RU2246920C2 - Surgical method for applying biological stimulation of regeneration recovery processes in the cases of cornea lesions - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: method involves introducing amnion strip of 3-4mm in width under eyeball conjunctiva around the limbus corneae 2 mm far from it. Cornea is bordered. Amniotic strip ends are left freely lying under conjunctiva in superoexterior eyeball quadrant.

EFFECT: increased resorption of inflammatory infiltrate, turbidity and vascularization; reduced fibroplastic process intensity.

1 dwg, 1 tbl

Description

The invention relates to ophthalmology, in particular to the treatment of injuries and inflammatory lesions of the cornea.

There are methods of biological stimulation for traumatic and inflammatory lesions of the cornea, which are a common type of ophthalmic pathology, leading to a limitation of professional choice, disability and the onset of disability. One way to increase the intensity of regenerative processes in the cornea, in addition to drug treatment, admittedly the closest solution is the biological coating of the cornea.

However, the variety of biological materials used for corneal coating indicates an insufficient satisfaction of ophthalmologists with the results of their impact on reparative processes in the cornea. It is proposed to use amnion for biological coating of the cornea, which has anti-inflammatory, vasoactive, and immunostimulating effects (Akira Mamoea, Akira Dzhunsuke, 2001. J. “Ophthalmosurgery”, p.8-9).

The disadvantage of this method is:

- rapid biodegradation and resorption of amnion as a result of direct collagenolytic effects on the transplant of tear fluid enzymes;

- additional injury to the cornea or sclera during fixation of the flap;

- complete shutdown, albeit temporarily, of the optical function of the operated eye;

- possible sliding and rejection of the amnion from the cornea;

- difficulty in objective monitoring of the pathological process in the cornea;

- access to the cornea of locally acting drugs is difficult - the occurrence of rough scarring of the cornea in places of “engraftment” of the epicorneal coating.

OBJECT OF THE INVENTION

Improving the effectiveness of the treatment of corneal lesions by enhancing the resorption of inflammatory infiltrates, opacities and vascularization and obtaining higher optical results to reduce the intensity of fibroplastic processes by conducting an amnion strip.

This task is achieved by the fact that using a surgical needle under the conjunctiva of the eyeball around the limb (which is actively involved in the healing process of the cornea and is a source of neovascularization of the cornea in the inflammatory response), a strip of amnion is 3-4 mm wide, the ends of which do not connect and do not fix, left freely lying under the conjunctiva in the upper-outer quadrant of the eyeball (drawing). An amnion strip with a length of 23-25 mm is inserted into a normal surgical needle, as is done with any suture material. Cornea is trimmed counterclockwise. Having thus closed the “ring” from the amnion, the free ends of its strip are tucked with the same needle under the conjunctiva.

Advantages of the proposed method:

- ease of implementation of the proposed surgical biostimulation technique and the possibility of its outpatient implementation, as it does not require special equipment and training;

- the operation is not accompanied by injury to the cornea or limbus, since it does not require fixation of the flap;

- eliminates the risk of subsidence and rejection of the transplant, since the transplant is placed under the conjunctiva;

- providing a longer biostimulating effect on the cornea (4-5 weeks) due to a decrease in the possibility of the destructive effect of collagenolytic enzymes of the lacrimal fluid on the biological tissue;

- acceleration of healing processes and a decrease in the intensity of the fibroplastic phase, which is accompanied by the formation of gentle, slightly vascularized clouding of the cornea, since the graft actively affects the limb region - the main structural formation that provides the regenerative and metabolic capabilities of the cornea;

- performing visual functions with the operated eye, ensuring an improvement in the quality of life of the patient, without excluding the operated eye from the act of vision, since the transplant does not cover the cornea, but is located under the conjunctiva of the limb;

- maintaining the possibility of conducting constant ophthalmological monitoring of the dynamics of the pathological process, since the graft does not cover the cornea, leaving it accessible for examinations;

- ensuring the socio-economic effect of increasing professional suitability and reducing restrictions on the labor activity of patients, as the treatment time is reduced, the functional results of treatment are increased;

- a decrease in the demand for therapeutic and optical keratoplasty, as the functional results of treatment are increased;

- cost reduction of other medications - proteolytic enzymes for resorption of corneal opacities and the prevention of coarse scar formations;

- reduction of bed days and time of disability.

