RU2845779C1 - Method for removal of new growths of iridociliochoroidal zone - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. New growths of an iridociliochoroidal region are removed; the first stage involves transscleral cryopexy of retina and choroid at 2 mm from the tumour borders. Second stage involves subtotal vitrectomy, and the vitreal cavity is filled with a perfluoroorganic compound. At the third stage, sclera is incised by 2/3 of its thickness at 2 mm from tumour borders, and a scleral flap is formed. Tumour centre is removed from the underlying sclera. At the fourth stage, the perfluororganic compound is removed from the vitreal cavity with subsequent endotamponade with silicone oil.

EFFECT: method enables removing large irido-cilio-choroidal neoplasms with preventing intraoperative complications.

1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used for surgical removal of large neoplasms of the iridociliochoroidal zone.

The proposed method for removing neoplasms of the iridociliochoroidal zone combines for the first time four known and widely used in clinical practice surgical techniques. The combination of these techniques is described for the first time. The first stage - cryopexy of the retina and choroid during resection of tumors of the iridociliary zone has been known for a long time (Linnik L.F. Surgical treatment of neoplasms of the iridociliary region: Dis. of Doctor of Medical Sciences. - Orenburg, 1970).

The second and fourth stages are the basis of vitreous surgery and are used in the treatment of retinal detachment (RU 2635487 C1, 11/13/2017; RU 2823761 C1, 07/29/2024), and have not been previously described as a stage of tumor removal.

The third stage - tumor removal - has been described by many authors in various modifications (Linnik L.F. Surgical tactics for removing vascular tract tumors. Ophthalmosurgery, 2004, No. 4. - P. 17-22; Damato B.E. Local resection of uveal melanoma. Dev Ophthalmol. 2012). All authors note the following intraoperative complications: vitreous prolapse, bleeding into the vitreous cavity, retinal and choroidal detachment, bleeding. In order to prevent complications, we have developed a method for multi-stage surgical removal of neoplasms of the iridociliochoroidal zone.

The objective of the proposed invention is to perform four stages of surgical intervention, the combination of which leads to the implementation of a technical result - the prevention of intraoperative complications.

The technical result is achieved by the fact that at the first (preparatory) stage, cryopexy of the retina and choroid is performed; at the second - subtotal vitrectomy with endotamponade with a perfluoroorganic compound (PFOC); at the third - block excision of the tumor; at the fourth - removal of PFOC from the vitreous cavity with subsequent endotamponade with silicone oil 1.02 g/cm ³ .

The method is carried out as follows. Operations are carried out under the control of an operating microscope. The second stage is carried out under general anesthesia, the remaining stages under local anesthesia with intravenous administration of painkillers.

The first stage is cryopexy of the retina and choroid - an incision and separation of the conjunctiva in the projection of the tumor is performed. Then, diaphanoscopy and marking of the tumor borders are performed, retreating from the intended borders by 2 mm, cryocoagulants are applied transsclerally. Subsequent stages are performed 3-4 weeks after cryopexy. This period is optimal for the formation of strong chorioretinal adhesions.

At the second stage - subtotal vitrectomy with PFOC endotamponade - three 25 G ports are installed with trocars 3.5-4 mm from the limbus in a self-sealing (biplane) manner: two ports for surgical instruments and one for a cannula with balanced irrigation saline solution. The ports are installed in the tumor-free zone (determined by diaphanoscopy). Then, using a vitreotome, subtotal vitrectomy is performed, the frequency is 8000-10000 cuts per minute, the vacuum is 650 mm Hg, the vitreous cavity is filled with PFOC. The operation is completed by removing the ports and applying transconjunctival scleral interrupted sutures 8-00 Vicryl to the areas of their installation.

