Method of organ-preserving treatment of intraocular tumours

FIELD: medicine.

SUBSTANCE: claimed invention relates to ophthalmology, namely to ophthalmic oncology and is intended for organ-preserving treatment of intraocular tumours. Transpupillary PDT is performed. After 3-20 days treansscleral PDT is carried out. After tumour devitalisation, total vitrectomy and endoresection of tumour is performed. Vitreous cavity is filled with substitute of vitreous body and laser coagulation of retina is carried out.

EFFECT: method ensures radical complete destruction of tumour with extension of indications to organ-preserving treatment with recovery of functional reserves of eye.

3 ex

 

The present invention relates to ophthalmology, namely oftalmologii, and is intended for treatment of intraocular tumors.

Among tumors of the organ of vision intraocular tumors occupy the second place, second in frequency only to the eyelid neoplasms. Among intraocular tumors secrete retinal tumor and tumor vascular tract of the eye. They occur at almost any age. In childhood prevalent tumors of the retina. Basically they are represented by retinoblastoma. The lion's share of tumors of the adult population are tumors of the vascular tract neuroectodermal origin (pigmented and non-pigmented nevi and melanoma). Their smaller part is mesoderm origin (hemangioma) [Pačes A.I., Brovkin A.F., Zigangirov, Clinical Oncology organ of vision. - Moscow. - Medicine. - 1980 - p.23].

The level of technology.

Treatment of intraocular tumors are divided into two main types: conservative and liquidation.

For nearly 4 centuries only and no alternative method of treatment of intraocular tumors remained enucleation. However, over the last half century, thanks to the achievements of radiation medicine in the Arsenal of ophthalmology, new technology that not only destroy the tumor, but also to maintain the GLA is how the body. Among these technologies, the preference is given to those organomagnesium methods that have a selective effect, and therefore less traumatic for functionally important structures of the eye, is not involved in the neoplastic process. These methods are more promising for visual functions.

Today the most popular among organ-sparing treatments are radiation treatment: brachytherapy, laser photodestruction, thermotherapy, photodynamic therapy photosensitizers.

Each of these treatment methods has its advantages and disadvantages, as well as their indications and contraindications for their use.

Laser photodestruction (synonym: laser coagulation) as an independent method of treatment has very limited indications. It is produced when postequalization tumors of small size, when their thickness exceeds 1.5 mm, and the diameter does not exceed 12 mm [Guide oftalmologii. - Ed. Approving. - Moscow. - Medicine. - 2002. - str-118]. A prerequisite for its implementation is the absolute transparency of the optical medium and maximum mydriasis, which allows full control during the procedure azure photodegradation.

Laser photodestruction inside the eye tumors used argon (range radiation 488 nm), krypton (range radiation 568-647 nm). Exposure to a specified range of light absorption of light energy by the tissue structures of the eye - pigment epithelium of the retina and choroid, with subsequent transformation into heat energy. This type of impact causes the denaturation of the proteins that form the basis of the ability of tumor cells with their subsequent death [ibid]. The mechanism of tumor cell death: coagulation necrosis with subsequent cell-free sclerosis.

The disadvantages of the method are its limitations: it is not shown when the tumors thicker than 1.5 mm the Penetrating power of radiation in the specified spectral range of the waves are not high. In addition, the effect in this mode is accompanied by the formation of dense coagulation film, which prevents further penetration of the laser beams. [Jalkh AE, Trempe CL, Nasrallah, et al Treatment of small choroidal melanomas with photocoagulation. // Ophthalmic Surg. - 1988. - vol.19 - pp.738-742. Lanzetta P; Virgili G; Ferrari E; U. Menchini Diode laser photocoagulation of choroidal I // Int Ophthalmol. - 1995. - vol.96. No. 4. - pp.239-247].

Transcleral brachytherapy is one of the common ways of treatment of intraocular tumors. It is widely used by tumors of the Equatorial and postequalization localization. The method is based on short distance (contact) exposure on the basis of the tumor from Clery various radioactive radiation sources. The radionuclide is placed on the matrix, located in the sealed stainless steel container having the shape of a spherical segment with a thickness of 1 mm, This design is called ophthalmoplegia. Ophthalmoplegia placed on the sclera (the place of the projection of the base of the tumor on the sclera), locking his special bow interrupted sutures.

