RU2704225C1 - Method of removing foreign body from posterior segment of eye - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For removal of foreign body from posterior segment of eye three sclerotomies are performed in meridians 7:30, 10:30, 1:30, ports 23–25 G are installed, sclero-corneal tunnel incision and two corneocentises are performed. That is followed by subtotal vitrectomy and removing the vitreous body together with the posterior hyaloid membrane. Foreign body is captured by means of gluing with inserted into vitreous body through paracentesis of cornea or sclerotomy with silicone tube connected with filled with cyanoacrylate adhesive syringe. Intraocular foreign body is then removed by gradually pulling the silicone tube through the anterior chamber and the cornea or transsclerally. When extracting foreign body from posterior segment of eye intraocular foreign body is captured by means of gluing with silicone tube with diameter of 23–25 G.EFFECT: method enables to extract magnetic and non-magnetic foreign bodies of different sizes without using a proportional instrument, enables dosed and delicate tightening of a foreign body with its gradual release from the capsule, timely hemostasis, as well as unlimited use of bimanual equipment.1 cl, 2 ex

Description

The invention relates to medicine, namely to methods used in eye surgery, in particular to a method for extracting a foreign body from the posterior segment of the eye.

Traumatic lesions of the organ of vision occupy one of the leading places in the practice of an ophthalmic surgeon. To date, trauma to the organ of vision and its consequences are the main cause of blindness and low vision of people of working age. In the structure of eye trauma, penetrating wounds make up from 67 to 84%, of which 37-51% occupy wounds with localization of a foreign body in the posterior segment of the eye. Due to an eyeball injury, 84.5% of victims aged 20 to 24 years become disabled, while in 16-57% of cases, the process ends in blindness. In 49-62% of cases, the result of shrapnel wounds of the eye is its anatomical death, which manifests itself in the form of subatrophy of varying degrees. The factors predisposing to eye death are traumatic removal of a fragment in 13.5% of cases, unsuccessful repeated attempts to remove it in 34% of cases, and unremoved foreign bodies in 16% of cases (Volkov V.V., Danilichev V.F., Eryukhin I.A. et al. Damage to the organ of vision // Modern Ophthalmology. - St. Petersburg: Peter, 2000. - P. 131-158.). Removal of foreign bodies (hereinafter referred to as “IT”) from the posterior segment of the eye is considered one of the most serious problems in ophthalmology and traumatology.

A known method of removing foreign bodies of the retina, in particular, of amorphous ("Method for removing amorphous foreign bodies of the retina": application No. RU 96107549, Russian Federation, application. 04.17.1996, publ. 10.07.1998). This method includes vitrectomy followed by extraction of foreign bodies with tweezers, characterized in that a blunt needle connected to a syringe is inserted through an incision in the flat part of the ciliary body and brought to a foreign body, then a negative pressure is created at the end of the needle by moving the piston under the impact of which a foreign body is attached to the needle and rises above the retina with subsequent removal of tweezers inserted into the vitreous cavity through another incision in the flat part of the ciliary body.

Also known is a method of removing intraocular foreign bodies from the posterior segment of the eye ("Method for removing intraocular foreign bodies from the posterior part of the rear eye": patent for invention No. 2364383, Russian Federation, application No. RU 2008113486, published on 04/10/2008, published on 08/20/2009 ) In the course of this method, a cataract tunnel sclerotic corneal incision and two corneocentesis are performed. Then, anterior continuous circular capsulorexis with a diameter of 4.5-5.5 mm is performed, hydrodissection and hydrodelineation, the lens substance is removed. A perforation hole is formed in the posterior capsule of the lens through which it is separated from the anterior hyaloid membrane, the flap of the capsule is taken with forceps and performed posterior continuous circular capsulorexis with a diameter of 4.0-5.0 mm, thus leaving the equatorial part of the capsular sac intact. Then, a three-port transciliary subtotal vitrectomy is performed, for which three sclerotomies are performed in the meridians 7:30, 10:30 and 1:30 parallel to the limb at a distance of 3.5 mm from it. Then the vitreous body is removed with the vitreotome together with the posterior hyaloid membrane. An intraocular foreign body is captured with collet forceps inserted into the vitreous cavity through a sclerotomy in the meridian 1:30, and it is brought out to the anterior chamber through the opening of the posterior capsulorhexis, and then the anterior capsulorhexis, from where it is removed with forceps inserted through the tunnel cataract sclerorhoric; sections of the sclera, tenon capsule and conjunctiva are sutured in layers, an intraocular lens is implanted in the equatorial part of the capsular bag. This method is adopted as a prototype, since it is the closest to the claimed technical essence.

