RU2776766C1 - Method for surgical treatment of retinal detachment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology. A subtotal vitrectomy is performed, the vitreous body is stained with separation of the posterior hyaloid membrane from the retina. The introduction of a perfluoroorganic compound, drainage of the subretinal fluid, endolaser coagulation of the retina, installation of a chandelier, tamponing of the vitreal cavity with one of the vitreous body substitutes are carried out. In this case, the central sections of the vitreous body are first removed. Then, after draining the subretinal fluid, using a 30 G viscodissector attached to a syringe, 0.4 ml of cohesive viscoelastic mixed with 0.2 ml of MembraneBlue-Dual retinal dye is injected into the retrohyaloid space. Then, the separation and subsequent removal of the peripheral parts of the vitreous body with a vitreotomy is carried out.

EFFECT: method allows to reduce postoperative complications, increase the reliability of the operation, maintain optimal conditions for reliable adaptation of the retina, maintain anatomical and topographic relationships in the eye.

1 cl, 3 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended for the surgical treatment of retinal detachment.

Retinal detachment is a serious disease characterized by separation of the retina from the choroid, which, if left untreated, will inevitably cause complete loss of vision in a short time. There are various methods of surgical treatment of retinal detachment. In severe cases, one has to resort to more complex operations, such as microinvasive subtotal vitrectomy followed by tamponade of retinal tears with silicone oil or long-acting gas of the vitreal cavity. This is necessary to ensure reliable fixation of the retina after laser coagulation during the formation of chorioretinal adhesions. Currently, there is no unified approach to surgical treatment, as well as a unified view on the mechanisms of development of this pathology.

The closest analogue is the "Method of surgical treatment of rhegmatogenous retinal detachment".

The method consists in the fact that for the treatment of rhegmatogenous retinal detachment, subtotal vitrectomy is performed with a frequency of cuts of 8000 per minute through ports installed 3.5-4 mm from the limbus in the flat part of the ciliary body, with separation of the posterior hyaloid membrane from the retina and filling the vitreal cavity balanced irrigation saline. A perfluoroorganic compound (PFOS) is injected to the lower edge of the existing retinal rupture, subretinal fluid is drained, and PFOS is replaced with air. Then, along the edges of all existing peripheral retinal breaks, endolaser coagulation of the retina with a power of 0.15-0.18 mW is performed. Additionally, a puncture is performed in the flat part of the ciliary body, departing from the limbus 3.5-4 mm to install a chandelier into it. Then, gradual filling of the vitreal cavity with PFOS is carried out to the lower edge of the gap through one of the ports with simultaneous aspiration of a balanced irrigation solution with a vitreotomy through the other port. After completion of endolaser coagulation of the retina, the operation is completed by plugging the vitreal cavity and suturing (RF Patent for Invention No. 2730932).

The disadvantages of this method of operation include the following:

Firstly, using this method, it is impossible to perform a careful, thorough and safe separation and subsequent removal of the peripheral parts of the vitreous body with a vitreotomy.

Secondly, with this method, there is a high risk of new retinal tears and, accordingly, recurrence of retinal detachment.

Thirdly, the above method is achieved by spending more time, since the more time spent on the operation, the more the patient needs pain relief, the likelihood of postoperative complications increases, and the risk of metabolic disorders in the structures of the eye increases.

The objective of the invention is to create a method for the surgical treatment of retinal detachment, which improves visual functions and restores binocular vision.

The technical result of the invention is to ensure a careful, thorough and safe separation and subsequent removal of the peripheral parts of the vitreous body with a vitreotome during the surgical treatment of retinal detachment with minimal trauma, thereby reducing the number of postoperative complications, increasing the reliability of the operation, maintaining optimal conditions for reliable adaptation of the retina, while maintaining anatomical and topographic relationships in the eye, which ultimately allows you to achieve optimal anatomical and functional results. The proposed method is carried out as follows.

The operation is performed under local anesthesia with intravenous administration of painkillers and sedatives. The surgical field is processed, the eyelid expander is installed.

