SU1706612A1 - Method for treating the cases of atonic entropion of lower eyelid - Google Patents

Abstract

The invention relates to ophthalmology and can be used in the treatment of patients with senile changes in eyelid tissues, leading to atonic torsion of the eyelids. The goal is to prevent the development of postoperative complications and recurrence of the disease. In the intermarginal space of the lower eyelid, in the projection of the lateral and medial parts, curved homohrash plates are implanted with a width twice as wide as the intermarginal space, the skin fold is cut between the grafts, and deep skin sutures are applied that capture all the layers of the eyelid.

Description

The invention relates to medicine, namely to ophthalmology, and can be used in the treatment of patients with senile torsion of the lower eyelid of an atonic character.

It is known that senile changes in eyelid tissue, in particular the lower one, lead to significant disturbances in the topography of the layers of the eyelid, changes in the structures of the eyelid and disrupt the functions of the eyelid. In addition, the constant contact of the eyelashes with the anterior segment of the eye is a powerful irritant to the sensitive conjunctiva and the cornea, causing mechanical damage to the epithelium and contributing to the development of a secondary infection. The mechanism of development of senile atonic torsion of the eyelid is quite complex, but not only is the dystrophic lamina of the eyelid obvious, but also the displacement of the eyelid skin layer relative to the laryngeal, which leads to the formation of an excessive skin fold, weakening the pressing effect of the muscular layer and cartilage dislocation plate up with its subsequent inversion.

The operation performs a partial resection of the muscle fibers of the circular muscle of the eye with movement of the transverse ends of the muscle upwards, thereby strengthening the pressing action of the muscle layer of the eyelid, ensuring adaptation of the inner surface of the eyelid to the eye block. However, this is also a one-sided and limited effect on the multicomponent mechanism for developing the lower eyelid of the lower eyelid in older people. Thus, the normal function of the eyelid is not ensured and operations do not guarantee the occurrence of recurrence of the lower eyelid recurrence.

The closest to the present invention is a method of treating the inversion of the lower eyelid, including the dissection of the eyelid in the intermarginal space in the lateral, middle and medial third

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a depth twice the height of the century’s own cartilage plate, followed by introducing rectangular plates of preserved cartilage into the formed spaces according to the dimensions of the spaces and suturing the dissected tissue of the intermarginal strip of the eyelid above them.

The method is simple, quick and easy to perform, but not without flaws. Its use is limited in patients with mixed forms of twisting the eyelid with elements of spastic and atonic torsion or with isolated atonic torsion, including in patients with anophthalmos or anophthalmos, when the eyelids are deprived of support in the form of the anterior part of the eye block. The operation does not affect the topography of the century layered structure, i.e. does not restore layer-by-layer bonding and intimate cleavage of the dermal-muscular and tarso-conjunctival eyelid plates. The disadvantages also include irritation of the anterior segment of the eye with the median nodal suture located in the intermarginal space and in contact with the cornea, as well as pressure on the ocular block by the deformed inner surface of the eyelid in the middle part due to postoperative aseptic inflammation around the cartilaginous streak. Patients may experience discomfort because the sensitivity of the cornea is very high, not only to the presence of suture material, but also to changes in the inner surface of the eyelid in contact with the cornea.

The aim of the invention is to prevent the development of postoperative complications and recurrence of the disease.

The use of the invention is recommended for the most severe forms of atonic blob-lower eyelids, when the known blotting operations are ineffective or ineffective.

The lateral and medial portions of the lower eyelid intermarginalnoe dissected space implanted into associated pockets formed curved gomohr schevye plate width twice the width intermarginalnogo space semilunar fold of skin excised parallel ciliary edge between implants and deep superimposed collated guides seams gripping edges skin incision and all underlying layers of the lower eyelid. During this operation, conditions are created that prevent dislocation and inversion of the eyelid cartilage, ilivaets disturbed compound musculocutaneous and tarzokonyunktivalnoy plates century. The use of surgery is advisable in those cases when a pronounced anophthalmus effect (congenital or acquired) is added to these eyelid changes, which fundamentally changes the anatomotonographic relationship of the eyelid of the eye block. Implantation of the homochroic strips, twice as widely used earlier, in combination with the metered curved surface of the two strips, is capable of ensuring sufficient adaptation of the posterior surface of the eyelid to the eye.

5 The difference of the proposed method from the known one is that not three, but two homochrasch plates are implanted, leaving the median intermarginal space intact, fusion is achieved

0 layers of the eyelid by superposition of deep sutures, homochyla plates are modeled not equal, but curved, the width of the plates is doubled, which prevents them from turning around the axis. So the way

5 provides an effect on all sides of the mechanism of the occurrence of the atonic torsion of the lower eyelid: the length of the cartilage plate of the eyelid is restored to normal, its layer-by-layer adhesion is regulated

0 century adaptation to the eye block.

Example 1, Ill M., 79 years old, and / b No. 2611/89, was admitted to the clinic of eye diseases with a diagnosis of recurrent operated torsion of the lower eyelid of the left

5 eyes. Surgery was performed nine months ago, but for the last four months, the patient was again disturbed by eye pain, foreign body sensation, occasional reddening of the eye and

0 sticking eyelashes. When examining the shape of the palpebral fissures, the correct, upper-palatine folds on both sides are sunken, which indicates senile atrophy of retrobulbar cellulose. Lower eyelid

5 almost completely inverted by the skin surface to the eye block, the eyelashes and the intermarginal space are visualized only after the eyelid is pulled down, the skin of the eyelid near the ciliary edge

0 deformed by postoperative scars, the conjunctiva of the eye block is irritated, mucopurulent discharged in the conjunctival cavity. The patient was operated according to the following procedure.

