RU2598801C1 - Method of repeated surgical treatment of strabismus by method of regulated joints - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology, and aims at surgical management of eye diseases, namely squint. After standard treatment of the operative field produce conjunctival incision at 1-5 mm from a limb, opposite of the muscle, resection of which one want to perform, then by «blunt» way this muscle is allocated. On the sclera within future muscle attachment, in two points located in 3-4 mm from each other, pierced suture needle with 6-0 closer to the limb relative to existing place of an attachment of muscle, the filament is brought under the muscle without suturing it. Thread is pulled, creating a duplicate of muscle, after muscle tension and creation of duplication thread tied on the bow. After reduction of the muscles conjunctiva are sutured, at the end of the operation by subconjunctive way is introduced glucocorticoid preparation and antibiotic solution, on the next day after operation under local topical anaesthesia is performed stitches removal of the conjunctiva, opening of the conjunctival incisional wound and adjustment of seam-sides to complete elimination of residual squint angle, then proceeds repeated suturing of the conjunctiva and introduced by subconjunctive way a glucocorticoid preparation and antibiotic solution.

EFFECT: method allows to reduce the number of operative and postoperative complications associated with dissecting and suturing of eye muscles, such as bleeding, hematoma, long-term hydrops, and also increasing of accuracy of squint correction by controlling the degree of tension of eye muscles.

1 cl, 3 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended for the surgical treatment of eye diseases, namely strabismus.

A known method for the treatment of strabismus is that on the first day a conjunctiva is cut 2-3 mm from the limbus and parallel to it, a conjunctiva is cut in the projection of each operated oculomotor muscle. The muscle is isolated, stitched and cut off from the attachment point, the thread in the sclera is drawn parallel to each other and a first simple knot and a second knot are tied in the form of a bow to loosen or tighten, recession or resection of the muscle on the second day. During resection, the muscle is pulled to the place of the former attachment, leaving no gap. At the end of the operation, on the second day, the edges of the surgical wound are sutured with 2-3 interrupted sutures applied to the conjunctiva (RF patent No. 2271183).

However, this method is intended only for the primary operation to eliminate strabismus. Its disadvantages are the invasiveness of the operation, associated with the need for cutting and stitching of the eye muscles, and the accuracy of the position of the eyeball is not always sufficient due to an excessive or insufficient degree of tension of the eye muscles.

The closest analogue is a way to eliminate strabismus on previously operated muscles. The method consists in conducting a conjunctival incision. The rectus muscle is isolated, it is separated, it is freed from the anterior ciliary arteries. The middle longitudinal part of the previously operated severed rectus or oblique muscle, which is 1/3 of the muscle width, is sutured 4-8 mm from the point of attachment and a scleral suture of 2-8 mm in front of the muscle is applied with the same needle and thread. The stitched area of the muscle is pulled anteriorly by the thread, forming the median muscle fold. The method provides restoration of the anatomical place of attachment of previously recessed muscles and their strengthening, reducing postoperative complications. (RF patent No. 2363428)

The disadvantages of the method are the invasiveness of the operation due to the need to flush directly the eye muscles themselves and not always sufficient accuracy of the position of the eyeball due to the excessive or insufficient degree of tension of the eye muscles and the inability to adjust this tension.

The objective of the invention is to develop a method that allows for the least traumatic restoration of the anatomical position of the recessed eye muscles, faster postoperative rehabilitation and the ability to adjust the degree of tension of the eye muscle and, accordingly, adjust the position of the eyeball after surgery, with the aim of accurately correcting strabismus.

The technical result obtained by solving this problem is to reduce surgical and postoperative complications associated with dissection and suturing of the eye muscles, such as bleeding, hematoma, prolonged edema, as well as improving the accuracy of strabismus correction by adjusting the degree of eye muscle tension.

The specified technical result is achieved by the fact that in the method of repeated surgical treatment of strabismus, including preoperative anesthesia, conjunctival incision and muscle separation, according to the invention, after standard processing of the surgical field, the conjunctiva is cut 1-5 mm from the limbus, opposite the muscle whose resection must be performed , and after separation of the muscle on the sclera, in the place of future muscle attachment, at two points located 3-4 mm from each other, the thread with the needle 6-0 is sutured closer to the limb relative to the essence at the attachment point of the muscle, while the thread is passed under the muscle without flashing it, the thread is pulled, creating a duplicate of the muscle, after tensioning the muscle and creating a duplicate, the thread is tied to a bow, after reposition of the muscle, the conjunctiva is sutured, at the end of the operation, the glucocorticoid drug and antibiotic solution are administered subconjunctively , the day after the operation under local topical anesthesia, the conjunctiva sutures are removed, the conjunctival surgical wound is opened and the bow suture is adjusted until the remainder is completely removed full-time strabismus angle, after which the conjunctiva is re-sutured and the glucocorticoid preparation and antibiotic solution are administered subconjunctively.

Between the totality of essential features and the achieved technical result, there is a causal relationship.

Due to the lack of need for dissection and flashing of the muscle, the invasiveness of the operation is reduced. By adjusting the degree of tension of the eye muscle, it becomes possible to regulate the position of the eyeball after surgery, which allows for accurate correction of strabismus.

