RU2720528C1 - Method for surgical treatment of retinal detachment with peripheral rupture by blocking the rupture with a drop of blood autoplasma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmosurgery. For surgical treatment of retinal detachment with peripheral rupture of retina 3-port vitrectomy 25-27G of valve type is performed with separation and removal of posterior hyaloid membrane, plugging the vitreal cavity, blocking the retinal rupture by applying a drop of blood platelet-rich autoplasma on the ruptured region. Tamponade of the vitreal cavity is performed intraoperatively, and after the operation, a balanced salt solution (BSS) is left in the vitreal cavity; for this purpose, after the vitrectomy, the balanced salt solution is partially replaced with a perfluororganic compound (PFOC). PFOC is introduced to the lower edge of the retinal rupture; after that, the subretinal fluid is drained through the rupture until the retina completely adjoins; then the BSS solution located above the PFOC is replaced with air. Further, the pressure in the vitreal cavity is lowered to mild hypotension, and then, from the outside, the sclera is pressed into the peripheral rupture by the standard sclerocompressor, bringing the retina into a horizontal position in the air medium and continuing sclerocompression. On the retinal rupture located on a horizontal area, using a syringe a drop of blood platelet-rich autoplasma in amount of 0.05–0.1 ml is placed, after that the remaining volume of air in the vitreal cavity is replaced with PFOC. PFOC tamponade is maintained for 2–3 minutes. That is followed by stopping sclerocompression, performing endolaser coagulation of the retina around the rupture and replacing the PFOC with the BSS solution.

EFFECT: method enables eliminating peripheral rupture of the retina, wherein in the postoperative period the patient does not need to be face down for a long time.

3 cl, 1 ex

Description

The invention relates to medicine, namely to ophthalmic surgery, and can be used for surgical treatment of retinal detachment with peripheral retinal rupture by blocking the rupture with a drop of autoplasm of blood enriched with platelets.

There are various methods of surgical treatment of regmatogenous retinal detachment (detachment with a gap). Some of them consist of vitrectomy followed by tamponade of the vitreous cavity with vitreous substitutes: gases with a long period of resorption, varieties of liquid PFOS, and silicone oils, both light and heavy.

The disadvantages of gas and silicone tamponade include: complicated cataract, which requires repeated surgical intervention to extract cataracts, secondary ophthalmic hypertension, emulsification of silicone oil, reoperation to remove silicone oil at the end of the tamponade, forced patient position (in case of gas tamponade) after surgery to be face down (from 1 to 3 days) and a number of other negative points.

The invention is known Patent RU No. 2698633 "Method for the surgical treatment of macular retinal ruptures", priority dated 12/27/2018 (developed in our center). Although in this technology the retinal rupture is not eliminated at the periphery, but in the macular zone, however, for the first time such a set of actions and their sequence was created that tamponade of the retinal rupture zone was performed intraoperatively, and the operation was completed by leaving BSS saline solution in the vitreous cavity, which is not is a tampon substance. As a result, an effective method for surgical treatment of macular retinal rupture with blocking a rupture of a drop of autoplasm of blood enriched with platelets without leaving a plugging substance in the eye was obtained, the method allowed to reduce surgical and postoperative complications and provided more comfortable conditions for the patient in the postoperative period.

As a prototype in our case, the invention was taken "Method for the surgical treatment of retinal detachment with peripheral retinal rupture" (RU patent No. 2683740). Its essence consists in performing a three-port subtotal vitrectomy using 25 and 27 G cannulas, removing the posterior hyaloid membrane, performing pneumoretinopexy and introducing 0.1-0.3 ml of autoplasma enriched with platelets into the area of the retinal rupture (PRP or in the Russian version of BTP is rich platelet plasma) and in the early postoperative period of the patient for 1-3 days laid face down. Platelet-rich plasma is obtained from the patient’s own blood, centrifuged (known technique).

The disadvantage of this method is the use of gas tamponade of the vitreous cavity, which leads to the occurrence of complicated cataracts and, consequently, to repeated surgical interventions. Also, the disadvantage of gas tamponade is the patient's forced position in the postoperative period, face down.