Indications for brachytherapy are determined by the size of the tumor [Guide oftalmologii. - Ed. Approving. - Moscow. - Medicine. - 2002. - str-134]. They are limited in the height of 5 mm and a maximum diameter of 14 mm Juxtapapillary tumors should not promenerat more than 3 mm, the radial size should not exceed 9.5 mm, and the meridional - no more than 1/3 (120°) of the circumference of the optic nerve disc. Limitations in size when planning for brachytherapy due to two issues: first, the size and shape of modern applicators, maximally adapted to the size of the eyeball, secondly, the maximum area of exposure to the eye tissue, the excess of which is associated with complications that entail the loss of the eye. The type of applicator also depends on the thickness of the tumor.

Incomplete regression of the tumor is possible relapses growth or tumor growth under scar [Karlsson UL, Augsburger JJ, Shields JA, et al. Reccurence of posterior uveal melanoma after 60Co episcleral plaque therapy. // Ophthalmology. - 1989. - vol.96. - pp.382-388.

In the case of recurrence, growth, or incomplete regression, after a year or more earlier (but not earlier than 6 months after the first brachytherapy), possible re-brachytherapy. However, resources and tolerability of the sclera to the re-exposure is very limited. When the total radiation dose to the sclera, approaching 300 Gr, develops scleromalacia where possible organ-preserving treatment is virtually eliminated [Zaruba GD Radiotherapy of tumors of the eye. - Moscow. - 1982 - the Dissertation on competition of a scientific degree of the doctor of medical Sciences. - page 343].

The disadvantages include: a strict limit on the size of the tumor, the restriction on the multiplicity of the use of the method, the long duration of rehabilitation and a wide range of these complications with a high probability of their development.

Thermotherapy is another radiation treatment of intraocular tumors, where the radiation source using infrared diode laser at a wavelength of 810 nm. The effect of thermotherapy based on a combination of volumetric hyperthermia of the tumor from 45 to 65° and coagulation intratumoral vessels. Thermotherapy is of two kinds - transpupillary and transscleral.

The advantages of TTT are as follows: non-invasive, relatively high efficiency, the capacity is ü sessions of exposure in the outpatient setting, the possibility of a replay session, the preservation of visual function.

Disadvantages can be considered: partial regression in some cases, a high frequency of recurrence of tumor growth, development of radiation resistance and the number of postradiation complications.

Lately there is a trend to combine multiple methods. So, transscleral thermotherapy can be combined with TTT.

Many authors use a combination of TTT with brachytherapy (the so-called sandwich method) [Seregard S., Landau I. Transpupillary Thermotherapy as an adjunct to rutenium plaque radiotherapy for choroidal melanoma. // Acta Ophthalmol. Scand. - 2001. - vol.79. No. 1. - pp.19-22; Keunen J.E., Journee de Korver. J.G. Transpupillary thermotherapy of choroidal melanoma with or without brachytherapy: a dilemma. // Br J Ophthalmology - 199 - vol.83, No. 8 - pp.987-988].

Attempts ophthalmooncologic to find a more effective combination among organ-sparing treatment suggests that the problem is far from being resolved.

At the turn of XX-XXI centuries in their Arsenal appeared and began to actively implemented a new method, called photodynamic therapy (PDT) of intraocular tumors. The essence of the method lies in the fact that the patient is injected photosensitizer (PS), which in a certain timeframe (they each FS) selectively accumulates in tumors, this creates a contrast ratio between the concentration of the drug in patologicheskaia and surrounding healthy tissues of the eye. The difference in the concentration of the drug in the pathological lesion and surrounding normal tissue can focus effect exclusively in the tumor. Irradiated transpupillary laser action at wavelengths that are at the maximum of the absorption spectrum of the used photosensitizer. Develops a cascade of photodynamic reactions, the main biological effect of which is destruction of the tumor. At the same time as photosensitizers can be used in a variety of natural and synthetic dyes. Irradiation is carried out traditionally transpupillary, that is, through the most advanced pupil.

