UA131027U - SUBSTANCE: method of emergency keratoplasty of perforative corneal ulcer - Google Patents

Abstract

The method of emergency keratoplasty of perforated corneal ulcer involves the formation of an autoscleral piece, separating it to the corneal edges. The detached piece is placed on its inner surface on the cornea, closing its defect, and fixed to the corneal edges by nodal sutures, followed by the fixation of the healing contact lens.

Description

The useful model belongs to medicine, namely to keratopathology and can be used for emergency closure of a corneal defect in case of perforation.

The well-known method of performing keratoplasty in the case of corneal perforation, taken as the closest analogue, in which the autoscleral keratoplasty operation is performed (1) by forming 2 scleral pieces from diametrically opposite sides of the eyeball, separating them to the edges of the cornea, then the pieces are turned over to the cornea, covering it defect, and sew the free edges of these 2 pieces.

However, this method has the following disadvantages: the pieces turn out to be inverted in relation to their original state, which is unnatural, and therefore they are subjected to rather rapid lysis (in the course of 1.5-2 weeks), without having time to epithelize the defect in the cornea. The presence of knotted seams between the pieces irritates the mucous membrane of the inner surface of the eyelids and eyeballs, supporting the inflammatory process.

The basis of a useful model is the task of improving the method of emergency keratoplasty of a perforated corneal ulcer, which provides increased efficiency due to the shape and method of fixation of the graft, more dense and long-term adaptation of the graft to the surface of the cornea.

The task is solved by the fact that in the method of emergency keratoplasty of a perforated corneal ulcer, which includes the formation of an autoscleral piece, its separation to the edges of the cornea, according to a useful model, the separated piece is placed on the cornea with its inner surface, closing its defect, and fixed to the edges of the cornea with knotted sutures followed by fixation with a therapeutic contact lens.

The method is carried out as follows. After a retrobulbar injection of an analgesic drug (for example, 2 95 lidocaine solution 1.5 ml.), in the upper-external sector of the eyeball, a strip of sclera 75 times its thickness is cut out from the sclera radially to the cornea. The area of the scleral piece is cut out to be 3-5 mm larger than the defect covered by it, because it significantly shrinks and decreases in size after separation from the underlying tissues.

The transplant is cut off from the adjacent tissues and the inner surface is applied to the cornea, covering its defect. The autograft is fixed to the periphery of the cornea with knots

With seams. So that the stitches do not injure the conjunctiva and for tighter fixation of the transplant, a therapeutic contact lens is worn over it.

An example of using the method. A 25-year-old girl came to the eye microsurgery department with complaints of pain, lacrimation, and loss of vision in the left eye. It is known from the anamnesis that for the last 5 years there have been exacerbations of keratitis twice a year. The last exacerbation is the most difficult.

Ophthalmological status upon admission of the patient to the clinic:

The visual acuity of the left eye is -0.02 not cor. Pronounced photophobia, moderate hyperemia of the edges and mucous membrane of the eyelids, the lower half of the cornea is sprouted by surface vessels, reaching the center. In the paracentral zone of the cornea, there is a round defect with a diameter of 1.5 mm made of cellular detritus and an inserted iris. Through the perforation, watery moisture is released, the anterior chamber is slit-like, sharp hypotony, the pupil is deformed by posterior synechiae. (Photo 1).

In view of the urgent condition of the left eye, the patient was urgently treated with autoscleral corneal plastic surgery with therapeutic and tectonic purposes according to the proposed method.

A retrobulbar injection of 2 95 lidocaine 1.5 ml was made. In the upper-external sector of the eyeball, a strip 4 mm wide and 9 mm long was radially cut from the sclera at the thickness of the sclera, which was cut off and then applied to the cornea, covering its defect, and sewn from the inner surface to the periphery of the cornea with 4 knotted sutures. The scleral piece was cut out in a larger size than the defect covered by it, because it shrinks and decreases in size after it is separated from the adjacent tissues. A medical contact lens is worn over the graft.

Already during the examination the next day, it was found that the eye irritation became less pronounced, the edges of the wound were adjusted well, the corneal defect was closed with an autograft, the anterior chamber was restored, and the ophthalmotonus was normalized. Posterior synechiae are broken by neosynephrine, the pupil has acquired a round shape with a good reaction to light.

A pink reflex appeared from the fundus (Photo 2).

In the postoperative period, general and local antibacterial drugs, glucocorticoids, and keratoprotectors were prescribed.

At the examination on the 7th day after the operation: the eye is calmer, swelling and infiltration of the cornea have regressed, the visible part of the cornea has become transparent, the position of the transplant is correct, because the corneal defect is closed.

During further ophthalmological observation after 3 months, a gradual lysis of a piece of autosclera was noted, a gentle paracentral opacification was formed at the site of the former corneal defect, the anterior chamber is of medium depth, the reaction of the pupil to light is preserved, palpable ophthalmotonus is normal. Visual acuity increased, MO5-0.5 not cor. (Photo 3).

4 months after the operation, the autograft continued to lyse, the cornea became more transparent, the visual acuity remained - 0.5 cor., in connection with gentle paracentral opacification (Photo 4).

At the examination after a year, the good condition of the eye was preserved.

The proposed emergency aid method is natural, does not require additional donor material, and is antigenically adapted, which allows the graft to remain on the cornea for a long time - up to 4 months, until it is completely healed, and to lyse independently as the through-through corneal defect closes, leaving a gentle cloudiness in areas of former perforation.

This method of treatment was successfully used in 12 patients with a perforated corneal ulcer. It allows you to save the eye as an organ and even get sight.

Sources of information: 1. Patent Ukr. Me70246A. IPC Ab1 E9/00. Publ. 15.09.2004. Bul.Me9

Claims (1)

USEFUL MODEL FORMULA The method of emergency keratoplasty of a perforated corneal ulcer, which includes the formation of an autoscleral piece, its separation to the edges of the cornea, which is distinguished by the fact that the separated piece is placed on the cornea with its inner surface, closing its defect, and fixed to the edges of the cornea with knotted sutures with subsequent fixation therapeutic contact lens. Photo 1. s Z Okh OV M OO OVO AH ME her os o xx SSS s o (( - o. PO S o i. y» Z o o» o. o. s : X s o s o. o o g o. XX o s p.; with. at. oh oh at. OO WOVVaKh Fr. . at. at. with o o. s M M M x Z Photo by. c : c 1 is her c Photo Z.