Trocars set four ports: three ports caliber 25-27 G and the fourth port 29 G 3.5-4 mm from the limbus. Ports for surgical instruments are set at 2 and 10 o'clock as standard. The port for the cannula with the supply of a balanced irrigation saline solution is set depending on the eye: for the right eye at 8 o'clock, for the left eye at 4 o'clock. The fourth additional port is set at 12 o'clock (29 G) and is used for permanent installation of a chandelier (light source), which allows the use of a bimanual vitreoretinal technique. To detail the structure of the anterior cortical layers of the vitreous body, a suspension of triamcinolone acetonide is used, then the central parts of the vitreous body are removed with the separation of the posterior hyaloid membrane from the retina using aspiration technique, starting from the optic nerve head, gradually raising the posterior hyaloid membrane to the periphery, removing the remains of the dye from using passive suction. Frequency 8000 cuts per minute, vacuum - 650 mm Hg. then 1-2 ml of a perfluoroorganic compound (PFOS) is injected into the vitreal cavity to the level of the retinal rupture, then the subretinal fluid is aspirated from the rupture with a vitreotome. Then, using a 30 G viscodissector attached to a syringe containing 0.4 ml of cohesive viscoelastic mixed with 0.2 ml of MembraneBlue-Dual retinal dye, it is slowly injected into the retrohyaloid space, which is located between the posterior hyaloid membrane and the inner limiting membrane retina. Thus, a more careful and thorough separation and subsequent removal of the peripheral parts of the vitreous body with a vitreotome is carried out, which minimizes the likelihood of new retinal breaks and, accordingly, recurrence of retinal detachment. After that, PFOS is sequentially replaced with sterile air. After that, along the edges of the existing retinal ruptures, endolaser coagulation is performed in 2-4 rows in a checkerboard pattern with a power of 0.15-0.18 mW, and a tamponade substance is injected into the vitreal cavity for the purpose of retinal tamponade. The choice of the type of plugging agent depends on the location of the retinal rupture, the timing of retinal detachment, and the presence of proliferative vitreoretinopathy. The operation is completed by removing the ports and applying transconjunctival interrupted 8-00 vicryl sutures to the sites of their installation. Produce subconjunctival injection of 0.2 ml of dexamethasone and 0.2 ml of antibiotic. Apply a monocular bandage.

The advantages of the proposed method are the following:

- thanks to the claimed method, it is possible to perform microinvasive surgery for retinal detachment in a highly effective and safe way;

- thanks to the viscodissection, a careful, thorough and safe separation and subsequent removal of the peripheral parts of the vitreous body with a vitreotomy is performed.

- due to a more thorough and careful removal of the peripheral parts of the vitreous body, the likelihood of new retinal tears and, accordingly, the recurrence of retinal detachment is minimized.

The method is characterized by the following clinical examples:

Example 1. Patient K., 62 years old. Diagnosis OS: Retinal detachment. Visual acuity OS: 0.05.

The operation was performed under local anesthesia with intravenous administration of painkillers and sedatives.

An operation was performed according to the claimed method, sodium hyaluronate 2% was used as a cohesive viscoelastic, the vitreous cavity was filled with a gas-air mixture (C3F6 gas). Complications during the operation and in the postoperative period were not observed. Visual acuity after OS operation: 0.01. Visual acuity after resorption of the gas-air mixture OS: 0.6. Ophthalmoscopically and according to B-scan complete anatomical fit of the retina.

Example 2. Patient V., 55 years old. Diagnosis OS: Retinal detachment. Visual acuity OS: 0.03.

The operation was performed under local anesthesia with intravenous administration of painkillers and sedatives.

An operation was performed according to the claimed method, sodium hyaluronate 2% was used as a cohesive viscose eraser, the vitreal cavity was filled with silicone oil 5700 est. Complications during the operation and in the postoperative period were not observed. Visual acuity after OS operation: 0.4. Ophthalmoscopically and according to B-scan complete anatomical fit of the retina.

Example 3. Patient S., 60 years old. Diagnosis OD: Retinal detachment. Visual acuity OD: 0.05.

The operation was performed under local anesthesia with intravenous administration of painkillers and sedatives.

An operation was performed according to the claimed method, sodium hyaluronate 2% was used as a cohesive viscoelastic, the vitreal cavity was filled with silicone oil 5700 est. Complications during the operation and in the postoperative period were not observed. Visual acuity after surgery OD: 0.5. Ophthalmoscopically and according to B-scan complete anatomical fit of the retina.

Claims (1)

A method for surgical treatment of retinal detachment, including subtotal vitrectomy, staining of the vitreous body with separation of the posterior hyaloid membrane from the retina, administration of a perfluoroorganic compound, drainage of subretinal fluid, endolaser coagulation of the retina, installation of a chandelier, plugging the vitreal cavity with one of the vitreous body substitutes, characterized in that first removal of the central parts of the vitreous body is carried out, then after drainage of the subretinal fluid using a 30 G viscodissector attached to a syringe, 0.4 ml of cohesive viscoelastic mixed with 0.2 ml of MembraneBlue-Dual retinal dye is injected into the retrohyaloid space, then separation and subsequent removal by vitreotome of the peripheral parts of the vitreous body.