The method is tested and has been used abroad in the treatment of intraocular tumors. The best results are associated with little pigmented tumors, which include amelanotic melanoma, osteomas and hemangioma of the choroid [Jurklies B, Anastassiou G, S Ortmans, et al. "Photodynamic therapy using verteporfin in circumscribed choroidal haemangioma." // Br J of Ophthalmology. - 2003 - Vol.87 - P.84-89; Madreperla SA. "Choroidal I treated with photodynamic therapy using verteporfin" // Arch Ophthalmol. - 2001. - Vol.119 - N 11 - P.1606-1610; Porrini G, Giovannini A, et al // Photodynamic therapy of circumscribed choroidal approach. // Ophthalmology. - 2003. - Vol.110. - P.674-680; Battaglia Parodi M, Da Pozzo S, et al. Photodynamic therapy for choroidal neovascularization associated with choroidal osteoma. // Retina. - 2001. - Vol.21. - P.660-711].

The method has a number of indisputable advantages:

First, it is non-invasive.

Secondly, the Parallels exposure geoeffective may be repeated.

Thirdly, PDT can be performed on an outpatient basis, which is more comfortable for the patient.

The method has some limitations. Revealed some regularities. Thus, it was found that the more pigmented tumor, the worse the efficiency and lower the depth of penetration into the tumor tissue, and therefore, a possible partial destruction of the tumor [Kim RY, Hu LK, Foster BS, et al. Photodynamic therapy of pigmented choroidal melanomas of greater than 3-mm thickness. // Ophthalmology. - 1996. - Vol.103. - P.2029-2036. Gonzalez VH, Hu LK, Theodossiadis PC, et al. Photodynamic therapy of pigmented choroidal melanomas. // Invest Ophthalmol Vis Sci. - 1995. - Vol.36. - P.871-878]. A partial effect in the future is associated with recurrence of tumor growth, and hence, with repeated courses of PDT.

Meanwhile, on the domestic pharmaceutical market oncologist appeared domestic photosensitizers. We have assumed that they can potentially be applied in ophthalmology in General and in oftalmologii, in particular. Among them photosense - derived phthalocyaninato series, as well as the photosensitizers of plant origin - chlorins. The effectiveness of these drugs proved photodynamic therapy of many cancers [Site: http://www.magicray.ru/RU/lecture/L1/1.html].

Our preliminary clinical and experimental studies have revealed the prospects of their application in oftalmologicheskiy problems

We also found that one of the ways to increase the efficiency of PDT can be transscleral approach to laser exposure (EN 2290905, 2007). This method is adopted for the nearest equivalent. The fact that tumors developing in the choroid, the original have expressed inlet or supply network of blood vessels located at the base. Impact through the pupil has only a partial effect. Better to take her power, causing photothrombosis lead to major vessels, and thus to cause tumor necrosis.

We have developed a method of organ preservation treatment, based on devitalizate tumor cells using PDT by transpupillary and transscleral by, followed by andarticle viable tumor from the vitreous cavity.

Use two approaches in the "sandwich technique" (on the part of the pupil+side sclera) enhances therapeutic effect and accompanied by a more complete destruction of the tumor. It is known that tumors of the choroid have a dual blood supply from vessels of the retina and blood vessels of the choroid [Amirian A.G., Brovkin A.F. Character vascularization mushroom uveal melanomas // Ophthalmology. - 2005. - volume 2. No. 2. - P.29-32]. If the tumor has a height of more than 5 mm, then the probability of this type of blood flow significantly increases the tsya. Only transpupillary PDT will not give full effect. While there is regression to the top of irradiated transpupillary, base grows and the tumor reappears at the original size... Thus, only the combination of these two effects can lead to regression of large tumors.

It is also known that the depth of degradation depends on the length of the laser radiation and radiation treatment. The greater the length of the laser radiation, the deeper the penetration into the biological object. For comparison, the depth of destruction 3.5mm - when using radiation length of 810 nm mode hyperthermia (1 minute exposure, the spot diameter in the focal plane of 3-5 mm) is increased to 10 mm when using a radiation length of 1060 nm and mode of photodynamic therapy. This significant difference is also due to fundamental differences in the mechanisms of biological action of these modes.

