Method of treating vertical squint with hyperfunction of inferior oblique eye muscle

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to ophthalmology, and can be applied in treatment of vertical squint with hyperfunction of inferior oblique eye muscle. For this purpose temporally in area of lower-internal angle of orbit near the place of inferior oblique eye muscle attachment transcutaneous injections of medication of botulinic toxin A in dose 20 UN are made. Preliminarily medication is diluted in 1.5 ml of physiological solution of sodium chloride. Then, immediately after this introduction rehabilitative conservative treatment is performed until eye-moving function is restored.

EFFECT: in case of refusal from surgery method creates conditions of maximal patient's plasticity to perception of typical conservative treatment of said type of squint, which leads to restoration of sight in shorter terms, prevention of disease recurrence.

1 ex, 1 dwg

 

The invention relates to medicine, in particular to ophthalmology, and can be used in the treatment of vertical strabismus with hyperfunction of the inferior oblique muscle of the eye (HKM).

Vertical strabismus occurs in 30-72% of patients with strabismus in children and is often combined with the horizontal. The leading role in the pathogenesis of vertical strabismus takes paresis (paralysis) superior oblique muscle. Mechanical imbalance caused by loss of function of the superior oblique muscle, leads to hyperthyroidism its antagonist inferior oblique muscle. This creates such a position of the eye in which the optic axis does not converge on the object, eyes diverted, the perception and conduct visual information throughout the visual system, violated the relationship between the right and left eye and the right balance between oculomotor muscles, impaired ability to surround visual perception.

The main method of treatment of vertical strabismus is the weakening of the inferior oblique muscle surgery.

There are many ways to decrease the action of the inferior oblique muscle. Complete myotomy of the inferior oblique muscle on Landoit Century (1885), a complete myotomy of the inferior oblique muscle from the scleral space snap on Duington L.H. (1923), myectomy middle third on McNeer K.W., Scott ALEXANDER and Yampolsky A. (1965) currently predstavlyaet only historical interest as characterized by low efficiency in correcting vertical deviation and noticeable violation mobility eyes.

For analog adopted a way of weakening the action of the inferior oblique muscle, the proposed Asafetidoy (Avetisov AS concomitant strabismus. - M.: Medicine, 1977. - 312 S.), lies in its intersection with subsequent fixation in a new place, providing her lack of Hyper: retreating 10-12 mm from the outer edge of the limb, make a vertical incision of the conjunctiva 12-15 mm in length, allocate outer straight muscle, push it upwards and hook grasp the lower trailing arm at a distance of 2-3 mm from the point of attachment to the sclera. On the muscle at the top and bottom impose a 2 seam, exciting 1/3 the width of the muscle. Lower trailing arm of the cross at the place of its attachment to the sclera and record the necessary distance two previously imposed by seams to the sclera at the new place downward and anteriorly along the muscle plane.

The disadvantages are the counterpart:

1) performing surgery under General anesthesia;

2) trauma (large conjunctival wound, injury to the ligament of Lockwood, the risk of perforation of the sclera in the immediate vicinity of the macula, while flashing muscles);

3) the risk of serious intra - and postoperative complications: scarring, gross violation of anatomic the ski relationships tissues, limiting the possibility of repeated interventions.

The closest analogue accepted method for the treatment of paralytic strabismus proposed Plush I.L. (Plisov IN the treatment of paralytic strabismus. Patent of the Russian Federation for the invention. EN 2257914 C1, priority from 31.03.2004). The method consists in the fact that injection drug Dysport containing Botulinum toxin, produced intraoperatively in extraocular muscles, which are ipsilateral antagonists and contralateral synergistic paralyzed muscles. After preparation of the surgical field and retro-bulbar (or intravenous balanced multi-component) anesthesia free access to direct extraocular muscle, which is an antagonist muscles involved in paralysis. Muscle allocate without violating the integrity of the muscle bags. Further, some distance not less than 5 mm from the point of muscle attachment of the bag to the sclera, in its middle part, enter the product Dysport dose of 10-20 units. Surgical wound is sutured. In a similar way to perform surgical procedures on extraocular muscle, which is the contralateral synergist paralyzed muscles. If paralysis involving two or more extraocular muscle, the drug is injected in the appropriate extraocular muscles of the contralateral synergist.

