SU1718914A1 - Method for extracapsular extraction of cataract - Google Patents

Abstract

The invention relates to medicine, in particular to ophthalmology, and is intended for the operative treatment of patients with cataracts. The aim of the invention is to reduce general and local complications. In a method of treating high myopia by implanting an IOL, including reducing intraocular pressure and dilating the pupil, reducing intraocular pressure and expanding the pupil, blocking the star ganglion with a solution of a local anesthetic with a ganglioblocker and simultaneously applying Iitrong ointment on the skin in the area of the projection, vascular bundle of the neck.

Description

The invention relates to medicine, in particular to ophthalmology, and is intended for the operative treatment of patients with cataracts.

Closest to the present invention is a method in which, to facilitate the implantation of an IOL, reduce intraocular pressure, deepen the anterior chamber and expand the pupil, an instrument for mydriatic and parenteral administration of diuretics is used on the eve or during surgery. .

However, topical application of various mydriatics (adrenaline Mechaton) causes a disturbance of the corneal epithelial layer, there may be undesirable side effects on the cardiovascular system: elevation of blood pressure with a decrease in blood flow to the myocardium, tachycardia, impaired circulatory vascular tract eyes until conjunctival hemorrhage Nij, increased bleeding tissue during operations, especially in patients with hypertensive and coronary heart disease, diabetes. The aim of the invention is to reduce general and local complications.

According to the method of cataract extraction, this goal is achieved by blocking the stellate ganglion with a solution of a local anesthetic and ganglioblocarr with simultaneous application of Nitrong ointment to the skin in the projection area of the vascular bundle of the neck.

The preserved set of symptoms leads to maximum mydriasis and IOP reduction by 40-50%, create optimal conditions for aspiration of lens masses and IOL implantation, prevent injury to the iris and corneal endothelium, as well as edema and exudative reaction, eliminate rupture of the posterior capsule, reduce operative time interventions. In patients with hypertensive disease

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New and coronary heart disease optimally reduces blood pressure and improves blood flow to the myocardium.

The proposed method is carried out as follows.

In the position of the patient on the back with a small roller under the shoulder blades, blood pressure (BP), heart rate (HR), respiratory rate (RR) are measured using Finland CARDIOCAP monitor. A 20% syringe with a volume of 20 ml is filled with a 2% pyromecain solution of 2-3 mg / kg, pentamine 1-1.5 mg / kg, diluted with saline twice, combined with a standard needle 5 cm long and 0.6 diameter mm The skin at the puncture site is twice treated with alcohol. At the level of the cricoid gland, the sternocleidomastoid muscle with the index finger is displaced outwards and the needle is inserted perpendicularly up to the stop in the transverse process of the cervical vertebra. Inject 2 ml of solution. Then the needle is pulled a few millimeters and at an angle of 30 °, it is pushed deep into and down towards the belt notch to a depth of 4 cm, and the solution of the aesthetic is constantly introduced. After filling the syringe piston and making sure that there is no blood, the resulting solution is injected. The needle is removed with an aseptic sticker. Then, from the Tube, a column of Nitrong ointment 2-4 cm (corresponding to 3.5-7.0 mg / kg nitroglycerin) is squeezed onto a graduated polyethylene film, applied to the skin of the lateral surface of the neck in the projection area of the vascular bundle. With light circular motions, the ointment is ground in an area of 10 x 10 cm and the film is left on the skin. Blood pressure, heart rate, and BH are measured, the condition of the patients is evaluated, anesthesia is performed, and the transparent lens is removed and the IOL is implanted.

The method is based on the sympatholytic effect of a local anesthetic that, blocking the stellate ganglion, one of the powerful sympathetic nodes of the cervical nerve trunk, interrupts the conduction of sympathetic impulses. The ganglionar blockade and its accompanying vazodil taki helps to improve uveal circulation, increase the linear velocity of blood flow (data of the carotid and supra-block arteries), decrease the pressure in the scleral veins and the ophthalmic tone. The ganglioblocker (pentamine) potentiates the action of a local anesthetic, having a predominant effect on venous tone. By improving the venous outflow, LDPE decreases, which leads to a decrease in IOP. Parasympathetic action

pentamine contributes to the maximum expansion of the pupil. The complications inherent in the prototype are excluded.

Applying ointment Nitrong prolongs the hypotensive effect in doses used in this method, moderately reduces blood pressure, improves myocardial blood supply. The blockade must be carried out no less than 30 minutes before the operation to occur.

0 effect. The implementation of the blockade more than .40 minutes before the operation is undesirable, because otherwise the effect during the operation will be less pronounced. The dosage of pyromekain less than 2 mg / kg is insufficient, and

5 more than 3 mg / kg is undesirable because of possible toxic effects.

With a dose of pentamine less than 1 mg / kg, the hypotensive effect is poorly pronounced, and a dose of more than 1.5 mg / kg can lead to an uncontrolled decrease in blood pressure. Applying ointment Nitrong less than 2 cm (3.5 mg) is not sufficient to achieve a cumulative effect, but: applique 1 bcc4g0g, 0mg) is impractical because a pronounced cumulative effect is possible. :

5 To confirm the effectiveness of the method, clinical studies were carried out in 18 patients with a high degree of myopia who underwent the extraction of a transparent lens for myopia and IOL implantation from 14 to 18 diopters.

