RU2271183C1 - Surgical method for treating strabismus cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves cutting conjunctiva 2-3 mm far from the limb in parallel to it. Conjunctiva is cut in projection of each oculomotor muscle under operation. The muscle is exposed, sutured and separated from insertion site. A thread is conducted in parallel in sclera and the first simple knot is tied, the second one being tied in a bow for relieving or tightening, recession or resection of muscle at the second day. When making resection, the muscle is pulled towards the former insertion site without gap being left. Operation wound edges are sutured at the second day after the operation and 2-3 interrupted sutures are placed on the conjunctiva.

EFFECT: stable results; excluded repeated operations; improved cosmetic results.

Description

The invention relates to medicine, more specifically to ophthalmology, and can be used for the surgical treatment of strabismus.

A known method for the surgical treatment of strabismus (Jampolsky A .; Current techniques of adjustable strabismus Surgery.Am.J.Ohhtal. 1979, vol. 88 3Pt1, p. 404-418) by performing two-stage operations on the oculomotor muscles of the eye using the method of adjustable sutures, including on the first day of the U-shaped suture in the direction of each operated oculomotor muscle, isolation, suturing on both sides and cutting off each muscle from the attachment site (tendon strip), suturing the threads along the edges of the former attachment and holding them in the thickness of the sclera, bringing the places closer together needle exit, stuck vanie first simple and second node bow (to adjust the eye position), the retsezirovannuyu arm fastened at a distance of 2 mm from the place of its anatomic attachment (muscle "hangs" on the strands), which can then lead to the necessity of re-operations strabismus. The next day under instillation anesthesia, since the procedure is very painful, 1-2 hours after removing the bandage, pull-ups or weakenings of the recession or resection are performed by increasing or decreasing the distance between the cut muscle and the place of its initial attachment (the place of fixation of the suture). After one-, two- or more-fold adjustment of the sutures and achieving the correct position of the eyes (bringing the muscle closer or farther away from the place of its initial attachment), the knots turn into a regular knot by simply pulling the thread from the loop side. The third and fourth simple knots make the seam completely reliable. For the lower eyelid, an antibiotic ointment with cortisone is laid. A monocular sterile dressing is applied. Moreover, after conducting U-shaped conjunctival incisions, the conjunctiva during recession and resection is pushed to the side of the primary attachment of each muscle and secured with a suture, leaving a free approach to the regulation nodes the next day. In this case, conjunctival scleral absorbable sutures and sclera from the limb to the conjunctival suture are left open in the postoperative period from 4 to 6 months, which even when the correct eye position and, if possible, functional result is achieved, the cosmetic effect during this period decreases and therefore, the rehabilitation time increases.

An object of the invention is to create an effective method of surgical treatment in order to achieve a stable result, reduce repeated operations for strabismus, achieve a high cosmetic result immediately after surgery, complete disappearance of double vision and restore binocular vision immediately during surgery.

The technical result is achieved, according to the invention, in that in the method of surgical treatment of strabismus, which includes conducting a conjunctival incision in the projection of each operated oculomotor muscle on the first day, isolating, stitching and cutting it off from the attachment site, holding the thread in the sclera and tying the first simple knot and the second in the form of a bow for weakening or pulling up, recession or resection on the second day, while the conjunctiva is cut 2-3 mm from the limbus and parallel to it; the threads in the sclera are parallel to each other; during resection, the muscle is pulled to the place of the former attachment without leaving a gap, and at the end of the operation on the second day, the edges of the operated wound are sutured with 2-3 interrupted sutures applied to the conjunctiva.

According to the invention, conjunctival incisions are performed parallel (concentrically) to the limb and 2-3 mm from it in the projection of each operated muscle, which reduces the invasiveness of the operation.

According to the invention, the needles in the sclera go parallel to each other, which provides a straight, straightened position of the muscles.

According to the invention, during resection, the muscle is pulled to the place of its former attachment, that is, its anatomical position is maintained and, thus, maximum resection is obtained. When adjusting the next day, it is technically easier to loosen the resection, and for the patient this manipulation is less painful than enhancing the resection when pulling the muscles to 2 mm previously left, as in the prototype.

