RU2703336C1 - Method of treating descemet's membrane separation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For the Descemet's membrane separation treatment, paracentesis is introduced through the cannula into an anterior chamber of sterile air of 2/3 of the anterior chamber volume and the outward removal of the liquid from the cavity formed by the Descemet's membrane and the corneal stroma, is performed through a tunnel incision made in external surface of cornea, corneal knife 19 G. Then pressure is applied on lower edge of tunnel incision, gradually removing knife from tunnel until complete drainage of fluid from cavity between Descemet's membrane and posterior stroma surface.

EFFECT: method provides stable improvement of eye visual functions by minimizing corneal stroma injuries and providing reliable Descemet's membrane attachment to the cornea.

1 cl, 1 ex

Description

The invention relates to medicine, in particular to ophthalmology, and is intended for the treatment of detachment of the descemet membrane.

A known method of treating detachment of the descemet membrane by applying a mattress suture, in order to fix the membrane to the cornea, followed by the introduction of air into the anterior chamber for additional pressure of the membrane [1]. The disadvantage of this method is its invasiveness, because when sutures are performed, there is a high probability of damage to the corneal endothelium, suturing is possible, and it is also known that the application of through sutures opens the way for infection. In this case, the presence of nodal sutures causes a pronounced corneal syndrome in the patient in the postoperative period. It should also be noted that this method does not always allow to obtain the desired therapeutic effect.

A known method of treating detachment of the descemet membrane by ensuring that it adheres to the cornea by removing fluid from the cavity formed by the descemet membrane and stroma of the cornea, in combination with the intracameral injection of gas, remove the liquid outward (prototype). To do this, after introducing gas into the anterior chamber, the formed cavity is drained by injecting a curved needle into the cornea at an angle of 45-55 °, with its tip emerging in the central zone of the drained cavity near the stroma, then expanding and opening the canal lumen by transverse movements of the needle, and at the end of the drainage of the needle make a smooth return stroke [2].

However, the necessary movements carried out by the needle to expand the formed channel significantly injure the stroma of the cornea, which increases fibrosis in this area, and, consequently, the terms of patient rehabilitation.

The technical problem solved by this invention is the creation of a reliable, less traumatic, and, at the same time, simple method for treating descemet membrane detachment.

The essence of the invention lies in the fact that, in a method of treating descemet membrane detachment, comprising introducing through paracentesis, using a cannula, 2/3 of the volume of the anterior chamber into the front chamber of sterile air and removing fluid from the cavity formed by the descemet membrane and stroma of the cornea, a tunnel incision made on the outer surface of the cornea with a 19 G corneal knife, after which pressure is applied to the lower edge of the tunnel incision, gradually removing the knife from the tunnel until complete drainage fluid from the cavity between the descemet membrane and the posterior surface of the stroma.

Among the essential features characterizing the method, the distinguishing ones are:

- the formation of a tunnel, self-sealing, drainage section;

- the formation of a drainage incision in the cornea is performed with a special corneal tunnel knife 19 G;

- to remove the liquid outward, it is necessary after the formation of the tunnel, self-sealing section to press on his lower lip, dosing revealing its lumen when removing the knife;

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

Detachment of the descemet membrane most often occurs during the formation of the incision and the introduction of the tip of the phacoemulsifier needle and its manipulations in the anterior chamber, hydration of paracentesis and tunnel incision [5]. The location of access in most cases is the upper sector of the eye (11-12 hours), and detachment of the descemet membrane originates there more often. If the detachment is small in area, it can be eliminated with the help of gas introduced into the front chamber. Since gas occupies an upper position in any cavity and has a large tamping force, and being in the anterior chamber, it presses on the exfoliated Descemet's membrane, displaces the fluid through the incision into the anterior chamber, therefore, the membrane is adjacent [3]. The literature describes cases of spontaneous detachment of the descemet membrane several days after phacoemulsification of cataracts with implantation of an intraocular lens. In this case, the exfoliated descemet membrane has no rupture and independent drainage of the liquid when introducing gas into the anterior chamber is impossible, therefore it is necessary to drain it through an additional hole formed in the cornea. If the descemet membrane has a gap, but the detachment is extensive, then the gas only contributes to the partial removal of the liquid, and it is precisely the part that is near the section (above) that the gas plays a negative role for the rest of the liquid removed from the section: moment will block her exit. As a result, the part of the liquid remote from the section will be in a confined space and will continue to cause detachment of the descemet membrane [4]. The solution is the drainage of an enclosed space formed by a delaminated descemet membrane and the inner surface of the stroma, with the removal of fluid to the outside. Drainage is made possible by a canal formed with a tunneling corneal knife 19 G, which passes through the outer surface of the cornea and exits in the central zone of the drained cavity near the stroma, without damaging the descemet membrane. In order for the channel to play the role of drainage, it is necessary to press on the lower lip of the incision, which will allow the fluid to come out.

