RU2784955C1 - Method for implanting an orbital spherical implant and a device for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions group relates to medicine, namely to ophthalmology. The diameter of the orbital spherical implant is determined preoperatively. Then enucleation is performed, the implant is immersed into the orbit. Next, the device is installed with a concave surface to the implant. Then, exophthalmometry is performed, while focusing on the protrusion on the front surface of the device, the level of protrusion of the device relative to the fellow eye is determined. Next, the implant is moved either posteriorly or anteriorly until a level of symmetry with the fellow eye is reached, after which the device is removed. Then two opposite extraocular rectus muscles are fixed to the surface of the implant or to the material in which the implant is wrapped. Next, the device is re-installed, then repeated exophthalmometry is performed to determine the level of protrusion of the device, with the implant moving either posteriorly or anteriorly until a level of symmetry with the fellow eye is reached. Next, the remaining two rectus muscles are fixed to the implant, and the device is reinstalled. Then, exophthalmometry is performed to determine the level of protrusion, and if the level is different, the two muscles that are fixed last are released, and the position of the implant is corrected. The specified sequence of actions with the installation and removal of the device, as well as with fixation and unfixation of the two muscles, fixed last, is repeated until the device is symmetrical in relation to the fellow eye, at the end of the operation, the conjunctiva and Tenon's membrane are sutured in layers. This method is carried out using the original device.

EFFECT: inventions group makes it possible to ensure the immersion of the implant to the required depth, the achievement of symmetry in the standing of the paired eyeball and the external prosthesis, and to reduce the severity of the anophthalmic syndrome.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used to determine the depth of the implant in the orbit.

Often, enucleation becomes the only possible treatment for diseases such as uveal melanoma in adults and retinoblastoma in children. Orbital arthroplasty can reduce the manifestations of anophthalmic syndrome and stimulate the growth of the orbit in children. Cosmetic results may vary when using implants of the same size in similar clinical situations. This is primarily affected by the depth of the implant in the orbit, as well as the selected external prosthesis: its shape, thickness, material. The literature does not describe a method for determining the depth of the implant in the orbit.

The objective of the invention is to develop a method for determining the location of the implant in the orbit and a device for compensating the thickness of the anterior wall of the musculoskeletal stump and the external ocular prosthesis.

The technical result of the method and device for its use is to ensure the immersion of the implant to the required depth, to achieve symmetry in the standing of the paired eyeball and the external prosthesis, to reduce the severity of the anophthalmic syndrome.

The technical result of the device is achieved by the fact that the device is a compensator made of transparent polymethyl methacrylate, having the form of a convex-concave lens and facing the concave part back. At the top, a protrusion 0.3 mm high is made, which must be guided during exophthalmometry. The concave surface has a radius of curvature corresponding to the curvature of the orbital spherical implant. The anterior surface has an average radius of curvature of the cornea and is 7.5 mm. The diameter of the device is 12 mm. The thickness of the device is 6.1 mm, which was determined empirically. To do this, the thickness of three different groups of 60 external prostheses was measured: thin-walled, thick-walled and children's. As a result, the average thickness of the prosthesis was obtained, which was 4.8 mm. Also, using ultrasonic biomicroscopy, the thickness of the anterior wall of the musculoskeletal stump of 20 people was calculated, its average thickness was 1.3 mm. By summing these values, the average thickness of the device was obtained, which was 6.1 mm.

The technical result of the method is achieved by the fact that when planning the operation before the operation, the size of the implant is determined. Enucleation of the eyeball is performed according to the protocol. The implant is immersed in the orbit, then the device is installed with a concave surface to the implant, then exophthalmometry is performed. Focusing on the protrusion on its front surface, the level of protrusion of the device relative to the fellow eye is determined, and if the level is different, then the implant is immersed either posteriorly or anteriorly. Next, the device is removed. Then two opposite extraocular rectus muscles are fixed to the surface of the implant or to the material in which the implant is wrapped. Next, the device is installed, then exophthalmometry is performed. Focusing on the protrusion on its front surface, the level of protrusion of the device relative to the fellow eye is determined, and if the level is different, then the implant is immersed either posteriorly or anteriorly.

Next, the remaining two rectus muscles are fixed to the implant. Next, the device is reinstalled, then exophthalmometry is performed. Focusing on the protrusion on its front surface, the level of protrusion of the device relative to the fellow eye is determined, and if the level is different, the last two muscles are released and the implant is immersed either posteriorly or anteriorly. The specified sequence of actions with the installation and removal of the device is repeated until the device is symmetrical with respect to the fellow eye. At the end of the operation, the conjunctiva and Tenon's membrane are sutured in layers.

The device is illustrated by the following graphic material:

In FIG. 1. shows the device in section, position 1 indicates the protrusion.

In FIG. 2. Top view.

The claimed technical result can only be obtained by using the totality of the proposed method and device for its use.

The method and device are used as follows: The first step is the processing of the surgical field. The conjunctiva is incised with conjunctival scissors along the entire circumference of the cornea, together with the Tenon membrane, is bluntly separated from the sclera.

Four rectus muscles are sequentially isolated using muscle hooks, stitched with a Polyester 5-0 ligature suture, their tendons are cut off from the eyeball with conjunctival scissors. The eye is pulled up by the sutures of the holder on the tendons of the severed rectus muscles. Through the use of eyelid lifters, the eyeball is dislocated, enucleation scissors are inserted behind the eye from the nasal side, and a neurectomy is performed. Hemostasis. The implant is placed in the muscle funnel. The device is placed on the front surface of the implant. Intraoperative exophthalmometry is performed, then the level of protrusion of the device relative to the fellow eye is determined, if the level is different, then the depth of immersion of the implant is adjusted anteriorly or deeper. Next, two opposite extraocular rectus muscles are fixed to the surface of the implant or its wrapped material. Under the control of an exaftholmemeter, the symmetry of the protrusion of the device relative to the level of protrusion of the fellow eye is evaluated. Next, the two remaining rectus muscles are fixed and control exophthalmometry is performed.

