RU2690412C1 - Method of sealing the vitreal cavity in through penetrating wounds of the eyeball - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to ophthalmology. To seal the vitreal cavity in through penetrating wounds of the eyeball, the covered area is covered with the help of an implant. Implant for closing a wound outlet is a collagen haemostatic sponge, for this purpose, two fragments exceeding a wound size are cut out of a collagen haemostatic sponge: one in form of a wound canal, the other of a disk-like shape. First fragment is introduced into the wound canal. Second fragment is laid on the wound above the first fragment on the side of the vitreal cavity. Wound canal is plugged with a collagen haemostatic sponge by a seamless fixation.EFFECT: method provides reliable seamless fixation of fragments of a collagen haemostatic sponge with preservation of their stable position.1 cl, 1 ex, 1 dwg

Description

The method of treatment relates to medicine, namely to ophthalmology and concerns the treatment of through wounds of the eyeball with a tissue deficit.

Analogs.

During explosions and gunshot wounds, the speed of a foreign body can be so great that it breaks the eye through. In these cases, two wounds are formed: in the anterior part of the eye, the inlet, in the posterior part, the outlet. The general principles of treatment of penetrating penetrating wounds of the eyeball are well known; up to the present, the problem of sealing the exit opening of the wound channel remains a problem. Attempting to seal the outlet of small size, located in the posterior pole of the eyeball, is associated with the risk of additional damage to intraocular structures. Some authors consider it possible to rely on independent healing of the orifice.

Various materials and methods for sealing and strengthening the damaged areas of the sclera have been proposed. The literature contains data on the use of peritoneal allografts (Allen JH), Amer. J. Ophthal. - 1953 - N36. - P. 1909-1910, fascia of the temporalis muscle (Chilaris G. , Liaricos S. Foseta of the temporalis muscle in scleral bucling and keratoprothesis operations // Am. J. Ophthal. - 1973. - Vol. 76. N1. - P. 35-37), inter-articular cartilage of the knee (Aruga A. Vorlaufeger Berichtuber die Vervendung von zwischen Gebenknopfelvom Kniezur Transplantation mit Verstorkung der sclera // Klin. MbiAugenheilk. - 1974. - Vol.164, N5. - P. 697), dura mater (Slavnova GA On the use of dura mater in scleral injuries in the experiment and the clinic // Proc. Ophthalmologists and the Soviet Union - Moscow, 1973, pp 529-531), brefotkaney:. brefoskly or cord amnion with vortonovym jelly (Zharov V. Primary brefoplastika in treatment of wounds and perforated subconjunctival scleral breaks // Diss. Cand. honey. sciences. Irzhevsk - 1987). Most often, fresh and canned homoscalers are used (Chechik - Queen E.A. Homoplasty in case of traumatic defects of the eyeball capsule // Vesti, ophthalmol. 1948. - No. 2. - P. 29-31).

Criticism of analogues.

The use of the above materials is associated with a number of negative aspects, due to the limited amount of material, the complexity of conservation methods and the limited time frame for using homotransplants, the difficulty of taking brefotkan, the possibility of infection of these materials due to an increase in the number of people infected with hepatitis B virus and HIV worldwide. It should also be noted that surgical manipulations and achieving reliable fixation of the above materials in hard-to-reach places of the eyeball, namely in the posterior segment of the eyeball, is always problematic, and the proposed materials and methods do not allow closure of the damaged scleral area in the posterior pole of the rear apple. It is risky to rely on self-sealing of the wound. high risk of infringement of intraocular structures in the exit or development of hypotension, followed by subatrophy of the eye.

The above factors have led to the emergence and use of new grafts from collagen materials. To strengthen the scleral ruptures and wounds, fibrous collagen was proposed (Saporovskiy S.S. et al. On primary collagenoplasty of sclera defects in case of severe perforated eye injuries // Fire injury of the organ of vision: Abstracts of the report. - L., 1989. p. 77-78 ).

The prototype of the invention.

The prototype of the proposed method is a method of sealing a gap and / or sclera wound, located in the posterior segment of the eyeball, proposed in 2007 by Neroev VV, Gundorova R.A. and co-authors.

The essence of the prototype method is as follows: when processing a penetrating wound and / or scleral ruptures in the posterior segment of the eyeball, after suture fixation of the sclera wound edges, the damaged area is covered with an implant, which consists of two parts:

1. The supporting element is a rigid plate made of perforated carbon fiber. The plate has a radius of curvature corresponding to the average curvature of the radius of the surface of the eyeball.

2. Carbon felt is placed between the supporting element and the sclera.

The shape and size of the supporting part of the implant make it different, depending on the shape, direction, location and size of scleral tears and / or sclera wounds. The carbon fiber support element is placed on the treated wound and / or scleral rupture in such a way that it completely covers the damaged area of the sclera. The fixing of the support element is carried out to the episclera sutures. At the same time leave a free area for the introduction of carbon felt. Carbon felt is placed between the abutment member and the sclera with tweezers. Felt under the support element is turned on from the non-fixed side and distributed evenly throughout the damage to the sclera. The volume of carbon felt is dosed individually, ensuring that it fits snugly to the sclera. After that, put another seam on the support element on the side of the introduction of felt.

Criticism of the prototype.

The preparation of a two-component implant from carbon materials and the sealing of the damaged area by it is a labor-intensive process, which increases the time of surgical intervention. The implant needs suture fixation, which greatly complicates the technique of operation with the localization of gaps in the posterior segment of the eye. Suture fixation of the implant is accompanied by additional trauma, which, ultimately, increases the risk of complications and significantly reduces the effectiveness of the treatment.

The purpose of the invention.

