RU2351298C1 - Method of prevention of pterygium relapse - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns ophthalmology and can be used for prevention of pterygium relapse at operation of its excision. Membranula of the semilunar form on the basis of polyvinyl alcohol containing mitomycin-c in amount of 0.2 mg is placed on the "bared" part of sclera on limbus edge place. The membranula extremities are set under conjunctiva at limbus. The membranula extremities are fixed to free edge of conjunctiva. The rest of the sclera is closed using separated healthy conjunctiva, pulling it from two the sides and fixing. The membranula is removed in 7 days.

EFFECT: method allows preventing repeated growth of pterygium, and also provides higher cosmetic effect at the expense of achievement of full cuticularisation of wound.

1 dwg, 2 ex

Description

The invention relates to medicine, in particular to ophthalmology, and can be used during surgical interventions for primary and recurrent pterygium.

A known method of surgical treatment of pterygium, including separation and removal of pterygium, conjunctival plasty and subconjunctival administration of 0.1 ml of 0.4 mg / ml mitomycin-C (ALAnduze. Pterygium Surgery With Mitomycin-C: Ten-Year Results // Ophthalmic Surgery and Lasers. - Yuly / August 2001. - Vol.32. - No.4, p. 341-345). The disadvantages of this method are the rapid resorption of the drug, a pronounced cytotoxic effect and pain syndrome up to 2 weeks, so the method is practically not used.

There is a method of surgical prevention of relapse of pterygium, adopted as a prototype, by using a graft from allogeneic tissue (epiphyseal blepharitis, dura mater, amniotic membrane, etc.) saturated with antimetabolite (5% solution of 5-fluorouracil or mitomycin-C) [certificate RF for utility model RU 26419 U1 dated 12/10/2002 .; Karamyan A.A., Ismailov M.I., Aliev A.G. A comprehensive technique for the prevention of aberrations of the optical system of the eye during surgical treatment of pterygium // journal "Modern technologies for diagnosis and treatment in ophthalmology", Makhachkala, 2004, S.435-137]. The disadvantages of the method are the insufficiently long exposure, since the antimetabolite is located on the surface of the graft without penetrating into its structure and is easily washed off with a tear, low cosmetic effect due to the presence of a visible allograft strip, the possibility of developing a reaction to foreign tissue, and the impossibility of accurate dosing.

The objective of the invention is to develop a method for preventing the re-growth of pterygium, which provides a local dosed prolonged effect of antimetabolite, taking into account the fact that at a low dosage it is possible to develop relapse of pterygium, with a high - pronounced cytotoxic effect.

The technical result when using the invention is a local dosed prolonged action of an antimetabolite gradually released from the polymer film, a higher cosmetic effect due to the complete epithelization of the wound.

The specified technical result is achieved by the fact that in the method of relapse prevention during the operation of removing the pterygium, including fixing on the "bare" part of the sclera along the edge of the limb of the material saturated with the antitetabolite mitomycin-C, according to the invention, a film of a semilunar form based on polyvinyl alcohol containing mitomycin-C is placed in an amount of 0.2 mg, the ends of which are adjusted under the conjunctiva at the limb, the ends of the film are fixed to the free edge of the conjunctiva, the remaining part of the sclera is closed with a separated healthy conjunctiva pulling it on both sides and fixing it, after 7 days the film is removed.

The proposed method is illustrated in the drawing, which shows the location of the used film.

The proposed method is as follows. The body and head of the pterygium are separated, the newly formed vessels and scars are scraped from the adjacent parts of the cornea, limbus and sclera, and the subconjunctival hyperplastic tissue is removed in the area of the pterygium body. A film of 1 semilunar shape, size 0.2 × 0.4 × 0.02 cm, containing mitomycin-C in an amount of 0.2 mg, soaked in 0.9% saline solution, lay the base on the edge of the limb on the “bare” part of the sclera, tightly pressed to it, the ends of the film with a spatula set under the conjunctiva near the limb, fix the film with four interrupted sutures 2-5 to the free edge of the conjunctiva, the remaining part of the sclera from the nose side is closed with a separated healthy conjunctiva, pulling from both sides, fixing the sutures 6- 7 (see drawing) On the 8th day conjunctival sutures are removed, captive ku delete.

A method of obtaining a film. First, an aqueous solution is prepared containing a predetermined amount of mitomycin-C and polyvinyl alcohol (PVA). To prepare a 2% solution of PVA, 1.59 g of PVA, 79.5 ml of bidistilled water and 158.8 mg of mitomycin-C are taken at a dosage of 0.2 mg per film and its thickness 0.02 cm. The resulting solution is poured into a glass cup and evaporate in vacuo to constant weight. The diameter of the cup is 9 cm, the diameter of the resulting film is 9.0 cm. With a film size of 0.2 × 0.4 × 0.02 cm, its weight is 2.2 mg. The optimal content of mitomycin-C in one film (one dose) is 0.2 mg (patent RU 2233158, 2004, authors Zaydullin I.S., Aznabaev M.T., Dautova Z.A., Aznabaev R.A., Monakov Yu.B., Kolosov S.V., Sigaeva N.N., Chirko K.S.)

