Combined transplant for scleroplasty

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and is intended for surgical strengthen the sclera with progressive myopia, and scleroplastic operations in other pathological conditions of the eye. The transplant is a mesh structure with a mesh size of 1 x 1 mm, formed biodegradable threads based on collagen and synthetic neuteralise threads. The invention provides forming a solid complex of the sclera-transplant, which leads to a long and lasting effect scleroplastic operations without the use of donor material.

The invention relates to medicine, namely to ophthalmology, and is intended for scleroplastic operations for progressive myopia.

Sclerocarya intervention occupy a leading place in the system of the anti-progressive myopia. Currently known scleroplastic operations differ in the technique of execution and used grafting material. As the plastic material, in addition to allostery used other donor is, ericard etc. (A. P. Nesterov and other Strengthening sclera broad fascia of the thigh with progressive myopia// Vestnik of ophthalmology, 1967, No. 1, S. 15-19; B. S. Belyaev and others Scleroplasty in the treatment of progressive myopia. Vestnik of ophthalmology, 1972, No. 3, S. 60-63; M. C. Zaikova, etc. Experience homochirality in progressive myopia. In the book: Eye microsurgery. Tbilisi, 1976, S. 162-172; E. C. Avetisov, E. P. Trotta, A. S. 833236, B. I. 20, 1981). However, applied biological tissue with time are involved in the pathological process, characteristic of the sclera of the boss, because the engraftment of the transplant occurs with the complete replacement of its cellular composition and collagen structures (B. Curtin et al., Longterm results of scleral reinforcement surgery// Amer. J Ophthalmol., 1987, v.l03, 4, p. 544-548; E. P. Tarutta, L. D. Andreyeva. A Morphological Study of the Transplants after Scleroplasty in Progressive Myopia //Exp. Eye Res., v. 67, suppi. i. Abstr.of XIII ICER, 1998, p. 68). During this process of myopic sclera of the operated patient transplanted biotransplant migrating fibroblasts, obviously synthesizing defective collagen replacement donor. This is the main drawback of donor materials, contributing to the reduction of the effect sclerocarya operations in the long term.

It should be noted also that the use of cadaver the traditions, recently has become even more undesirable because of the risk of infection with hepatitis viruses and HIV.

In this regard, particularly the urgent search for synthetic degradiruya biocompatible materials, i.e. materials that for a long time do in the body of a particular function (for example, when the endoprosthesis), without causing undesirable damaging or toxic effects (G. A. Pkhakadze. Biodestruction polymers. Kiev: Naukova Dumka, 1990, S. 3-7). With this purpose, with scleroplasty already been tested silicone tape (C. F. Utkin. Semiconsciously in progressive myopia in children and adolescents //journal of ophthalmology, 1987, No. 3, S. 54-56), and synthetic textiles made of Mylar threads Explant (N. N. Bushuyeva. Long-term results of different methods sclerocarya operations in children and adolescents with progressive myopia // Ophthalmological Journal, 1989, No. 4, S. 194-198). The last material is characterized bioinert and unlike silicone tape that was bad prizemlyalis and cause unwanted reactions from the inner membranes of the eye, used in clinical practice. Thanks to its mesh stinations degradiruya materials, providing a mechanical strengthening of the scleral shell is practically no influence on the biosynthesis of collagen in the sclera and the formation of strong connective tissue capsule.

In order scleroplastic material performed at the same time frame function and stimulated the synthesis of collagen in the sclera of the recipient, we propose a combined transplant, combining absorbable biological material based on collagen and neuteralise synthetic material based on nylon or polyester fibers.

The technical result of the invention is the formation of a solid complex sclera-transplant", which provides a long and lasting effect sclerocarya operations without the use of donor material.

The obtained graft tightly fused with the sclera of the recipient by stimulating processes collagenopathy decay products (peptides and polypeptides), natural collagen threads transplant. While the decay products of biological components activate not only the formation of a connective tissue capsule, but also the biosynthesis of collagen in the sclera of the recipient, the biodegradation of the collagen fibres, non-biodegradable synthetic mesh structure actively invade connective tissue. The result is not undergoing resorption, stable, and resistant to elongation complex sclera-transplant".

