RU2633345C1 - Method for evaluating scleroplastic transplant position at posterior pole of myopic eye - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: before and after the operation, the optical biometry of the posterior eye pole in the horizontal meridian is performed. The central length of the eye is determined at 0° from the fovea center, the paracentral one - at 15° in the nasal and temporal directions, peripheral one - at 30° from the fovea center in the nasal and temporal directions. If the central and paracentral length is shortened in both directions by 0.25-0.5 mm and if there is no shortening of the peripheral length, the position of the transplant and its tension are evaluated as correct.

EFFECT: method allows to increase the accuracy of the position evaluation and tension level of the scleroplastic transplant to select the further adequate patient surveillance by conducting the optical biometry of the posterior eye pole in the horizontal meridian.

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Description

The present invention relates to ophthalmology and is intended to assess the effectiveness of scleroplasty used for surgical strengthening of the sclera with progressive myopia, namely to assess the adequacy of the location of the graft at the posterior pole of the eye.

As you know, the success of scleroplastic surgery largely depends on the correctness (accuracy) of the transplant at the posterior pole of the eye in the projection of the macular zone (EP Tarutta. Sclero-strengthening treatment and prevention of complications of progressive myopia. In the book: S.E. Avetisov, T .P. Kashchenko, A.M. Shamshinova, red. Visual functions and their correction in children. Moscow: Medicine. 2005: 191-201). Graft displacement may be one of the reasons for the unsatisfactory result of scleroplasty. Insufficient contact of the transplant with the sclera of the recipient also impedes their fusion and causes an unsatisfactory outcome of the operation (Pristavko EF, Bagdasarova TA Comparative evaluation of surgical treatment of high progressive and complicated myopia. In the book: 5th All-Union Congress of Ophthalmologists. Moscow ; 1979; 1: 119-120). Displacement or excessive tension of the graft can lead to serious complications, such as compression of the optic nerve and vortical veins, as well as various intraocular hemorrhages (Vasileva V., Boykikev P. Scleroplasty with progressive myopia. Ophthalmology (Sofia). 1978; 28 (3) : 149: 151; Flick L.P. To the analysis of the functional outcome of scleroplasty with myopia. In the book: 5th All-Union Congress of Ophthalmologists. Moscow; 1979; 1: 161-162).

It is known to use tantalum markers (marks) for assessing the position of a scleral graft, which were fixed at certain points to the scleral graft before surgery. The correct placement of the graft after scleroplasty was determined by visualizing the marks using computed tomography (Brian G.R., Hollows F.C. Slingmarkersinsclerareinforcement surgery. Ophthalmic Surg. 1988; 19 (9): 647-8). This method is taken as the closest analogue of the invention. However, this method is characterized by the complexity of technical performance, requires special equipment that is not used in routine ophthalmic practice and significant material costs, in addition, it does not allow to obtain information about the level of transplant tension.

The objective of the invention is to develop a method for assessing the position and level of tension of the graft, used for surgical strengthening of the sclera of the posterior pole of the myopic eye, devoid of these disadvantages.

The technical result of the proposed method is to increase the accuracy and simplify the assessment of the position and level of tension of the scleroplastic graft to select further adequate tactics of patient management.

The technical result is achieved by determining changes in the central, paracentral and peripheral length of the eye using optical biometry of the posterior pole of the eye.

A prerequisite for the proposed method is our previously obtained data on the possibility of assessing the contour of the retina in the posterior pole of the eye by studying peripheral refraction and the length of the eye in the horizontal meridian using optical biometry. (Tarutta E.P., Milash S.V., Tarasova N.A. et al. Peripheral refraction and retinal contour in children with myopia according to the results of refractometry and partially coherent interferometry. Bulletin of Ophthalmology. 2014; 6: 44-9). In this regard, studies have been carried out on the possibility of assessing the position of the scleroplastic graft using optical biometry.

Our studies have revealed that after bandaging scleroplasty (according to Snyder-Thompson) with an adequate transplant location, a significant shortening of the anteroposterior axis of the eye by 0.25-0.5 mm is observed while simultaneously shortening the paracentral axis of the eye at 15 ° in the nasal and temporal direction from the center of fovea - by 0.2-0.3 mm. Moreover, the peripheral length of the eye in the 30 ° zone in the nasal and temporal direction from the center of the fovea does not change. This means that the graft is located at the posterior pole corresponding to the center of the macula, and its tension provides the greatest shortening of the PZO in the center and somewhat less, but symmetrical, in the paracentral temporal and nasal zones 15 ° from the center, which corresponds to the projection of the edges of the graft. The width of the graft used for scleroplasty according to Snyder-Thompson is 10 mm, that is, 5 mm in each direction from the midline. With a PZO length of 25 to 28 mm, an area of 5 mm from the center of the macula corresponds, on average, to 15 °. The absence of changes in the peripheral length of the eye in areas of 30 ° from the center, that is, outside the graft size, indicates the correct localization of the latter. With a possible displacement, sliding of the graft from the center of the posterior pole, axis shortening will be observed in the paracentral and / or peripheral zones, and the length of the central axis of the eye will remain unchanged.

The level of transplant tension is estimated by the magnitude of the shortening of the central length of the eye. Lack of shortening means a lack of tension and a poor, insufficiently tight fit of the graft to the patient's sclera. The shortening of the PZO by more than 0.5 mm indicates excessive tension and compression of the eye tissue, which is fraught with the complications described above.