The disadvantages of the above methods include the need to use a commensurate tool and the limited use of bimanual technique. The need to use a commensurate instrument is due to the fact that the intraocular foreign body is captured with collet forceps, which has limitations in the shape and size of the captured body. The limited use of bimanual equipment is due to the continuous operation of one of the operator’s hands. The operator is forced to hold tweezers with closed jaws where the IT is located. As a result of this position, with a long stage of IT release from the surrounding capsule, tremors can occur, which leads to a rough execution of the operation stage, damage to surrounding tissues and bleeding.

A technical problem is the need to develop a method with a reduced risk of damage to eye tissues.

The technical result is the ability to extract foreign bodies of various sizes both through the corneal and through the scleral incision without the use of a commensurate instrument, the possibility of metered and delicate pulling of a foreign body with its gradual release from the capsule, timely hemostasis, as well as the unlimited use of bimanual technique for mobilizing a fragment , and for the formation of a proportional wound of the cornea or sclera for the final extraction of a foreign body.

The technical result is achieved by the fact that in the method of extracting a foreign body from the posterior segment of the eye, during which three sclerotomies are performed in the meridians 7:30, 10:30, 1:30, ports 23-25 G are installed, subtotal vitrectomy is performed, the vitreous is removed together with the posterior hyaloid membrane, according to the invention, the intraocular foreign body is captured by gluing with a silicone tube connected to a filled with cyanoacrylate adhesive inserted into the vitreous cavity through corneal paracentesis or sclerotomy itsom and then outputted intraocular foreign body by gradually pulling up the silicone tube through the cornea and anterior chamber or transscleral.

The capture of intraocular IT by gluing with a silicone tube inserted into the cavity of the vitreous body through corneal paracentesis or sclerotomy connected with a syringe filled with cyanoacrylate adhesive makes it possible to extract any magnetic or non-magnetic IT of various sizes from the posterior segment of the eye without using a commensurate tool. This is due to the fact that the capture is carried out due to the adhesion of the cyanoacrylate adhesive and the foreign body, and the size of the silicone tube connected to the syringe filled with cyanoacrylate adhesive does not affect the possibility of IT capture. In addition, thanks to the capture of intraocular IT using a silicone tube connected to a syringe filled with cyanoacrylate glue, there is an unlimited possibility of using bimanual technique. This is due to the fact that when using the proposed method there is the possibility of a metered and delicate (as opposed to using the method with a metal tool) pulling up IT with its gradual release from the capsule, as well as with timely hemostasis. In the event of an unforeseen strong fixation of IT and a change in tactics of operation, the silicone tube is easily cut off at the surface of the IT.

When implementing the proposed method, IT is captured by gluing with a silicone tube with a diameter of 23-25 G connected to a syringe filled with cyanoacrylate adhesive. This range of diameter silicone tubes is due to higher safety, and also provides better results and faster healing. The use of 23-25 G trocars allows you to carry out all the necessary manipulations with the least trauma for the membranes of the eye. The technology of using 23-25 G does not require suturing, healing takes place without rough scarring, if necessary, repeated interventions in the same projections can be performed.

The method is as follows.

General and subthenon anesthesia is performed, the surgical field is treated, and then an eyelid expander is installed. Next, conjunctival peritomy is performed and a place for surgical access is chosen. Then a sclerotomy is performed in the given meridians, after which a sclerotic-corneal tunnel incision and two corneocentesis are performed. If IT has damaged the lens material or large IT, standard phacoemulsification is performed. In a preferred embodiment of the method, the incisions are made in the meridians of 7:30, 10:30, 1:30 sclera. The caliber and location of the incisions is selected individually (the caliber of sclerotomy sections is -0.5 mm (25 G), 0.7 mm (23 G) or more, and a combination of punctures of different diameters is also possible). Then, if necessary, perform posterior capsulorhexis, establish an infusion cannula and a wide-field contact lens on the cornea. An illuminator for detecting IT and a surgical instrument are introduced. Then a vitrectomy and IT capture are performed by bonding with a silicone tube connected to a syringe filled with cyanoacrylate adhesive. The capture of IT occurs due to the adhesion of the cyanoacrylate adhesive and the foreign body, which occurs after the partial release of the cyanoacrylate adhesive by pressing the syringe plunger. After that, the IT is lifted from the fundus and transferred to the anterior chamber of the eye by delicate manipulations with the silicone tube to which the IT is fixed, and then it is removed from the eye through the tunnel incision of the cornea. With scleral access, similar manipulations are performed and IT is extracted through the sclera incision. An intraocular lens is then installed and a vitreous fluid, gas, or silicone is replaced. If necessary, suturing of the corneal and (or) sclerotomy openings is performed. Then the conjunctiva is sutured. Next, remove the eyelash, apply an antibiotic (ointment / drops) and apply a protective bandage.

The inventive method is illustrated by examples.

Example 1

The operation is modeled on cadaveric pig eyes. To fix the cadaver eyeball, a device was used, which is characterized by a vacuum fixation method and includes a diode illuminator, which allows simulating a reflex from the fundus.