Thus, empirically revealed the possibility of destruction of large amounts of tumor (up to 11 mm, base diameter up to 22 mm). They are achieved through the consistent use of multiple laser radiation sources and access to laser exposure (transpupillary+transscleral), and photosensitizers. However, the closed space of the eyeball with his gematologicheskimi barrier is seriesdescription on the way to a complete regression of these tumors to flat chorioretinal scar. Devitalizirovannaya tumor arrays (conglomerates nonviable tumor cells with pigment residues) act in the vitreous cavity, are the source of dispersion of the pigment in the vitreous body with waitahanui potential, and need their radical destruction.

Earlier removal of such tumors was performed through large incisions in the sclera above the base of the tumor, while the contents of the eyes practically poured, lost control of turgor eyes. At the stage of evacuation of the tumor increased risk expulsive bleeding from major vessels of the eye and the choroid, and the development of retinal detachment and dislocation of the lens. This greatly reduced the chances of eyes on recovery and limited indications for such organochromium treatment methods.

Today these readings, in contrast, expanded, due to vitreoretinal surgery and, in particular, combined vision system for vitreoretinal surgery "Accurus 800 CS". Vitreoretinal surgery is a unique low-impact method, when surgical access is dosed through mini-incisions in the sclera width 23-25G in the projection of the flat part of the ciliary body. The advantage of this technology is:

- an opportunity removal devitalizirovannaya tumor arrays of photoshoparama method slice,

- the ability to control hemostasis using anticoagulatory that allows you to operate on a "dry field"

- ability to comply with elasticnet during the operation, which increases the patient's chances at the vital level,

- constant monitoring of intraocular pressure during and after surgery, which increases the chances of the eyeball to its conservation at the organ level,

- the ability to map membranes of eyes with full adaptation of the retina in place of its saving thanks endolaser coagulation and silicone or gas tamponade, which allows you to keep eyes on the functional level of residual visual functions).

The task of the invention is to develop a combined highly effective method for the treatment of intraocular tumors.

Our proposed method consists in pre-intravenously to patients with intraocular tumors of any photosensitizer and the subsequent conduct of photodynamic therapy in the optimum time, which are defined photosensitizing agent. While PDT is performed on the laser wavelength in the maximum absorption used FS with a total radiation power from 80 to 800 mW/cm2conducted first transpupillary, and then through 3-20 days transscleral in the same range of m is snasti using a special fiber and subsequent andarticle viable tumor from the vitreous cavity through a mini-ports - the holes in the sclera in time from 3 days to 1 month, depending on the time of occurrence of the devitalisation of the tumor.

The minimum dose of injected photosensitizer is determined individually.

The dose of injected FS, as the exposure dose is determined by the size and degree of pigmentation of intraocular tumors. The larger the size of the tumor and more pigmentation, the higher the required FS and power of laser irradiation. Greater tumor array requires the use of large cumulative radiation doses.

However, it is found experimentally that a high single dose in excess of 800 mW/cm2associated with increased risk of cataract development, and at a dose of less than 80 mW/cm2the effects of PDT are not developing [Mvisa "the Possibility of using domestic Photosens under the fluorescent diagnostics and photodynamic therapy of tumor and pseudophoenix eye diseases". - Moscow. - 2004. - str. - Thesis for the Cand. the honey. Sciences].

Irradiation is carried out transpupillary standard way [Likhvantseva VG Thermotherapy of intraocular tumors. Moscow. - 2009], then through 3-20 days transscleral in the same power range after marking the boundaries of the tumor on the sclera transilluminated by focusing the laser radiation on the pathologic lesion using the special is on fiber. When this fiber have at such a distance from the impact zone, so that the light beam overlaps the base of the tumor. After devitalisation of the tumor through (3 days - 1 month), while total vitrectomy produce andarticle tumors that provides reduced risk of systemic metastasis, recurrence risk and allows you to create conditions for the preservation of the remaining uninvolved parts of the retina. Consequently, it is possible to preserve visual function. Tamponade substituents of the vitreous body and laser coagulation of the retina provide full adaptation of the retina.