According to the invention, after adjusting the sutures to achieve the correct position of the eye, the nodes on the muscles are finally tied up, and 2-3 nodal sutures are put on the conjunctiva, combining the edges of the surgical wound, as the conjunctiva was cut parallel to the limb, and in the prototype the surgical wound remains open, it Do not suture at the end of the operation.

Thus, immediately after the operation, a high cosmetic result is achieved and the rehabilitation period is reduced by 1.5-2 times (2-3 months).

The method is as follows.

Under anesthesia, in the projection of each oculomotor muscle 2-3 mm from the limbus and parallel to it, a conjunctival incision is made, the muscle is isolated from the surrounding tissue, flashed at the recession attachment site, and when resected, it is stepped back to the calculated distance for resection.

Next, the muscle is cut off at the attachment site and thorough hemostasis is performed, and with the same needles, the muscle is hemmed at the edges of its former attachment point, and then the needles are held in the sclera thickness parallel to each other, and after the puncture, the first simple knot and the second bow are tied so that the next day to correct the position of the eyes.

During resection, the muscles are hemmed to the place of the former attachment without a gap (the muscle does not hang).

The next day, under local anesthesia, after determining the position of the operated eye, the muscle tension is adjusted by changing the tension of the threads (dissolve the knot tied with a bow) until the eye is in a straight position (Dev = 0). Knots turn into bow knots into ordinary knots, and the third and fourth simple knots make the seam completely reliable. The remaining threads are cut off.

At the end of the operation, 2-3 nodal sutures (8-0 silk) are applied to the conjunctiva and the edges of the conjunctiva are combined, the sclera is closed, drops are dripped with antibiotics. A monocular sterile dressing is applied.

According to the known method, 10 patients were operated on.

In all cases, severe pain was noted when adjusting muscle tension. The final cosmetic effect was achieved after 4-6 months, since the surgical wound was left open.

In two cases, repeated operations were performed for strabismus.

According to the invention, 10 strabismus operations were performed. In no case was severe pain observed in the regulation of muscle tension. The final high cosmetic and lasting result was achieved in all cases immediately after the operation.

Example: Patient A., 20 years old.

Diagnosis: convergent friendly alternating strabismus, mild hypermetry of the right eye. Objectively: eye movement in full, optical media are transparent, the fundus without foci of pathology. Deviation of the eye to the nose 20 degrees according to Hirschberg. The objective angle of converging squint at the synoptophor is 20 degrees. Visual acuity OD = 0.2 sphere + 2.0 = 0.4 n / corr., OS = 0.8. The nature of vision is monocular, the leading eye is left. Fusion reserves are absent.

An operation was performed on the motor muscles of the eye (recession of the internal rectus muscle 4 mm and resection of the external rectus muscle 6 mm) according to the described technique.

Visual acuity after surgery:

OD = 0.2 sphere + 2.0 n / corr and OS = 0.8.

Doubling is absent. Dev = 0

The surgical treatment method according to the invention can significantly reduce the need for repeated operations for strabismus and achieve high cosmetic results immediately after surgery than the use of traditional surgical methods.

This method can be used not only in cases of "complex" strabismus, but also in "simple" cases.

This method is especially effective for strabismus, accompanied by double vision. The ability to adjust the stitches until the ghost disappears completely and binocular vision is restored immediately in the operating room is a guarantee of a stable result.

Claims (1)

A method for surgical treatment of strabismus, including on the first day a conjunctiva incision in the projection of each operated oculomotor muscle, isolation, stitching and cutting it off from the attachment site, threading in the sclera and tying the first simple knot and the second knot in the form of a bow to loosen or tighten, recession or resection on the second day, characterized in that the conjunctiva is cut 2-3 mm from the limbus and parallel to it; the threads in the sclera are parallel to each other; during resection, the muscle is pulled to the place of the former attachment without leaving a gap, and at the end of the operation on the second day, the edges of the surgical wound are sutured with 2-3 nodal sutures applied to the conjunctiva.