RU2234901C1 - Surgical method for treating the cases of pterygium formation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves withdrawing the pterygium. Barrier autoplasty of conjunctiva is carried out on pedicle. Cornea is covered with ultraviolet radiation protector in the withdrawn pterygium area, ablation coefficient being equal to that of cornea. Withdrawn pterygium area surface ablation is carried out with excimer laser at 193 nm wavelength and spot diameter of 2 mm to build smooth cornea surface under visual control.

EFFECT: enhanced effectiveness of treatment; accelerated cornea epithelialization.

7 dwg

Description

The invention relates to medicine, more specifically to ophthalmology, and can be used in the surgical treatment of pterygium.

Pterygium is a dystrophic disease of the eye, in which a degeneratively altered vascularized conjunctiva of the eyeball grows into the surface layers of the cornea, in the form of a triangular film, with its apex facing the center (Fig. 1). It is usually located on the inside of the eyeball and slowly grows, reaching the central zone and overlapping the pupil area.

Pterygium is one of the main consequences of the damaging effects of adverse climatic and environmental conditions on the cornea. Intense ultraviolet radiation, strong winds with dust contribute to the emergence and rapid progression of the disease. In patients, the conjunctiva is inflamed chronically, as the disease progresses, visual acuity decreases, in the future, in advanced cases, it is possible to restrict eye movement and a persistent decrease in vision.

Traditional methods of surgical treatment of pterygium are often accompanied by relapses of the disease, gross clouding of the cornea, irregularity of its surface (astigmatism), severe pain in the early postoperative period. Therefore, the improvement of surgical techniques for the treatment of pterygium is an urgent problem.

A known method of surgical treatment of pterygium (ALAnduze. Pterygium Surgery With Mitomycin-C: Ten-Year Results // Ophthalmic Surgery and Lasers. - Yuly / August 2001. - Vol. 32. - No. 4, p. 341-345), including separation and removal of pterygium, conjunctival plasty and subconjunctival administration of 0.1 ml of 0.4 mg / ml Mitomycin-C. However, in the postoperative period, marked pain syndrome (about 2 weeks), irregularity of the corneal surface are noted. In addition, the use of Mitomycin-C can cause severe complications, including impaired epithelization and scleral ulceration.

The closest analogue to solving the technical problem is a method of surgical treatment of pterygium, including its removal and carrying out barrier plasty of its own conjunctiva (autoplasty) (Kmiha N., Kamoun B., Trigui A. et al. Effectiveness of conjunctival autograft transplantation in pterygium surgery // J -Fr-Ophtalmol. 2001 Sep; 24 (7): 729-732). However, even with thorough mechanical cleaning of the cornea in the area of the removed pterygium, its surface remains uneven, which leads to a slowdown in the regeneration proceeding with pain.

An object of the invention is to provide an effective method for surgical treatment of pterygium in order to reduce postoperative complications by providing a perfectly smooth surface of the cornea in the area of the removed pterygium, to reduce the possibility of disease recurrence by forming a barrier from the patient’s healthy conjunctiva on the path of the mucosa growing on the pathologically changed cornea and improving the cornea topography due to the elimination of flattening of the cornea in the pterygium zone.

The technical result is achieved by the fact that in the method of surgical treatment of pterygium, including its removal, conducting barrier autoplasty of the conjunctiva on the leg, applying an ultraviolet tread to the cornea in the area of the removed pterygium with an ablation coefficient equal to the ablation coefficient of the cornea to align this zone, and performing ablation (resurfacing ) the surface of this zone with a flat beam of an excimer laser with a wavelength of 193 nm and a spot diameter of 2 mm until a smooth surface of the cornea is reached under visual control.

The method is as follows: under local anesthesia, through the infiltration of a 2% solution of lidocaine, pterygium tissue from the cornea and episclera is separated using a spatula and a round knife. Separated tissue excised. Thermocoagulation of bleeding episcleral vessels is carried out. In the area of the upper arch at the limb, a thin flap of a healthy conjunctiva is cut out, leaving a feeding leg in the upper inner section of the conjunctival sac (Fig. 2). The tenon capsule is left intact. The flap is deployed and laid on the exposed sclera at the site of the removed pterygium (figure 3). The flap is fixed with several episcleral sutures. In the place of formation of the flap under the upper eyelid, sutures on the conjunctiva are not imposed. A dexamethasone solution of 0.1% - 0.3 ml is administered under the conjunctiva.

Next, the patient is transferred to the operating table excimer laser installation. An ultraviolet tread with an ablation coefficient equal to the ablation coefficient of the cornea is applied to the cornea in the area of the removed pterygium. Actoveginine jelly diluted with an artificial tear at a concentration of 1: 1 or viscoelastic is used as a protector. Cornea is ablated with a flat beam excimer laser with a wavelength of 193 nm and a diameter of 2 mm in the regime of phototherapeutic keratectomy. Using an operating microscope, the quality of the resulting surface of the cornea is visually monitored. When achieving perfect surface smoothness, the operation is completed.

