RU2014810C1 - Method of treating amotio retinae - Google Patents

Abstract

FIELD: medicine, particularly, ophthalmology. SUBSTANCE: new method prescribes sealing retinal defect by intrasclerally administering foam composition through scleral notch made to form subcutaneous pocket. EFFECT: lower rate of traumatism and shorter time required for operative intervention to cure amotio retinae.

Description

 The invention relates to the field of medicine - ophthalmology.

 A known method of intrascleral filling for detachment of the retina using a gelatin implant [1].

However, it requires sterilization in a hot air oven at 140 ^{° C} for 4 hours, autoclaving is not allowed due to a change of physico-chemical properties of the implant. Before the operation, the gelatin implant is hydrated in saline with the addition of an antibiotic (usually linkopin) 75 mg / ml for 40 minutes. Thus, the preoperative implant treatment time is about 5 hours.

 There is also a method of treating retinal detachment, in which central filling is performed with a silicone implant. It is inserted into a preformed fold scleral pocket and fixed with P- or Z-shaped scleral-scleral sutures [2].

 However, silicone implants intended for intrascleral administration are autoclaved, followed by treatment with an antibiotic solution, which in total is about 3 hours; Another way to process a silicone implant is to place it in an atmosphere of gas - ethylene oxide, after which it is recommended to ventilate it to avoid irritation of the sclera.

The disadvantages of the applied methods of intrascleral impression with gelatin or silicone implants are:
- the need for long-term sterilization of implants intended for intrascleral administration (from 2 to 5 hours);
- the possibility of secondary infection of implants;
- the need for instrumental formation of a leaf pocket with subsequent diathermocoagulation of its bottom and fixation of the valves through the application of U- or Z-shaped sutures, which significantly lengthens the time of the operation and increases the morbidity of the surgical intervention.

 Conducting intrascleral filling according to the classical method is difficult when localizing retinal gaps in the posterior pole of the eye.

 The technical result of the invention is to reduce the morbidity and postoperative complications.

 This result is achieved by the fact that in the method of treating retinal detachment, which involves the intrascleral administration of filling material over the rupture area, a distinctive feature is that a foaming composition is introduced to fill the cavities in the body through a notch in the sclera, made with the formation of an undermining pocket.

 The expandable gelling polymer composition is an aqueous solution of a ternary copolymer (N-vinyl pyrrolidone, acrylamide hydrazide and ethyl acrylate) with catalytic additives (TU 64-2-309-80). This biocompatible polymer composition is recommended by the USSR Ministry of Health (Order No. 1339 of 12.31.87) for use in ophthalmic practice. It is known to use this composition to strengthen the sclera with progressive myopia [3].

 Due to its chemical composition, the polymer composition can be introduced by injection in the liquid phase.

 The preliminary addition of an activator (3% hydrogen peroxide) promotes foaming and structuring of the injected solution directly in orbit. 1.5-2 min after injection, an elastic foam hydrogel is formed, the volume of which is 2-2.5 times larger than the initial one and can be adjusted by the dose of the introduced foam composition.

 Histomorphological studies show that the injection of the polymer composition causes an arrestive inflammation, a macrophage reaction leads to a gradual resorption and lysis of the foam. In terms of up to 1.5 years, the foam gel is completely replaced by connective tissue. At the point of contact of the foam with the sclera, scar tissue is formed that is intimately fused to the sclera tissue. Long and extensive experimental studies have not revealed the toxic, damaging or irritating effect of this composition on the membranes of the eye.

 Under local anesthesia (novocaine solution 2% - 8.0), limbal peritomy is performed; the rectus muscles are fixed with suture holders. NBO-2 with a binocular ophthalmoscope performs a detailed stereophthalmoscopy of the fundus in order to determine the projection of the retinal defect on the sclera. The projection site is marked with a solution of brilliant green or diathermocoagulation. A sclera is incised with a blade or diamond knife, departing from the scleral projection of a gap of 3-4 mm. Through the notch of the sclera, a digging pocket is formed with a spear-shaped knife, which exceeds the retinal defect by 2-3 mm. In the formed pocket on the needle, a certain dose of the foam component is introduced until the required filling height is obtained. In this case, the ophthalmological control of achieving contact of the edges of the retinal defect with the filling is indicative. By changing the volume of the introduced foam composition, it is possible to simulate the height of the seal.

 The operation ends with the application of two conjunctival sutures 0000 (6-0).

 A specific example of the method.

 Patient Makov B.G., a / c 4390, was admitted to the department 09/12/90 g with a diagnosis of OS-post-concussion partial low retinal detachment with valve rupture, stage A. From the anamnesis - he received a ball hit on the OS in mid-August 1990: after 2 days, a veil appeared before the OS. When contacting an ophthalmologist at the place of residence, retinal detachment was revealed. The patient was sent to the Institute for surgical treatment.

 On examination, visual acuity: OD = 1.0; OS = 0.5 n / k. OD - calm, intact, OS - calm, the cornea is transparent, in the crystalline lens the initial opacities of the posterior cortical layers, filamentous-granular destruction of the vitreous. The fundus of the eye: the optic disc is pink, the borders are clear, a partial low retinal detachment in the upper outer quadrant with a hole gap of 1 hour.

 The patient received intrascleral filling of the gap using a foam gel. Operation progress: under local anesthesia with a solution of novocaine 2% - 8.0, the conjunctiva was opened perilimbally from 12 to 3 hours. The upper rectus and outer rectus muscles were taken on holding sutures. The NBO-2 frontal ophthalmoscope performed stereophthalmoscopy of the fundus. By means of sclerocompression, the projection of retinal rupture on the sclera was determined. The projection location is marked with a solution of brilliant green. Notching the sclera with a diamond knife, departing from the scleral projection of the gap by 2 mm; the formation of a subcutaneous pocket exceeding a retinal defect by 2 mm. 1 ml of the foam composition was introduced into the formed pocket on the needle, the contact of the edges of the retinal defect with the filling was ophthalmoscopically reached. Local cryopexy of the sclera around the filling zone. Silk 8.0 on the conjunctiva is a seam.

 On examination after surgery: visual acuity OS = 0.5 n / a, anterior segment without dynamics. The fundus: the optic disc is pink, the borders are clear, the retina is adjacent to all quadrants, the retinal tear on the indentation shaft (the prominence of the indentation shaft is 3 mm), limited by cryocoagulation.

 The patient is under dynamic observation for 1 year, the condition of the fundus is stationary.

The technical result from the use of foam as an intrascleral implant is provided:
- autostery foam composition;
- the ability to simulate intrascleral fillings by area and height;
- a decrease in the morbidity, since there is no need to impose scleroscleral sutures;
- a reduction in preoperative implant preparation (lack of necessary sterilization);
- the possibility of filling hard-to-reach retinal defects.

Claims (1)

 METHOD FOR TREATING RETAIN EXTRACTION, providing for intrascleral injection of filling material over the rupture area, characterized in that a foaming composition is introduced to fill cavities in the body through a notch in the sclera, made with the formation of an undermining pocket.