RU2165249C1 - Method for removing encapsulated splitter from eyeball - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying argon laser retina coagulation around the encapsulated splitter being localized in posterior eyeball tunics. Foreign body capsule is destroyed by means of endolaser coagulation. Uncovered splitter zone is mechanically increased by moving the endolaser coagulation end piece. When needed, the capsule endolaser coagulation is repeated. EFFECT: uncovering capsule above the splitter; avoided hemorrhage and amotio retinae occurrence.

Description

 The invention relates to medicine, in particular to ophthalmology, and can be used to remove intraocular encapsulated foreign bodies located in the membranes of the eyeball.

 It is known that the removal of foreign bodies from the posterior part of the eye is very difficult and often leads to retinal detachment and hemophthalmus. In this regard, it was concluded (R. Gundorova et al. - Eye injuries. // M., - Medicine, - 1986, - 310 p.), That it is better to leave it than to remove it from the eye, if it allows foreign body position relative to the retina. Another author (Neroev V.V. - Rational tactics of management and treatment of patients with intraocular foreign bodies of the posterior part of the eye. // Diss. Candidate of Medical Sciences, - M., - 1987, - 167 pp.) Also considers it appropriate to leave foreign body in the eye, if there are no signs of metallosis and the fragment itself is covered with a dense fibrinous capsule.

 However, a splinter, which has been inside the eye for a long time, causes a formidable complication - metallosis of the eyeball tissues: among this disease, siderosis occurs in up to 80% of cases - the process from the effects of iron oxidation products and in 20% of cases - chalcosis in copper-containing foreign bodies (R. Gundorova A. - Prevention, early diagnosis, clinic and treatment of post-traumatic complications associated with prolonged exposure to chemically active foreign bodies in the eye.// Diss. Doctor of Medical Sciences, - M., - 1968, - pp. 103-134.).

 Is there a known way to expose a fragment? including dissecting the capsule, using Gref and Sato knives, removing it with collet tweezers or a probe magnet (Gundorova R.A. et al. - Eye injuries .// M., - Medicine, - 1986, - pp. 112-145 .).

 There is a method of removing encapsulated fragments localized in the shells of the posterior part of the eye, in which a foreign body is "exposed" with the help of a vitreophage, after which it is captured with collet tweezers and removed. However, during the execution of these manipulations, complications arise in the form of traction retinal detachments and hemorrhages (Lagua N. - Extraction of an encapsulated of foreign bodies by means of pars plana vitrectomy.// Klin. Mbl. Augenheilk, -1979, - Bd. 174, - H. 4, - S. - 542-547).

 To remove the encapsulated fragment from the posterior pole of the eye, use tweezers to expose the fragment, and to prevent retinal detachment, a circlet with transscleral cryopexy is used (Slusher M.M. et a1. - Management of intraretinal foreign body. // Trans. Amer. Acad. Ophthalmol. and Otolaryng., - 1982, - V. 89, - N. 4, - P. 369-373). (Joondeph BC et al. - Management of subretinal foreign bodies with a cannulated extrusion needle. // Amer. J. Ophthalmol., - 1990, - V. 110, - N 3, - P. 250 - 253.) developed their tactics removal of an intraocular foreign body with localization of a fragment behind the retina. After performing a vitreotomy: an elastic tip put on the cannula is brought to the foreign body behind the retina. The foreign body is moved by the cannula to a gap in the retina and fixed with tweezers, which then remove the foreign body. After that, endolasercoagulation is performed around the retinal rupture.

 A known method of transvitreal removal of foreign bodies localized in the posterior part of the eye, including YAG laser treatment of a foreign body capsule in the form of radial dissection of the capsule itself to expose the fragment and prophylactic barrier argon laser coagulation to prevent traction retinal detachment during surgical removal of a foreign body (A.C. . SU N 1451912, 1988.). This method is taken as the closest analogue.

 Known methods have proven themselves in the removal of foreign bodies due to the retina. However, almost all of them are traumatic in relation to the retina and can cause complications in the form of bleeding or detachment of the retina. In some cases, it does not seem technically possible to violate the integrity of a dense capsule with neovascularized vessels above a foreign body even with the help of shock YAG laser exposure.

 The proposed method is based on the fact that the impact on the capsule of a foreign body occurs with a minimal operative effect on the eyeball, is strictly dosed and without traction on the retina, practically without the risk of damage to neovascular vessels with argon laser coagulation of the capsule at the time of its destruction and an increase in the exposure zone of the fragment by the tip itself endolaser, thereby reducing the risk of retinal detachment and bleeding at the time of surgery and in the postoperative period. It also reduces the time of surgery.

 The technical result of the method is to reduce the risk of retinal detachment and bleeding at the time of surgery and reduce the time of surgery.

 The technical result is achieved by preliminary fixation of the retina around the foreign body using argon endolaser coagulation along the border of the foreign body bed and exposing it with the endolaser tip after the destruction of the foreign body capsule by endolaser coagulation.

 The method is as follows.

 After conducting a clinical study confirming the presence of a foreign body under the retina using x-ray localization, ultrasound scanning and ophthalmoscopy, the patient is prepared for surgery to remove a foreign body.