Combined graft is made as follows. Mesh lantawadee form on the basis of nylon or polyester fibers with a cell size of 1x1 mm stitched along the length in the sterile environment of the collagen thread (suture "collagen 5.0") in increments of 1 mm, the size of the cells achieves the most dense mesh to match the diameter of the cross-section of sutures<Length of the obtained graft ranges from 48 to 52 mm (depending on the length of the anterior-posterior axis of the operated myopic eyes), the width of the narrow portion is 5 mm wide and 12 mm

Made the transplant is used as follows. An incision of conjunctiva and tenon's capsule in the upper outer and lower outer quadrants. Down the ligature under the outer straight muscle with the bridge of the conjunctiva and tenon's capsule over it. The lower straight muscle take on the hook, emit lower oblique muscle stretch on two hooks and bring the lower end of the graft, which is then stitched to the sclera under the lower direct muscle in 2 mm from the place of its attachment with podat under the outer straight muscle at the same time directing it toward the posterior pole of the eye, and then fixed to the sclera under the top direct muscle in 2-3 mm posterior to the place of its attachment. The graft is spread and placed on the surface of the sclera by means of a curved spatula. Remove the seam-taped, put the seam on the conjunctiva (E. C. Avetisov, E. P. Trotta, A. S. 833236, B. I. 20, 1981).

Scleroplastic operations using the proposed transplant by the method described above were carried out in 15 patients aged 10 to 15 years with progressive myopia medium and high.

The following are examples of clinical use of combined graft for surgical strengthen the sclera.

Example 1. Patient S., aged 11. Diagnosis: randrianirina progressive high myopia, complicated peripheral vitreoretinal dystrophy. Before surgery, the visual acuity OD with sph - 6.5 = 1.0, OS sph - 7.5 D = 1.0. Acoustic density of the sclera in the region of equator/posterior pole of the eye OD =41/38 DB, OS = 40/37 DB. Eographically coefficient (RK) is 0.8%. Stocks relative accommodative - 1.0 diopters. The operation took place scleroplasty OS with the aforementioned method. After 6 months. after surgery, the visual acuity S = 42/41 DB. Eographically coefficient is 1.5%. Stocks relative accommodative - 4.0 diopters. Thus, as a result of the intervention increased accommodation capacity, the improvement of the biophysical characteristics and blood supply to the retina, the weakening of clinical refraction, which indicates the stabilization of the myopic process on the operated eye.

Example 2. Patient P. , aged 15. Diagnosis: acquired progressive high myopia, myopic astigmatism. Before surgery, the visual acuity OD with sph - 8.0 cyi - 1.25 ax 30o= 1.0. OS c sph - 8.0 D cyi - 1.25 ax 30o= 1.0. Acoustic density sclera OD = 42/39 DB, OS = 42/39 DB. PK is 1.5%. Stocks relative accommodative - 0.5 diopters. The operation took place scleroplasty OS with the aforementioned method. After 6 months. after surgery, the visual acuity OD with sph - 8.0 = 1.0, OS sph - 8.0 D =1.0. Acoustic density sclera OD = 42/39 DB, OS =42/41 DB. PK is 1.9%. Stocks relative accommodative - 3.5 diopters. The obtained data testify to the increase in accommodation capacity, the improvement of the biophysical characteristics of the sclera and the blood supply to the retina, stabilization of refraction, i.e., the favorable effect of an intervention.

The transplant for scleroplasty, representing a net structure, characterized in that it has a cell size of 11 mm and is formed of biodegradable threads based on collagen and synthetic neuteralise threads.

 

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SUBSTANCE: the present innovation deals with affecting corneal epithelium with radiation of UV laser in the form of diaphragmed Gauss, diameter of laser bundle ranged 0.3-1.2 mm, energy density being 100-300 mJ/sq. cm. Then comes layer-by-layer removal of corneal epithelium by replacing bundle's center for the knots of scanning pattern developed by equilateral triangles. Replacing should be started from central retinal knot connected with patient's pupillary center at random order, the center of the next bundle should be placed into another knot of scanning pattern at maximally possible distance against previous knot, and thickness of every removed epithelial layer should be increased from the center towards periphery by forming a transitional area.

EFFECT: shortened period for removing patient's epithelium.

3 dwg, 2 ex

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