RU2123314C1 - Method of placing irrigation system into tenon's space - Google Patents

Abstract

FIELD: ophthalmology. SUBSTANCE: in order to provide introducing therapeutic substances, one end of S-shaped catheter is led through the bulk of dry sponge and laid onto sclera, whereas the second end is led out through tissues above upper conjunctive vault, and cut of conjunctiva is tightly sutured. EFFECT: simplified placement of system and therefore reduced risk of infecting and traumatizing eye.

Description

 The invention relates to ophthalmology, and in particular to methods of administering drugs. In case of eye diseases, there is a known method of administering drugs through a catheter inserted into a retrobulbar space along a previously inserted injection needle (B-18461 Krol Tez. Doc. 8 of Congress 1990, p. 93, Prolonged catheterization of retrobulbar space).

 However, given the complications possible with an injection (hematoma, penetrating wound, painful manipulation, the possibility of a negative psychological reaction of the patient), the search for better methods of administering drugs is relevant.

 Known surgical method of administering drugs through a catheter mounted in a tenon space. The disadvantages of this method are: complexity, lack of tightness, which can lead to ascending infection, since through a conjunctival incision the catheter leaves the tenon space into the conjunctival cavity, bending through the upper eyelid, is fixed in the skin with an adhesive plaster. The presence of a foreign body (tube) in the conjunctival cavity leads to trauma to the conjunctiva and cornea, causes pain in the patient, and also leads to healing of the conjunctival incision by secondary intention. The end of the tube, located in the tenon space, is wrapped with a wet sponge around the longitudinal axis of the catheter, which lengthens and complicates the manipulation, but does not create proper fixation (Ophthalmic Surgery. Nesterov, Basinsky, 1991, N 4. P. 56. "Subtenon implantation of a collagen infusion system in treatment of glaucoma ").

 The aim of the proposed method is to simplify the technique by taking out the catheter from the tenon space and fixing, which reduces the risk of infection and eye injury.

 This goal is achieved due to the S-shaped conduction of the tube through a dry hemostatic sponge, due to the infusion system above the superior conjunctival arch and its removal through the upper eyelid to the forehead skin and hermetic closure of the conjunctival incision.

 Due to the S-shaped conduction of the tube through the hemostatic tube, sufficient fixation of the tube is achieved, which is absent in the prototype method. In turn, the collagen system, being the skeleton for the sponge, prevents its rapid dispersion. Holding a tube in the tissues above the superior arch of the conjunctiva without exiting it into the conjunctival cavity provides: better fixation by reducing mobility, because there is no contact with the moving eyeball and conjunctiva and additional bends through the edge of the conjunctival incision and the upper eyelid; tightness (the conjunctival incision is completely sutured, the wound edges quickly adapt, a delicate scar forms, unlike the way the catheter is inserted into the conjunctival cavity; the possibility of ascending infection and reverse current of injected drugs is excluded. There is no reaction from surrounding tissues. Removing the catheter is simple and painlessly.

 The method was studied under experimental conditions in the eyes of rabbits and tested in a clinical setting. In no case was spontaneous catheter prolapse noted. The irrigation system was removed at the end of the course of treatment (after 10-15 days). There were no cases of an allergic reaction from the surrounding tissues, as well as cases of infection and reverse flow of drugs. All patients during the treatment process using the irrigation system felt good.

 The method is as follows: the operation is performed under general anesthesia. A conjunctiva is incised 7 mm from the limbus in the upper outer segment of the eyeball. One end of the tube with a skin needle is carried out from the subconjunctival space under the upper arch of the conjunctiva through the thickness of the upper eyelid in the outer section, the second end of the tube, S-shaped through a dry hemostatic sponge, is moistened in saline and injected into the formed tunnel, placed on the sclera. The conjunctival incision is hermetically sutured with silk. A cannula is put on the outer end of the tube from the hard connection of the catheter.

 Example 1

 A boy of 12 years old was admitted to the Department of Ophthalmology with a diagnosis of Partial atrophy of the optic nerve.

 In the department: an operation was performed under mask-and-mask, ferrous-fluorotan anesthesia.

Operation progress:
1. Preparatory stage: a dry flap of a hemostatic sponge is stitched with a soft silicone tube S-shaped. A skin needle is worn on its second end. The sponge is moistened with saline. Then, the conjunctiva and tenon membrane are incised 7 mm from the limbus in the upper outer segment. A skin needle is inserted under the upper edge of the conjunctival incision, the upper layer of the conjunctiva is bent around, carried through the thickness of the upper eyelid in its outer part and brought to the skin. In the formed tunnel on the sclera, the second end of the silicone tube with a hemostatic sponge is laid. A continuous silk suture is then applied to the conjunctiva. A cannula is inserted from the rigid subclavian catheter 06 with a rubber cap onto the outer end of the tube and is fixed to the forehead skin with a band-aid.

 Thus, the proposed method is simple in technical implementation, avoids violations of the tissues of the eye and its functions, which allows us to recommend the proposed method for the administration of drugs, including in children.

Claims (1)

 The method of introducing drugs into the tenon space, including the incision of the conjunctiva and tenon membrane, introducing a catheter with a hemostatic sponge at the end into the tenon space and introducing its second end onto the forehead skin, characterized in that the catheter is S-shaped through the thickness of a dry sponge, the second end excreted through the tissue above the superior conjunctival arch, and the conjunctival incision is hermetically sutured.