SU1736486A1 - Method of treating amotio retinae with multiple ruptures in peripheral part of fundus of the eye - Google Patents

Abstract

Use: in medicine, namely in ophthalmology, for the treatment of retinal detachment. Essence: a tunnel 3-4 mm wide is formed in the subtenon space, passing along the retinal damage area, an inflatable balloon of elastic material previously inserted in the deflated state into the tunnel is used as a seal; . After the removal of the cartridge, the deforming eye pressure is relieved, thereby increasing the sharpness of the patient's vision.

Description

WITH

with

The invention relates to medicine, namely to ophthalmology, and concerns a surgical method of treating retinal detachment due to its multiple breaks in the peripheral part of the fundus of up to 3 quadrants.

There are known methods for treating this kind of retinal detachment by circularly pressing the sclera of the eye block with catgut, nylon thread, stitching submersible fillings of various materials to the sclera,

The disadvantages of these methods are relatively high invasiveness, as well as the fact that after the operation the ocular block remains permanently deformed, which adversely affects visual acuity.

Closest to the proposed method is episcleral filling with finely cellular porous silicone cords with a diameter of 3-7 mm. The operation is as follows. After a circular incision of the conjunctiva 5 mm from the limbus, the selection of 4 straight muscles and their fixation on the stitches, the retinal breaks are localized, their location, length and configuration are determined. cryopexy in this zone.

The next stage is the imposition of four U-shaped seams to a depth of 2/3 of the thickness of the sclera. This moment of the operation is quite responsible, because too superficial flashing of the sclera leads to seam cutting, and excessively deep fraught with perforation of the sclera. Poor seaming of the seam will not ensure the formation of an indented shaft. Next is a circular silicone cord under the right muscles and U-shaped seams,

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its ends are sewn end to end. Circular indentation can be combined with a radial indentation, for which short seals of 13–16 mm in length are used, fixed by additional U-shaped seams. Stable fit of the retina was noted in 83%. Visual acuity increased on average from 0.01-0.05 to 0.32-0.4.

The disadvantage of the prototype is its relatively high invasiveness due to the extended surgical incision. In addition, when imposing U-shaped: seams are often intraocular hemorrhage, and sometimes damage the retina with a surgical needle. As a result of the operation, postoperative deformity of the eye block occurs, resulting in a change in refraction with elements of corneal astigmatism, which adversely affects visual acuity. Upon completion of the described treatment, patients require glasses or contact correction.

The purpose of the invention is to achieve higher visual acuity without additional correction, reducing the trauma of the operation, reducing intraoperative complications in retinal detachments with multiple ruptures in the peripheral part of the fundus.

This goal is achieved by the fact that the total length of the incision of the conjunctiva is limited to 6–12 mm in size, and a tunnel of 3-4 mm width is formed in the sub-tenon space, passing along the region of retinal breaks; As a seal, an inflating balloon previously inserted into the aforementioned tunnel in the deflated state is used; transconjunctive throw-over seams are used to fix the balloon. The can is lowered and removed a few days after the operation (after the formation of pigmented chorioretinal adhesions).

Removing the cartridge eliminates postoperative deformity of the eye block, inherent in the prototype method. As a result, the visibility of the patients is improved. Traumatizing the operation is reduced due to the following factors. Unlike the prototype method, which requires a circular incision of the conjunctiva, in the proposed method only 2-4 small incisions with a length of 3 mm are made. In addition, it eliminates the need for multiple scleral U-shaped sutures, each of which significantly injures the sclera, often leading to internal hemorrhage. As a result,

reduce intraoperative complications,

The method is carried out as follows.