The aim of the invention is to develop a method of sealing the sclera in case of penetrating wounds of the eyeball, which does not require suture fixation.

The essence of the invention.

The essence of the proposed method is illustrated in FIG. 1, where pos. 1 - the first fragment of a collagen hemostatic sponge, pos. 2 - the second discoid fragment of a collagen hemostatic sponge.

As an implant to close the outlet, it is proposed to use a collagen hemostatic sponge. To do this, two fragments are cut out from the collagen hemostatic sponge that exceed the size of the wound, one of which has the shape of a wound channel (Fig. 1, pos. 1), the other has a discoid shape (Fig. 1, pos. 2). The first fragment (pos. 1) is introduced into the wound canal, the second fragment (pos. 2) is placed on the wound on top of the first fragment from the vitreal cavity. The second fragment, being under pressure from silicone oil or another tamping agent, prevents the first fragment (pos. 1) from falling out of the wound channel into the eyeball cavity.

With the localization of the rupture and / or scleral wound near the optic nerve to prevent such complications as compression of the optic nerve, a rounded bed can be cut out in the discoid sponge.

Due to the good plastic properties of the collagen hemostatic sponge, it is possible to cut out a shape suitable for each individual case. Due to the germination of the implant and the gradual replacement of it with connective tissue, a reliable fixation of fragments of a collagen hemostatic sponge while maintaining their stable position is ensured.

An example of a specific implementation method

Patient: R., 14 p.

Diagnosis: OS. Penetrating through wound of the eyeball with prolapse of the inner sheaths. Traumatic cataract. Hyphema. Coloboma iris. Hemophthalmus. Retinal disinsertion. Detachment of the choroid. Foreign body orbit. The wound of the upper eyelid.

On admission: VisOS = 1 / & pr 1 incerta

A collagen hemostatic sponge was used as an implant to close the outlet. To do this, two fragments were cut out of the collagen hemostatic sponge, exceeding the size of the wound, one of which was in the form of a wound channel and the other was disc-shaped. The first fragment was inserted into the wound canal, the second fragment was laid on the wound on top of the first fragment from the side of the vitreal cavity.

Do not carry out suture fixation of the implant.

Treatment: Stage 1 - IChO wounds + phacoaspiration + Subtotal vitrectomy + posterior trepanation of the sclera + drainage SJL + PFOS + IOL

2nd stage (after 7 days) - tamponade of the outlet + endolasercoagulation + plastic iris + replacement for silicone oil.

At discharge: Vis OS = 1 / & pr l incerta. OS IOP = 21 mm Hg

The features of the invention, the distinctive features of the prototype.

1. According to the proposed method of sealing the vitreal cavity with penetrating wounds of the eyeball, a collagen hemostatic sponge was used, in contrast to the prototype method, where carbon materials such as carbon fiber and carbon felt were used as implants.

2. According to the proposed method does not conduct suture fixation of the implant.

3. The first fragment of collagen hemostatic sponge is introduced into the wound channel, the second fragment of the hemostatic sponge is placed on the wound over the first fragment from the side of the vitreal cavity.

The technical result from the application of this method.

Due to the good plastic properties of the collagen hemostatic sponge, it is possible to cut out a shape suitable for each individual case.

The method provides reliable fixation due to germination of the implant and its gradual replacement with connective tissue while maintaining a stable position.

Using the proposed method of sealing the wound outlet will provide:

- reliable sealing of the rupture and / or sclera wound with simplification of the surgical technique in case of damage to the posterior segment of the eyeball, plugging of the wound channel with a collagen hemostatic sponge without suture fixation.

- no deformation of the contour of the eyeball implant with the prevention of subatrophy of the eye.

- reducing the risk of infectious complications.

Sources of information taken into account:

1) L.A. Zernova, Yu.E. Batman. The use of scleral graft in the primary surgical treatment of contusion fractures of the sclera. // Materials I Russian conf. "Clinical studies of drugs" Moscow. - 2001

2) L.A. Zernov, P.A. Potter. Alloscleroplasty is a method of surgical treatment of contusion ruptures and penetrating wounds of the sclera. // Collection of conference theses. Institute them. Helgoltz. Moscow, - 2005

3) L.A. Zernov, P.A. Gonchar, N.V. Dushin, A.A. Novitsky. Surgical treatment of contusion ruptures and penetrating wounds of the sclera using alloscleroplasty. // Mr. Optometrist number 2. St. Petersburg. - 2005

4) Islamov Z.S. Eye contusion, complicated by subconjunctival scleral rupture. // Diss. Cand. honey. sciences. - M., 1990 - 168 p. Islamov Z.S. et al. Collagenastic with severe contusion of the eye, complicated by scleral rupture).

5) Chechik-Queen E.A. Homoplasty in traumatic defects of the capsule of the eyeball // News, ophthalmol. 1948. - №2.

6) M.A. Frolov, L.A. Zernov. The results of surgical treatment of contusional ruptures and penetrating wounds of the sclera by the method of allosclerosis. // Ophthalmology Volume 6. №3. Moscow. - 2009

7) Neroev V.V., Gundorov R.A. et al. The way to seal the gap and / or sclera wounds, located in the posterior segment of the eyeball in 2007 - the prototype.

Claims (1)

The method of sealing the vitreal cavity with penetrating wounds of the eyeball, including sheltering the damaged area with an implant, characterized in that a collagen hemostatic sponge is used as an implant for closing the wound orifice: one is shaped like a wound channel, another is disc-shaped, the first fragment is inserted into the wound channel, the second fragment is placed on the wound over the first fragment The nta from the side of the vitreal cavity, the collagen wound channel is tamponed with a collagen hemostatic sponge by seamless fixation.

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