Thus, our proposed method PDT intraocular tumors allows you to combine PDT "sandwich method" for full devitalisation and avascularization with endometrial resection of the tumor.

The advantages of our proposed method is the enhancement of therapeutic effect with the expansion of indications for organochromium treatment.

The technical result of the invention is a radical complete destruction of the tumor with extension of the indications for organochromium treatment and recovery of functional reserves of the eye.

The technical result is achieved due to the combination transpupillary and transscleral PDT andarticle neoplasms after vitrectomy.

The method is as follows.

Intravenously injected photosensitizer with the recommended doses for this disease.

PDT is performed in time, the optimal accumulation taken FS. Use of laser radiation has a wavelength in the maximum absorption of the Federal Assembly.

When the accumulation in the tumor FS conduct individual planning mode radiation exposure. The parameters of the radiation power is determined by the array of the tumor. The greater the thickness of the tumor, the stronger must be the radiation exposure. For tumors with a height of 2 mm is enough radiation capacity of 80 mW/cm2. Tumor height of 5 mm require more power, for example, 800 mW/cm2and is calculated as shown previously, individually.

The patient is administered in endotracheal anaesthesia. On the operating table after exposure of the sclera from the conjunctiva in place of the proposed location of the tumor, conduct transscleral or transpupillary illumination to determine the exact boundaries of the projection of the base of the tumor on the sclera.

Transscleral impact is realized in accordance with the marking boundaries using PDT laser effects laser with the wavelength in the maximum absorption FS. Transpupillary PDT influence carry out through the pupil. The power of radiation exposure varies from 80 mW/cm2d is 800 mW/cm 2when each of the exposures.

Through 3-20 days, depending on the condition of the tumor, controlled using various methods, after injection of the photosensitizer radiation exposure exercise already transscleral using a special optical fiber, forming a light beam with a spot diameter, the size of which capture 1-2 mm of healthy tissue located outward from the marking of the boundaries of the projection of the base of the tumor on the sclera.

Then in the hospital after 3-30 days after devitalisation of the tumor in terms of mask or endotracheal anesthesia and local anesthesia alcaina of 0.5%, aseptic processing conjunctival fornix drugs guidikova acid, exercise individially access through mini-ports in the sclera width 23-25G made in the projection of the flat part of the ciliary body.

Perform total vitrectomy. Then devitalizirovannaya tumor extract with vitrectomy method of fragmenting. After removal of the tumor is achieved by the full adaptation of the retina to seal the retina with tamponade the vitreous substitutes and laser coagulation of the retina. Wounds in the sclera width 23 G sutured wikilove 8-0 sutures.

Example 1. Patient, 65 years of age. Diagnosis: melanoma of the choroid (.T2N0M0) of the right eye. On the left eye of the initial senile kata the act. The original size of the tumor height was 6.0 mm, diameter 17 mm

The patient entered Radachlorin calculation of 0.7 mg/kg of body weight. After 3 hours spent transpupillary irradiation of the tumor at a dose of 500 mW/cm2in accordance with the size of the tumor and pigmentation. In 7 days after poslednee the top of the tumor the patient it was decided to hold transscleral PDT. Was introduced Radachlorin calculation of 0.7 mg/kg of body weight. After 3 hours the patient in the operating conditions imposed in endotracheal anaesthesia. On the operating table after exposure of the sclera from the conjunctiva in place of the proposed location of the tumor, held transscleral illumination to determine the exact boundaries of the projection of the base of the tumor on the sclera. Spent the boundary marking the projection of the tumor on the sclera. They were taken to 11 mm from the limbus in the sector of 5-7 hours.

PDT spent transscleral, when this dose was 500 mW/cm2. This had the light guide so that the diameter of the light spot in the focal plane of radiation exposure was 20.0 mm

After 2 weeks there was devitalizate tumor, which was reflected in the appearance of non-uniformity of the surface of the fluid in the space between the retina and the top of the tumor and the absence of blood flow (ultrasound Doppler data) and visualization of photothrombosis vessels in its stroma clinically. The implementation is and andarticle tumor through a mini-ports in the sclera.

