RU2850620C1 - Method of treating patients with regmatogenic retinal detachment - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used to treat patients with rhegmatogenous retinal detachment. To do this, a 25G posterior closed vitrectomy is performed. A perfluoroorganic compound is injected into the vitreous cavity. Subretinal fluid is aspirated through the peripheral retinal tear using a vitreotome. Next, the internal limiting membrane is contrasted using a dye in the projection of the peripheral tear. The membrane is peeled to an area twice the diameter of the tear. Endolaser coagulation is performed along the edge of the tear using forceps. The perfluoroorganic compound is removed. The vitreous cavity is tamponaded with sterile air, followed by the introduction of silicone oil. An antibiotic solution is injected under the conjunctiva. A sterile bandage is applied.

EFFECT: invention allows the retina to be mobilised, tangential tension to be reduced, and a more reliable and anatomically correct fit of the retina in the tear projection to be achieved, significantly reducing the risk of recurrence.

1 cl, 1 ex

Description

The invention relates to the field of medicine, namely to ophthalmology, and can be used to treat patients with rhegmatogenous retinal detachment.

It is known that the development of this disease is caused by the formation of a retinal break, which allows vitreous fluid to accumulate between the neurosensory layers and the retinal pigment epithelium, requiring surgical treatment. Accordingly, the surgeon's primary goal is to close the break by creating a chorioretinal adhesion in the defect area. Various methods are currently used to create adhesions in the projection of the retinal break, including endolaser coagulation, cryocoagulation, and transpupillary laser coagulation of the retina. Studies have shown that retinal detachment surgery is accompanied by peeling of the internal limiting membrane to prevent epiretinal membrane proliferation, which can lead to decreased vision in the postoperative period. (Chen G, Tzekov R, Fang Y, Tong Y, Li W. Internal limiting membrane peeling in rhegmatogenous retinal detachment: A meta-analysis. PLoS One. 2024 Mar 15; 19(3):e0297230. doi: 10.1371/journal.pone.0297230. PMID: 38489304; PMCID: PMC10942048). In one study, visual impairment due to epiretinal membrane growth after retinal detachment repair was completely prevented by internal limiting membrane peeling in approximately 30% of cases selected for the presence of superficial retinal wrinkling. Akiyama K, Fujinami K, Watanabe K, Matsuki T, Tsunoda K, Noda T. RETINAL SURFACE WRINKLING AS AN INDICATOR FOR INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR RETINAL DETACHMENT. Retina. 2021 Aug 1; 41(8):1618-1626. doi: 10.1097/IAE.0000000000003094. PMID: 34397965; PMCID: PMC8297538.)

The proposed method involves peeling of the internal limiting membrane and endolaser coagulation in the projection of the peripheral retinal break.

The method differs in that it is necessary to make the size of the rhexis twice the diameter of the rupture.

The technical result is that the proposed method will allow for maximum mobilization of the retina, reduce tangential tension, and achieve more reliable and maximally anatomically correct adhesion of the retina in the projection of the rupture, significantly reducing the risk of recurrence.

The method is carried out as follows.

A standard posterior closed vitrectomy with a 25G optic disc is performed. A perfluorocarbon compound is injected into the vitreous cavity to straighten and reattach the central retina. Subretinal fluid is aspirated through the peripheral retinal break. The internal limiting membrane is then contrasted with a dye in the projection of the peripheral break, and a membrane peeling is performed to a size twice the break diameter. Endolaser coagulation is performed along the break margin with a collet tweezers. The perfluorocarbon compound is removed, and the vitreous cavity is packed with sterile air, followed by the introduction of silicone oil or a gas-air mixture. An antibiotic solution is injected subconjunctivally. A sterile dressing is applied.

Clinical example.

Patient H., 55 years old, diagnosed with retinal detachment in the left eye. History of sudden vision deterioration over two weeks. Distance vision has been impaired since childhood. Denies any surgeries or eye injuries. Visual acuity OD/OS: 0.05 sph (-)2.0 D=1.0/0.001 n/c. IOP (P) OD/OS: 14/13 mmHg. Objectively: the anterior segment is unremarkable, the optic disc is pale pink, e/d 0.2 DD, the retina is totally detached, there is a 5-hour tear in the middle periphery against the background of retinal dystrophy of the "lattice" type. The patient was offered surgical treatment of retinal detachment of the left eye.

A standard posterior closed vitrectomy (25G) was performed. A perfluorocarbon compound was used to straighten and reattach the central retina. Subretinal fluid was aspirated through the retinal break using a vitreous cutter. The internal limiting membrane was then contrasted with a dye in the projection of the peripheral break, and a membrane peeling of twice the break diameter was performed using a collet tweezers. Endolaser coagulation was then performed along the break margin. The perfluorocarbon compound was removed, and the vitreous cavity was packed with sterile air, followed by the introduction of silicone oil. An antibiotic solution was injected subconjunctivally. A sterile dressing was applied.

Postoperatively, the patient achieved retinal reattachment in all segments of the left eye. Upon discharge, visual acuity was 0.04 sph (+) 3.0 D=0.2. The subsequent postoperative period was uneventful. Three months later, the second stage of surgical treatment was performed: silicone aspiration with sterile air tamponade. At a follow-up examination three weeks later, visual acuity in the left eye was 0.05 sph (-) 2.0 D=0.6. A further observation period of 2 months revealed no recurrence of retinal detachment.

The proposed method represents an important achievement in the field of ophthalmology and can be used in clinical practice for the treatment of patients with retinal detachment.

The method provides more reliable and precise closure of the retinal tear, which helps reduce the risk of recurrent retinal detachment.

Claims (1)

A method for treating rhegmatogenous retinal detachment, which involves performing a posterior closed vitrectomy of 25G, then introducing a perfluoroorganic compound into the vitreous cavity, aspirating subretinal fluid through the retinal break with a vitreotome, then contrasting the internal limiting membrane with a dye in the projection of the peripheral break, peeling the membrane to a size twice the diameter of the break with a collet tweezers, then performing endolaser coagulation along the edge of the break, removing the perfluoroorganic compound, tamponing the vitreous cavity with sterile air followed by introducing silicone oil, introducing an antibiotic solution under the conjunctiva, and applying a sterile dressing.