RU2619749C1 - Method for treatment of strabismus with hyperfunction of the lower oblique muscle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: emit lower oblique muscle, stretched her on the hooks in place of the natural attachment. Delamination muscles performed in two parts along the attachment points of the muscles to the sclera. The upper part of the muscle is cut off from the place of attachment at a distance that depends on the degree of hyperfunction of the inferior oblique muscle, namely: 4mm - At one point 7 mm - At 2 degrees, 9 mm - At 3 degrees and 11 mm - At 4 degrees. The isolated before the lower part of the muscle after moving to sew remaining after clipping the top of the inferior oblique muscle, and cut off parts of the inferior oblique muscle is performed radiofrequency electrode unit in the cut coagulation mode.

EFFECT: method allows to increase the effectiveness of the proposed surgical treatment by a combination of the prediction of the result of the forthcoming operation to eliminate the hyperfunction of the inferior oblique muscle, depending on the degree of hyperfunction of the inferior oblique muscle in a particular patient, and by reducing the likelihood of developing complications by preventing the possibility of muscle bleeding in the performance of these operations.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of hyperfunction of the lower oblique muscle of the eye.

There is a method of treating hyperfunction of the lower oblique muscle of the eye (see the description of the invention to patent No. 2531458 of 08/14/2013), which consists in isolating the lower oblique muscle, stretching it on hooks at the place of natural attachment and exfoliating the muscle to highlight its part, which is stitched at the place attachment, then cut it off, move to the place of sewing at the place of attachment of the lower rectus muscle and sew.

The movement of only part of the selected stratified muscle to the site of attachment of the inferior rectus muscle while maintaining the remaining part of the inferior oblique muscle at the site of physiological attachment can lead to hypocorrection of the planned result of the operation, which in the future involves additional surgery to correct the consequences of the operation. In addition, the disadvantage of this method is the possible perforation of the sclera when sewing at the site of attachment of the lower rectus muscle. Accordingly, there is a high likelihood of muscle bleeding during these well-known operations, and therefore coagulation of blood vessels is an obligatory step in such operations, which requires constant attention of the surgeon and additional time that lengthens the time of surgery.

The present invention solves the problem of developing a new method for the treatment of hyperfunction of the lower oblique muscle of the eye. In our proposed method, the weakening of the strength of the operated muscle occurs by lengthening the muscle by sewing the displaced lower part of the muscle to the remaining part of the muscle after cutting off the upper muscle, which makes it possible to weaken the effect of the lower oblique muscle with its hyperfunction at all degrees. In addition, the use of an electrode of a radio wave apparatus to cut off parts of the inferior oblique muscle does not require preliminary coagulation of blood vessels, which reduces the likelihood of muscle bleeding and generally reduces the time of surgery. Thus, the technical result obtained using the proposed method consists in increasing the effectiveness of the proposed surgical treatment by combining the accuracy of predicting the result of the upcoming operation to eliminate hyperfunction of the lower oblique muscle depending on the degree of hyperfunction of the lower oblique muscle in a particular patient and by reducing the likelihood of developing complications by prevention of the possibility of muscle bleeding during these operations.

The specified technical result is achieved by the fact that in the method of treating strabismus with hyperfunction of the inferior oblique muscle, which consists in isolating the inferior oblique muscle, stretching it on hooks at the site of natural attachment and exfoliating the muscle to isolate its part that is stitched at the attachment site, then it is cut off, move to the place of sewing and sew, the delamination of the muscle is carried out in two parts along the muscle from the place of attachment to the sclera, the upper part of the muscle is cut off from the place of attachment at a distance of no more than: 4 mm - at 1 degree, 7 mm - at 2 degrees, 9 mm - at 3 degrees and 11 mm - at 4 degrees of hyperfunction of the lower oblique muscle, the previously selected lower part of the muscle after movement is sewn to the upper part of the lower oblique muscle remaining after cutting, and the clipping of parts the lower oblique muscle is carried out by the electrode of the radio wave apparatus in the cut mode with coagulation.

A method of treating strabismus with hyperfunction of the lower oblique muscle is as follows.