After local anesthesia, the zone of retinal damage is localized by transconjunctival pressure. The projection of the retinal damage zone is noted on the conjunctiva of the eye block. In the zone of identified retinal breaks, transconjunctival cryopexy is performed to provoke adhesive inflammation. An incision of the conjunctiva and the tenon's membrane 3 mm long is made on one side of the zone of damage to the retina. Through the incision, a tunnel is formed in the joint space, along a retinal damage area, using a special spatula. The tunnel is 6–8 mm longer than the retinal damage zone and can capture up to 3 quadrants. In cases where the length of the tubes exceeds 1 quadrant, in order to facilitate the spatula, 1-2 intermediate sections of the conjunctiva and the tenon sheath are made (not shown). The end of the tunnel is positioned 3-4 mm beyond the marked area of retinal damage. Here, the last incision 4 of the conjunctiva and the tenon sheath is made. The next stage of the operation is carrying the can in the deflated condition through a preformed tunnel. The balloon is made of an elastic biologically inert material, for example, silicone rubber. In non-stained condition, the diameter of the cartridge is 1.2-1.5 mm. A flexible polymer tube is attached to one of the ends of the canister, used as a supply hose for inflating and lowering the can. A thread is attached to the other end of the canister, used as a traction element when the can is passed through a tunnel. With the help of a special conductor, the thread is first drawn through the tunnel, and then with its help, the deflated balloon is pulled. After checking the position of the cartridge, it is inflated. For this, the end of the conductive tube is connected to a syringe and 1.5-2.0 ml of sterile saline is injected into the can. In each case, the balloon is inflated to a size that ensures contact of the choroid with the retina over the entire area of its rupture zone. The diameter of the inflated balloon is usually 5-10 mm. Monitoring of retinal adherence to the choroid is performed by an ophthalmoscope. To stabilize the desired size of the expanded balloon, the end of the conductive tube is tied up and then disconnected from the syringe. The plugged end of the supply tube is attached to the skin of the forehead with adhesive tape. At the final stage of the operation, the extreme conjunctival incisions are placed one at a time, so that the surgical thread grabs the episcleral edge of the conjunctiva around the end parts of the cartridge.

Thus, the position of the cartridge is securely fixed. In the case of using a relatively long cartridge to prevent its middle part from being displaced, it is also fixed by applying 1-2 transconjunctional stitching seams (not shown). At the end of the operation, a patient is given a binocular belt for 1-2 days. The subretinal fluid is absorbed during this time and a reliable fit of the retina to the choroid takes place. After 7-12 days, i.e. after the formation of pigmented chorioretinal adhesions, the balloon is removed under local anesthesia.

Example. Sick P., 41 years old, diagnosis: retinal detachment of the left eye, occupying the lower half of the fundus with a wide gap at the periphery (from 15 h 30 min to 18 h).

Visual acuity of -0.1, not corrected.

Under local anesthesia with a 2% solution of novocaine, a three-millimeter incision of the conjunctiva and tenon's membrane 3 mm from the localized edge of the retinal rupture zone was made (at 15h). A tunnel 2 mm wide is formed in the subteno- nous space, passing along the retinal rupture zone, under the external direct muscle, 11 mm from the limbus and extending 3 mm beyond the boundary of the rupture line (at 18 h 30 min). In this place, a second three-millimeter incision of the conjunctiva and the tenon's membrane was made. A silicone rubber cartridge was introduced into the formed tunnel in an unbreakable condition with a length of 10 mm and a diameter of mm. A supply tube with an inner diameter of 0.5 mm and a length of 200 mm is connected to the cartridge from one end, and a thread is attached to the other end, and the cartridge is passed through the tunnel. 1.0 ml of sterile saline is injected into the cartridge using a syringe after which the length of the canister was 20 mm, diameter 7 mm. This was sufficient to ensure contact of the choroid with the retina throughout the entire rupture zone. The cartridge is fixed at the ends by overlapping conjunctival cuts along one seam. On the 2nd day after surgery retinal detachment

the patient is undecided. After 7 days, the patient was discharged from the hospital. The cartridge was removed on an outpatient basis on the 13th day after the operation. Complications in the subsequent period were not observed. Keenness

the vision of the left eye is 0.7, is not corrected. Compared with the known method of treatment of retinal detachment caused by its multiple breaks, the proposed treatment method allows to achieve

patients with a higher level of visual acuity without additional correction. After removal of the cartridge, the deforming eye block is removed, the elements of corneal astigmatism characteristic of the prototype method are eliminated. In addition, the proposed method of treatment is much less traumatic than the known one, since its implementation does not require a circular incision of the conjunctiva. The surgeon makes only 2 (less often 3 or 4) three-millimeter incisions. The invasiveness of the operation is also reduced due to the fact that instead of imposing scleral U-shaped sutures that perform

the function of fixing the seal is also the function of pressing it into the sclera; in the proposed method of treatment, transconjunctive cross over seams less traumatic for the sclera are used, which

only the function of fixing the cartridge. All this reduces the course of treatment and in most cases avoids the need for spectacle or contact vision correction.

Claims (1)

The invention The method of treatment of retinal detachment with multiple breaks in the peripheral part of the fundus by depression sclera, characterized in that, in order to reduce the traumatic operation, to reduce intraoperative complications, a tunnel with a width of 3 to 4 mm is formed in the subtenon space areas of retinal breaks, an inflatable balloon previously inserted into the tunnel in the descended state is used as a seal; transconjunctival throw-over stitches are used to fix the balloon, the balloon is released and removed several days after the formation of pigmented chorioretinal adhesions.