5 Anesthesia of the lower eyelid with a 2% solution of novocaine 3.0. Using a long razor blade, the intermarginal space was cut in the medial part of the lower eyelid near the lacrimal opening and in the lateral part to a depth of 6 mm. Two thin plates 5.5 mm long, 4 mm wide, 1.5 mm thick, made in the form of an arcuate curved strip were modeled from a preserved homochrome treated with an alcohol solution of iodine. Using tweezers, the strips are placed into the thickness of the eyelid through the formed incisions in the intermarginal space of the eyelid so that the surface of the stripe is convex facing the eye block, which enhances the resistance to the twisting of the patient's eyelid plate. The incisions above the immersed implants are sutured with interrupted sutures (viral 8/0).

Then, an indent of 4 mm from the ciliary edge of the eyelid is formed by two skin tweezers with a height of 2.5 mm, spreading from the lateral to the medial border of the eyelid parallel to its edge. The skin fold is excised at the base, after which the edges of the incisions were compared between the sEES, which indicated the correct calculation of the number of removed skin and did not create the prerequisites for its excessive pulling down. The edges of the skin incision are compared with interrupted sutures overlaid with the capture of all the underlying tissues — the muscle layer, the apex of the eyelid plate and the edge of the skin incision. An atraumatic needle 11 mm long with 6/0 black silk was used. At the end of the operation, the wound is treated with brilliant green and aseptic dressing is applied.

When examining the patient on the fourth day after surgery at discharge from the hospital: the lower eyelid edema persisted, traces of subcutaneous hematoma were visible. The edge of the lower eyelid was located correctly, the eyelashes were turned away from the eye block, the adaptation of the eyelid to the eye block was traced throughout the eyelid. Hyperemia and swelling in the lateral and medial parts of the eyelids were observed directly under the superimposed vicryl sutures in the intermarginal space. The anterior segment of the eye block is calm. The sutures were removed from the intermarginal space on the seventh day, and from the skin of the eyelid to the tenth. After discharge, the patient was observed on an outpatient basis.

When viewed after 11 months: the position of the lower eyelid of the left eye is normal, the edge of the eyelid is pressed to the eye block, the surface of the intermarginal space is even, normal color, a light scar is hidden parallel to the ciliary edge, hidden in the skin fold. The functions of the closing, movement, and clamping of the eyelids are fully preserved, with no tendency to turn the ciliary edge. The anterior segment of the eye block is calm, has no complaints.

Example 2. Sick K., 73 years old, and / b number 2741/88, operated in the clinic for bilateral twisting of the lower eyelids. The patient had bilateral congenital anophthalmos due to the underdevelopment of retro-bulbar tissue. On admission, the patient had an inversion of the ciliary edge of both lower eyelids, and the inversion increased with a downward gaze, largely due to pronounced enophthalmos of both eyes. In the lower conjunctival fornix, very deeply due to enophthalmus, a large amount of mucous expelled was found, the conjunctiva of the eye block near the lower part of the limbus was hyperemic.

The patient was performed the operation in this way, first on the right eye and after three days on the left eye. The patient was discharged on the eighth day after the first operation, was on outpatient monitoring. There were no complaints about the feeling of a foreign body in the eye, visually from two sides the correct position of the eyelid adapted to the eye block was noted at all gaze positions; there was no injection of bulbar conjunctiva. In the remote period after the operation, 13 months later: the patient retained bilateral anophthalmos, the conjunctiva of the eye blocks is calm, the position of the lower eyelids is correct, the ciliary edge and the intermarginal space of the eyelids are even, the front edge of each century is lower than the back, the eyelashes do not touch the eye blocks, with When the eyes moved downwards, the ciliary edges maintained their correct position and the adaptation of the eyelids to the eye blocks was not disturbed.

Thus, as a result of surgical treatment (examples 1 and 2), operations were successfully performed in a patient with severe congenital enophthalmos and in a patient with the usual effects of senile atrophy of retrobulbar tissue. This confirms the feasibility of performing the operation when inverting the lower eyelid of the atonic character, when one of the main factors of pathogenesis is enophthalmos of different degrees that develop with age. The examples of two patients showed that the possibility of developing postoperative complications in the form of eyelid reversal due to strict dosing of the skin excision was eliminated, irritation of the sensitive cornea with suture material and the deformed eyelid surface was prevented, due to implantation of the cartilage strips and deep seams. The restoration of the layered structure of the century and the strengthening of the cartilage plate of the century ensured the prevention of disease recurrence in patients. The simulation of homochra spine implants with a metered curved plane made it possible to ensure a good adaptation of the posterior surface of the eyelid to the eye block. The operation is technically simple, practically has no contraindications to use, does not require additional equipment, can be performed on an outpatient basis.

Claims (1)

Invention Formula A method of treating atonic torsion of the lower eyelid by implanting homochial strips into the intermarginal space of the eyelid in the lateral and medial parts of it, characterized in that, in order to prevent postoperative complications and recurrence of the disease, curved homohra strips with a width twice the width of the intermarginal space of the century are modeled, the semilunar skin fold is excised between the implanted homochraschine strips in the projection of the lower edge of the eyelid carcinoma, they impose deep nodal sutures matching the edges of the skin incision and covering all the layers of the eyelid.