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The optic nerve fossa is a fairly rare congenital anomaly, occurring in 1 in 11,000 ophthalmic patients. Approximately 85% of cases are unilateral, with men and women equally affected. It manifests itself between the ages of 20 and 40 with a decrease in vision due to macular disorders.

Although the pathogenesis of the disease is not fully known, as a rule, it is associated with incomplete closure of the embryonic palpebral fissure. There was no association between the optic nerve fossa and systemic diseases. Histological examination reveals expansion and displacement of the scleral canal, penetration of the retina into the optic nerve trunk, rudimentary retinal tissue in the disc area, and retinal nerve fibers on the walls of the coloboma. It is inherited in an autosomal recessive manner.

Ophthalmoscopically, the optic nerve fossa is a round or oval depression in the optic disc of a grayish color with clear boundaries ranging in size from 1/8 to 1/2 of the disc diameter (Fig. 1). Usually the fossa is localized in the temporal half of the ONH. Very rarely there are two fossae; the second in these cases is localized in the nasal half of the disc. The pits have different depths, sometimes vessels are visible at the bottom of them. In most cases, the affected disc is enlarged.

The most common complication of the optic nerve fossa is retinal detachment (schisis) in the macula. One of probable causes The formation of retinoschisis in the macular region is the flow of cerebrospinal fluid from the subarachnoid to the subretinal space. The penetration of intravitreal fluid through the fossa of the optic nerve is not excluded, which, with prolonged existence, leads to the development of cystic macular edema and even through macular rupture. Treatment of the optic fossa is carried out with a decrease in visual acuity due to retinoschisis and currently consists of transciliary vitrectomy, gas-air tamponade, possibly in combination with laser coagulation along the edge of the fossa.

Optical coherence tomography clearly illustrates optic disc defects and retinal separation, changes occurring in the fovea (Fig. 2, 3).

Rice. 1. Biomicroscopy of the fundus of a patient with an optic nerve pit and retinoschisis that involves the macula. Visual acuity 0.1.

Rice. 2. Tomogram through the macula and optic nerve of a patient with an optic fossa. On a horizontal scan, retinal separation into several layers is determined. There was no connection between the intraretinal and vitreous spaces, at the same time, a channel into the subarachnoid space is visible.

Optic pits are a congenital deficiency of tissue in the head of the optic nerve. Serous macular retinal detachment occurs in 50% of people with this anomaly, usually between the ages of 20 and 40. The incidence is 1 in 1,000. In 10-15% of patients, both eyes are affected. For the first time the disease is described by T. Wiethe.

Pathogenesis

The pathogenesis of the optic disc fossa is unclear. Some authors suggest that the optic nerve fossa is a mild form of optic nerve coloboma, i.e. also due to incomplete closure of the palpebral fissure. Arguments confirming this point of view, its supporters call quite rare cases of a combination of coloboma and fossa of the optic disc.

There are facts that are not consistent with this hypothesis:

• firstly, disc pits are often located in places related to the embryonic fissure;
• secondly, disc pits are usually unilateral, sporadic and do not combine with other developmental anomalies;
• thirdly, disc pits are not combined with colobomas of the iris or retina.

Although an optic nerve coloboma may sometimes present as a crater-like deformity resembling a pit of the optic disc, and it may be difficult to distinguish a low-segment fossa from a small coloboma, the above facts seem sufficient to demonstrate an apparent difference in the pathogenesis of colobomas and optic pits. The presence of one or more cilioretinal vessels emerging from most of the fossae of the optic nerve suggests that this fact is also somehow related to the pathogenesis of the anomaly.

Approximately 45-75% of eyes with congenital optic fossa develop serous macular detachment. The course of development of macular complications:

1. retinoschisis of the inner layers of the retina is formed, the cavity of which communicates directly with the disc fossa
2. a rupture of the outer layers of the retina is formed below the boundaries of the retinoschisis cavity;
3. detachment of the outer layers develops around the macular rupture, which is associated with the influx of fluid from the cavity of retinoschisis (detachment of the outer layers of the retina during ophthalmoscopy can imitate detachment of the pigment epithelium, but with FAH there is no hyperfluorescence characteristic of the latter);

Detachment of the outer layers eventually increases and obliterates the retinoschisis cavity. At this stage, the complication is clinically indistinguishable from primary serous macular detachment.

Clinical manifestations

With ophthalmoscopy, the fossa of the optic disc looks like a depression of a round, oval, sometimes polygonal shape, which has a white, gray or yellow color. Usually it is located in the temporal part of the disk, sometimes in the center and extremely rarely in its nasal part.

The diameter of the pits of the optic disc varies from 1/3 to 1/8 of the RD. The disease is often unilateral. Bilateral fossae of the optic disc occur in 15% of cases. With a unilateral lesion, the abnormal disc appears slightly larger than the normal disc.

Serous detachment the retina occurs mainly in the fossa of the disk of temporal localization. This detachment has a teardrop shape and starts from the temporal edge of the disc, spreading to the macula, sometimes captures the entire posterior pole, without going beyond the temporal vascular arcades.

• Over time, grayish precipitates may be deposited on the posterior surface of the detached retina.
• With prolonged existence of detachment in its zone, alterations of the pigment epithelium may be noted,
• the formation of microcysts in the thickness of the exfoliated neuroepithelium,
• in rare cases - through macular holes.

This disc anomaly is often associated with congenital redistribution of pigment in the peripapillary region and the presence of the cilioretinal artery (59% of cases). The area of ​​the pit may be covered with a grayish membrane with many holes.

Diagnostics

With a significant size of the disc fossa, its sagittal section can be obtained using B-sonography; at small sizes - optical coherence tomography.