Visual acuity was 0.1 n/a Corr. Surveillance for 3 years showed a stabilization process.

Thus, there was a stabilization of the neoplastic process (saving the patient's life), the preservation of the eye as a cosmetic body (improved quality of life) and the presence of residual visual functions (the function result).

Under the proposed method treated 29 people. We all received a positive clinical effect in the form of a flat chorioretinal scar. Complications are not checked.

Thus, our proposed combined method of treatment of intraocular tumors is quite effective, can be used in the practice of ophthalmology. Can serve as an independent organ-preserving treatment and in combination with other organochromium ways.

The way an organ-preserving treatment of intraocular tumors, including transscleral photodynamic therapy (PDT), characterized in that the pre-exercise transpupillary PDT, transscleral PDT carried out through 3-20 days after it, and after devitalisation of tumors carry out total vitrectomy and andarticle tumors, fill vitreal cavity substitute for the vitreous body and carry out the coagulation of the retina.



 

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1 ex

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be used for surgical treatment of open-angle glaucoma. L-shaped conjunctival cut, one side of which is located concentrically with limb and the other side is located radially to limb, is made. In one scleral bed cut out and formed are large, proximal, and small, distal, superficial flaps with ratio of length 2:1; proximal flap is turned towards limb, distal flap is turned from limb. Anterior wall of Schlemm's canal with strips of corneoscleral and corneal tissue is ablated. Medial scleral flap is formed and removed. Apex of distal superficial scleral flap is tucked into the recess, formed under its base. Proximal superficial scleral flap is shortened and laid into scleral bed. Suture is applied on conjunctiva.

EFFECT: method makes it possible to increase efficiency of microinvasive non-penetrating deep sclerectomy by formation of additional ways of intraocular fluid outflow in deep layers of sclera, ensuring their functioning independently on fusion of superficial scleral flap and, as a result, ensuring stable hypotensive process.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of ophthalmology. Ports are installed, LEDs and instruments are introduced, vitrectomy is performed, section of epiretinal membrane (ERM) is detached, bent aside, cut and ablated by means of vitreotom. Longitudinal axis of port for vitreotom is matched with direction at ERM edge, forming axis of surgical impact (ASI). Longitudinal axis of vitreotom is matched with line of longitudinal symmetry of ERM, with formation of plane of surgical impact (PSI). External surface of vitreotom tip is brought under retinal ERM surface, asynchronous fluctuating movements around fluctuation centre are realised with ratio of positive amplitude to negative amplitude within the interval from 1.5 to 1.0; centre of fluctuating movement is moved along external curved ERM surface; during each stage of discrete movement vitreotom tip is moved along ASI and in PSI 2-3 mm forward, then 1-2 mm backward; vitreotom tip being moved on retinal ERM surface to the opposite edge of ERM, increasing area of detached retinal surface of ERM, thus starting formation of rectilinear tunnel. In mode of 200-300 mm Hg vacuum fixation of upper wall of ERM tunnel in vitreom window and pulling ERM upwards are performed, after that, level of vacuum is reduced to zero and vitreom tip is moved again along ASI and in PSI forward, until 4-5 mm long tunnel is formed. Vitreom tip is brought under external border of tunnel, window of vitreom tip is brought into contact with upper wall of tunnel, then in mode of cutting vitreom tip is moved along tunnel in ERM, dividing ERM into two equal flaps, angle of flap bending aside constituting 20-30 degrees. Point bleeding from newly formed vessel of retina surface is covered with silicone tip of introduced into eye cavity extrusion needle, forming in 300-400 mm Hg vacuum mode convex surface of retina, facing with convexity posterior capsule of crystalline lens, then vacuum is released, extrusion needle is removed from eye cavity, diathermocoagulator is introduced and precision diathermocoagulation of newly formed vessel of retina surface on apex of formed in vacuum mode convex surface of retina is carried out with diathermocoagulator tip.

EFFECT: method makes it possible to increase accuracy of diathermocoagulation, reduce area of burn, ensure efficient hemostasis after single impact, reduce risk of intraoperative complications.

