RU2421200C1 - Method of removal of iris pupil tumour - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology, namely to ophthalmo-oncology, and aims at removal of an iris pupil tumour. It involves a self-sealing tunnel cut 3-5 mm long from an opposite side from the tumour and an additional auxiliary paracentesis. The tumour is excised through the tunnel cut, a spatula is delivered behind it, and a tunnel cut opening is increased immediately; then a pressurised viscoelastic is introduced through the paracentesis, and the tumour is washed out through the tunnel cut. If the length of the tunnel cut exceeds 4 mm, 1 interrupted suture is applied.

EFFECT: method allows reducing injures of a cornea, tissues of an anterior segment, relieving postoperative corneal astigmatism, ensuring higher accuracy of surgical manipulations due to better visual control, and creating an approach more convenient for a surgeon, and also reaching early rehabilitation of the patients with better functional outcomes.

2 cl, 2 ex

Description

The present invention relates to ophthalmology, namely to ophthalmology, and is intended to remove a tumor of the pupil edge of the iris.

According to different authors, tumors of the iridociliary zone comprise from 20 to 40% of all tumors of the uveal tract.

A known method of treating a tumor of the pupil edge of the iris by local excision of the neoplasm (block excision) is used, including the corneoscleral approach to remove isolated neoplasms of the iris.

There are various methods for making an incision to ensure optimal access for excision of a tumor in the iridociliary zone: corneoscleral, scleral, corneal. The choice of method depends on the location and volume of education. So, to remove an iris tumor, a limb incision is traditionally used along the meridians corresponding to the location of the tumor. It should be noted that most tumors of the iridociliary zone are localized in the lower half of the iris, leading to technical difficulties in performing the operation.

The closest analogue of the proposed method is a method of the same purpose, including the removal of an iris tumor through a corneal incision along the limb, the localization of which corresponds to the location of the tumor. After that, the tumor is excised within the limits of healthy tissues and a continuous suture is applied to the edges of the limbal section of the cornea [Lineik L.F. Organ-preserving operations for vascular tract tumors, ophthalmological journal, 1977, No. 8, pp. 572-576].

However, this method has disadvantages. This is an inconvenient access for the surgeon, since tumors of the iris are in most cases localized in the lower half. Surgical trauma to the cornea also occurs, since in order to ensure full access to excise the tumor, the corneal incision should significantly exceed the size of the tumor, which causes long-term corneal edema in the postoperative period. At the same time, the nodal sutures do not always provide complete sealing of the wound, and therefore there is an outflow of intraocular fluid through the incision, leading to hypotension in the early postoperative period and displacement of the iridocrystal block anteriorly, further closing the anterior chamber angle and subsequently developing to intraocular hypertension.

Scope of operation, multiple and large incisions cause long, sluggish uveitis, leading to the formation of iridocrystalline synechiae.

Due to intraoperative deformation of the cornea in the postoperative period, corneal astigmatism is observed, exacerbated by the imposition of a large number of nodular corneal sutures, the frequency and degree of astigmatism being higher, the closer the incision is formed to the limbus. This significantly reduces visual acuity, and spectacle correction of astigmatism in most cases is intolerable to patients.

The method affects the lengthening of postoperative rehabilitation of patients and reduces its functional outcome.

The task of the invention is to develop a new access for removal of a tumor of the pupil edge of the iris.

The technical result of the proposed method is to reduce trauma to the cornea, tissues of the anterior segment of the eye, postoperative corneal astigmatism, increase the accuracy of surgical procedures due to better visual control and create a more convenient access for the surgeon, as well as early rehabilitation of patients with better functional outcomes.

The technical result is achieved through the use of a small corneal tunnel incision with an additional corneal paracentesis on the opposite side of the tumor, as well as through the use of viscoelastic to wash out the excised tumor from the anterior chamber.

Using access in the upper limb, since most tumors of the iris are located in the lower limb, is more technically convenient for the surgeon. The use of viscoelastic to maintain the volume of the anterior chamber and the absence of the need to raise the corneal flap provide the best conditions for visual monitoring of surgical procedures.