Assessment of the position of the graft after scleroplasty by the proposed method was performed in patients aged 11.82 ± 0.21 years with a high degree of myopia -7.53 ± 0.3 diopters and anteroposterior axis (PZO) length of 26.51 ± 0.22 mm. All patients were examined before and 1 week after sclerotherapy. In this case, the central, paracentral and peripheral lengths of the eye were determined in five zones of the retina: along the central axis, at 15 ° and 30 ° in the nasal and temporal direction (N15 °, N30 °) (T15 °, T30 °) from the center of the fovea in the horizontal Meridians before and after scleroplasty surgery. The length of the eye along the visual axis (0 ° from the fixation point) is called central, in the 15 ° zones in the nasal and temporal direction - paracentral, 30 ° in the nasal and temporal direction from the fixation point - peripheral. The distance of the marks from the center was calculated according to the Bradis tables taking into account the known distance from the eyes to the device (60 mm) and the angle of deviation of the gaze. In most patients after bandaging scleroplasty, a significant shortening of the central and paracentral length in both directions by 0.25-0.5 mm and the absence of shortening of the peripheral length of the eye were revealed. In this case, the position of the graft and its tension are evaluated as correct. Subsequent clinical and diagnostic observations made it possible to consider scleroplasty effective in terms of slowing the progression of myopia, which confirms the reliability of the method for assessing the position of the graft in such patients.

With a displacement and / or insufficient tension of the graft, drug and hardware treatment is prescribed 1 month after the operation in order to increase the effect of the operation. With excessive transplant tension, anti-edematous, antihypertensive therapy, exercises for the oculomotor muscles are prescribed. The measurement results are taken into account during subsequent operations, adjusting the direction, location, degree of transplant tension, which avoids the repetition of errors.

The method is as follows. In cycloplegic conditions, using optical biometry, for example, on the IOL Master 500 apparatus (CarlZeiss, Germany), the eye length is determined in five zones: when looking directly and when fixing special marks. Labels are located on the screen of the device and provide a metered deviation of the gaze by 15 ° and 30 ° to the nose and temporal sides. The study is carried out before and after scleroplasty. Optical biometry of the posterior pole of the eye is performed in the horizontal meridian and the central length of the eye is determined at 0 ° from the center of the fovea, paracentral at 15 ° in the nasal and temporal directions, and peripheral at 30 ° from the center of the fovea in the nasal and temporal directions. When shortening the central and paracentral length in both directions by 0.25-0.5 mm and the absence of shortening of the peripheral length, the position of the graft and its tension are evaluated as correct.

Clinical example 1. Patient K., 12 years old with a diagnosis of OU-Acquired uncomplicated high myopia. Progressive. VisOD = sph-8.5D = 1.0; ODZZO = 27.2 mm, VisOS = sph-8,0D = 1,0; ODPZO = 26.9 mm, OU in the macular zone, the reflex is preserved, the macula is well differentiated. The patient was examined by the proposed method before and 1 week after sclero-strengthening surgery according to the Snyder-Thompson OD test.

Shortening of the central length of the eye by 0.45 mm, paracentral 0.23 from the temporal side and 0.25 mm from the nasal side and the absence of shortening of the peripheral length on both sides are noted. These changes correspond to the correct position of the graft at the posterior pole, without displacement to the nose or temple and moderate moderate tension. The position and tension of the graft are assessed as adequate.

Clinical example 2. Patient C. 12 years old with a diagnosis of OU-Congenital uncomplicated myopia of high degree. Progressive. VisOD = sph-7.0 Dcyl-1.0 Dax 10 ° = 0.6; PZO = 26.9 mm, VisOS = sph-6.75Dcyl-1.0Dax 0 ° = 0.6; PZO = 26.85 mm. OU in the macular zone there is no reflex, no focal changes. The patient was examined by the proposed method before and 1 week after sclerotomy surgery according to the technique of Snyder-Thompson OD.

After the operation, the central length (PZO) did not change, a shortening of the paracentral length from the temporal side (T15 °) by 0.33 mm and a slight shortening of the peripheral length from the temporal side (T30 °) by 0.17 mm. The paracentral and peripheral lengths on the nasal side have not changed. An inadequate location of the graft was diagnosed, namely, displacement to the temporal side of the macula. Due to the inadequate location of the graft, low scleroplasty efficacy can be predicted, therefore, in the early postoperative period (1 month after surgery), functional and drug treatment was prescribed to enhance the effect of the operation and prevent the progression of myopia.

Thus, the proposed method allows us to assess the adequacy of the position and tension of the scleroplastic transplant to select further tactics of patient management.

Claims (1)

A method for assessing the position of a scleroplastic graft at the posterior pole of the myopic eye, characterized in that before and after the operation, optical biometry of the posterior pole of the eye is performed in the horizontal meridian and the central length of the eye is determined at 0 ° from the center of the fovea, paracentral - at 15 ° in the nasal and temporal direction , peripheral - 30 ° from the center of the fovea in the nasal and temporal direction and with a shortening of the central and paracentral length in both directions by 0.25-0.5 mm and the absence of shortening of the peripheral length I estimate t the position of the graft and its tension as correct.