2 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to ophthalmology and can be applied in surgical treatment of blepharoptosis. Method lies in cutting upper eyelid skin, separation from underlying tissues of circular eye muscle, exposing cartilage and levator. Levator is divided into two parts, which are sewn near their place of detachment. After that, muscles are cut off from the place of detachment and transferred on symmetrically located sections near cartilage base, and fixed to new place of attachment. Sutures are applied on eyelid skin. It is also possible to carry out method of sparing blepharoptosis microsurgery during which dosed impact on group of levator muscles is performed. After that, levator is tightened by transfer of places of its attachment to upper eyelid cartilage base in projection of anatomic location.

EFFECT: application of claimed group of inventions makes it possible to reduce operation trauma by dosed impact on levator muscles without impact on adjacent tissues, as well as due to enhancement of levator with preservation of its morphologic structure, makes it possible to reduce volume of scarring in places of suture application.

2 ex

FIELD: medicine.

SUBSTANCE: implant of cornea for introduction into optic centre (Z) of human eye cornea aimed at elimination of ametropia, in particular presbyopia or presbyopia in combination with hypermetropia or myopia. For offer of cornea implant which is suitable for introduction into optic centre (Z) of human eye and can be used for correction of presbyopia alone or presbyopia in combination with hypermetropia or myopia, it is supposed that efficient thickness (a) of cornea implant (2), measured in direction of optic axis (5) of eye, is more than 50 microns and maximal width (b), measured in plane, perpendicular to thickness, is less than 1 mm, and cornea implant (2) does not fulfill function of reflection with respect to human eye.

EFFECT: claimed implant and methods of its implantation make it possible to eliminate ametria without complications in form of reduction of vision acuity, to correct presbyopia, to apply implant which produces good cosmetic effect.

21 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology, and may be used for treating proliferative diabetic retinopathy. It involves inserting ports, introducing a light guide, carrying out vitrectomy, detaching a part of an epiretinal membrane (ERM), unbending it, cutting by using a vitreous cutter. It is combined by matching a longitudinal axis of the port for the vitreous cutter directed towards an edge of the ERM with generating a surgical axis (SA), matching a longitudinal axis of the vitreous cutter and a longitudinal axis line of the EMR with generating a surgical plane (SP). An external surface of a vitreous cutter tip is delivered under a retinal surface of the ERM to perform asynchronous oscillatory movements about a centre of oscillation with the positive to negative amplitude ratio within the range 1.5 to 1.0; the centre of oscillation is moved along an external curvilinear surface of the ERM, each stage of discrete movement involves moving the vitreous cutter tip along the SA and in the SP 2-3 mm front, then 1-2 mm; with the vitreous cutter tip advanced along the retinal surface of the ERM to an opposite edge of the ERM, increasing an area of the detached retinal surface of the ERM to start thereby formation of a rectilinear tunnel; in a vacuum mode of 200-300 mm Hg, an upper wall of the ERM tunnel is fixed in a vitreous cutter window while the ERM is pulled upwards; then the vacuum level is dropped to zero, and the vitreous cutter tip is moved along the SA and in the SP again forward to formation of the tunnel 4-5 mm long; the vitreous cutter tip is delivered under an external border of the tunnel; the vitreous cutter window is brought to contact with an upper wall of the tunnel; then the vitreous cutter tip is advanced in a cutting mode along the tunnel in the EMR with dividing the EMR on two equal flaps; the edge of each ERM flap is unbent at an angle of 20-30 degrees in relation of a retinal surface, in the vacuum mode 200-300 mm Hg the edge of each ERM is fixed by the vitreous cutter tip and pulled up with detaching the EMR from the retinal surface; the detached ERM fragment is removed with using the vitreous cutter tip in the cutting mode; the similar procedure is used to remove the rest ERM fragments.

EFFECT: method enables simultaneous reduction of operative injures, IOP variation amplitudes in the eyeball, prevented changes of spatial retinal and epiretinal interposition caused by the IOP variations due to instrument change and eye cavity depressurisation.

