that in the method of removing silicone oil from the eye cavity, which involves performing anesthesia, connecting an aspiration-irrigation system, for this, 3 transconjunctival scleral punctures are performed with 25G ports installed in them for fiber and irrigation and silicone oil is replaced with physiological saline after its removal, through the port for irrigation, physiological saline is injected under a controlled pressure of not more than 1 bar, which displaces the silicone mass about through the free ports.

The method of removing silicone oil from the cavity of the eye is as follows.

After local anesthesia and treatment of the surgical field, 3 transconjunctival scleral punctures are performed 4 mm from the limbus in 3 meridians (for example) at 2, 10 and 11 hours. They install 25 G ports for the fiber, irrigation and replacement of silicone oil with physiological saline after its removal. Saline is injected through the port for irrigation for 2 hours using the Millenium, Assistant ophthalmic surgical system using silicone injection under controlled pressure of not more than 1 bar. Saline displaces silicone oil, which leaves through the free ports at 10 and 11 hours by creating increased intraocular pressure. After removing the silicone oil through the port, an optical fiber is introduced at 11 hours to inspect the vitreal cavity, after which the ports are removed. Through-hole punctures of the shells are self-sealing. Suturing of the sclera and conjunctiva is not required.

Clinical example: patient K., born in 1961, No. a.k. 316123, No. IB 19913,

Ds .: OD - operated retinal detachment, condition after subtotal vitrectomy, silicone in the vitreous cavity, high myopia, initial cataract, condition after laser retinal coagulation,

OS - high degree myopia, complex myopic astigmatism.

06/01/2011 surgery for retinal detachment OD. Surgical treatment was carried out in 2 stages: stage 1: circulation + subtotal vitrectomy + administration of PFOS + ELK, after 10 days, stage 2: removal of PFOS, silicone tamponade (Oxane silicone oil with a viscosity of 1300 cSt). 1 month after stage 2, an additional restrictive laser coagulation of the retina OS was performed. 09/15/2011 surgery on OD to remove silicone oil.

The progress of the operation to remove silicone oil: treating the skin of the eyelids with a disinfectant and the surgical field with a 1% betadine solution, 0.9% sodium chloride solution, 0.5% oftaxquix. Local anesthesia: epibulbar (0.5% alkaine solution) - 3 times. The surgical field was covered with an ophthalmic tissue with a pocket and a sticky layer. Blepharostat was applied. Three transconjunctival scleral punctures were performed 4 mm from the limbus in 3 meridians at 2, 10 and 11 hours. Introduced 25G ports. Saline was injected through the port at 2 hours using the Assistant ophthalmic surgical system in the mode of introducing silicone under a controlled pressure of not more than 1 bar. Using physiological saline, silicone oil was displaced through the free ports at 10 and 11 hours due to increased intraocular pressure. It took 10 ml of saline to remove the silicone. Silicone was removed in 5 minutes. After removing the silicone oil through the port at 11 o’clock, a light guide was inserted to examine the vitreous cavity, and a silicone contact lens was placed on the cornea. Inspected the vitreous cavity. The retina is in all departments. There is no hemophthalmus. The light guide was brought out. The ports have been deleted. Through punctures of the shells are self-sealing. Suturing of the sclera and conjunctiva is not required. Subconjunctival injection of dexazone 2 mg and ceftazidime 50 mg. An aseptic blindfold was applied to the eye.

Claims (1)

The method of removing silicone oil from the eye cavity, which consists in conducting anesthesia, connecting an aspiration-irrigation system, for which 3 transconjunctival scleral punctures are performed with 25G ports for fiber and irrigation installed in them, and silicone oil is replaced with physiological saline after its removal, characterized in that that through the port for irrigation, physiological saline is injected under a controlled pressure of not more than 1 bar, which displaces silicone oil through free ports, including 25G is, for aspiration.