After fixation of the eyeball, a sclerotomy was performed in the meridians 7:30, 10:30, 1:30, parallel to the limb at a distance of 3.5 mm from it, then ports 23-25 G were installed. Next, a sclerotic-corneal tunnel incision 2 wide , 8 mm in the meridian of 11:30 and two corneocentesis in the meridians of 9:00 and 2:30, as well as the anterior capsulorexis with a diameter of 5.0 mm, hydrodissection and hydrodelineation.

The substance of the lens is removed by phacoaspiration. Next, the capture of the posterior capsule with tweezers and a circular continuous posterior capsulorexis with a diameter of 5.0 mm were performed. Through the sclero-corneal incision, through the anterior and posterior capsulorhexis, tweezers with the help of tweezers introduced metal irregularly sized 1.5x1.0 mm into the eye. IT is lowered onto the retina of the cadaver eye. The vitreous body was then removed along with the posterior hyaloid membrane using a vitreotome. After that, a silicone tube connected to a syringe filled with cyanoacrylate glue was inserted through a sclerotomy. Then, after pressing the syringe plunger, a partial release of the cyanoacrylate adhesive and adhesion of the silicone tube to the cyanoacrylate adhesive and IT occurred, which ensured the grip and firm fixation of the IT. Then metered and delicate pull-ups of IT were performed, while the operator had the possibility of unlimited use of bimanual equipment. The IT was brought into the anterior chamber through the openings of the posterior and then the anterior capsulorhexis, from which IT was subsequently removed through the sclero-corneal tunnel incision. An acrylic intraocular lens (hereinafter referred to as "IOL") was implanted into the capsule bag. Corneocentesis was sealed by hydration.

Example 2

The operation is modeled on cadaveric pig eyes. To fix the cadaver eyeball, a device was used, which is characterized by a vacuum fixation method and includes a diode illuminator, which allows simulating a reflex from the fundus.

After fixation of the eyeball, sclerotomy was performed in the meridians 7:30, 10:30, 1:30, parallel to the limb at a distance of 3.5 mm from it, then ports 23-25 G were installed. Then a sclerotic-corneal tunnel incision was made with a width of 2.8 mm in the meridian 11:30 and two corneocentesis in the meridians 9:00 and 2:30, as well as the anterior capsulorexis with a diameter of 5.0 mm, hydrodissection and hydrodelineation.

The substance of the lens is removed by phacoaspiration. Next, the posterior capsule was captured with tweezers and a circular continuous posterior capsulorhexis with a diameter of 5.0 mm was made. Through a sclero-corneal incision, through the anterior and posterior capsulorhexis, tweezers with the help of tweezers were inserted into the eye with plastic, measuring 1.5 × 1.0 mm, of irregular shape. IT is lowered onto the retina of the cadaver eye. Then the vitreous was removed along with the posterior hyaloid membrane using a vitreotome. After that, a silicone tube connected to a syringe filled with cyanoacrylate glue was inserted through a sclerotomy. Then, after pressing the syringe plunger, a partial release of cyanoacrylate glue and adhesion of the silicone tube with cyanoacrylate glue and IT occurred, which ensured the grip and firm fixation of IT. Then metered and delicate pull-ups of IT were performed, while the operator had the possibility of unlimited use of bimanual equipment. The IT was brought into the anterior chamber through the openings of the posterior and then the anterior capsulorhexis, from which IT was subsequently removed through the sclero-corneal tunnel incision. An acrylic IOL was implanted into the capsule bag. Corneocentesis was sealed by hydration.

Thus, the inventive method allows to remove foreign bodies of various sizes both through the corneal and through the scleral incision without the use of a commensurate instrument, provides the possibility of metered and delicate pulling of the foreign body with its gradual release from the capsule, timely hemostasis, and also allows unlimited use of bimanual techniques both for mobilizing the fragment and for forming a commensurate wound of the cornea or sclera for the final extraction of foreign native body, which together reduces the risk of damage to eye tissue.

Claims (2)

1. A method of extracting a foreign body from the posterior segment of the eye, during which three sclerotomies are performed in the meridians 7:30, 10:30, 1:30, ports 23-25 G are installed, a sclerotic-corneal tunnel incision and two corneocentesis are performed, then subtotal vitrectomy and the vitreous body is removed together with the posterior hyaloid membrane, characterized in that the intraocular foreign body is captured by gluing with the corneal paracentesis or sclerotomy using a silicone tube connected to the floor nano cyanoacrylate glue with a syringe, and then the intraocular foreign body is removed by gradually pulling the silicone tube through the anterior chamber and cornea or transsclerally. 2. The method according to p. 1, characterized in that when removing the foreign body from the posterior segment of the eye, the intraocular foreign body is captured by gluing with a silicone tube with a diameter of 23-25 G.