RU2828742C1 - Method for correcting shape of internal angle of eye in patients with palpebral syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology. An epicanthoplasty is performed by performing an incision of the skin, followed by an acute excision of soft tissues between the skin and the anterior branch of the medial ligament of the eyelids. An anterior branch of the medial ligament is separated, fibres of the orbicular muscle of the eye are visualized, then an interrupted suture is applied with 6/0 absorbable suture covering the fibres of the orbicular muscle of eye 2 mm above and 2 mm below the anterior branch of the medial ligament. Further, the suture is tightened and tied over the ligament; the skin incisions are closed with interrupted and mattress absorbable sutures.

EFFECT: method enables to form a more regular, pointed shape of the inner corner of the eye with minimal surgical trauma, to obtain a high cosmetic and functional result.

1 cl, 5 dwg, 1 ex

Description

The invention relates to ophthalmology and can be used for surgical treatment of patients with palpebral syndrome in order to correct the shape of the inner corner of the eye.

Palpebral syndrome (blepharophimosis syndrome) is a sporadic or hereditary genetic disease that has an autosomal dominant type of inheritance and is manifested mainly by changes in the eyelids in the form of blepharophimosis, ptosis of the upper eyelid and reverse epicanthus.

The clinical picture is rarely limited to the above-mentioned classical triad and is often supplemented by a number of accompanying symptoms. One of the characteristic and significant manifestations of palpebral syndrome is a change in the shape and widening of the inner corner of the eye.

In patients with palpebral syndrome, the internal angle is covered by reverse epicanthus, and its altered shape becomes apparent after epicanthoplasty.

Existing surgical treatment methods (V-Y epicanthoplasty, Del Campo epicanthoplasty, medial epicanthoplasty by draping, double Z-plasty by Mustarde, methods of transnasal fixation of internal angles, medial canthopexy, their numerous combinations and modifications) are aimed at eliminating reverse epicanthus and telecanthus. However, they do not correct the altered shape of the internal angle of the eye.

The closest analogue is the method of reconstruction of the inner corner of the eye in patients with blepharophimosis syndrome (Patent of the Russian Federation for Invention No. 2805394). A through-and-through stepped incision is made in the lower eyelid at a distance of 4-5 mm medial to the inferior lacrimal punctum. An opening with a diameter of 1 mm is formed in the wall of the superior lacrimal canaliculus, in the projection of the medial commissure of the eyelids. A silicone tube with a diameter of 1 mm is inserted. One end of this tube is passed through the superior lacrimal canaliculus, lacrimal sac, nasolacrimal duct and brought out into the nasal cavity under the inferior turbinate. The second end of the same tube is passed through the distal section of the inferior lacrimal canaliculus, the formed opening in the wall of the superior lacrimal canaliculus, lacrimal sac, nasolacrimal duct and brought out into the nasal cavity under the inferior turbinate. The ends of the silicone tube are tied in the nasal cavity with prolene thread. The incised edge of the lower eyelid is moved to the medial commissure and fixed with interrupted sutures. The edges of the stepped incision are aligned with interrupted sutures. The silicone tube is removed after 2-3 months.

The disadvantages of this method are the violation of the integrity of the lower lacrimal canaliculus, the need for long-term wearing of a silicone tube in order to prevent overgrowth of the lower lacrimal canaliculus in the postoperative period.

The objective of the proposed invention is to create a safe method for correcting the shape of the inner corner of the eye in patients with palpebral syndrome, allowing for the formation of its correct, pointed shape without violating the integrity of the lacrimal ducts.

The technical result is the achievement of an anatomically correct shape of the inner corner of the eye, as well as obtaining a high functional and cosmetic result.