The use of small sections of the cornea, which do not require suturing, and, as a result, a reduction in the duration of the operation, reduce trauma to the cornea and tissues of the anterior segment.

The decrease in the degree of postoperative corneal astigmatism is a consequence of a small section of the cornea, and, accordingly, a smaller change in the curvature of the cornea.

Faster rehabilitation and better functional results are achieved due to a decrease in the duration of the operation, inflammatory reactions after the operation and a decrease in postoperative astigmatism.

The method is as follows.

1. A corneal tunnel incision is made, which is formed on the side opposite to the tumor. The length of the cut depends on the size of the formation and ranges from 3 to 5 mm.

2. Through a tunnel incision, viscoelastic is introduced into the anterior chamber to maintain the anterior chamber volume, then a tumor with a supply of healthy tissues is excised through the tunnel incision with collet scissors, fixing the iris with collet forceps through a paracentesis incision. If necessary, an additional viscoelastic is introduced into the anterior chamber.

3. After excision of the tumor, a spatula is inserted into the tunnel incision, the lower plane of which squeezes the inner corneal flap to increase the clearance of the tunnel incision. Through paracentesis, on the opposite side of the tunnel incision, viscoelastic is introduced into the anterior chamber, due to increased pressure in the anterior chamber, the tumor is washed out through the tunnel incision along the spatula.

4. On the pupil edge of the iris, as is customary, sutures are applied to restore the diaphragmatic function of the pupil.

The invention is illustrated by examples.

Example 1

Patient P., 71 years old.

Diagnosis of the left eye: a tumor of the pupil edge of the iris.

Objectively: in the zone of the lower pupillary margin along the meridians of 5-7 hours there is a tumor.

An iridectomy operation was performed according to our method using a tunnel incision at 11-12 hours 3 mm long and the introduction of viscoelastic into the anterior chamber to remove the excised tumor from the anterior chamber. The round shape of the pupil is restored by applying 1 nodal suture. The wound is sealed. Under the conjunctiva, a combination of antibiotic and anti-inflammatory drug solutions was injected.

Histological diagnosis: iris leiomyoma.

On the first day after the operation, slight corneal edema was noted in the area of the tunnel incision, which significantly decreased already on the third day after the operation. There was a lack of planned complications. On the 5th day the patient was discharged from the hospital.

3 months after surgery:

Visual acuity was 0.8 with a correction of cyl-0.75 = 1.0

The cornea is transparent.

Example 2

Patient S., 65 years old.

The diagnosis of the right eye: a tumor of the pupil edge of the iris.

Objectively: along the meridians of 6-8 hours, there is a neoplasm in the area of the pupil edge of the iris.

An iridectomy operation was performed according to our method using a tunnel incision at 12-13 hours 4 mm long and the introduction of viscoelastic into the anterior chamber to remove the excised tumor from the anterior chamber. The round shape of the pupil is restored by applying 1 nodal suture. The wound is sealed with intrastromal administration of saline.

Histological diagnosis: iris leiomyoma.

On the first day after the operation, there was a slight swelling of the cornea in the area of the tunnel incision. 3 days after the operation, a transparent cornea with no signs of edema is objectively observed, on the 5th day the patient was discharged from the hospital.

3 months after surgery:

Visual acuity was 0.8 with a correction of cyl-1,0 = 1,0

The cornea is transparent.

Thus, in the above examples, the application of the proposed method allowed to carry out operations with less trauma and significantly reduce the postoperative period due to a less pronounced inflammatory reaction and faster rehabilitation, as well as to obtain minimal corneal astigmatism.

Claims (2)

1. A method for removing a tumor of the pupil edge of the iris, characterized in that a 3-5 mm long self-sealing tunnel incision is made from the side opposite to the tumor and an additional auxiliary paracentesis, the tumor is excised through the tunnel incision and a spatula is brought in with a simultaneous increase in the clearance of the tunnel incision, then, through paracentesis, viscoelastic is injected under pressure and the tumor is washed out through the tunnel incision. 2. The method according to claim 1, characterized in that when the length of the tunnel section is more than 4 mm, 1 nodal suture is applied to it.