The essence of the invention lies in the fact that a method for re-surgical treatment of strabismus after previously conducted unsuccessful operations with a hypereffect is proposed. The method includes preoperative regional, local topical and general anesthesia. After standard processing of the surgical field, the conjunctiva is cut from a limb of 1-5 mm, opposite the muscle, the resection of which must be performed to eliminate the hypereffect from the once recession. Then the muscle is secreted in a "blunt" way. On the sclera, in the place of future muscle attachment, at two points located 3-4 mm from each other, the thread with the needle is stitched 6-0 closer to the limb relative to the existing muscle attachment site (3-6 mm from the limb), while the thread is carried out under the muscle without flashing it. When the thread is tensioned, a duplicate of the muscle is created, which allows to double the effect of resection. After muscle tension and duplication, the thread is tied not on a knot, but on a bow, so that it is possible to adjust muscle tension the day after surgery and finally eliminate small angles of residual strabismus, which is especially important during repeated operations, since eliminating small angles strabismus is very difficult. In this case, it is not necessary to cut off the muscle from the place of its attachment to the sclera, thereby reducing the invasiveness of the operation. After reposition of the muscle, the conjunctiva is sutured with a thread of 8-0. At the end of the operation, a glucocorticoid preparation and an antibiotic solution are administered subconjunctively. The day after surgery under local topical anesthesia, the conjunctiva sutures are removed, the conjunctival surgical wound is opened and the muscle-suturing bow is adjusted (its weakening or tension) until the residual strabismus angle is completely eliminated. After adjusting the suture, the bow is pulled onto a regular nodal suture and the conjunctiva is re-sutured. After that, a glucocorticoid drug and an antibiotic solution are administered subconjunctively.

The inventive method of treatment was tested in LLC “Ophthalmological Center Konovalova” on 10 patients (10 eyes) aged 15 to 27 years (of which 3 men, 7 women).

In all cases, after treatment, strabismus was cured.

The use of the method of repeated surgical treatment of strabismus by the method of adjustable sutures eliminates the appearance of surgical and postoperative complications associated with dissection and suturing of the eye muscles, such as bleeding, hematoma, prolonged edema, and also improve the accuracy of strabismus correction by adjusting the degree of eye muscle tension.

The invention is confirmed by examples.

Example 1

Patient M., 16 years old.

On admission: Complaints of divergent strabismus. 10 years ago she was operated on for a converging squint on her left eye.

On examination:

Visual acuity of the left eye - 0.8 does not correct (80%).

Fields of view are the norm.

Intraocular pressure 15 mmHg

Examination revealed a divergent strabismus of 15 degrees. The cornea is transparent. The fundus without pathology.

The operation was performed on the left eye in accordance with the claimed method.

The day after surgery, the vision of the left eye improved to 0.8, does not correct (80%). When viewed, the optical media are transparent. The anterior chamber of the eye is of medium depth. The fundus without pathology. The deviation angle is 0 degrees.

After 1 month, the deviation angle is 0 degrees.

Example No. 2. Patient B., 27 years old.

On admission: Complaints of divergent strabismus. 20 years ago she was operated on for a convergent strabismus in her left eye.

On examination:

Visual acuity of the left eye - 0.6 does not correct (60%).

Fields of view are the norm.

Intraocular pressure 18 mmHg

Examination revealed divergent strabismus of 10 degrees. The cornea is transparent. The fundus without pathology.

The operation was performed on the left eye in accordance with the claimed method.

The day after surgery, the vision of the left eye 0.6 does not correct (60%). When viewed, the optical media are transparent. The anterior chamber of the eye is of medium depth. The fundus without pathology. The deviation angle is 0 degrees.

After 1 month, the deviation angle is 0 degrees.

Example 3

Patient K., 19 years old.

On admission: Complaints of divergent strabismus. 11 years ago she was operated on for a convergent strabismus in her right eye.

On examination:

Visual acuity of the right eye - 0.9 does not correct (90%).

Fields of view are the norm.

Intraocular pressure 18 mmHg

Examination revealed divergent strabismus of 20 degrees. The cornea is transparent. The fundus without pathology.

The operation was performed on the right eye in accordance with the claimed method.

The day after surgery, the vision of the left eye 0.9 does not correct (90%). When viewed, the optical media are transparent. The anterior chamber of the eye is of medium depth. The fundus without pathology. The deviation angle is 0 degrees.

After 1 month, the deviation angle is 0 degrees.

Claims (1)

A method for repeated surgical treatment of strabismus, including preoperative anesthesia, conjunctiva incision and muscle separation, characterized in that after standard processing of the surgical field, the conjunctiva is incised 1-5 mm from the limbus, opposite the muscle whose resection must be performed, and after muscle separation the sclera, in the place of future muscle attachment, at two points located 3-4 mm from each other, the thread with the needle is stitched 6-0 closer to the limb relative to the existing muscle attachment point, while the thread is carried out pull the thread under the muscle without flashing it, creating a duplicate of the muscle, after tightening the muscle and creating a duplicate of the thread, tie the string on a bow, after the reposition of the muscles, the conjunctiva is sutured, at the end of the operation, the glucocorticoid drug and antibiotic solution are administered subconjunctively, the next day after the operation, under the local topical conjunctiva sutures are removed with anesthesia, the conjunctival surgical wound is opened and the suture bow is adjusted until the residual strabismus angle is completely eliminated, and then repeated conjunctiva and subconjunctival injected glucocorticoid drug and antibiotic solution.