The invention is illustrated by Figures 1-5. Figure 1 shows a view of the inner corner of the eye in a patient with palpebral syndrome before surgery. Figure 2 shows a view of the surgical wound after skin incisions have been made. Figure 3 shows the isolated anterior branch of the medial ligament and visualized fibers of the orbicularis oculi muscle. Figure 4 shows the application of a nodal suture with the capture of fibers of the orbicularis oculi muscle 2 mm above and 2 mm below the anterior branch of the medial ligament. Figure 5 shows a tied nodal suture above the anterior branch of the medial ligament to obtain a sharpened inner corner of the eye.

Position 1 denotes the reverse epicanthus, position 2 – the widened inner corner of the eye, position 3 – the soft tissues located between the skin and the anterior branch of the medial palpebral ligament, position 4 – the orbicularis oculi muscle, position 5 – the anterior branch of the medial ligament.

The method is carried out as follows:

A Z-shaped skin incision is made in the area of the inner corner of the eye. Then the soft tissues between the skin and the anterior branch of the medial palpebral ligament are excised sharply. The anterior branch of the medial ligament is isolated. The fibers of the orbicularis oculi muscle are visualized. In order to correct the shape of the inner corner of the eye, a nodal suture is applied with 6/0 absorbable thread, capturing the fibers of the orbicularis oculi muscle 2 mm above and 2 mm below the anterior branch of the medial ligament. The thread is pulled tight and tied above the ligament. The skin incisions are sutured with nodal and absorbable mattress sutures.

The method allows to form a more correct, pointed shape of the inner corner of the eye with minimal surgical trauma, to obtain a high cosmetic and functional result.

The method is illustrated by the following clinical example:

Patient A., 10 years old, was hospitalized at the Federal State Autonomous Institution "National Medical Research Center "Microsurgery of the Eye" named after Academician S.N. Fedorov" with the diagnosis: OU Palpebral syndrome, reverse epicanthus, anomaly of the inner corner of the eye, blepharophimosis, congenital ptosis of the upper eyelid.

Complaints: according to the mother, a change in the shape of the eyes, an additional skin fold in the inner corner of the eyes, drooping of the upper eyelids.

Anamnesis: according to the mother, the above complaints, palpebral syndrome since birth. Hereditary anamnesis is not burdened. Operations before contacting the Scientific and Technical Complex are denied.

Objectively: OU The upper eyelid is lowered. In a calm state, MRD is +0 mm, with eyebrow tension +1 mm. The palpebral fold is absent. In the area of the inner corner, there is a skin fold from the lower eyelid to the inner corner of the eye. When pulling the epicanthal fold, an expanded inner angle of a square shape is visualized. The length of the palpebral fissure is 19 mm.

According to the standard examination data, no concomitant ophthalmological pathology was detected.

The patient underwent surgery on both eyes using the proposed method.

The patient had no complaints the day after the operation. Objectively, slight tissue swelling was noted in the area of the postoperative wound. The sutures on the skin were clean, sound, the edges of the postoperative wound were adapted. The inner corners of the eyes were of the correct pointed shape.

A routine examination was performed on the 14th day. The patient has no complaints. Objectively: there is no tissue edema in the area of the operation. The sutures on the skin are clean, consistent, in the process of resorption. The inner corners of the eyes are of a regular, pointed shape.

At the follow-up examination 6 months after the operation, the patient has no complaints. In the area of the skin incision, there are thin, barely noticeable, whitish scars. The inner corner is of a regular, pointed shape.

Claims (1)

A method for correcting the shape of the inner corner of the eye in patients with palpebral syndrome, characterized by the fact that epicanthoplasty is performed, for which a skin incision is made, then the soft tissues between the skin and the anterior branch of the medial ligament of the eyelids are sharply excised, the anterior branch of the medial ligament is isolated, the fibers of the orbicularis oculi muscle are visualized, then a nodal suture is applied with an absorbable thread 6/0, capturing the fibers of the orbicularis oculi muscle 2 mm above and 2 mm below the anterior branch of the medial ligament, then the thread is pulled together and tied above the ligament, the skin incisions are sutured with nodal and mattress absorbable sutures.