RU2453296C1 - Microdiathermoplasty technique for treating infectious corneal ulcers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and aims at treating infectious corneal ulcers. It involves microdiathermoplasty presented by coagulation and mechanical removal of pathologically changed corneal tissues from a wound surface. That is ensured by sequential microdiathermoplasty of the whole ulcer surface, walls, bottom, contents to apparently healthy tissue. Thereafter, a working part of the same electrode of a diathermocoagulator is used to clean mechanically the created wound surface from the coagulation tissues.

EFFECT: method enables the efficiency on the surface of the infectious corneal ulcer and the achieved adequate functional effects without using a donor cornea and may be recommended to be applied in out-patient environment.

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Description

The present invention relates to ophthalmology and is intended for the treatment of infectious corneal ulcers. Corneal lesions occur in 70% in the form of ulcers. According to some sources, ulcerations of the cornea caused by the herpes simplex virus account for up to 55.4% of all ulcerative lesions of the cornea. Indications for the proposed method are superficial and deep lesions with ulceration, as well as herpetic ulcers with purulent infiltration (superinfection layering) as an urgent intervention due to serious danger to the eye and with local dystrophic and necrotic changes in the surface layers of the stroma, which are not accompanied by ulceration, but interfering with recovery.

There is a method of treating traumatic keratitis of an infectious nature using hydromonitor infusion, which consists in supplying an irrigation fluid (hemodez + gentamicin 4%) to the cornea, which is under a predetermined pressure from a syringe (I.V.Sangicheva, Abstract of a Ph.D. dissertation., 1995, p. .7-9). The disadvantage of this method is the surface effect on the tissue without affecting the deeper lying sections of the cornea (stroma). Thus, the therapeutic effect is achieved within the epithelium and the bowman membrane.

There is a method of treating superficial keratitis using cryoapplication with a cryo-applicator such as KGP or KG 65-20 with snow-cooled carbon dioxide from a balloon - 45-50 degrees. Applications are applied to a corneal defect stained with fluorescein, a tip with a diameter of 1-1.5 mm for 3-5 seconds, with an interval of 3-5 seconds, until the frozen area is completely thawed. Sessions are repeated after 3-4 days, until the corneal defect is completely epithelized, no more than three (Varenko O.A. Abstract of Cand. Diss., 1980, p. 2). The disadvantage of this method is the need for repeated exposure to the affected area, which can lead to changes in the structure of the healthy part of the cornea.

Cryoblowing is carried out by removable tips with cryomanipulators with pad diameters of 4-6-8 mm (depending on the size of the pathological focus), without the use of anesthesia; the tip is brought to the cornea (up to 2-3 mm) for 15-20 seconds; daily or every other day; 3-10 sessions per treatment course (Varenko O.A., Abstract of Ph.D. dissertation., 1980, p. 3). The disadvantages are the same as in the method above, as well as only its surface effect.

It is known the use of argon laser coagulation for superficial keratitis was carried out after preliminary staining of the ulcerated areas with 1% solution of the corresponding photoinhibitor. Laser energy applications were carried out strictly within the affected area with exposures of 0.1-0.2 sec. The diameter of the light spot was chosen arbitrarily (from 50 to 500 μm) depending on the area of the affected area. In this case, the corresponding radiation powers were used. The technique for applying laser applications depended on the nature of the lesions. In the case of superficial or shallow (not more than 1/3 of the thickness of the cornea) stromal ulcers, coagulates were applied tightly to one another, covering them with the entire ulcerated surface. In the presence of deep (more than 30% stromal thickness) stromal ulcers, only the marginal departments of the latter coagulate. The number of applications varies from 10 to 130 for each session. In total, from 1 to 3 sessions of laser coagulation are carried out (Bolshunov A.V. Abstract of Ph.D. dissertation., 1976, pp. 10-11). The disadvantage of this method is the impossibility of coagulation of ulcerative defects with a depth of not more than 30% of the thickness of the cornea.

The closest analogue of the proposed method is a method of the same purpose, which consists in layered keratoplasty, using a gentle microsurgical technique that provides a radical excision of the focus of inflammation followed by a seamless or suture-adhesive technique for strengthening a viable transplant (A. A. Kasparov. Ophthalmogerpes. M., 1994, , p. 178-179). At the same time, with the help of a corneal trepan, a pathological focus is excised to the desired depth within healthy tissues. A layered graft of a similar shape is cut from the cornea of a fresh donor eye, placed on a prepared bed in the cornea of the recipient and fixed with a continuous suture or biological glue.

The disadvantages of this method are the obligatory availability of fresh, suitable for use donor material - the eyes, the risk of rejection of the donor cornea, the anesthetic risk associated with anesthesia, the presence of an operating room.

The objective of the proposed method is to develop an improved method for urgent treatment of infectious corneal ulcers.

The technical result of the proposed method is the rapid relief of an acute deep process with acceleration of regeneration of the damaged portion of the cornea in a conventional outpatient clinic.

