RU2341237C1 - Method of restoration of phrenic function of iris at traumatic damages - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: move pupillary edge of an iris to the optical centre. Stick to a pupillary zone using an aspiration cannula on distance of 1-2 mm from the pupillary edge and move the cannula on radius to the optical centre, changing its position on perimetre. At a combination of abaissement of an iris to an iridodialysis the first stage stitch an iris root, not fastening the suture threads on the sclera.

EFFECT: provides possibility to obtain the greatest possible optical and cosmetic effect, to keep sight of the patient at sparing character of carrying out of all manipulations, having excluded injuring action on a lens.

3 cl, 2 ex

Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in the surgical treatment of iris injuries.

Iris injuries (iridodialysis, prolapse on the surface of the cornea, etc.), as a rule, lead to deformations of the iris tissue and wrinkling, as a result of which its diaphragmatic function is disturbed, photophobia, light scattering, cosmetic defects appear, and visual acuity decreases.

According to Aznabaev M.T. with employees (Aznabaev T.M. et al. “Plastic surgery of the iris”, Ufa, “Gilem”, 1997, p.40) the injured iris tissue cannot be restored on its own, therefore surgical intervention is required to eliminate defects .

Known methods for eliminating the consequences of injuries of the iris (RF patent No. 2226376, z. 24.09.02, publ. 04/10/2004, BI No. 10 and patent No. 220084, z. 09/19/02, publ. 20.11.2004, , BI No. 32, No. 2156613, З. 02.12.99, published on 09.27.2000, BI No. 27) do not provide for the formation of a pupil from an injured iris and restoration of its diaphragmatic function.

The objective of the invention is to develop a gentle effective method of restoring the diaphragmatic function of the iris during its traumatic injuries by forming a pupil in the optical center of the eye from the injured tissue of the iris.

The essence of the invention lies in the fact that when falling through the wound in the cornea, the iris is moved with a spatula into the anterior chamber and a corneal suture is applied. An aspiration cannula is introduced into the anterior chamber through paracentesis and, using a vacuum, the surface of the iris is cleaned of fibrin, blood clots and fine particles resulting from the injury.

Then the iris tissue is straightened, sucking a cannula to it and pulling it from the root of the iris to the center. To form the pupil, the cannula is attached to the pupil of the iris at a distance of 1-2 mm from the pupil edge and the cannula is moved along the radius to the optical center, changing its position along the perimeter of the pupil.

With a combined injury of the iris (iridodialysis, prolapse), the iris with a spatula is moved to the anterior chamber, then iridodialysis is eliminated, for which the torn iris root is moved to the place of its anatomical position and sewn to the sclera with a continuous suture, without tying the threads with a knot.

The technical result from the implementation of the proposed method is expressed in the following:

- excludes traumatic effects on the lens when smoothing the iris tissue, because the tissue of the iris is lifted by vacuum above the surface of the lens;

- provides the possibility of maximum expansion of the iris tissue;

- the pupil is formed in the optical center, the maximum possible optical and cosmetic effect is achieved;

- particles of fibrin, blood and fine particles resulting from injury are removed from the surface of the iris.

The proposed method is as follows: the precipitated iris is seasoned with a spatula in the front chamber.

In case of combined injury (iridodialysis and prolapse), the first step is to eliminate iridodialysis in a known manner (RF Patent No. 2226376, IPC 7 A61F 9/007, September 24, 2002, published on April 10, 2004, BI No. 10), without tying the suture thread on the sclera.

Then, through paracentesis, an aspiration cannula is introduced into the anterior chamber and fibrin, blood clots, and fine particles are removed from the surface of the iris using a vacuum. The tissue of the iris is spread out, sticking to the deformed areas and pulling it from the root of the iris to the center. A pupil is formed from the cleaned and expanded tissue, for which a cannula is attached to the pupil zone at a distance of 1-2 mm from the pupil edge and the cannula is moved along the radius to the optical center, changing its position along the perimeter. If the pupil edge does not reach its anatomical position, the seam on the sclera is weakened and the pupil edge is pulled to the center, if the pupil is in an eccentric position, the seam on the sclera is pulled, ensuring the formation of the pupil in the optical center.

Suture threads on the sclera are tied only after the pupil has moved to the optical center. In the absence of iridodialysis, the precipitated iris is moved with a spatula into the anterior chamber, a corneal-scleral suture is performed (depending on the nature of the injury) and the pupil is formed using an aspiration cannula according to the described technique.

The proposed method is illustrated by clinical examples.

Example 1

Patient P., AK No. 184622, year of birth 1976.

The patient was admitted with blunt trauma OD.

Objectively: the cornea is edematous, the loss of the iris through refractive scars at 12 and 6 hours, the separation of the root of the iris from 6 to 12.30 hours, the anterior chamber is slit-like, the pupil is slit-like, eccentric, the crystalline lens is transparent.

Vis OD - counting fingers on the face.

November 13, 06, the patient underwent surgery in accordance with the proposed method. At the first stage of the operation, the iris was tucked into the anterior chamber with a spatula and sutured to the cornea, then iridodialysis was fixed in a known manner, without tying the ends of the threads on the sclera into a knot. At the second stage of the operation, an aspiration cannula was inserted into the anterior chamber and, in accordance with the proposed technique, they cleaned the surface of the iris, straightened it and formed a pupil, which occupied an eccentric position. They tightened the iris with a scleral suture, secured the central position of the pupil and fixed the scleral suture with a knot.

11/21/06, at discharge: objectively - the pupil is round.

Vis OD - 0.1 - does not correct.

03/13/07 - during the control check objectively: the pupil is round, the cornea is transparent.

Vis OD - 0.6 with correction - 0.9.

Example 2

Patient Sh., Year of birth 1998, AK No. 171193.

Received 07/26/04 g with a diagnosis of penetrating wound of the cornea OS with prolapse of the iris. Traumatic cataract of the left eye.

Objectively: OS is irritated, the cornea is transparent, in the paraoptic zone at 7 o’clock a linear incision is 4 mm long with an iris falling out.

Vis OS - pr.in certa

07.27.04, the patient underwent surgery. The fallen iris was tucked into the anterior chamber with a spatula and a continuous suture was placed on the cornea. Then we performed the necessary procedures for aspiration of the lens masses and implantation of an IOL. The deformed iris tissue was straightened using a vacuum aspiration cannula in accordance with the proposed method, fibrin residues were removed from the surface of the iris and a pupil was formed in the optical center of the eye.

At discharge, the pupil is round.

Vis OS - counting fingers on the face, swollen cornea.

One month after surgery, Vis OS - 0.06, three months after surgery - 0.125 n / a.

Claims (3)

1. A method of restoring the diaphragmatic function of the iris during traumatic injuries, which involves repositioning it in an anatomical position, characterized in that the surface of the iris tissue is sequentially cleaned with the help of an aspiration cannula, it is straightened, the pupil edge is moved to the optical center and then the pupil is formed, for which purpose they are sucked by the aspiration cannula to the pupil zone at a distance of 1-2 mm from the pupil edge and move the cannula along the radius to the optical center, changing its position along the perimeter RU. 2. The method according to claim 1, characterized in that when combining an injury to the iris tissue with iridodialysis, it is first eliminated in a known manner, leaving the suture threads un tied. 3. The method according to claim 2, characterized in that the filaments are fixed by a knot after changing their tension during the formation of the optical center of the pupil.