RU2717215C1 - Low-traumatic method of surgical treatment of strabismus - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to ophthalmology. Recovered muscle is recovered, sutures are placed on its tendon, creases are formed. At that, before formation of fold, upper or lower third of tendon in avascular zone is medial to ciliary vessels by vicryl 7-0 thread from inside to form cross-like suture. Ends of the suture are fixed with three nodes under the tendon; the same suture needle is used to apply the scleral suture at the point of attachment of the muscle to the sclera. In the same way, the opposite third of the tendon with the scleral suture is sutured. Then, needle-stitched section is pulled up to attachment point of muscle to sclera to form a uniform fold of tendon. Sutures are fixed with three knots and the sutures are cut off.EFFECT: method enables reducing the traumatism, which leads to reducing intra- and postoperative complications, achieving a good cosmetic and functional result in oculomotor muscles.1 cl, 1 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used for the surgical treatment of strabismus.

In the complex treatment of strabismus, surgical methods for correcting the action of the oculomotor muscles are of great importance. At the same time, clinical experience allows attributing strabismus elimination operations to rather traumatic interventions. The traditional technique of strabismus surgery with an amplifying type of operation involves a violation of blood supply in the pool of the anterior ciliary arteries, which significantly increases the risk of ischemia of the anterior segment in the postoperative period.

The closest analogue is a method of enhancing the action of the direct oculomotor muscles (Wright KW. Rectus muscle tightening procedures. In: Wright KW, editor. Color Atlas of Strabismus Surgery. Strategies and Techniques. New York: Springer; 2007. pp. 149-55.), consisting in the allocation of the strengthened muscle, determining the place of suturing on the strengthened muscle, suturing the tendon along the edges with a thread not to the entire thickness, forming a fold, suturing the place of suturing the muscle to the sclera.

The disadvantage of this method is that the seams with which the muscle is stitched, often cut through, which weakens the effect of the operation and requires a new surgical intervention. If the front ciliary arteries fall into them when tying sutures, then blood supply is disrupted in them, which increases the risk of ischemia of the anterior segment of the eye.

The objective of the invention is to provide a less traumatic method for the surgical treatment of strabismus.

The technical result of the invention is to reduce the invasiveness of the method, which leads to a decrease in intra- and postoperative complications, to achieve a good cosmetic and functional result in operations on the oculomotor muscles.

The technical result is achieved by the fact that in the method of eliminating strabismus, including the allocation of a strengthened muscle, determining the location of suturing on its tendon, forming a fold, according to the invention, first, the upper or lower third of the tendon is sutured with a vicryl 7-0 thread from the inside (from under tendons) outward with the formation of a cruciform suture medial to the ciliary arteries without clamping them, the ends of the suture are fixed with three nodes under the tendon, with the same needle and suture, a scleral suture is applied at the edge of the attachment site eniya muscles to the sclera, similarly sewn opposite third tendon overlay scleral suture is then pulled up over both threads stitched portion to place the muscle attachment to the sclera to form a uniform thin pleated tendons, joints are fixed three nodes, the yarn is cut.

The determining essential distinguishing features of the proposed method, in comparison with the prototype, are:

1. Sewing of the tendon is not performed to the full width, but only in the avascular zone medial to the ciliary vessels, which eliminates injury to the neurovascular bundle.

2. Stitching of a muscle tendon is performed on the entire thickness of the tendon, which prevents the eruption of sutures.

3. Sewing is done with thin vicryl 7-0 threads from the inside (from under the tendon) outwards with the formation of a cruciform seam, which helps to smooth the fold, since the nodes are located under the muscle.

The method is as follows:

After processing the surgical field, a conjunctival incision is performed. The rectus muscle is isolated. Wright’s hook with a groove, which prevents accidental perforation of the sclera with a needle, sutures the upper or lower third of the tendon, first, for example, the upper one, with vicryl 7-0 thread, 6-8 mm from the point of muscle attachment, depending on the degree of gain needed. In this case, the needle is injected in the avascular zone medially to the ciliary vessels from the inside (from under the tendon) outwards with the formation of a cruciform suture. The ends of the thread are fixed by three nodes under the tendon. In the same way, the lower third of the tendon is stitched. Then, with the same needles with threads, scleral sutures are placed along the edge of the muscle attachment site, the stitched muscle section is pulled by the threads anteriorly to the attachment site, forming a uniform thin fold of the tendon. They are fixed with three nodes. Threads cross.

The proposed method is illustrated by the following example.

Example 1 Patient I., 5 years old, diagnosis: OU Friendly alternating convergent strabismus. Hypermetropia of moderate degree.

Visus OD = 0.6 sph + 2.0 = 1.0

OS = 0.6 sph + 2.5 = 1.0. The anteroposterior axis (PZO) OD = 22.1 mm, OS = 21.98 mm. Objective strabismus angle according to synoptophor +27 degrees. Nature of view: OU alternating. From the anamnesis: deviation of both eyes to the nose from 3 years. Since 3 years, eyeglass correction and occlusion.

Under combined anesthesia, surgical treatment of the right eye was performed. After preparation of the surgical field, a recession of the internal rectus muscle was performed according to the standard technique. Strengthening of the external rectus muscle was carried out by the claimed method, while the first third of the tendon was sutured, and then the lower one.

The postoperative period was uneventful. After the operation, the objective strabismus angle by synoptophor is +5 degrees. The nature of vision is simultaneous. One year after 3 courses of conservative treatment, Visus OD = 1.0. OS = 1.0.

PZO OD = 22.15 mm, OS = 21.98 mm. The objective strabismus angle according to the synoptophor is 0 degrees. Nature of vision: OU binocular.

The method was tested on 134 children with convergent friendly strabismus and allowed to obtain high functional and cosmetic results in the surgical treatment of strabismus.

Claims (1)

A way to eliminate strabismus, including the allocation of a strengthened muscle, determining the place of suturing on its tendon, the formation of a fold, characterized in that before the formation of a fold, the upper or lower third of the tendon is sutured in the avascular zone medially to the ciliary vessels with vicryl 7-0 thread from the inside outwards with the formation of a cruciform suture , the ends of the thread are fixed with three nodes under the tendon, the scleral suture is applied with the same needle and thread at the edge of the place of attachment of the muscle to the sclera, similarly, the opposite is sutured a third of the tendon with a scleral suture, then the stitched section is pulled over both threads to the site of muscle attachment to the sclera, forming a uniform tendon fold, the sutures are fixed with three nodes, the threads are cut.