RU2106844C1 - Method for surgical correction of ocular refraction - Google Patents

Abstract

FIELD: medicine, ophthalmology. SUBSTANCE: method deals with removal of corneal epithelium, then it is placed into physiological solution. Stromectomy is conducted and epithelium is returned into stromic channel. Operation area is dried up with sterile air. EFFECT: higher efficiency.

Description

 The invention relates to medicine, more specifically to ophthalmology, and can be used in the surgical correction of ametropia - high myopia and high degree hyperopia.

 A known method of surgical correction of anomalies of refraction of the eye, including the removal of the surface layer of the cornea, stromectomy in the area of the formed bed, the return of the layer in place (Refract Corneal Surg, 1993, 1993 (1) p.12-19).

 As a result of stromectomy by the known method, it is impossible to form an epithelium corresponding to its anatomy (4-5 layers), as well as the shape and structure of each layer of the epithelium, because a new epithelium is formed, which has a different thickness over its entire length, depending on the diameter and thickness of the stromectomy. The displacement of hyperplasticized epithelium with respect to new collagen leads to persistent subepithelial opacities, which require repeated surgical interventions, in addition, prolonged instillation of dexamethasone in combination with antihypertensive drugs, which negatively affects the eye as a whole, is required.

 The objective of the invention is to provide a method for surgical correction of ametropia while maintaining the anatomical structure of the anterior surface of the cornea.

 The technical result achieved by using the invention is to reduce postoperative complications, such as epithelial hyperplasia, which leads to persistent clouding of the cornea in the central optical zone, which reduces preoperative corrective visual acuity and requires repeated surgical intervention.

 The technical result is achieved by the fact that in the method of surgical correction of eye refraction, including stromectomy, the epithelium is removed, placed in physiological saline, and after stromectomy and returning it to the stromal bed, the surgical area is dried with sterile air.

 The return of the previously removed epithelium to the stromalt bed leads to the preservation of the architectonics of the anterior surface of the cornea and a high functional effect.

 The Baumen membrane is a modified hyalinized part of the stroma, it is difficult to differentiate from it and has the same chemical composition as the cornea's own substance. The border of the baumen shell with the epithelium is well defined, with the stroma it merges unnoticed. The basal layer of the epithelium is located directly on the baumen membrane, its connection with it is not strong enough and under pathological conditions there is a limited, and sometimes extensive, detachment of the epithelium from the baumen membrane.

 Given these anatomical features of the cornea, we propose the instillation of dicain in order to detach the epithelium from the baumen membrane. Subsequently, removal of the epithelium, stromectomy, and return of the epithelium to the stromal bed are performed.

 A method of correcting anomalies of eye refraction is as follows.

 Under local anesthesia, the patient is marked with the central optical zone and the zone of subsequent trepanation of the outer layer of the cornea. Trepan with a diameter of 6 to 7 mm is trepanation to a depth of 60 - 80 microns. With a solution of dicain, a temporary swelling of the epithelium is achieved in the central zone of the cornea, limited by the previously performed trepanation, and de-epithelization is performed. The removed epithelium is placed in physiological saline. Oraeger rotary microkeratome produces a stromectomy. Previously removed epithelium is returned to the stromal bed. The corneal bed is dried with a stream of air under a pressure of 9.8 kPa for 30-60 s. Subconjunctival injection is performed. The operation is completed by the position of the binocular dressing for 1 day, which excludes the friendly movement of the eyes, which can lead to a mechanical shift in relation to the dorsal bed.

 The next day with biomicroscopy: the cornea is transparent, shiny, the epithelium is adapted. There is no swelling, the joint zone in transmitted light is not determined.

 Example. Patient S., 22 years old. Diagnosis: High myopia inpatient amblyopia.

vis OD - 0.2 sph - 12.5 - 0.4 vis OS - 0.02 sph - 13.0 - 0.3 Keratomy OD - 43.52
OS - 43.87
- eyes OD - 27.21 mm OS - 27.33 mm PO3 si - 0.5
The patient underwent stromectomy according to the proposed technology.

Under local anesthesia, the central optical zone and the trepanation zone were marked with 3.2 and 7.0 mm markers. The cornea was trepanated to a depth of 70 μm. By instilling a solution of dicain, temporary epithelium swelling is achieved in the central zone of the cornea and the epithelium is removed. The removed epithelium was disk-shaped with a diameter of 7.0 mm and a thickness of 70 μm. The removed epithelium is placed in physiological saline. Oraeger rotary microkeratome produces a stromectomy. The removed stromal disk was 6.0 in diameter and 100 microns thick. The stromal bed is washed with physiological saline and the previously removed epithelium is placed on it. The cornea is dried with a stream of sterile air at a pressure of 9.8 kPa for 50 s. Perform subconjunctival injection and apply a binocular dressing
On the second day after surgery:
vis OD - 0.2 - 0.3 sph - 1.5 - 0.4 vis OS - 0.2 sph - 0.2 - 0.3
Keratometry OD - 32.71 OS - 32.54
The cornea is transparent. In total, 22 people were operated on using the proposed technique.

Claims (1)

 A method of surgical correction of anomalies of eye refraction, including stromectomy, characterized in that the epithelium is removed and placed in physiological saline, and after stromectomy and returning it to the stromal bed, the surgical area is dried with sterile air.