The technical result is achieved due to microdermatoplasty in the form of coagulation and mechanical removal of pathologically changed corneal tissue from the wound surface.

The proposed method for the treatment of the initial manifestations of corneal infectious ulcers using microdermatoplasty is aimed at urgent treatment of deep foci of infection and accelerated wound regeneration.

The idea of microdermatoplasty is to coagulate the entire pathological focus: walls, bottom and contents, after which the working part of the same electrode of the diathermocoagulator mechanically cleanses the resulting wound surface from coagulated tissues.

After that, instillations of disinfectant drops are made into the conjunctival cavity, the laying of a gel and antibacterial eye ointment that improves regeneration. After 2-3 days, epithelization of the wound surface is noted. In the more distant postoperative period (2-3 weeks), the replacement of the lost volume with a translucent connective tissue is noted.

The method is as follows: after three instillations in the conjunctival cavity of a 1% solution of dicaine (or another ophthalmic anesthetic), an eyelid expander is installed and the patient is seated in a slit lamp. Further, under visual control, by means of a tip inserted into the handle of a microdermatocoagulator, for example, ECHC MTUSI 20-01, with the simultaneous supply of energy, the ulcer surface, its walls and bottom are coagulated within apparently healthy tissues, then mechanically clean the working part of the same diathermocoagulator electrode the resulting wound surface from coagulated tissues. All manipulation as a whole can be designated as microdermatoplasty.

Next, antibacterial drops are instilled into the conjunctival cavity, an eye ointment is placed and the eye is sealed with closed eyelids for 24 hours.

Clinical examples

A 34-year-old patient R. turned to the Department of Reconstructive Surgery of the anterior segment of the eye at the Research Institute of GB RAMS with complaints of severe redness, lacrimation, pain, photophobia, foreign body sensation in the left eye. From the anamnesis: within 2 weeks was observed by an ophthalmologist with conjunctivitis. Received instillation antibacterial therapy without a pronounced positive effect. When handling objectively: lacrimation, photophobia, blepharospasm. Pronounced mixed eyeball injection. On the cornea in the upper limb from 10 to 2 hours there is a white infiltrate with a yellowish tint 1.0-2.0 mm wide and 1/3 of the depth of the cornea.

Under a threefold instillation anesthesia, microdermatocoagulation of the infiltrate was performed with simultaneous removal of pus-melted tissue to dense layers of the cornea within apparently healthy tissues. The scab formed at the site of the pathological focus was removed by the mechanically working part of the same electrode of the diathermocoagulator. A subconjunctival mixture of autoblood with half-dan was introduced. An antibiotic solution, a solution of mydriatic are instilled into the conjunctival cavity, a tetracycline ointment is laid. Parabulbar injection of an antibiotic solution. Tape with tetracycline ointment for 24 hours.

After 3 days, the patient noted an improvement in the form of a decrease in corneal syndrome. After 18 days, the complete epithelization of the wound defect was noted with the restoration of the corneal volume in the area of microdermatoplasty with the formation of translucent opacification.

A 45-year-old patient F. turned to the department of reconstructive surgery of the anterior segment of the eye at the Research Institute of GB RAMS with complaints of redness, lacrimation, pain, photophobia, decreased vision in the right eye. From the anamnesis, the patient was treated at the place of residence with antibacterial and anti-inflammatory drops for keratitis. When handling objectively: lacrimation, photophobia. Pronounced mixed eyeball injection. Paracentrally in the thickness of the cornea (1/2 of its thickness) there is a white-yellow infiltrate measuring 3 by 3 mm, covered with necrotic epithelium. Purulent infiltrate coagulation was made, after which the working part of the same electrode of the diathermocoagulator mechanically cleaned the wound surface from coagulated tissues. An antibiotic solution, a solution of mydriatic are instilled into the conjunctival cavity, a tetracycline ointment, parabulbar injection of an antibiotic solution is laid. Tape with tetracycline ointment for 24 hours. After 4 days, the patient noted an improvement in the form of relief of pain, a decrease in lacrimation and photophobia. 7 days after microdermatoplasty, complete corneal defect epithelization was noted. 3 weeks after the procedure, the formation of a facet with translucent opacification was noted. Increased visual acuity.

Thus, the proposed method of urgent treatment allows you to effectively act on the surface of an infectious corneal ulcer and to achieve satisfactory functional results without the use of a donor cornea. The method can be recommended for use on an outpatient basis.

Claims (1)

A method for the treatment of infectious corneal ulcers, characterized in that microdermatoplasty is performed in the form of coagulation and mechanical removal of pathologically changed corneal tissue from the wound surface by successive microdermatocoagulation of the entire surface of the ulcer - walls, bottom, contents - to apparently healthy tissue, after which the working part of the same electrode diathermocoagulator mechanically clean the resulting wound surface from coagulated tissues.