A method of surgical treatment of retinal detachment
(57) Abstract:The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of retinal detachment. During a vitrectomy to remove the front proliferation of the vitreous body in the space behind the iris. Enter PFOS to the level of the dentate line. Spend retinotomy in the zone of attachment of the retina to the dentate line. The method allows to increase the area adjoining the retina. This prevents the recurrence of retinal detachment. The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of retinal detachment.A known method of surgical treatment of retinal detachment, including vitrectomy, introduction into the vitreous cavity of liquid perfluorocarbons, retinotomy and laser coagulation (RF patent N 2093123).One disadvantage of this method is that retinotomy is carried out in the area of the retina, after which fit debonded retina becomes functionally intact, resulting in a field of vision in the operated eye defect appears, the corresponding zone retinotomy.The technical result is achieved in that in the method of surgical treatment of detachment of the retina, including vitrectomy, introduction performancesthe compounds (PFOS), retinotomy and the coagulation region of retinotomy, according to the invention during a vitrectomy to remove the front proliferation of the vitreous body in the space behind the iris, is administered PFOS to the level of the dentate line and are retinotomy in the zone of attachment of the retina to the dentate line.In the surgical treatment of retinal detachment in a known manner retinotomy performed under the control of the operating microscope in the area of the retina that is located closer to the equator or center of the eye. However, this area when a successful fit of the retina can be functionally intact. Thus, the area of the retina, which produces retinotomy, completely out of sight, which significantly reduces the functional result of the operation.The use of intraocular microendoscope allowed to explore the extreme periphery of the retina and required retinotomy in place of fixing the retina is the area that HP CLASS="ptx2">After processing the surgical field and anesthesia eyeball common in ophthalmic surgery techniques: put blueparrott, 4 mm from the limbus in verhnovodjane, upper outer and ninananajna quadrants exercise 3-4 mm incision of the conjunctiva and tenon's membrane. In these quadrants produce electrocoagulation surface vessels of the sclera and perform three paracentesis. In ninananajna quadrant establish and stitched to the paracentesis system constant supply of infusion solution.Vitrectomy start with removing the front proliferation of the vitreous body in the space behind the iris tip vitrectomy and/or endometrial tools.The front proliferation of the vitreous body is removed to prevent the recurrence of retinal detachment.Through the use of the endoscope monitoring through the screen color monitor, making visible the process of vitrectomy in the space behind the iris (the invisible area).After removing the front proliferation in the vitreous body of the tool is directed toward the posterior pole of the eyeball. Monitoring vitrectomy is carried out through the screen of a color monitor endoscopydingo for the level of PFOS vitreal cavity carried out endoscopically. On the monitor screen clearly seen the level of PFOS and its relation to the dentate line and eye - attachment of the retina. As the filling of PFOS vitreal cavity retin crushes and adjacent to the choroid, subretinal fluid otlavlivatsya to the periphery and accumulates under the retina above the level of PFOS (between the last and gear line - attachment of the retina) in the form of a roller.Make the filling of PFOS to the level of the dentate line and under endoscopic control are retinotomy on the extreme periphery of the retina in the area of its attachment to the dentate line. Due to the pressure of PFOS on the retina, subretinal fluid flows from the formed retinotomies holes and debonded retin finally straightening out and attached. Thus, intravitreal is drainage of subretinal fluid. Then around the area of retinal defects in two rows in staggered under endoscopic control is carried out by the laser coagulation of the retina.For the implementation of the coagulation of the retina are used not only diode laser endoscope with a wavelength of 810 nm, and argon firm "Alkon" model "Biophysic" with a wavelength of 532 nm.The way p is rotface, the high myopia, peripheral retinal degeneration. Before surgery visual acuity - right projection light. When pre-operative binocular ophthalmoscopy of retinal breaks are not detected.Operation: OS - total vitrectomy under the control of the endoscope, the introduction of PFOS, peripheral retinotomy, endolasercoagulation retina, primaryindex 20% of air-gas mixture artillerigatan (C4F8).Progress: three paracentesis sclera in the flat part of the ciliary body with podlivaniem cannula for supplying irrigation solution and under endoscopic control and visual inspection through a microscope, using the contact prism perform total vitrectomy. After complete removal of the vitreous body in the vitreal cavity administered PFOS, carry out visual inspection for its level relative to the dentate line. PFOS is injected in the amount of 3.0 ml of to the level of the dentate line. The infusion of PFOS retin crushes, and at its extreme periphery of the roller is formed of debonded retina with subretinal fluid. In the field of roller debonded of the retina from its attachments make retinotomy, thereby assesse. Then around retinotomies holes and areas of visible defects - zones dystrophies produce coagulation in two rows in staggered under endoscopic control. PFOS removed from the vitreal cavity and produce pneumomechanical 20% of air-gas mixture artillerigatan (C4F8). At the completion of the operation, the retina is adjoined.Example 2
The patient s Diagnosis: ONE - post-traumatic Subtotal retinal detachment, traumatic scar the cornea, aphakia and aniridia, total hemophthalmus. In anamnese - penetrating eye injury with the presence of a foreign body. PHO wound with foreign body removal produced by place of residence. Before surgery acuity of light perception eccentric. The fundus of the eye is not ophthalmoscopically.Operation: OD - total vitrectomy under endoscopic control, the introduction of PFOS, peripheral retinotomy, endolasercoagulation retina, tamponade silicone oil.Progress: Conduct vitrectomy correspond to the course of the operations described above. However, the distinguishing feature of this intervention is that the total vitrectomy due to the presence of a Central scar the cornea and n is skepicism control. After total removal of the case into the vitreal cavity under the control of the endoscope to the level of the dentate line in the amount of 3.0 ml administered PFOS. After its introduction the retina is partially extends, and at its extreme periphery of the roller is formed with subretinal fluid. Partial unfolding the retina due to the fact that particularday region detected stellate scar the retina (best place primary localization of a foreign body). In the field of roller debonded of the retina at the extreme periphery of the place of its attachment produce retinotomy thereby perform intravitreal drainage of subretinal fluid. Then around retinotomies holes in two rows in staggered under endoscopic control produce coagulation. PFOS removed from the vitreal cavity. Given the partial unfolding of the retina and the presence of paramacular stellate scar, produce tamponade with silicone oil. After surgery, the retina cracked down and lay down. The method of surgical treatment of detachment of the retina, including vitrectomy, introduction performancesthe compounds (PFOS), retinotomy and the coagulation region of retinotomy different temat PFOS to the level of the dentate line and are retinotomy in the zone of attachment of the retina to the dentate line.
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