Examples Ill I., 34 g, and. B. No. 1144. Diagnosis: high myopi in both eyes. Concomitant diseases were not detected, weight 76 kg. Ophthalmostatus before surgery: Vis, 04; Sph - 16., 4; IOP 00 20 mm Hg; pupil diameter 5 mm. The position of the patient on his back with a small roller under the shoulder blades, HELL 130/80 mm Hg, heart rate 80 in 1 min, BH 17 in 1 min.

30 minutes before the operation, a 20% syringe with a volume of 20 ml is used to collect a 2% pyromecain solution 2 mg / kg, pentamine 1 mg / kg, diluted

0 saline solution twice, combined with a standard needle 5 cm long and 0.6 mm in diameter. The skin at the puncture site is treated twice with alcohol. At the level of the cricoid gland, the sternocleidomastoid 5, the mastoid muscle with the index finger is displaced outward and inserts the needle perpendicularly up to the stop in the transverse process 6 of the cervical vertebra. Inject 2 ml of solution. Then the needle is pulled a few millimeters and with an angle of 30 ° it is pushed inward and downward towards the belt notch, the solution is introduced to a depth of 4 cm. ane-j stetics. Sweat the syringe plunger and convince yourself that there is no blood, and leave it left; Shys solution. The needle is removed, an aseptic sticker is inserted. Then a column of Nitrong ointment, 2 cm (corresponding to 3.5 mg / kg nitroglycerin) is squeezed from a tube onto a graduated polyethylene film, applied to the skin of the lateral surface of the neck in the projection area of the vascular bundle. With light circular motions, the ointment is diluted: on the area of 10x10 cm, the yuplene kuna is placed on the skin. After the implementation of the method, blood pressure of 110/60 mm Hg, IOP of 14 mm Hg, pupil diameter of 8 mm are measured. Operation: removal of a transparent lens with IOL implantation + 6 (T-14). The operation was performed at optimal IOP and maximally dilated pupil without additional use of any pharmacological agents. After the end of the IOP operation, 18 mm Hg, pupil diameter 5 mm, the postoperative period was uneventful. Control after three months Vis OD - 0.4; Sph - 0.5 cil - 1.5; ah-100 0.9-1.0. - ..

.2. Patient K., 49 years old, as No. 13762. Diagnosis: OD high myopi, high degree anisometrae. Concomitant diseases: hypertensive disease, atherosclerosis, weight 86 kg. Ophthalmopathy: Vis OD 0.01-15cil- 2.0 Ah 30-OB1VGO OD22 mm Hg; pupil diameter 4 mm; HELL 150/90 mm Hg; HR82 in 1 min, BH 17.

35 minutes before the operation, the method was carried out according to the proposed method: a dose of pyrosacaine 2.5 mg / kg; pentamine dose 1.25 mg / kg; dose of Nitrong ointment 3 cm (5.25 mg). .After carrying out the method, the blood pressure is 120/70 mm Hg; IOP of 15 mm Hg; pupil diameter 9 mm.

Operation: 11/24/87. 00 — removal of the transparent lens with implantation of a posterior-chamber IOL + 5.0 (T-26). After termination of the operation: IOP 19 mmHg .; pupil diameter 5 mm; the postoperative period was uneventful. Control after three months VIS OD - 0; 32 cyt - 2.0; ah, 5.

3. Patient R., 24 years old, and b. No. 1585. Diagnosis: OD high myopi. Co

confusing. diseases: you are not vlen. Ophthalmopathy: Vis OD 0.01; sph - 16.0 0.03; IOP 23 mm Hg; pupil diameter 4 mm; HELL 140/90 mm Hg, heart rate 96 in 1 min; BH 20.

40 minutes before the surgery, the method according to the proposed method, a dose of pyromecain 3 mg / kg, a dose of pentamine 1.5 mg / kg, a dose of ointment Nitrong 4 cm (7.0 mg). After carrying out the method, the blood pressure is 100/60 mm Hg; IOP 16 mmHg; pupil diameter 8 mm. Operation; 12/01/87. OD - removal of the transparent lens with implantation of the posterior chamber IOL + 6.0 (T-14). After the end of the IOP operation, 18 mm Hg, pupil diameter 5 mm; the postoperative period was uneventful. Three month control Vis OD - 0.25 Sph -1, 3-0.4; IOP of 18 mm Hg The method is shown in the operations of removing a transparent lens and implanting an IOL with high myopia.

The proposed method has relative contraindications in patients with arterial hypotension.

The proposed method is safe, easy to implement, there were no complications associated with the use; with high myopia operations, the method allows to effectively control IOP and pupil diameter and significantly improve treatment results.

Formula a isobteni

The method of extracapsular cataract extraction by medicamentally expanding the pupil and reducing the intraocular pressure, characterized in that, in order to prevent general and local complications, the star ganglion blockade is performed with a local anesthetic and ganglioblokator solution with simultaneous application of Nitrong ointment to the skin in the projection area. neck.

Claims (1)

Claim A method for extracapsular cataract extraction by medically dilating the pupil and lowering intraocular pressure, characterized in that, with the aim of preventing general and local complications, a stellate ganglion is blocked with a solution of local anesthetic and ganglion blocker with the simultaneous application of Nitrong ointment on the skin of the projected vascular bundle.