Closure technique of sclera ruptures with tissue deficiency

FIELD: medicine.

SUBSTANCE: sclera rupture is coated with conjugate covalent-bound chlorine e6 with human albumin in molar ratio 1:2.5 thus covering the surrounding tissues 1-2 mm. Thereafter, the sclera rupture region is exposed to continuous scan laser light of power 500 mWt within 1-2 minutes with coated conjugate. The wavelengths relates to maximum light absorption of chlorine e6.

EFFECT: reliable closure of rupture, prevention of sclera deformation, lower risk of infectious complications.

1 ex

 

The invention relates to medicine, namely to ophthalmology, and is designed for sealing gaps sclera with deficiency of tissue.

Contusion of the eyeball with rupture of the sclera is one of the most difficult groups in ocular trauma care and is 4-6% (Gundorov R.A., Stepanov A.V. Surgery contusion injuries of the eyeball. // Oftalmol. Journe. - 1994. No. 6. - S-326) of the total and 14.2% of blunt trauma of the eye.

For severe damage to the sclera characterized by roughness and crush of the edges of the gap and tissue defects. Anatomical mapping of the edges of the wound suture method is not sufficient for a reliable repair integrity of the eyeball, even in the absence of tissue deficit. In addition, the high risk of further complications such as secondary ectasia of the sclera along the seams, svetooborudovaniya, tractional retinal detachment and subatrophy eyes (Moshetova L.K. Mechanical eye injuries. Clinical and morphological studies. Abstract. Diss. MD M., 1993. 48 C.; Khoroshilov-Maslova I.P., Andreev V.P., Bulls VP, Chichua GA Functional-morphological features vitreoretinal proliferation after penetrating eye injuries complicated by the case. // The Bulletin of oftalmol. - 1998. No. 6. - P.10-14).

Important when rupture of the sclera is the prevention of complications such as infection, because the open injury with what eviciton tissue is often accompanied by loss of the internal layers of the eyeball in the wound and the formation of post-traumatic staphyloma.

For sealing gaps sclera deficit fabric used Dura (Slavnov G.A. the Use of Dura for scleroplasty in the experiment. // Vestnik St.Petersburg University. oftalmol. - 1974. No. 1. - P.59-61), brittini (Zharov V. Primary peoplelike in treatment of perforated wounds and subconjunctival breaks sclera: Dis. Kida. the honey. Sciences. - Izhevsk, 1987), collagen hemostatic sponge (Islamov SS eye Contusion, complicated subconjunctival rupture of the sclera: Dis. candlenut. - M., 1990. - 168 C.). The disadvantages of these methods are associated with the complexity of preservation methods and limitations of the terms of use homotransplantation, difficulty taking brettina, the possibility of infection of the materials, increased invasiveness due to suture fixation. It is also known the use of polyester canvas with a contusion breaks sclera (Tkhelidze N.T. Autoclavability using polyester ophthalmic blade when contusion rupture of the sclera. // Modern methods of diagnostics and treatment of diseases of the cornea and sclera: Sat. the scientific. senior - M., 2007. - S-347). The disadvantage of this method is the need for suture fixation of polyester fabric to episclera.

The objective of the invention is to develop a method of sealing gaps sclera deficit fabrics that do not require the corresponding suture fixation.

The technical result is reliable sealing of the gap, the lack of deformation of the sclera, reducing the risk of infectious complications.

The technical result is achieved due to the fact that:

1) chlorin E6 (photosensitizer (PS)) is able, even in small doses to exhibit a high photochemical activity during laser irradiation;

2) next after applying the gap conjugate covalently linked chlorin E6 with human albumin laser irradiation with the given parameters:

- activates FC conjugate composition, causes a photochemical reaction that leads to the formation of strong elastic film on the surface of the gap, tightly holding his edge and ensure its full sealing (due to the formation of covalent bonds between protein molecules (J. Khadem, A. Veloso, F. Tolentino et al. Photodynamic tissue adhesion with chlorine E6 protein conjugates // Invest Ophthalmol Vis Sci. 1999; 40: 3132-3137));

- has antibacterial effect, which is caused by the selective binding of FC cells of pathogenic microorganisms due to their presence in the area of the defect. Arising during photodynamic therapy of free radicals, radical ions (radical ions) and, in particular, singlet oxygen damage cell membranes and DNA of the cells of pathogenic microorganisms (as gram-positive, so gramotritsatelnyh), which leads to their death.

The method is as follows.

Conducting the standard preparation of the surgical field. Impose a makeshift seams to prevent sagging of the edges of the gap. Then to break the sclera with the capture of the surrounding tissues of 1-2 mm using a plastic needle with a thin layer applied conjugate covalently linked chlorin E6 with human albumin in a molar ratio of 1:2,5. Then irradiate the area of the rupture of the sclera coated with a conjugate continuous scanning laser 500 mW within 1-2 minutes with a wavelength corresponding to the maximum absorption of the Federal Assembly of light radiation (662 nm with the use of chlorin E6).

The conjugate is covalently linked chlorin E6 with human albumin in a molar ratio of 1:2.5 to get one of the known methods, for example, as described in Invest Ophthalmol Vis Sci. 1999; 40: 3132-3137 (J. Khadem, A. Veloso, F. Tolentino et al. Photodynamic tissue adhesion with chlorine E6 protein conjugates).

The method is illustrated by a clinical example.

Patient S., 36 years. Entered the KF of IRTC "eye microsurgery" with a diagnosis of a Severe contusion of the eyeball with rupture of the sclera, hyphema, partial hemophthalmus OD. Vis OD - wrong svetoproekt. IOP OD - 16 mm Hg

The patient underwent a revision of the wound, the edges of the rupture of the sclera, edge crush, revealed the loss of the shells in the gap. The village is e washing of the wound with a solution of the antibiotic and reposition the choroid produced sealing scleral rupture under the proposed method. Postoperative period was without infectious complications. Partial hemophthalmus resorbed yourself.

The observation period of 6 months: complete sealing scleral rupture, anterior chamber of normal depth, eyes calm, the fundus of the eye reflex pink, shell .Vis OD of 0.3. IOP OD - 18 mm Hg

Under the proposed method treated 7 patients with rupture of the sclera with deficiency of tissue. The follow - up period of up to 18 months. In all cases achieved complete sealing scleral rupture without deformation of the sclera, the postoperative period without infectious complications.

Thus, the inventive method provides a reliable sealing of the gap, no deformation of the sclera, reducing the risk of infectious complications.

Method of sealing gaps sclera deficit fabric, characterized in that the rupture of the sclera with the capture of the surrounding tissues by 1-2 mm put a conjugate covalently-linked chlorin E6 with human albumin in a molar ratio of 1:2,5, and then irradiate the area of the rupture of the sclera coated with a conjugate continuous scanning laser 500 mW within 1-2 minutes with a wavelength corresponding to the maximum absorption of the chlorin E6 light radiation.



 

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