RU2308918C1 - Method for surgical treatment of thrombosis of central retinal vein - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with carrying out vitrectomy, removing posterior hyaloid membrane and internal boundary retinal membrane in macular area followed by tamponade of vitreous cavity with perfluoroorganic compound (PFOC). Radial optic neurotomy (RON) should be carried out from nasal side of optic nerve's disk in vessel-free area. After that one should intravitreously fulfill panretinal lasercoagulation being beyond the limits of vascular arcades. Then it is necessary to intravitreously irradiate central and paracentral retinal areas with low-intensity laser radiation (LILR) at wave length ranged 632-633 nm, power of 5 mW at light guide's edge at total period of irradiation ranged 5-10 min. Then PFOC should be substituted for gas. The innovation in question enables to achieve rapid and stable reconstruction of hemodynamic values, resolution of hemorrhages, decreased retinal edema, stable and prolonged improvement in acuity and electroretinography values and wider field of vision.

EFFECT: higher efficiency of therapy.

1 cl, 2 ex

Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used for the surgical treatment of thrombosis of the central retinal vein (CVS).

A known method of surgical treatment of thrombosis of the central retinal vein (RF patent 2235529), including performing vitrectomy, removal of the posterior hyaloid membrane, radial optical neurotomy (RON).

The specified method makes it possible to quickly restore venous outflow, but it is not aimed at improving blood flow in the small vessels of the retina and choroid and does not allow to effectively combat the formation of ischemic zones that are the initiators of neovascularization.

The objective of the invention is to provide an effective method for the surgical treatment of CVT thrombosis.

The technical result of the proposed method is a quick and stable restoration of hemodynamic parameters, resorption of hemorrhages and resorption of retinal edema, persistent improvement of functional results: visual acuity, visual field, electroretinography indicators. The technical result is achieved due to the fact that:

1. vitrectomy can enhance retinal oxygenation by circulating in the vitreous cavity a fluid that is saturated with oxygen from the choroid and ciliary body;

2. removal of the posterior hyaloid membrane enhances the oxygenation effect of vitrectomy;

3. removal of the internal border membrane (VPM) in the macular region prevents the appearance of tangential traction of VPM;

4. the introduction of gas into the vitreous cavity increases the diffusion of oxygen from the choroid through the retina.

All these measures (1-4) can reduce retinal ischemia.

5. RON leads to the rapid restoration of venous outflow;

6. panretinal laser coagulation outside the vascular arcades prevents the development of secondary neovascular glaucoma;

7. subsequent intravitreal irradiation of the central and paracentral zone of the retina with low-intensity laser radiation (LLLT) with a wavelength of 632-633 nm, a power of 5 mW at the fiber end, with a total irradiation time of 5-10 minutes, improves blood flow in small vessels of the retina and choroid, which contributes to rapid resorption of hemorrhages, resorption of retinal edema and improved functional results.

The claimed technical result can be obtained only by using the totality of the techniques proposed by us method.

The method is as follows.

At the preparatory stage, the surgical field is treated, standard anesthetic management is performed. Sclerectomy sections are performed, vitrectomy is performed, the posterior hyaloid membrane, the inner border membrane in the macular region are removed, the vitreous cavity is swabbed with organo perfluorinated compound (PFOS), and RON is performed on the nasal side of the optic nerve disc in the avascular zone. Then, intravitreal panretinal laser coagulation is performed outside the vascular arcades. After that, the central and paracentral zones of the LLLT retina with a wavelength of 632-633 nm, a power of 5 mW at the end of the fiber, are intravitreally irradiated, with a total irradiation time of 5-10 minutes. At the end of the operation, PFOS is replaced with gas.

Intravitreal irradiation of the central and paracentral zone of the retina of the LLLT is carried out either by the scanning method, or by laser radiation fields with a diameter of 3 mm on the retina, with the neighboring fields overlapping 5% of the area.

The invention is illustrated by the following examples.

Example 1. Patient C., 63 years old. He entered the Kaluga branch of the Federal State Institution IRTC "Eye Microsurgery" with a diagnosis of central retinal vein thrombosis of the left eye. The duration of the disease is about 3 weeks.

OS visual acuity at admission is 0.01 n / k. Ophthalmoscopically on OS - a picture of complete CVC thrombosis: blurring of the boundaries of the optic disc, sharp tortuosity and plethora of veins, multiple hemorrhages and severe diffuse retinal edema in the central region with the spread of vascular arcades to the region.

According to optical coherence tomography (OCT), the thickness of the retina in the central region was 560 μm.

Ultrasound examination of the vessels of the eyeball (OS) in duplex scanning with color Doppler mapping obtained the following data: Vps - 8.1 cm / s; Ved - 1.0 cm / s; RI 0.88; PI - 1.89.

