RU2381019C1 - Method of treating multiple damage of eye cornea with plural chemically nonaggressive foreign bodies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: pedicle graft taken from Tenon's capsule of a damaged eye within superior rectus muscle is used as a epicorneal coverings. A strong sorptive, phagocytic, enzymatic, antiinflammatory and trophic action of the graft on the corneal pathological processes ensures rapid reduction thereof with recovering eye cornea and non-inflammatory elimination of foreign bodies through the wound tracts without opacifications.

EFFECT: treating multiple damage of eye cornea with plural chemically nonaggressive foreign bodies.

1 ex

Description

Technological disasters, terrorist acts, and local military conflicts put forward an important problem for ophthalmology - the problem of treating severe combined lesions of the cornea with multiple chemically non-aggressive foreign bodies.

The invention relates to medicine and can be used to treat combined eye damage with multiple chemically non-aggressive foreign bodies.

Known methods for surgical removal of foreign bodies with a superficial location with a spear-shaped needle, a needle from a syringe or pointed tweezers [1]. Non-magnetic foreign bodies with deep occurrence can be removed according to the method of I.A. Wasserman - a cornea is cut from a depth of 0.2-0.3 mm above the place of occurrence of a foreign body by trepan FM5. The non-through corneal disc is separated by V.P. Filatov's scraper. A foreign body is removed from underneath with a needle or tweezers, and then the disc is placed in place [2].

These methods are mainly used to remove single foreign bodies from a healthy cornea. It is quite clear that with a combined lesion of the eye with multiple chemically non-aggressive foreign bodies with different depths, removal of foreign bodies by the indicated methods will invariably lead to eye death and blindness.

The closest way to the same purpose, but with multiple foreign bodies of the cornea of the eye, which we took as a prototype, is the following.

First of all, fragments protruding above the surface of the cornea of the eye and causing pain to the victim are removed. The remaining fragments are left until they are eliminated (reaching the surface) and then gradually removed [2].

This technique is mainly based on the quantitative side of this injury, although it is known that surgical removal of a foreign body from the cornea of the eye in 40% of cases can cause keratitis [3], and keratitis in 12 to 98% of cases can go into corneal ulcer of the eye [4 ].

We are dealing with a combined lesion of the cornea of the eye with multiple chemically non-aggressive foreign bodies, when several damaging factors are combined in this trauma:

1. Concussive damage to the cornea and anterior segment of the eye, which affects the nutrition of the cornea, its vitality, metabolic processes and the course of the injury.

2. Often this injury is combined with a burn lesion of the cornea, the treatment of which in itself is a big problem.

3. Many injuries of the cornea with foreign bodies inside it, which themselves adversely affect the corneal tissue.

4. An infection enters through numerous wound channels, and in addition we also receive a bacterial lesion of the cornea of the eye.

It is quite clear that with such a combined injury that results in a sharp decrease in vision, blindness or loss of eye, the approach to treatment should be completely different.

Our invention is based on the principle of the struggle for the vitality of the cornea and the natural elimination of foreign bodies from the cornea of the eye without any surgical intervention. This result is achieved by covering the entire affected surface of the cornea with a flap on the feeding leg from the tenon capsule of the affected eye, taken from the intact zone in the region of the superior rectus muscle, where the tenon capsule is most viable. After passing this flap under the conjunctiva of the eyeball through the conjunctiva incisions in the upper and lower parts of the limbus, the flap covers the affected cornea and stitches with the tenon capsule below. Episcleral sutures on the limbal sections of the conjunctiva.

