RU2710495C1 - Method of recovering the physiological shape of the optic nerve head in glaucomatic optic neuropathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmosurgery. External rectus muscle is excised in the tendon area. Traction of eyeball with a cornea in the nasal side is carried out. U-shaped suture is applied by needle-drilling of the episclera in the peripapillary zone and the optic nerve over the outer shell, at distance of 2 mm from the sclera. Suture is tightened with three assemblies. Then, after cutting off the internal rectus muscle and eyeball traction, a second similar U-shaped suture is placed outside.

EFFECT: method enables recovering the physiological shape of the optic nerve head and visual acuity to a light perception with an incorrect projection, thereby improving the quality of life of the patients suffering glaucoma, reducing traumatism and the risk of developing complications.

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Description

The invention relates to medicine, namely to ophthalmosurgery, and can be used for the surgical treatment of glaucoma optical neuropathy.

An increase in the physiological excavation of the optic disc due to an increase in intraocular pressure in glaucoma leads to the development of glaucoma optic neuropathy, which entails irreversible oppression of visual functions, up to blindness.

Modern approaches to the treatment of glaucoma optical neuropathy are based mainly on methods to reduce intraocular pressure to the target level (Gorbulina V.S., Zatey A.O. Modern approaches to the treatment of glaucoma optical neuropathy // Scientific forum: Medicine, biology and chemistry: Sat Art. according to the materials of the XV international scientific and practical conference No. 7 (15). M., Publishing house "ICNO", 2018. S. 36-42). The most common operations are sinuastrabulectomy and deep sclerectomy, which restore the drainage function of the eye.

However, a decrease in intraocular pressure does not affect the changes that have already occurred in the head of the optic nerve, namely, the presence of glaucoma excavation, and therefore structural disturbances in the optic nerve persist and vision is not restored.

Conservative treatment of glaucoma optical neuropathy is traditionally used: angioprotective, neuroprotective, antioxidant, as well as methods of electrical stimulation of the optic nerve.

There is a surgical method for correcting glaucoma optic neuropathy aimed at revascularizing the optic nerve using Alloplant biomaterial. The eyeball is turned upside down with suture-holders. A keratotomy blade produces two scleral notches. An episcleral flap on a vascular pedicle is cut from one notch to another from front to back. Then the flap is inserted into the suprachoroidal space with two microspatulas of a special design through the incision and the sclera is inserted, and on top of it, the allograft is introduced into the suprachoroidal space with two microspatulas to revascularize the optic nerve, sliding the tip of the spatula along the posterior surface of the sclera. The optic nerve is located in the notch between the two legs of the allograft (Polyakova Elena Yuryevna, Baranchikova Irina Vladislavovna. Experience with the use of Alloplant biomaterial in the treatment of congenital atrophy of the optic nerve (clinical case) // Bulletin of OSU. 2012. No. 12 (148)).

Disadvantages: there is no clinically confirmed improvement in blood flow in the choroid plexus of the optic nerve, glaucoma excavation persists.

A known method of surgical treatment based on transvitreal dyscision of the inner border membrane of the retina over the optic disc. Through a flat part of the ciliary body under the control of a binocular ophthalmoscope with a 20 diopter lens, a 30G needle is punctured, an isotonic sodium chloride solution is injected until the pulsation of the central retinal artery disappears. Then, the inner border membrane is discisized in the avascular zone of the optic nerve disk in the upper sector, after which the needle is removed through the initial puncture (Zapuskalov I.V., Khoroshikh Yu.I. Biomechanics of the “peripheral heart” in the tissues of the eye. Tomsk, 2013.140 s. .).

The disadvantage of this method is the high probability of damage to the optic nerve.

There is a method of decompression of the optic nerve by introducing an implant into the retrobulbar space, stable in shape and in a volume sufficient to displace the eyeball anteriorly, which leads to an increase in the angle of exit of the optic nerve at the posterior pole of the eye (Lutsevich Ekaterina Emmanuilovna, Method for the treatment of glaucoma optical neuropathy, Patent No. 2308913, publ. 10/27/2007, bull. No. 30).

The disadvantages of the method: invasiveness, the risk of complications.