At the third stage, after the incision and separation of the conjunctiva, the surgical resection boundaries are marked under transillumination, retreating 2 mm from the tumor boundaries. The sclera is incised 2/3 of its thickness along the marked boundaries and a scleral flap is formed. The tumor focus is removed with the underlying part of the sclera. If necessary, the loss of PFOS is replenished to normal eyeball tone. The operation is completed by suturing the scleral wound and conjunctiva. A subconjunctival injection of 0.2 ml of dexamethasone and 0.2 ml of antibiotic is administered. A monocular bandage is applied.

The fourth stage - removal of PFOC from the vitreous cavity with subsequent endotamponade with silicone oil - is performed one week after the third stage. First, phacoemulsification with implantation of an intraocular lens is performed. Then, three 25 G ports are installed with trocars 3.5-4 mm from the limbus in a self-sealing (biplane) manner: two ports for surgical instruments and one for a cannula with the supply of a balanced irrigation saline solution. The ports are installed in areas close to those where the ports were installed in the second stage. PFOC is removed from the vitreous cavity and filled with 1.02 g/cm ³ silicone oil. The operation is completed by removing the ports and applying transconjunctival scleral interrupted sutures of 8-00 Vicryl to the areas of their installation. A subconjunctival injection of 0.2 ml dexamethasone and 0.2 ml antibiotic is given. A monocular bandage is applied.

The method is illustrated by the following clinical examples.

Clinical example #1

Patient L., 15 years old, notes the appearance of a "curtain" in front of the right eye. When contacting the Scientific and Technical Complex of the Moscow City Hospital, ophthalmoscopy in the outer section visualizes the edge of a large, dark-colored intraocular tumor.

According to UBM and B-scan of the right eye: in the outer segment, an intraocular formation of the ciliary body is determined, extending to the root of the iris and choroid, protruding into the vitreous body, contacting the lens, up to 9.7 mm high, up to 9.1 mm long. Visual acuity OD: 0.9.

Diagnosis: OD Melanoma of the iris, ciliary body and choroid (T3NoMo).

The patient was recommended to undergo organ-preserving treatment by means of multi-stage surgical intervention with block excision of neoplasms of the iridociliochoroidal zone.

The operation was performed in accordance with the described technology.

There were no complications during the operation or in the postoperative period. Visual acuity after the operation 2 years later OD: 1.0. Ophthalmoscopically and according to B-scan data, no tumor recurrence was noted, complete anatomical attachment of the retina.

Clinical example #2

Patient V., 44, notes decreased vision in her right eye. When she visited the Moscow Scientific and Technical Complex of the Moscow City Hospital, biomicroscopy revealed a pigmented lesion in the lower outer section at the root of the iris, and the edge of a dark-colored intraocular tumor was visualized behind the lens; ophthalmoscopy in the same section revealed the edge of a large intraocular tumor.

According to UBM and B-scan of the right eye: in the lower outer segment, an intraocular formation of the iris, ciliary body and choroid is determined, protruding into the vitreous body, contacting the lens, up to 7.2 mm high, up to 12 mm long. Visual acuity OD: 0.5.

Diagnosis: OD Melanoma of the iris, ciliary body and choroid (T3NoMo).

The patient was recommended to undergo organ-preserving treatment by means of multi-stage surgical intervention with block excision of neoplasms of the iridociliochoroidal zone.

The operation was performed in accordance with the described technology.

There were no complications during the operation or in the postoperative period. Visual acuity after the operation after 7 months OD: 0.3. Ophthalmoscopically and according to B-scan data, no tumor recurrence was noted, complete anatomical attachment of the retina.

Claims (1)

A method for removing neoplasms of the iridociliochoroidal zone, characterized by the fact that at the first stage, transscleral cryopexy of the retina and choroid is performed, retreating 2 mm from the tumor borders; at the second stage, subtotal vitrectomy is performed, the vitreous cavity is filled with a perfluororganic compound; at the third stage, an incision is made in the sclera by 2/3 of its thickness, retreating 2 mm from the tumor borders, and a scleral flap is formed; the tumor focus is removed with the underlying part of the sclera; at the fourth stage, the perfluororganic compound is removed from the vitreous cavity with subsequent endotamponade with silicone oil.