The objective of the invention is to provide a method for the surgical treatment of retinal detachment with peripheral rupture by blocking rupture with a drop of blood plasma enriched in platelets and intraoperative tamponade of the retinal rupture zone, without leaving a plugging substance in the vitreous cavity.

The technical result consists in eliminating peripheral retinal rupture, in the postoperative period the patient does not need to be face down for a long time, postoperative complications such as complicated cataracts, secondary ophthalmic hypertension are actually reduced, the patient has the opportunity to use air transport immediately after the operation. The method has proven to be reliable and effective.

The specified technical result can be obtained if, in the method of surgical treatment of detachment with peripheral retinal rupture, which includes performing a 3-port 25-27G valve-type vitrectomy with isolation and removal of the posterior hyaloid membrane, plugging the vitreous cavity, blocking retinal rupture by applying to the area rupture of a drop of autoplasm of blood rich in platelets, according to the invention, tamponing of the vitreous cavity is performed intraoperatively, and at the end of the operation, left in the vit of the cavity, balanced salt solution (BSS), for this, after performing a vitrectomy, the balanced salt solution is partially replaced by an organofluorine compound (PFOS), PFOS is introduced to the lower edge of the retinal rupture, then the subretinal fluid is drained through the gap until the retina is completely adherent, then the BSS solution located above PFOS, it is replaced by air, then the pressure in the vitreous cavity is reduced to mild hypotension, and then outside, the sclera is pressed into the peri-area with a standard sclerocompressor of a spherical rupture, bringing the retina with a gap to a horizontal position in the air and, without stopping sclerocompression, a drop of autoplasm of blood rich in platelets in the amount of 0.05-0.1 ml is placed with a syringe into a retinal gap located on a horizontal platform after of this, the remaining volume of air in the vitreous cavity is replaced by PFOS, the PFOS-ohm tamponade is kept for 2-3 minutes, then sclerocompression is stopped, endolasercoagulation of the retina around the gap is performed and PFOS is replaced with a BSS solution.

Explanatory signs:

- reduce the pressure in the vitreous cavity to mild hypotension by adjusting the air supply;

- when replacing PFOS with a BSS solution, PFOS is removed using a vitreotome.

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

- plugging of the vitreous cavity is performed intraoperatively,

- at the end of the operation, a balanced saline solution (BSS) is left in the vitreal cavity, for this:

- after vitrectomy, the balanced saline solution is partially replaced by an organofluorine compound (PFOS), and PFOS is administered to the lower edge of the retinal rupture,

- after that, a subretinal fluid is drained through the gap until the retina is completely snug,

- then the BSS solution located above PFOS is replaced with air,

- then lower the pressure in the vitreous cavity to mild hypotension,

- then outside, with a standard sclerocompressor, press the sclera in the peripheral gap zone, bringing the retina into the horizontal position with a gap in the air,

- without stopping sclerocompression, a drop of autoplasm of blood rich in platelets in the amount of 0.05-0.1 ml is placed with a syringe on the retinal gap located on a horizontal platform,

- after that, the remaining volume of air in the vitreous cavity is replaced by PFOS,

- withstand tamponade PFOS-ohm 2-3 minutes, then stop performing sclerocompression,

- carry out endolasercoagulation of the retina around the gap,

- replace PFOS with a solution of BSS.

