Method removal of foreign body from posterior segment of the eye

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology. Spend the barrier organizergoogle of the retina around the bed of a foreign body under the retina. Cut through the retina of a horseshoe incision is made around the foreign body capsule neodymium YAG laser. After removal of the foreign body are laterocaudal flap of the retina over the bed and retina around the bed of a foreign body by endolaser. The method allows to remove the foreign body from under the retina and to get a good fit dissected retina and reduce the risk of hemorrhage and retinal detachment.

The invention relates to medicine, namely to ophthalmology, and can be used to remove foreign bodies under the mesh sheath posterior pole of the eyeball.

It is known that removal of foreign body from posterior segment of the eye is very difficult and often leads to retinal detachment and case. In this regard, the conclusion (Gundorov R. A. and other Injuries of the eye.// M, - Medicine, - 1986, - 310 C.), it is better to leave it than to make his removal from the eye, if the position of a foreign body otnositelnye bodies posterior to eyes.// Diss. ... candles. the honey. Sciences, - M, - 1987, - 167 C.) also considers it appropriate to leave a foreign body in the eye, if there are no signs of metallosis and the fragment covered with dense fibrinous capsule.

However, splinter, long inside the eye, causing a dangerous complication is metallosis tissues of the eyeball: among the disease up to 80% of cases occur sideros process from the effects of oxidation products of iron and 20% of cases - halkos when copper-containing foreign bodies (Gundorov R. A. Prevention, early diagnosis, clinic and treatment of post-traumatic complications associated with prolonged stay in the eye of chemically active foreign phone // Diss. ... Prof. the honey. Sciences, - M, - 1968, - S. 103-134).

For exposure of the shard (Gundorov R. A. and other Injuries of the eye.// M, - Medicine, - 1986, - 310 C.) to make a cut in the capsule, using knives Graefe, Sato, and then foreign body remove collet tweezers or a magnet-probe.

When the encapsulated fragments localized in the membranes of the posterior offer "naked" foreign body with the help of vitriolage, after his capture collet forceps and removed. However, during the execution of these manipulations in the of pars plana vitrectomy.// Klin. Mbl. Augenheilk, - 1979, - Bd. 174, - H. 4, S. 542-547).

To remove the encapsulated fragments of the posterior pole of the eye using tweezers to outcrops of the shard, and for the prevention of retinal detachment apply circles with transscleral cryopexy (Slusher M. M. et at. - Management of intraretinal foreign body.// Trans. Amer. Acad. Ophthalmol. and Otolaryng., The 1982 - V. 89, - N. 4, - P 369-373).

Joondeph B. C. et al. (Management of subretinal foreign bodies with a cannulated extrusion needle.// Amer. J. Ophthalmol., - 1990, - V. 110, - N 3, - p. 250-253) have developed their tactics removal of intraocular foreign body localization shard behind the retina. After performing vitrectomy for the retina to the foreign body fail elastic lug is mounted on the cannula. Foreign body to move the cannula to the breakdown in the retina and fixed with tweezers, which then remove the foreign body. After that, around the retinal tear are endolasercoagulation.

Was developed tactics transvitreal removal of foreign bodies localized in the posterior part of the eye, including YAG laser effect on the capsule of a foreign body in the form of radial dissection of the capsule for exposure shard and preventive barrier organizergoogle to prevent tractional retinal detachment during the operational WUSA eyes.// M, - A. S. S. U. N 1451912, - 1988). This method is used as the nearest equivalent.

The known methods have proven their effectiveness in removing the debris from the retina. However, almost all of them are traumatic in relation to the retina and can cause complications such as bleeding or detachment of the retina. In some cases, to violate the integrity of the tight capsule with neovascularization vessels over foreign body does not seem technically possible, even through the shock YAG laser irradiation.

The proposed method is based on the fact that the effects on the retina in the area of occurrence of foreign body occurs outside the Lodge shard with additional preventive arkansasarkansas of the retina, thereby reducing the risk of retinal detachment and bleeding at the time of surgery and in the postoperative period.

The technical result of this method is the reduction of the risk of retinal detachment and bleeding at the time of the operation.

The technical result is achieved by pre-fixing of the retina around the foreign body using organizergoogle on the border of the bed of a foreign body and the exposure of the foreign body through the dissection of the retina in the foster clinical research using intenlational, ultrasound scanning and ophthalmoscopy and confirmation of the presence of a foreign body under the retina of the patient is prepared for surgery to remove a foreign body.

Amidst maximum mydriasis, under local anaesthesia, instillaciei solution dikaina produce preliminary barrier organizergoogle retina using argelaguer under control contact fundus lens type Abraham: encapsulated around a foreign body causing lasercoagulation 3-4 mm from the edge in three rows and in a staggered manner. After 5-7 days the patient in the hospital by using YAG laser irradiation dissect the retina on the inner edge of the barrier argelaguet horseshoe under the control of the contact fundus lens. After that, in the operating reveal tissue of the sclera in the area of the flat part of the ciliary body and depending on the nature of the foreign body remove foreign body either with tweezers or a magnet. After removal of a foreign body in the wound introduce the tip of endolasercoagulation and produce additional organizergoogle flap of the retina over the bed of a foreign body and the occurrence of chipping. The wound is sutured and under conjuctiva injected antibiotics.

Example. Sick Tr-EB 44 years Portotecnica aphakia, impacted intraocular foreign body in the posterior pole of the eyeball is covered by the retina. Visual acuity OD/OS: 0,05/0,8; IOP OD/OS: 24/22 mm RT.article According to the air - inhibition of the activity of the retina ML of 2.5 times, according to x-ray examinations is a foreign body in the posterior part of the eye (conditional on the scheme partly in membranes of the eyes), according to the ULTRASONIC scanning is a foreign body is located in the posterior part of the eye shells, covered with retina.