Tenon's sheath and conjunctiva were sutured sequentially with a continuous 6-0 vicryl suture.

The invention is illustrated by the following examples.

Example 1: Patient K., age 55 years. Diagnosed with melanoma of the choroid (T3N0M0), enucleation of the right eye is indicated. There are no contraindications for primary orbital arthroplasty. The diameter of the orbital implant was determined, which was 18 mm. The concave surface of the device has a radius of curvature of 9 mm. Next, the operation was performed according to the claimed method using the claimed device. The enucleation of the eyeball was performed, the implant was immersed into the orbit. Next, the device was installed with a concave surface to the implant, then exophthalmometry was performed, focusing on the protrusion on the front surface of the device, the level of protrusion of the device relative to the fellow eye was determined, obtaining the results of the left eye - 15, the right prosthetic eye with the device - 12. Then the implant was immersed anteriorly to achieving a level of symmetry with the fellow eye. After that, the device was removed and two opposite extraocular rectus muscles were fixed to the surface of the implant. The device was reinstalled and repeated exophthalmometry was performed to determine the protrusion level of the device, obtaining the results of the left eye - 15, the right prosthetic eye with the device - 15, then the remaining two rectus muscles were fixed to the implant, the device was reinstalled, then exophthalmometry was performed to determine the protrusion level, obtaining the results of the left eye - 15, the right prosthetic eye with the device - 13, performed unfixation of the two muscles, fixed last, by adjusting the position of the implant. Then exophthalmometry was performed to determine the level of protrusion, having received the results of the left eye - 15, the right prosthetic eye with the device - 15. The muscles were fixed. After the suturing of the muscles was completed, the final intraoperative exophthalmometry was performed: the left eye - 15, the right prosthetic eye with the device - 15. The device was removed. Tenon's membrane and conjunctiva were sutured in layers. The patient was discharged after 5 days.

At the control appointment after 3 months - a state without negative dynamics. According to the result of exophthalmometry: the left eye - 15, the prosthetic eye -15.

Example 2: Patient N., age 2 years. The diagnosis was made: (Retinoblastoma, T2cN0M0, group E), enucleation of the right eye was indicated. There are no contraindications for primary orbital arthroplasty.

The diameter of the orbital implant was determined, which was 17 mm. The concave surface of the device has a radius of curvature of 8.5 mm. Next, the operation was performed according to the claimed method using the claimed device. The enucleation of the eyeball was performed, the implant was immersed into the orbit. Next, the device was installed with a concave surface to the implant, then exophthalmometry was performed, focusing on the protrusion on the front surface of the device, the level of protrusion of the device relative to the fellow eye was determined, obtaining the results of the left eye - 12, the right prosthetic eye with the device - 12. After that, the device was removed and fixed two opposite extraocular rectus muscles to the lavsan mesh in which the implant was wrapped. The device was again installed and repeated exophthalmometry was performed to determine the level of device protrusion, obtaining the results of the left eye - 12, the right prosthetic eye with the device - 12, then the remaining two rectus muscles were fixed to the implant, the device was re-installed, then exophthalmometry was performed to determine the level of protrusion, obtaining the results of the left eye - 12, the right prosthetic eye with the device - 12. Tenon's membrane and conjunctiva were sutured in layers. The patient was discharged after 5 days.

At the control appointment after 2 months - a state without negative dynamics. According to the result of exophthalmometry: the left eye - 12, the prosthetic eye - 12.

Claims (2)

1. A method for implanting an eye prosthesis into the orbit, including preoperative determination of the diameter of the orbital spherical implant, then enucleation is performed, the implant is immersed into the orbit, then the device according to claim 2 is installed with the concave surface to the implant, then exophthalmometry is performed, while focusing on the protrusion on the front surface of the device, determine the level of protrusion of the device relative to the fellow eye, then the implant is moved either posteriorly or anteriorly until a level of symmetry with the fellow eye is reached, after that the device is removed, then two opposite extraocular rectus muscles are fixed to the surface of the implant or to the material in which the implant is wrapped , then the device is re-installed, then repeated exophthalmometry is performed to determine the level of protrusion of the device, with the implant either posteriorly or anteriorly until the level of symmetry with the fellow eye is reached, then the remaining two rectus muscles are fixed to the implant, the device is re-installed , then exophthalmometry is performed to determine the level of protrusion, and if the level is different, the two muscles that are fixed last are released, and the position of the implant is corrected; the specified sequence of actions with installing and removing the device, as well as fixing and unfixing the two muscles fixed last, is repeated until the device is symmetrical in relation to the fellow eye, at the end of the operation, the conjunctiva and Tenon's membrane are sutured in layers. 2. A device for implanting an eye prosthesis into the orbit, made of polymethyl methacrylate and having a convex-concave shape in the form of a lens, while the concave surface is facing backwards, and at the top of the anterior convex surface there is a protrusion 0.3 mm high, the concave surface has a radius of curvature, corresponding to the curvature of the orbital spherical implant, the convex surface has a radius of curvature corresponding to the curvature of the cornea, the diameter of the device is 12 mm, the thickness of the device is 6.1 mm.

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