The treatment results (table 1) showed that when patients were discharged from the hospital, the average visual acuity indicators significantly exceeded those of the control group, although their initial values were the same, the hospital stay and the number of secondary corneal dystrophies were also reduced.

Table 1 Clinical criteria Etiology of lesion Surgical Corneal Biostimulation Without surgical stimulation of the cornea Visual acuity at discharge Burns 0.68 ± 0.05 0.49 ± 0.05 Metaherpetic keratitis 0.32 ± 0.05 0.2 ± 0.05 Purulent keratitis 0.46 ± 0.07 0.3 ± 0.07 Duration of hospital stay, days Burns 29.2 ± 1.2 40.4 ± 1.5 Metaherpetic keratitis 20 ± 1.2 35 ± 1,2 Purulent keratitis 17 ± 1,2 25 ± 1.2 The number of secondary dystrophies Burns 6.7 ± 0.03 19.5 ± 0.03 Metaherpetic keratitis 8 ± 0.03 20 ± 0.03 Purulent keratitis 1 ± 0.03 4 ± 0.03

Example No. 1.

Bnoy K., 36 years old. Clinical diagnosis: Chemical burn of the cornea III degree of the right eye, stage of trophic disorders.

Objective: A moderately expressed mixed injection of the eyeball, the cornea is clouded, thickened. In the lower half, a persistent epithelial defect. Due to changes in the cornea, deeper underlying media and fundus details are not visible, visual acuity is reduced to 0.05. Against the background of desensitizing, anti-inflammatory treatment, the patient underwent pericorneal biostimulation with amnion. After 10 days, the cornea of the right eye acquired transparency, its complete epithelization occurred. Optical media, such as the lens, vitreous body, and fundus details, were clearly visible. Visual acuity increased to 0.3.

Example No. 2.

Boy S., 60 years old. Clinical diagnosis: Creeping ulcer of the cornea of the left eye.

Objectively: Mixed injection of the eyeball. In the optical zone of the cornea after antibiotic treatment, residual inflammatory infiltration of the stroma persists, and quite intense opacification is formed. Visual acuity is reduced by 0.08 (not corrected).

10 days after biostimulation by the amnion of the perilimbal space, the transparency of the cornea increased, the intensity of opacification decreased, which led to an increase in visual acuity to 0.2. After 1 month, visual acuity increased to 0.5. A small intensity avascular opacification formed on the cornea.

Example No. 3.

Under the supervision there were 36 patients who were divided into 3 groups:

I - Patients with chemical and thermal burns of the cornea (9 people).

II - Patients with metaherpetic keratitis (9 people).

III - Patients with purulent keratitis (18 people)

The main group (30 people) on the background of etiotropic treatment received surgical pericorneal biostimulation with amnion.

The control group (6 people) underwent only drug treatment.

Thus, the proposed method of treatment is more effective by reducing the duration and intensity of inflammatory reactions, the degree of vascularization of corneal opacities and increasing optical results, as well as reducing postoperative complications in the form of sliding and rapid destruction of the graft. The method is applicable in any eye surgical hospital.

Claims (1)

A method of surgical biostimulation of regenerative and recovery processes in corneal lesions, including the use of an amniotic membrane, characterized in that under the conjunctiva of the eyeball around the limb at a distance of 2 mm from it, a 3-4-mm-wide amnion strip is carried out with a surgical needle, the cornea is sutured, the ends of the amniotic the strips are left freely lying under the conjunctiva in the upper outer quadrant of the eyeball.