From the anamnesis - seven years ago received a penetrating wound of eyeball with the introduction of magnetic metal fragments during machining on a lathe. On the day of injury by place of residence produce primary surgical treatment of wounds of the cornea with traumatic cataract extraction and negative attempt to remove a foreign body. After conservative treatment, the visual acuity of the right eye with aphakic correction 0.4, IOP OD within 22-24 mm RT.article.

In connection with deterioration of visual acuity and change in color of the iris of the patient appealed to the specialized ophthalmic institution. There will diagnose the presence of old metal shard events metallosis. The patient offer the s with neovascular vessels over the splinter. Given the likelihood of bleeding during dissection of the capsule and traction movement dense fabric propose to use the YAG laser circular dissection of the retina around the foreign with the preliminary barrier organaugusta retina bed of a foreign body.

Before surgery, on the background of the maximal mydriasis OD, produce angelzero barrier coagulation of 4 mm from a foreign body in a checkerboard pattern in three rows around the foreign body in the amount of 64 coagulate. 5 days after exposure to conduct YAG laser dissection of the retina in 1-2 mm around the foreign body. Foreign body almost completely naked without bleeding from the neovascular vessels capsules. On the same day in the operating room under local anesthesia to remove the foreign body through the flat part of the ciliary body with the tip of the magnet due to the retina. The same access enter the tip of endolasercoagulation and produce additional coagulation of the flap of the retina over the bed of a foreign body and partially along the edges of the retina. Loss of the vitreous body in the operative wound was not observed. Imposed 2 nodal joints on the sclera and continuous seam 8-00 on conjuctiva. Under conjuctiva entered antibiotic solution. The bandage.

Chere is Naya, in the vitreous body of a single suspension. In the fundus: the bed of a foreign body clean, surrounded pronounced lazerkoagulyatsii. The cut off part of the retina is fixed. Effects of hemorrhage and retinal detachment no. Visual acuity OD - 0,05, IOP OD - 24 mm RT.article According to the U.S. - no changes.

3 months after surgery - OD calm, the sutures were removed. Anterior segment unchanged, except for the partial recovery of the color of the iris. In the vitreous body of reasonable suspension. The fundus of the eye - the optic nerve disc pale pink, the vessels are relaxed, in the field of operative intervention area of the retina is surrounded by a pigmented lazerkoagulyatsii. In the centre of it is fixed u-shaped flap of the retina. The retina adjacent everywhere. Visual acuity OD with SF. + 11,0 = 0,2, IOP OD - 22 mm RT.article.

Readings are way transactions associated with removal of foreign body from the retina and the occurrence of retinal detachment and bleeding.

The method has no contraindications.

As a result of application of this method it is possible to avoid traction effect on the retina when the dissection of the capsule or of the retina over foreign body removal of foreign bodies under the retina, as well as crgg after its removal also provides grip of the retina.

Method removal of foreign body from posterior segment of the eye, including preliminary barrier organizergoogle of the retina around the foreign body capsule and removal of the foreign body through the flat part of the ciliary body, characterized in that after organizergoogle produce a u-shaped incision of the retina medially from the zone of coagulation, and after the removal of a foreign body capsule is fixed to the box using organizergoogle.

 

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The invention relates to medicine, in particular to ophthalmology
The invention relates to medicine, namely to ophthalmology
The invention relates to medicine, in particular to ophthalmology
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The invention relates to medicine, in particular to ophthalmology
The invention relates to medicine, in particular to ophthalmology
The invention relates to ophthalmology and is intended for removal of magnetic foreign body from posterior segment of the eye

FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva. Direct muscle is exposed and separated. Forceps is applied to the separated muscle 4-7 cm far from the place of its attachment to sclera. The muscle is notched to 1/2 of its width 1-2 mm far from the forceps on the proximal side. The muscle is bluntly exfoliated. Muscle flap is turned to after cutting it from sclera. The flap end is sutured to sclera 1-5 mm distal from the previous attachment place. Eyeball is displaced in conjunctival sack to opposite side with respect to the feeble muscle. Interrupted sutures are placed on conjunctiva incision.

EFFECT: enhanced effectiveness in correcting large squint angles.

4 dwg

FIELD: medicine.

SUBSTANCE: method involves cutting off external wall of Schlemm's canal on the whole width extent of internal scleral flap bed after making non-penetrating deep sclerectomy operation. At least three drains are entirely introduced into Schlemm's canal lumen and arranged all over the whole circumference of the Schlemm's canal. Hydrated hydrogel is used as draining polymer material. The hydrogel contains 0.5-5.0% aminocaproic acid solution, etamzylate solution and diprospan solution.

EFFECT: increased and retained hypotensive action; increased distance between internal and external wall of Schlemm's canal; reduced risk of traumatic complications in implanting drains; avoided inflammatory response of eye structures.

1 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves introducing device for fixing retina rupture edges into vitreous cavity after having done subtotal vitrectomy. The device has a pair of microsurgical needles connected to each other with surgical thread. Required number of needle pairs is introduced in succession to have required number of straight segments for fixing rupture edge. Needle ends are brought out in pairs together with thread to external sclera surface and cut, and the thread ends are fixed near the sclera surface.

EFFECT: reduced risk of traumatic complications; reliability of retina rupture edges fixation.

3 cl

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

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FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

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