An antibiotic solution (ciloxane) is instilled into the eye, actovegin jelly is placed. The operation is easy to perform, gives a good cosmetic effect.

During the operation, several anti-relapse factors are important: the ideal smoothness of the cornea, the barrier from its own healthy conjunctiva and the expansion of the internal arch due to the additional area of the conjunctival flap.

In the postoperative period already on the day of surgery, 4-fold instillations of a 20% solution of sulfacyl sodium and 3-fold instillations of maxitrol are prescribed (combines dexamethasone and two antibiotics).

In the first 2-3 days after surgery, the cornea in the keratectomy area is usually moderately edematous, a temporary decrease in its transparency may be observed. Pain syndrome (weak or moderate intensity) is usually observed within 1-2 days after surgery.

A relapse of the disease occurred in one case when a viral infection with the development of stromal keratitis and vascular ingrowth layered in the postoperative period. Repeated FTK and intensive antiviral therapy allowed to stop the process.

UV protection was strongly recommended for all patients with eye protection. Bright sun, wind, dust and all eye irritating factors must be avoided.

Our proposed method of operation is simple and easy to execute. Its main advantages are:

- Reduction of corneal astigmatism

- Fast corneal epithelization

- Low relapse rate (1.1%)

- Lack of severe pain

Clinical example:

Patient I., 63 years old.

Diagnosis: Pterygium of the left eye of the III degree (figure 4).

Vis OS = 0.3cyl + 3.0ax90 = 0.7 n / k

Autorefractometry: sph + 0.25cyl + 6.0ax90

On a computer keratotopogram (figure 5), flattening of the cornea in the horizontal meridian (direct astigmatism) is clearly visible.

The patient underwent an operation: under local anesthesia, through the infiltration injection of a 2% lidocaine solution, pterygium tissues from the cornea and episclera were separated using a spatula and a round knife. Separated tissue excised. Conducted thermocoagulation of bleeding episcleral vessels. A thin flap of a healthy conjunctiva was cut out in the upper arch near the limb, leaving a feeding leg in the upper inner part of the conjunctival sac. The flap was unfolded and laid on a naked sclera at the site of the removed pterygium. The flap was fixed with several episcleral sutures. A dexamethasone solution of 0.1% - 0.3 ml was administered under the conjunctiva.

The patient was transferred to the operating table of the excimer laser installation. An ultraviolet tread with an ablation coefficient equal to the ablation coefficient of the cornea (viscoelastic) was applied to the cornea in the area of the removed pterygium. The cornea was ablated with a flat beam excimer laser with a wavelength of 193 nm and a diameter of 2 mm in the regime of phototherapeutic keratectomy. Using an operating microscope, the quality of the resulting corneal surface was visually monitored. Upon achieving perfect smoothness of the surface, the operation was completed. An antibiotic solution (ciloxane) was instilled into the eye, and Actovegin jelly was placed.

The course of the postoperative period is smooth, pain syndrome of low intensity was observed within 1 day. Complete corneal epithelization occurred on the 2nd day after surgery.

In 1 week after the operation, the eye is calm, the cornea is transparent, the underlying tissues without features (Fig.6).

Vis OS = 0.8 n / a

Autorefractometry: sph + 0.25cyl + 0.5ax95

On a computer keratotopogram (Fig.7), the corneal surface is regular, physiological astigmatism.

Over the observation period (3 years), no relapse of the disease was noted.

The invention is illustrated by drawings, where

figure 1 is a view of the eye with pterygium III degree;

figure 2 - phase of the operation, when the pterygium is removed and in the upper arch is cut a superficial flap of the conjunctiva;

figure 3 - stage of the operation, when the selected conjunctival flap is deployed on the leg, forming a barrier;

figure 4 is a view of the eye of the patient I. before surgery;

figure 5 is a computer keratotopogram of the eye of the patient I. before surgery;

Fig.6 is a view of the eye of patient I. after surgery;

Fig.7 is a computer keratotopogram of the eye of the patient I. after surgery.

Claims (1)

A method for surgical treatment of pterygium, including removal of pterygium, conducting barrier autoplasty of the conjunctiva on the pedicle, applying an ultraviolet protector to the cornea in the area of the removed pterygium with an ablation coefficient equal to the ablation coefficient of the cornea to align this zone, and performing ablation of the surface of this zone with a flat excimer laser beam with a length waves of 193 nm and a spot diameter of 2 mm to achieve a smooth surface of the cornea under visual control.

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