RU2072818C1 - Method of elimination of cyclodialysis - Google Patents

Abstract

FIELD: ophthalmology. SUBSTANCE: method for elimination of cyclodialysis includes preliminary separation over circle of conjunctiva in 2 mm from limbos, and then, atraumatic needle with thread is pricked perpendicular to surface of sclera, and needle is moved in compliance with its curvature, and ciliary body is punctured. In so doing, the latter is pulled and fixed with needle as with hook, after which needle is pricked out through sclera at distance of 2-3 mm from point of prick, and needle is pricked again in the middle between the first prick and prick-out, and performed in similar manner. Ends of thread are pulled to each other and tied. manipulations are repeated several times depending on the length of detachment. Each new prick is made in the middle between two last prick-outs. EFFECT: satisfactory results.

Description

 The invention relates to medicine, namely to ophthalmology, and relates to the question of strengthening the ciliary body, in case of detachment, by surgery.

 A known method of strengthening the ciliary body by surgery. The operation is performed under general anesthesia. Increase intraocular pressure by introducing into the anterior chamber an isotonic sodium chloride solution. A study of the iris-corneal angle goniolinsa. A conjunctival flap with a base at the limb is formed at 12-6 hours and folded onto the cornea. Then, a scleral flap is planned with respect to thickness from 12:30 to 2:30 and 3:30 to 5:30 hours. An incision is made in the sclera at a distance of 2 mm from the limbus, dissecting the flap by 1.5 mm in the direction of the cornea. Plot 2:30 to 3:30 h (then 8:30 - 9:30) not cut to avoid damage to the long posterior ciliary artery. An incision into the supraciliary space is made at a distance of 3 mm from the limbus, which provides free access to the bed of the ciliary body. In this case, a clear fluid seeps through the incision, and the ciliary body does not adjoin the sclera. Then 5 interrupted sutures are applied in each quadrant through the anterior lip of the sclera and a small area of the tissue of the ciliary body. The scleral flap is sutured with a discontinuous suture 8: 0. The conjunctiva is sutured with a continuous catgut suture 6.0 (Gundorova R.A. Malaev A.A. Yuzhakov A.M. Eye injuries. M. Medicine, 1968, p. 326-327).

 The disadvantages of the method.

 1. Opening of the fibrous capsule of the eye (the possibility of wound infection).

 2. The method is not reliable enough, because partial fixation of the ciliary body to the sclera (absent between the quadrants).

 3. Cyanide tissue trauma.

 4. The complexity of the technique.

 The invention is aimed at solving the problem of creating a reliable way to eliminate cyclodialysis with minimal invasiveness and more simple in execution.

 The developed method allows with less trauma to eliminate cyclodialysis and restore the hydrodynamics of the eye.

 The specified technical result can be obtained due to suture fixation of the ciliary body to the sclera. New is that the fixation is carried out without opening the fibrous capsule. Namely: under a conjunctiva pre-separated in a circle 2 mm from the limb, an atraumatic needle is inserted with a thread perpendicular to the sclera surface, then the needle is advanced in accordance with its curvature, the ciliary body is pierced, pulling it and fixing the needle like a hook, inject the needle through the sclera onto a distance of 2-3 mm from the injection site, again put into the middle between the first injection and injection and carried out in a similar way, then the ends of the thread are pulled and tied. Repeat these manipulations several times depending on the length of the detachment of the ciliary body. Moreover, each new injection is made in the middle between the last two injections.

 Between the totality of the essential features of the invention and the achieved technical result, there is a causal relationship.

 The whole sequence of actions described in the distinguishing part ensures the elimination of cyclodialysis without opening the fibrous capsule of the eye, and therefore, with less chance of wound infection, less trauma to the eye tissue and in a simpler way. And the seam used, namely: "they inject with an atraumatic needle with a thread perpendicular to the sclera surface, then they advance the needle in accordance with its curvature, pierce the ciliary body, pulling it and fixing it with a hook, puncture the needle through the sclera at a distance of 2-3 mm from injection sites and again injected into the middle between the first injection and injection, and carried out in a similar way, then the ends of the thread are pulled and tied. ", provides reliable fixation of the ciliary body to the sclera throughout the detachment.

 Reliable fixation of the ciliary body ensures restoration of the normal anatomical ratio in the eye and the outflow pathways of intraocular fluid, which normalizes the hydrodynamics of the eye intraocular pressure.

 The method is as follows.

 Before the operation (and during it), a study of the iris-corneal node with a goniolina is performed. Make a circular incision of the conjunctiva 5 mm from the limbus, separating it to the limbus. 2 mm from the limb, inject with an atraumatic needle with a 10: 0 thread (Alcon) perpendicular to the sclera surface, advance it in accordance with its curvature, pierce the ciliary body, pulling it and fixing it with a hook, puncture the needle through the sclera at a distance of 2-3 mm from injection. In this case, at the moment of fixation of the ciliary body, the pupil is pulled up towards the limb in the corresponding meridian. Then, the needle is injected in the indicated manner in the middle between the previous injection and the puncture, stitching, pulling and fixing the ciliary body, punctured through the sclera, knotted. It turns out a complex of loops of thread fixing the ciliary body to the sclera. Repeat these manipulations several times depending on the length of the detachment, and a new injection is made in the middle between the previous two punctures. Periodically monitor the process of hemming with goniolins. The conjunctiva is sutured with a suture.

 Example. Patient Ch. 39 years old. He entered the center 7 months after a blunt injury to his right eye with a metal rod complaining of low vision with his right eye.

 Diagnosis: concussion outcome, traumatic mydriasis, partial cataract, lens subluxation of the 2nd degree, vitreous hernia, ciliary detachment, secondary hypotension.

 The right eye is calm, the cornea is transparent, the anterior chamber is deep, the pupil is 8 mm, the hernia of the vitreous body with a cord to the cornea for 17 hours, the cloudy lens is displaced to the bottom, its equator is visible from above and outside. The fundus reflex is pink. VOD 0.02, IOP 12 mm Hg. Gonioscopically visible complete detachment of the ciliary body. The left eye is healthy.

 On the right eye, the operation of hemming the ciliary body was performed according to the claimed method.

 The operation and the postoperative period proceeded without complications. After 4 days, the patient was discharged home. Upon discharge, the right eye is calm. The condition of the anterior segment of the eye is the same. Gonioscopically and B-scan recorded the full fit of the ciliary body. IOP 2 mm Hg.

 During a gonioscopic examination after 3 months, the ciliary body adheres to the entire length, intraocular pressure is normal.

 Thus, the inventive method of surgical treatment of cyclodialysis provides a reduction in trauma to the tissues of the eye, is a relatively simple and reliable way.

Claims (1)

 A method for eliminating cyclodialysis by suturing the ciliary body to the sclera, characterized in that they are preseparated around the conjunctiva 2 mm from the limbus and then injected with an atraumatic needle with a thread perpendicular to the sclera surface, advance the needle in accordance with its curvature, pierce the ciliary body, at the same time they pull it up and fix it with a needle like a hook, after which they puncture the needle through the sclera at a distance of 2-3 mm from the injection site, and again inject it into the middle between the first injection and the injection and carry out an analog In other words, the ends of the thread are pulled up and tied, the manipulations are repeated several times depending on the length of the detachment, with each new injection made in the middle between the last two punctures.