The developed method was tested in 8 patients / 10 eyes / with recurrent pterygium from the age of 23 to 65 years. The control group consisted of 10 patients / 10 eyes / with recurrent pterygium from the age of 26 to 76 years. Both groups are homogeneous in age and degree of pterygium. In the study group, postoperative relapses were not observed. In the control group 3 cases. The difference is statistically significant.

We give examples of clinical use of the proposed method.

Example 1. Patient M., 55 years old, medical history No. 7898, was hospitalized with a diagnosis of OS - recurrent prairium of the 2-3rd degree. It was previously operated on 2 years ago for progressive pterygium, repeated growth began 2 months after the first operation.

Under local anesthesia, a relapsing pterygium coated with a “bare” sclera in the limb was removed with a film containing mitomycin-C. The body, the head of the pterygium, newly formed vessels and scar tissue were separated from the sclera of the eyeball. The remnants of the newly formed vessels and scar tissue were scraped off with a sharp scalpel. The head and scar tissue of the pterygium was cut off. A half-moon film containing 0.2 mg of mitomycin C moistened in 0.9% saline was laid with a base along the edge of the limb on the “bare” part of the sclera, pressing it tightly against it, the ends of the film were put together with a spatula under the conjunctiva limb and fixed with interrupted sutures to the free edge of the conjunctiva, the remaining "bare" sclera from the nasal side was closed with a separated healthy conjunctiva, pulled from two sides, fixing the sutures.

The postoperative period was uneventful. A day after the operation: on the cornea, slight swelling at the site of an open wound, initial epithelization, conjunctival sutures are wealthy, moderate conjunctival hyperemia, mainly in the projection of conjunctival sutures, the film lies closely along the edge of the limb to the sclera of the eyeball. Deep optical media are transparent, the reaction of the pupil to the light is lively, the fundus without features. Conducted local treatment. On the 8th day: the cornea is epithelized, residual conjunctival injection, conjunctival sutures are removed, the film is removed.

After 3 months: the cornea is transparent, a slight turbidity in the limbus, the conjunctiva of the eyeball is pale pink, there is no injection of the eyeball, there are no newly formed vessels on the cornea. The optical media are transparent, the pupil’s reaction to light is live.

The follow-up period was 6 months. During the observation period there was no re-growth of pterygium.

Example 2. Patient A., 60 years old, medical history No. 7730. The diagnosis of OI-pterygium 3-4 degree. Incomplete complicated cataract. Both eyes were operated on in one day. OI removal of pterygium coated with "bare" sclera with a film containing mitomycin-C. The body, the head of the pterygium and the newly formed vessels were separated from the sclera of the eyeball. Residues on the cornea, limbus and sclera were removed with a sharp blade. The head and body of the pterygium were cut off. A half-moon film containing 0.2 mg mitomycin-C soaked in 0.9% physiological saline was placed along the edge of the limb onto the “bare” part of the sclera, pressing firmly against it, the ends of the film were set with a spatula under the conjunctiva of the limb and fixed with interrupted sutures, the ends of the film were fixed with interrupted sutures to the free edge of the conjunctiva, the remaining "bare" sclera from the nasal side was closed with a separated healthy conjunctiva, pulled from both sides and fixed with sutures. In the end, an antibiotic was instilled.

The postoperative period was uneventful. A day after the operation: the OI cornea is transparent, at the site of removal of the head and body of the pterygium on the cornea there is slight swelling and clouding of the limbus, the initial epithelization of the corneal surgical wound, the conjunctiva sutures are solid, moderate conjunctival hyperemia, mainly in the suture area, the film contains mitomycin -C in place, closely adjacent to the sclera, well fixed to the conjunctiva. The reaction of the pupil to the light is alive, deep optical media are calm, incomplete opacification of the lens, fundus without features. On the 8th day: the cornea is transparent in the optical zone, a slight clouding of the cornea near the limb, the cornea is completely epithelized, the residual conjunctival injections were removed, the conjunctival sutures were removed, the film containing mitomycin-C was removed, epithelialization of the limb and “bare” sclera occurred on both eyes equally, when stained with a solution of methylene blue 1%, the wound does not stain. The reaction of the pupil to the light is alive, deep optical media are calm, incomplete opacification of the lens, fundus without features. The follow-up period was 6 months. There were no relapses over the entire observation period.

Thus, the proposed method using films containing mitomycin-C, after removal of recurrent pterygium, effectively prevents the re-growth of pterygium.

Claims (1)

A method for the prevention of recurrence of pterygium during its removal by fixing on the “bare” part of the sclera along the edge of the limb a material saturated with mitomycin-C antimetabolite, characterized in that a film of a semilunar form based on polyvinyl alcohol containing mitomycin-C in an amount of 0.2 mg is placed , the ends of which are adjusted under the conjunctiva at the limb, the ends of the film are fixed to the free edge of the conjunctiva, the remaining part of the sclera is closed with a separated healthy conjunctiva, pulling it on both sides and fixing, after 7 days, the film delete.