The patient is treated according to the proposed method.

After RON, panretinal laser coagulation was performed intravitreal beyond the vascular arcades. Then, the central and paracentral zones of the LLLT retina were irradiated intravitreal with a total exposure time of 5 minutes. At the end of the operation, PFOS was replaced by gas.

1 month after surgery, visual acuity on OS increased to 0.05 n / a. On the fundus was observed almost complete resorption of edema of the retina and a significant reduction in the number of hemorrhages.

OCT in dynamics revealed a decrease in retinal thickness to 240 μm in the central region.

According to the ERG data, the OS recorded an increase in the amplitude characteristics of wave-a from 4.7 to 6.3 μW and wave-b from 19.8 to 24.4 μW, compared with the preoperative level.

Upon repeated ultrasound examination 1 month after the operation, the following data were obtained: Vps - 18.3 cm / s; Ved - 7.0 cm / s; RI 0.62; PI is 1.24.

During the observation period of up to 2 years, the patient's condition in terms of visual acuity, field of view, electroretinography, and hemodynamic parameters remained stable.

Example 2. Patient K., 74 years old. When contacting the Kaluga branch of the Federal State Institution IRTC “Eye Microsurgery”, thrombosis of the central retinal vein of the right eye was diagnosed. The period from the onset of symptoms to entry is about 2 weeks.

On admission: visual acuity OD - 0.03 n / a. On the fundus OD - complete thrombosis of the CVS trunk: the boundaries of the optic nerve disc are stained, retinal veins sharply convoluted and dilated, multiple retinal hemorrhages, cystic retinal edema in the macular region.

According to OCT, the thickness of the retina in the central region was 525 μm.

An ultrasound examination of the vessels of the eyeball (OD) (in the duplex scanning mode with CDC) obtained the following data: Vps - 10.8 cm / s; Ved - 2.2 cm / s; RI 0.80; PI is 1.86.

The patient was treated according to the proposed method.

After RON, panretinal laser coagulation was performed intravitreal beyond the vascular arcades. Then, the central and paracentral zones of the LLLT retina were irradiated intravitreal with a total exposure time of 10 minutes. At the end of the operation, PFOS was replaced by gas.

4 weeks after the surgical treatment, a positive trend was noted. Visual acuity increased to 0.1 in the operated eye. On the fundus there was a significant decrease in retinal edema, resorption of retinal hemorrhages.

The thickness of the retina in the central region decreased to 260 μm. ERG on OD in dynamics - an increase in the amplitude characteristics of wave-a from 4.2 to 5.1 μW and wave-b from 15.6 to 22.3 μW compared to the initial level.

Upon repeated ultrasound examination 4 weeks after the operation, the following data were obtained: Vps - 16.9 cm / s; Ved - 6.8 cm / s; RI 0.60; PI - 1.20.

During the observation period of up to 1 year, the patient's condition in terms of visual acuity, field of view, electroretinography, and hemodynamic parameters remained stable.

The proposed method treated 15 patients with CVC thrombosis. In all cases, the claimed technical result is achieved.

The effectiveness of the claimed method in relation to hemodynamic parameters of the eye is additionally illustrated by the following data. In the Kaluga branch of FGU MNTK "MG" 13 patients with CVC thrombosis underwent surgical treatment, which differs from the proposed method by the absence of intravitreal irradiation of the central and paracentral zone of the retina. When comparing the obtained results, a statistically significant longer stabilization of the volumetric blood flow velocity was observed in patients who underwent intravitreal irradiation of the LLLT at the time of 6 and 12 months after surgery (p <0.001).

Thus, the inventive method provides a quick recovery of hemodynamic parameters, their long-term stabilization, resorption of hemorrhages and resorption of retinal edema, persistent improvement of functional results: visual acuity, visual field, electroretinography indicators.

Claims (2)

1. A method of surgical treatment of central retinal vein thrombosis, including vitrectomy, removal of the posterior hyaloid membrane, radial optical neurotomy (RON), characterized in that before the RON, the inner border membrane is removed in the macular region, tamponade of the vitreous cavity with organofluorine compound (PFOS) is performed, and after RON, panretinal laser coagulation is performed intravitreal outside the vascular arcades, then the central and paracentral zones of the set are intravitreal irradiated atki low intensity laser radiation (LLLT) with a wavelength of 632-633 nm, 5 mW at the fiber end, the total exposure time of 5-10 minutes, after which PFOS replaced by gas. 2. The method according to claim 1, characterized in that the intravitreal irradiation of the LLLT is performed either by scanning, or by fields with overlapping adjacent fields on 5% of the area.