2 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology. It involves inserting ports, introducing a light guide, carrying out vitrectomy, detaching an epiretinal membrane (ERM), unbending it, cutting and removed by using a vitreous cutter. It is combined with matching a longitudinal axis of the port for the vitreous cutter directed towards an edge of the ERM with generating a surgical axis (SA), matching a vitreous cutter axis and a longitudinal symmetry axis of the ERM with generating a surgical plane (SP); an external surface of a vitreous cutter tip is delivered under a retinal surface of the ERM to perform asynchronous oscillatory movements about a centre of oscillation with the positive to negative amplitude ratio within the range 1.5 to 1.0; the centre of oscillation is moved along an external curvilinear surface of the ERM; each stage of discrete movement involves moving the vitreous cutter tip along the SA and in the SP 2-3 mm front, then 1-2 mm; with the vitreous cutter tip advanced along the retinal surface of the ERM to an opposite edge of the ERM, increasing an area of the detached retinal surface of the ERM to start thereby formation of a rectilinear tunnel; in a vacuum mode of 200-300 mm Hg, an upper wall of the ERM tunnel is fixed in a vitreous cutter window, while the ERM is pulled upwards; then the vacuum level is dropped to zero, and the vitreous cutter tip is moved along the SA and in the SP again forward to formation of the tunnel 4-5 mm long; the vitreous cutter tip is delivered under an external border of the tunnel; the vitreous cutter window is brought to contact with an upper wall of the tunnel; then the vitreous cutter tip is advanced in a cutting mode along the tunnel in the EMR with dividing the EMR on two equal flaps; further a bleeding is directed from a new vessel found close by a macular region coated with connective tissue bridges and membrane-like structures towards the macula with turning an eyeball in relation to the surgical plane with using the vitreous cutter and the light guide introduced in the eye cavity to cover it with blood completely to ensure complete retraction of a blood clot in 15-30 seconds; further the eye ball is set in an initial position; then the vitreous cutter is delivered under an edge of the blood clot and pulled up and aspirated in an vacuum mode 300-400 Hg mm with removing the blood clot with underlying connective tissue bridges and membrane-like structures.

EFFECT: method allows reducing operative injures, using an effect of blood fibrin adhesion with epimacular membrane-like structures enables one-step removal of membrane-like structures eliminating any mechanical effect of an instrument on the macula, provides cutting surgery time, extent of the anaesthesia care, a risk of developing individual side effects of the anaesthesia in the patients suffering diabetes for a long period of time and having severe comorbide background.

2 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine. A vitreoretinal surgical system comprises a flow control system to supply first and second fluid mediums when in use into an infusion cannula of the vitreoretinal surgical system. Said flow control system comprises: a first fluid flow source; a second fluid flow source; a switching unit of said flow of said first fluid medium and said flow of said second fluid flow; a first channel for said flow of said first fluid medium, a second channel for said flow of said second fluid flow and a connecting device. Said first channel is an infusion channel for fluid flow. Said second channel is a gas channel for gas flow. The connecting device comprises a first inlet for said first channel; a second inlet for said second channel; an outlet for said first fluid medium or for said second fluid medium for variable connection when in use of the first or second fluid mediums with the infusion cannulas; usually closed return valve and a receiver portion. Said return valve is opened when said switching unit switches said flow of said first fluid medium to said flow of said second fluid medium. The receiver portion has an internal surface precisely adjusted to an external surface of said return valve for minimising when in use air bubble or gas formation in the first fluid medium when the flow of said first fluid medium is supplied into said infusion cannula.

EFFECT: invention enables for a vitreoretinal surgeon to make switching between a surgical infusion solution and air or other gas, without resorting to assistance and avoiding potential eye limping caused by fluid flow interruption.

6 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely ophthalmology and aims at removing silicone oil bubbles from an anterior eye chamber with preceding vitreal cavity tamponade. A cannula is introduced into the anterior chamber on a syringe filled with normal saline which when injected presses silicone oil bubbles out through the cannula directly delivered thereto.

EFFECT: method provides eye-ground visualisation, promotes eliminating a risk of dystrophic corneal changes when is found in contact with silicone oil and a risk of IOP increase if Schlemm's canal is blocked with silicone oil, as well as ensures eliminated anterior chamber emptying due to normal saline compensation and escape of new portions of silicone.

1 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

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