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

The selected actions during vitreoretinal surgery and their correct sequence of execution allowed us to solve the problem. First, after a 3-port vitrectomy is performed (during vitrectomy, the vitreous is excised, replacing it with a balanced saline solution (BSS)), the BSS solution is partially replaced with an organofluorine compound (PFOS), and PFOS is introduced to the lower edge of the retinal rupture. After that, a subretinal fluid is drained through the gap until the retina is completely snug. The BSS solution located above PFOS is then replaced with air. This replacement allows the sclera to be pressed and the retina to be positioned with a gap in a horizontal position to reliably block the gap. But before the sclera is pressed, the pressure in the vitreous cavity should be reduced to mild hypotension, and only after that, with the standard sclerocompressor, press the sclera in the area of the retina rupture, bringing the retina into the horizontal position in the air. At the same time, sclerocompression is continued to be held, and a drop of autoplasm of blood rich in platelets in the amount of 0.05-0.1 ml (depending on the size of the gap) is placed with a syringe on the retinal gap located on a horizontal platform. After that, the remaining volume of air in the vitreal cavity is replaced by PFOS. Thus, the vitreous cavity becomes completely filled with PFOS (plugging substance). Withstand tamponade PFOSom 2-3 minutes. Practice shows that this time is enough for more tight adhesion (adhesion) of the fibrin film (the film forms on the surface of the autoplasm) to the retina due to the high specific gravity of PFOS. Then sclerocompression is stopped (the membranes in the impression zone are straightened) and high-quality endolasercoagulation of the retina around the gap can be performed (to strengthen the location of the detached retina). After that, replace PFOS with a solution of BSS. The finding of the plugging substance in the vitreous cavity is not further required. The peripheral gap is reliably blocked, the retina is adjacent. There is no threat to the macular zone.

Example. Patient R. 1971 appealed to our center on September 04, 2019 with complaints about a sharp decrease in visual acuity of the left eye (OS) that arose three months ago. History: radial keratotomy of both eyes in 1989, cataract extraction of both eyes in 2013; Vis OS - 0.05 eccentric, IOP OS - 4 mm Hg, narrowing of the visual fields from the temporal side; Vis OD - 1.0

When examining the left eye: keratotomy scars on the cornea, IOL in the correct position, optic nerve disc disease, pink, contours are clear, the course and caliber of blood vessels are not changed, the macula is without features, peripheral retinal detachment in the temporal sector with a gap of 3 hours.

Diagnosis: regmatogenous retinal detachment, artifact, operated myopia of a high degree, condition after keratotomy of the left eye.

The next day, the patient underwent surgery using the proposed technology in his left eye.

When viewed the day after the operation: Vis OS - 0.2; the anterior segment is unchanged, the retina is adjacent, in the vitreous cavity a suspension of BoTP, IOP - 12 mm Hg, extension of the boundaries of the field of view.

The patient was discharged home.

At the control examination after 1 month: visual acuity of the left eye - 0.35; anterior segment unchanged, the retina is adjacent, IOP - 15 mm Hg, extension of the field of view.

The patient was sent under the supervision of an ophthalmologist at the place of residence.

In the Yekaterinburg center, 6 eyes were operated on in the described manner. All operations were successful, in all cases it was possible to achieve fit of the retina and blocking the gap on the periphery of the retina. The result was a higher functional result. In the postoperative period, complications, such as cataracts or glaucoma, were not noted.

Claims (3)

1. A method of surgical treatment of retinal detachment with peripheral retinal rupture, including performing a 3-port valve-type 25-27G vitrectomy with extraction and removal of the posterior hyaloid membrane, plugging the vitreous cavity, blocking retinal rupture by applying a platelet-rich blood drop to the rupture region characterized in that the plugging of the vitreous cavity is performed intraoperatively, and at the end of the operation, balanced salt solution (BSS) is left in the vitreous cavity, d To do this, after a vitrectomy, the balanced saline solution is partially replaced by an organofluorine compound (PFOS), PFOS is introduced to the lower edge of the retinal rupture, then the subretinal fluid is drained through the rupture until the retina is fully adhering, then the BSS solution located above the PFOS is replaced with air. then they lower the pressure in the vitreous cavity to mild hypotension and after that, the sclera is pressed externally with a standard sclerocompressor in the area of the peripheral gap, bringing the retina with a gap into the mountains isontal position in air and, without stopping sclerocompression, a drop of autoplasm of blood rich in platelets in the amount of 0.05-0.1 ml is placed with a syringe on the retinal gap located on a horizontal platform, after which the remaining volume of air in the vitreous cavity replace with PFOS, withstand PFOS tamponade for 2-3 minutes, then stop performing sclerocompression, carry out endolasercoagulation of the retina around the gap and replace PFOS with a BSS solution. 2. The method according to p. 1, characterized in that they lower the pressure in the vitreal cavity to mild hypotension by adjusting the air supply. 3. The method according to p. 1, characterized in that when replacing PFOS with a solution of BSS, PFOS is removed using a vitreotome.