An important point, ensuring the minimization of the invasiveness of the intervention in the claimed method, is that the drainage channel is formed in the form of a tunnel with a corneal knife 19 G:

The incision is formed in a single translational movement with a 19 G corneal knife, which allows forming a self-sealing tunnel incision with minimal trauma for the corneal tissue, and when pressing on the lower edge of the incision, when removing the knife from the cornea, without additional trauma to the surrounding tissues, perform metered drainage of fluid from the space formed by exfoliated descemet membrane and the posterior surface of the cornea.

Using a 19 G corneal knife to create a channel, it is possible to obtain a controlled process of fluid outflow: it is easy to control the process of fluid removal by pressing the lower edge of the tunnel incision without injuring the surrounding tissue, without making additional side movements.

Thus, between the set of essential features and the achieved technical result, there is a causal relationship.

The method is as follows. Under local anesthesia, Lidocaine solution 2% -1.0 performs paracentesis in the zone in which the descemetic membrane is not exfoliated. Through paracentesis, using a cannula, sterile air is introduced into the anterior chamber: 2/3 of the anterior chamber volume. Then, at an angle of 45-55 ° to the cornea, a 19 G corneal knife (MANI, length 6 mm, diameter 220 microns) is injected into the cornea, with its tip emerging in the central zone of the drained cavity near the stroma. Then, making pressure on the lower edge, the knife is gradually removed from the tunnel incision until the fluid is completely drained from the cavity between the descemet membrane and the posterior surface of the stroma. At the same time, the air in the anterior chamber presses the membrane to the stroma, pushing the remaining fluid through the incision created by the knife. Under the conjunctiva, a solution of Dexamethasone 0.4% -0.5 ml, Gentamicin 20 mg, Lidocaine 2% -0.3 ml is administered. The operation is completed.

The inventive method, LLC “ML MITSAR” operated on 10 patients after patients with keratopathy after phacoemulsification of cataracts with implantation of an intraocular lens on the OCT revealed an extensive detachment of the descemet membrane. In all 10 cases, the descemetic membrane was flat. In the long-term follow-up, relapse of the descemet membrane was not observed in the operated patients.

Example. Patient S., born in 1960, came to our Center 1.5 months after the operation of cataract phacoemulsification with implantation of an intraocular lens of the left eye. Upon receipt: VisOS = 0.05 n / a

objectively: pronounced corneal edema, descemetitis;

OCT - extensive detachment of the descemet membrane of the left eye

Diagnosis: Artifakia, detachment of the Descemet OS membrane.

The operation is performed to eliminate detachment descemet membrane according to the claimed method. On the operating table, the exfoliated Descemet membrane is completely snug.

The day after surgery:

VisOS = 0.7 upon examination of the OS: the cornea is transparent, the descemet membrane lies along the entire area, there are folds in the anterior chamber, the air bubble occupies 1/3 of the volume.

When viewed after a month:

VisOS = 1.0

upon examination of OS: the cornea is transparent, the Descemet membrane adheres to the entire area, moisture is transparent

On examination after 6 months: the cornea is transparent, the descemet membrane is adjacent

VOS = 1.0

The technical result obtained by solving this problem is to minimize trauma to the corneal stroma when performing a drainage incision in it, to stably improve the visual functions of the eye by ensuring a reliable fit of the descemet membrane to the cornea.

Literature:

1. S. E. Amaral, D. A. Palay. Technique for repair of descemet membrane detacyment // Am. J. Ophthalmmol. -1999. -Vol. 127. - P. 88-90.

2. Patent No. 2178687 dated January 27, 2002, Tahchidi H.P. "A method for the treatment of descemet membrane."

3. Egorova A.V. A combined method of treating extensive detachment of the descemet corneal membrane after cataract surgery / A.V. Egorova, A.V. Vasiliev // Modern technologies of cataract and refractive surgery: Sat. scientific articles. - M., 2013 .-- S. 62-66.

4. Tahchidi H.P., Ulyanov A.N. A method for surgical treatment of detachment of the descemet membrane, which developed after cataract removal // Ophthalmic surgery. - 2005. - No. 1. - S. 24-26.

5. Kim T. A new technique for repairing Descemet membrane detachments using intracameral gas injection / T. Kim, S.A. Hasan // Arch Ophthalmol. - 2002 .-- 120 (2). - P. 181-183.

Claims (1)

A method of treating descemet membrane detachment, comprising introducing through paracentesis, using a cannula, into the anterior chamber of sterile air 2/3 of the anterior chamber volume and removing fluid from the cavity formed by the descemet membrane and stroma of the cornea through an incision made in the outer surface of the cornea the fact that the removal of liquid outward is carried out by performing a tunnel incision with a corneal knife 19 G, after which pressure is applied to the lower edge of the tunnel incision, gradually removing the knife from the tunnel For complete drainage of fluid from the cavity between the descemet membrane and the posterior surface of the stroma.