Weeks the action: for the introduction of botulinum toxin-A need to perform surgery, which also entails the risk of the same complications as in the similar.

The task of the invention:

1. Decrease the morbidity of treatment at the expense of the surgical intervention and anesthesia.

2. The reduction in the duration of the manipulation.

3. The reversibility of the process in relation to the function of the oculomotor muscles.

The invention consists in that the treatment of vertical strabismus with hyperfunction of the inferior oblique muscle, including its elongation is carried out in two stages: the first stage in the lower oblique muscle of the eye by percutaneous injection once the drug is administered on the basis of botulinum toxin type a, then, in the second stage, carry out rehabilitation of conservative treatment in the model scheme (orthoptic treatment, prismatic correction) before recovery of oculomotor function.

Drug (Dysport®) imposed at the rate of 20 UNITS. The method is carried out without opening the conjunctival cavity and the selection of the inferior oblique muscle that does not require anesthesia, is a short-term (3-4 months), safe, gives the opportunity to repeat the procedure several times in the course of rehabilitation.

The method is as follows. After treatment the skin of the lower eyelid 70% alcohol in 5 mm temporal from the lower inner angle of the orbit at the point of insertion of the inferior oblique thinking the s produce intramuscular injection of 20 UNITS of botulinum toxin type A (Dysport®), restored in 1.5 ml of 0.9% solution of sodium chloride (see drawing, where : a is the place of injection).

The technical result of this method is:

1. The reversibility of the process: temporary paralysis of the inferior oblique muscle develops on the 7th day, lasts no more than 4 months. During this time period ongoing rehabilitation activities (orthoptic treatment, prismatic correction) allows to eliminate the imbalance of the oculomotor system and to cure the patient from this disease, without modifying the anatomic relationship of the oculomotor system.

2. Refusal of surgical intervention, with the above mentioned disadvantages.

3. The refusal of General anesthesia, which itself can cause a number of complications, particularly in pediatric patients.

4. The method does not require precise injection of the drug (the variation in the point of introduction is ±10 mm). Area of diffusion of botulinum toxin injections of 20 mm, in this anatomical area other points of application for the impact of botulinum toxin no. So there is no side effect of botulinum toxin injections.

5. The economic effect due to the exclusion of the cost of surgery.

The search for sources of scientific, technical and patent information has not revealed how, identical to declare, in connection with what can be concluded about the accordance of the proposed technical solution the criteria of "novelty" and "inventive step".

The proposed method treated 14 patients - in all cases a positive result, there were no complications.

The invention is illustrated by the following specific example of the method.

Example

Patient M., 5 years. Diagnosis: friendly convergent alternating with vertical component of strabismus, hypermetropia low degree of both eyes. The original angle of strabismus +15º and 12ºc up in bringing both sides. Made intramuscular injection of 20 UNITS of botulinum toxin type a (Dysport®) in the lower oblique muscle of the eye on both sides (see Annex, where a is the point of introduction of botulinum toxin in the lower oblique muscle). After 3 weeks, the vertical component of strabismus was neutralized. No side effects were. Within 3 months the child was held conservative rehabilitation activities (orthoptic treatment on the synoptophore, prismatic correction of the horizontal component of strabismus, electrostimulation direct external muscles of both eyes), which until then had prevented vertical strabismus. Developed binocular vision. Surgical treatment is not needed.

The method of treatment of vertical strabismus with hyperfunction of the inferior oblique muscles of the eye, including the use of botulinum toxin a, wherein the temporal from ninevoltromeo angle PRS is the ITA's the point of insertion of the inferior oblique muscles perform intramuscular injection of botulinum toxin a in the amount of 20 UNITS, in this advance preparation restore in 1.5 ml of physiological sodium chloride solution, and then carry out rehabilitation of conservative treatment prior to recovery of oculomotor function.



 

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