 Against the background of maximum mydriasis and under local anesthesia in the operating room, sclera tissue is opened in the area of the flat part of the ciliary body and the tip of the endolaser argon coagulator is inserted into the vitreous body. Under the control of funduslins, the tip is led to an encapsulated fragment and endolaser argon coagulation is made around the bed of a foreign body in a checkerboard pattern in 2-3 rows and on the surface of the capsule bag and neovascular vessels. In the process of coagulation violate the integrity of the capsule. The resulting gaps are diluted with the tip of an endolaser with a complete exposure of the fragment from the capsule. Then the tip of the endolaser is changed to a surgical instrument, which removes the exposed foreign body. Depending on the nature, the foreign body is removed with either tweezers or a magnet. After removal of the foreign body, the wound is sutured and antibiotics are administered under the conjunctiva. Bandage.

 Example. A 36-year-old patient was admitted to the inpatient ophthalmology department with the diagnosis: OD - penetrating corneoscleral scar, post-traumatic aphakia, internal intraocular foreign body of the posterior pole of the eyeball, covered with a dense capsule with neovascular vessels on the surface of the capsule. Visual acuity OD / OS: 0.02 / 0.6; IOP OD / OS: 22/22 mm Hg. Art. According to EFI - inhibition of the activity of the retina OD by 1.5 times; according to x-ray studies - a foreign body in the posterior part of the eye (according to the conditional scheme, partially in the shells of the eye), according to ultrasound scanning - a foreign body is in the posterior part of the eye in the membranes and hammered in.

 From the anamnesis - five years ago he received a penetrating wound to the eyeball with the introduction of a metal magnetic fragment during the processing of the part with a sledgehammer. On the day of injury at the place of residence, primary surgical treatment of a corneal wound was performed with the extraction of traumatic cataract and a negative attempt to remove a foreign body. After conservative treatment, visual acuity of the right eye with aphakic correction reached 0.3-0.4; IOP OD within 22-24 mm Hg

 Due to the deterioration of visual acuity and a change in the color of the iris, the patient turned to an ophthalmological institution. Diagnose the presence of an encapsulated fragment with the phenomena of metallosis of the tissues of the eyeball. The patient is offered the removal of an intraocular foreign body. However, upon examination, the presence of a dense capsule above the fragment with pronounced vessels on the surface of the capsule is noted. Given the likelihood of bleeding during dissection of the capsule and the tractional movement of the retina due to the dense capsule, it is proposed to use YAG laser dissection of the capsule over a foreign body with preliminary barrier argon coagulation of the retina of the bed of a foreign body.

 Against the background of maximum mydriasis, OD produce an argon laser barrier coagulation 4 mm from the foreign body in a checkerboard pattern in three rows around the foreign body in the amount of 131 coagulate. 5 days after argon exposure, a YAG laser dissection of the retina over a foreign body is performed. Foreign body is not naked. There was almost no bleeding from the neovascular vessels of the capsule. On the same day, in the operating room, under local anesthesia, the sclera is opened in the area of the flat part of the ciliary body of the upper quadrant and the tip of the endolaser coagulator is introduced into the incision to enhance the barrier coagulation of the retina around the foreign body (due to the absence of the YAG laser dissection, the foreign body was decided not to be removed). Under the control of the fundus lens, endolaser coagulation of the capsule neovascular vessels was started. As a result of exposure, a violation of the integrity of the capsule bag was noted. The tip mechanically increases the gaps between the sites of endolaser argon coagulation. As a result, the foreign body is completely exposed and removed without complications. Vitreous prolapse in the surgical wound was not observed. 2 nodal sutures were laid on the sclera and a continuous suture 8-00 on the conjunctiva. Under the conjunctiva, an antibiotic solution is administered. Bandage.

 2 days after surgery, the state of OD is satisfactory: slightly irritated, the sutures are clean, the cornea is calm, a single suspension in the vitreous body. On the fundus: the bed of a foreign body is clean, surrounded by pronounced laser coagulates. There are no phenomena of hemorrhage and retinal detachment. Visual acuity of OD - 0.08, IOP OD-24 mm Hg According to ultrasound, there are no changes.

 3 months after surgery - OD is calm, the sutures are removed. The anterior segment is unchanged, except for a partial restoration of the color of the iris. In the vitreous body, a moderate suspension. The fundus of the eye is a pale pink optic nerve disc, the vessels are calm, in the area of surgical intervention, the retinal area is surrounded by pigmented laser coagulates. The retina is everywhere. Visual acuity of OD from sph. + 11.0 = 0.4: IOP OD - 22 mmHg

 The indications of the method are operations associated with the removal of the encapsulated foreign body and with the risk of retinal detachment and bleeding.

 The method has no contraindications.

 As a result of the application of this method, traction effects on the retina can be avoided when the capsule is dissected above the foreign body and when the foreign body located in the membranes of the eye is removed, bleeding from blood vessels.

Claims (1)

 A method for removing an encapsulated fragment from the shells of the eyeball, including its preliminary release from the capsule by destruction with preliminary barrier laser coagulation of the retina around the bed of the fragment, characterized in that the release is made by alternately coagulating and mechanically acting on the capsule with the tip of an argon endolaser.