The closest analogue of the proposed method for the treatment of optical glaucomatous neuropathy can be considered an operation of decompression of the optic nerve. The method is as follows: open and separate the conjunctiva concentrically to the limb 5 mm from it in the inner segment, then isolate, stitch and cut off the internal rectus muscle in the tendon, its end is fixed with a clip. Next, the eyeball is traced outward while the orbital tissue is pushed back with a retractor. Find the exit point of the optic nerve from the eyeball. The scleral canal is localized, with a knife Sato cut it over 4 mm deep to 1 mm. The muscle is fixed to the tendon. The conjunctiva is sutured (Shmyreva V.F. et al. Bulletin of Ophthalmology, 2001, No. 2, pp. 3-5).

However, the method is traumatic and has many complications: damage to the tissue of the optic disc, damage to the retina, the appearance of massive hemorrhages from the choroidal pool.

Thus, all currently known methods do not lead to the restoration of the physiological shape of the optic head, therefore, structural disorders in the optic nerve persist and even progress, and vision is not restored.

The objective of the invention is to improve the quality of life of patients with glaucoma.

EFFECT: reduction of glaucoma excavation of the optic nerve. Restoration of visual acuity to light perception with the wrong projection.

The technical result is achieved due to the fact that in a method that includes opening and separating the conjunctiva from the limbus, cutting off the internal rectus muscle in the tendon, traction of the eyeball outside, fixing the muscle, suturing the conjunctiva, first cutting off the external rectus muscle in the tendon, perform ocular traction cornea in the nasal direction, then a U-shaped suture is applied, stitching the episclera in the peripapillary zone and the optic nerve for the outer membrane, departing from the sclera by 2 mm, tighten the suture with three nodes, after clipping internal rectus and traction eyeball outwards - impose a second similar U-shaped seam.

The method is illustrated by drawings, where in FIG. 1 shows the cut-off point of the rectus muscle; figure 2 - the imposition of a U-shaped seam; figure 3 - tightened U-shaped seam.

A method of restoring the physiological shape of the optic head with glaucoma optic neuropathy is as follows. Under general anesthesia, the patient is treated with a surgical field with a 3% alcohol solution of chlorhexidine. Separate the conjunctiva from the limbus. The external rectus muscle (1) is taken on the holders at the scleral fixation point and intersected in the tendon region (2) (Figure 1). Traction of the eyeball with the cornea in the nose. A U-shaped suture (nylon 6/0) (5) is applied, stitching the episclera (4) in the peripapillary zone and the optic nerve (3) behind the outer shell, departing from the sclera by 2 mm with a stitch width of 2-3 mm (Figure 2 - Figure 3). The suture is tightened with three nodes (Figure 3), the external rectus muscle is fixed to the sclera. Then they take the internal rectus muscle onto the holders, cut it off in the tendon region, carry out traction of the eyeball outside, impose a second similar U-shaped suture (Figure 1 - Figure 3). The internal rectus muscle is fixed to the sclera. The conjunctiva is sutured at the limb with four interrupted sutures (silk 6/0). Lay 1% ocular tetracycline ointment. Apply an aseptic dressing.

Example

Patient N., 68 years old. Diagnosis: open-angle 4C stabilized glaucoma of the right eye. Visual acuity 0. The patient underwent surgery as described above. As a result of the surgical treatment, reduction of the optic nerve excavation with glaucoma was achieved. The color of the optic nerve head has changed from grayish to a more physiological shade. Visual acuity after surgery amounted to light perception with the wrong projection.

The proposed method allows to restore the physiological shape of the head of the optic nerve and visual acuity to light sensation with the wrong projection, thereby improving the quality of life of patients with glaucoma. The method is not traumatic, the risk of complications is minimal.

Claims (1)

A method of restoring the physiological shape of the optic head with glaucoma optical neuropathy, including opening and separating the conjunctiva from the limbus, cutting off the internal rectus muscle in the tendon, traction of the eyeball outside, muscle fixation, suturing of the conjunctiva, characterized in that the external rectus is first cut off in the region tendons, traction of the eyeball with the cornea in the nasal side, impose a U-shaped suture, flashing the episclera in the peripapillary zone and the optic nerve for the external the sheath, departing from the sclera by 2 mm, is sutured with three knots, and after cutting off the internal rectus muscle and traction of the eyeball outside, a second similar U-shaped suture is applied.

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