After local anesthesia in an adult or general anesthesia in children, a conjunctiva is cut in a length of 12 mm in the lower-outer quadrant 10 mm from the limb by an electrode of a radio wave apparatus in a cut mode of 20 watts. The lower oblique muscle is isolated, then the conjunctiva is pulled outwards and down with two hooks, and the lower oblique muscle is taken with the third hook, stretched on two hooks at the site of natural attachment and the muscle is stratified. Stratification of the muscle is carried out in two parts along the muscle from the place of attachment to the sclera. First, the lower part of the muscle is isolated, which is stitched at the attachment site, then it is cut off and moved to the sewing site.

The upper part of the muscle is cut off from the attachment point at a distance of no more than: 4 mm for grade 1, 7 mm for grade 2, 9 mm for grade 3, and 11 mm for grade 4 hyperfunction of the lower oblique muscle. The cut off lower part of the muscle after movement is sewn to the upper part of the lower oblique muscle remaining after cutting off. Moreover, the clipping of parts of the lower oblique muscle is carried out by the electrode of the radio wave apparatus in the cut mode with coagulation of 28 watts. A continuous suture is placed on the conjunctiva.

Clinical example (example not edited)

Patient K., 16 years old. Diagnosis: OD - Hyperfunction of the lower oblique muscle of the 3rd degree. Weak hypermetropia.

OS - Hyperfunction of the lower oblique muscle of the 2nd degree. Weak hypermetropia.

Visual acuity: OD - 0.9-1.0, OS - 0.9-1.0

The angle of strabismus according to Hirschberg when adducting upward on the right eye, deviation upward 25 °, and on the left eye 15 °.

An operation on the right eye for the treatment of strabismus with hyperfunction of the lower oblique muscle was performed under laryngeal anesthesia. A conjunctiva 12 mm long was performed in the lower-outer quadrant 10 mm from the limb by the radio wave apparatus electrode in a 20 W cut mode. The lower oblique muscle was isolated, stretched on two muscle hooks with a limiter, and the muscle was stratified into 2 parts along 9 mm from the site of attachment to the sclera. Then, the lower part of the muscle was isolated, which was stitched at the attachment site and cut off with the electrode of the radio wave apparatus in the cut mode with coagulation with a power of 28 W. The other upper part of the muscle was cut off with the electrode of the radio wave apparatus in the cut mode with coagulation with a power of 28 W, deviating from the attachment point by a distance of 9 mm, corresponding to the 3rd degree of hyperfunction of the lower oblique muscle. The previously cut off lower part of the muscle after movement was sewn to the polyglycolide thread 6.0 remaining after cutting off the upper part of the lower oblique muscle. A continuous suture was made on the conjunctiva with polyglycolide thread 8.0.

Then, in the same sequence, an operation was performed on the left eye. After isolating the inferior oblique muscle and stretching it on two muscle hooks with a limiter, the muscle was stratified into 2 parts along the attachment point to the sclera by 7 mm. Then, one lower part of the muscle was stitched at the attachment point and cut off with the electrode of the radio wave apparatus in the cut mode with coagulation with a power of 28 W, and the other upper part of the muscle was cut with the electrode of the radio wave apparatus in the cut mode with coagulation with the power of 28 W, retreating from the attachment point by a distance of 7 mm, corresponding to 2 degrees of hyperfunction of the lower oblique muscle. Then, the previously cut off lower part of the muscle after movement was sewn to the polyglycolide thread 6.0 remaining after cutting off the upper part of the lower oblique muscle. A continuous suture was made on the conjunctiva with polyglycolide thread 8.0.

On examination the day after surgery and follow-up examination after 1 and 6 months, vertical deviation with upward adduction was eliminated in both eyes.

Claims (1)

A method for treating strabismus with hyperfunction of the inferior oblique muscle, including isolating the inferior oblique muscle, stretching it on hooks at the site of natural attachment and exfoliating the muscle to isolate part of it that is stitched at the site of attachment, and then it is cut off, moved to the sewing site and sewn, different the fact that the delamination of the muscle is carried out in two parts along the muscle from the place of attachment to the sclera, the upper part of the muscle is cut off from the place of attachment at a distance depending on the degree of hyperfunction of the lower oblique mouse s, as follows: 4 mm - with 1 degree, 7 mm - 2 degrees at 9 mm - at 3 degrees and 11 mm - with 4 degrees; the previously extracted lower part of the muscle after movement is sewn to the upper part of the lower oblique muscle remaining after cutting off, and the parts of the lower oblique muscle are cut off by an electrode of the radio wave apparatus in the cut mode with coagulation.