In domestic and foreign literature available to us, we did not find reports that in this type of injury, to achieve the claimed clinical result, an epicorneal coating of the entire surface of the cornea of the eye should be used with a flap on the feeding leg taken from the tenon capsule of the affected eye. Tenon's capsule is the tissue that covers the eyeball, located between the conjunctiva of the eyeball and the sclera of the eye. Being a low-differentiated tissue, it is very flexible, feeds osmotically and has powerful sorption properties. With irritation, its own vessels are activated in it, providing the affected area with nutrition, phagocytic and enzymatic protection, improving metabolic processes. The mechanism of the therapeutic effect of the epicorneal coating with a flap on the feeding leg from the tenon capsule of the affected eye is composed of:

1. Maximum protection of the wounded cornea of the eye from weathering and trauma for centuries.

2. Prevention of bacterial damage to the cornea, infection of wounds.

3. A powerful sorption phagocytic, enzymatic, anti-inflammatory and trophic effects on pathological processes in the cornea of the eye, restoring it.

4. Against this background, due to the enzymatic-sorption effect, non-inflammatory elimination of foreign bodies occurs through uninfected own wound channels. In this case, almost no turbidity remains. Non-eliminated foreign bodies remain intact in the cornea of the eye, without inflammatory changes.

The essence of the method is illustrated by a clinical example. A child of 12 years old with a powder explosion received a corneal burn of the II degree and multiple foreign bodies of the corneas of both eyes. Visual acuity of the right eye of 0.1 n / a. Visual acuity of the left eye of 0.3-0.4 n / a. Autotenonoplasty was performed on the right eye; foreign bodies with severe inflammatory and pain syndrome were repeatedly removed on the left eye for several days.

On the right eye, after covering with an autotenon capsule, the pain syndrome immediately disappeared. After 2 weeks, the autotenon flap was removed, the visual acuity of this eye was 0.5-0.6. Most of the powders were eliminated without clouding of the cornea, and the deep-lying powders remained lying without signs of inflammation in the intact cornea.

In the left eye, visual acuity decreased to 0.1-0.2 with a lot of clouding at the site of removal of foreign bodies and clouding of the corneal stroma in the area of deep-lying foreign bodies.

There were several such operations, and all with a good outcome.

As follows from the foregoing, a method of treating a combined lesion of the cornea of the eye with many chemically non-aggressive foreign bodies by non-surgical removal of the cornea from the eye is characterized by epicorneal coating of the entire damaged surface of the cornea with a flap on the feeding leg from the tenon capsule of the damaged eye, taken in the region of the upper straight line muscles that provide not only mechanical protection of the damaged cornea, but also the prevention of infection of wounds. The powerful sorption, phagocytic, enzymatic, anti-inflammatory and trophic effects of the flap on pathological processes in the cornea contribute to their rapid relief and restoration of the cornea of the eye.

Against this background, thanks to the enzymatic-sorption effect of the flap, non-inflammatory elimination of foreign bodies through uninfected own wound channels occurs. In this case, almost no turbidity remains. Non-eliminated foreign bodies remain intact in the cornea of the eye. A tenon flap is removed from the cornea of the eye after an average of 10-12 days, depending on the severity of the injury.

An analysis of long-term results showed the stability of the cornea and the lack of progression of opacities in the areas where foreign bodies occur.

Thus, the above information indicates the possibility of implementing the claimed invention.

Auto material is available, the method is simple to execute and can be performed in any eye department.

The method recommended in the claimed invention is intended for use in medicine, namely in ophthalmology.

Bibliography

1. B.L. Polyak. Unworn wounds with foreign bodies in the cornea and sclera. Damage to the organ of vision. Medicine, 1972, p. 47-54.

2. L.A. Dymshyts, M.B. Emergency eye care. - L .: Medicine, 1966, p. 74-78.

3. V.A.Shaimova. Purulent corneal ulcer. New in Ophthalmology, 2001; No. 4, p. 34-36.

4. Peter K., Kayzer A. Comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Ophthalmology, 1995; 102 (12): 1936-1942.

Claims (1)

A method of treating combined lesions of the cornea of the eye with multiple chemically non-aggressive foreign bodies by non-surgical removal of them from the cornea of the eye, characterized in that by epicorneal coating of the entire damaged surface of the cornea of the eye with a flap on the feeding leg from the tenon capsule of the damaged eye, taken from the intact zone in the region of the upper straight line muscles provide biological elimination of foreign bodies from the cornea.