Visual acuity in patients remains normal until the onset of macular complications. By the age of 16, due to the development of macular detachment of the neuroepithelium, visual acuity of 0.1 or less is noted in 80% of patients.

visual field defects are diverse and often do not correlate with the localization of the fossa, often reveal various disorders in the form of expansion of the blind spot or the appearance of small paracentral or falciform scotomas. With persistent macular changes, visual field defects progress. The scotomas detected in the visual field correspond to defects in the retinal pigment epithelium detected by ophthalmoscopy or FAG.

On angiography the disc fossa appears as a zone of hypofluorescence in the early and intermediate phases. In most patients, its hyperfluorescence is noted in the late phase. Diffusion of the dye beyond the fovea into the area of ​​serous retinal detachment is usually absent.

The area of ​​serous detachment is hypofluorescent in the early phase due to shielding of choroidal fluorescence. On delayed images, its weak hyperfluorescence is determined. In the presence of local alterations of the pigment epithelium, hyperfluorescence is noted according to the type of fenestrated defects.

ERG remains normal in most patients even in the case of macular complications. VEP is not changed until the development of macular detachment. With the advent of macular complications, in all cases, a decrease in the amplitude of the P 100 component is noted, less often, an elongation of its latency.

Histologically The fossa of the optic disc is a herniated protrusion of the elements of the neurosensory retina in the region of the defect in the cribriform plate of the sclera. The retinal fibers descend into the fossa, then return and exit in front of the incoming optic nerve. Some pits communicate with the subarachnoid space.

The occurrence of retinal detachment is associated with the passage of intraocular fluid under the retina in the region of the fossa of the optic nerve or the penetration of cerebrospinal fluid from the subarachnoid space along the intersheath spaces of the optic nerve.

Differentiate this detachment follows with other serous macular detachments, most notably central serous choriopathy.

Evolution and forecast

The occurrence of serous retinal detachment leads to a significant decrease in vision. It becomes irreversible if the detachment persists for more than 6 months. Spontaneous attachment of serous detachment as a result of resorption of subretinal fluid occurs in about 25% of cases and can be observed many months and even years after its appearance. With prolonged existence of serous retinal detachment, the pigment epithelium in the detachment zone suffers, cases of the formation of a through macular hole are described. A possible complication is choroidal neovascularization at the edge of the optic disc.

Treatment

Conservative treatment, including dehydration therapy and topical corticosteroids, is ineffective. Previously, laser coagulation of the retina was used to block the flow of fluid from the disc fossa to the macula, but the effectiveness of this technique was rather low and difficult to predict due to the impossibility of adequate overlapping of the retinoschisis cavity using laser coagulation alone.

Currently, a combined technique is used, including vitrectomy followed by intravitreal tamponade with expanding perfluorocarbon gas and barrier laser coagulation. Combined treatment allows to achieve an increase in visual acuity in all patients, anatomical success - in 87%.

The fossa of the optic disc is a congenital anomaly, which is a limited depression in the disc

optic nerve.

The disease occurs in the population with a frequency of 1; 10,000-11,000 [Tron E.Zh., 1968]; first described by T. Wiethe (1882).

I І:ikzh.'itsch. The pathogenesis of the optic disc fossa is unclear. Some authors suggest that I of the optic nerve "1 IMNSISN is a mild form of coloboma! of the optic nerve, i.e. also due to incomplete closure of the palpebral fissure. Arguments confirming this point of view, its supporters call quite rare cases of a combination of coloboma and fossa of the optic disc. There are facts that do not agree with this hypothesis: firstly, disc pits are often located in places that are not related to the embryonic fissure, secondly, disc pits are usually unilateral, sporadic and do not combine with other developmental anomalies; Third, disc pits do not associate with iris or retinal colobomas.Although an optic nerve coloboma can sometimes present as a crater-shaped deformity resembling a optic disc pit, it can be difficult to distinguish a lower-segment fossa from a small coloboma outlined above the facts seem sufficient to prove an apparent difference in the pathogenesis of colobomas and optic pits. The presence of one or more cilioretinal vessels emerging from most of the fossae of the optic nerve suggests that this fact is also somehow related to the pathogenesis of the anomaly.

Histological studies. There is a defect in the cribriform plate in the area of ​​the fossa. The retinal fibers descend into the fossa, then return and exit in front of the incoming optic nerve. Some pits communicate with the subarachnoid space.

Clinical manifestations. With ophthalmoscopy, the fossa of the optic disc looks like a deepening of a circle

Loy or oval, having a white, gray or yellow color (Fig. 13.27). The diameter of the pits of the optic disc varies from to RD. Usually, the fossa is localized in the temporal half of the disk, but it can also be located in other sectors. The disease is often unilateral. Bilateral fossae of the optic disc occur in 15% of cases [Tron E.Zh., 1968; Theodossiadis G.P. et al., 1992; Jonas J.B., Freisler K.A., 1997]. With a unilateral lesion, the abnormal disc appears slightly larger than the normal disc.

With a significant size of the disc fossa, its sagittal section can be obtained using B-sonography; at small sizes - optical coherence tomography.

Approximately 45-75% of eyes with a congenital fossa of the optic disc develop serous macular detachment [Ganichenko IN, 1986;

Schartz H., McDonald H.R., 1988;

Theodossiadis G.P. et al., 1992]. LincoffH et al. (1988) studied the course of development of macular complications: 1) retinoschisis of the inner layers of the retina is formed, the cavity of which reports

Results of optical coherence tomography in a patient with an optic disc fossa complicated by the development of retinoschisis and rupture of the outer layers of the retina.

Xia directly with the fossa of the disk (Fig. 13.28); 2) a rupture of the outer layers of the retina is formed below the boundaries of the retinoschisis cavity; 3) detachment of the outer layers develops around the macular rupture (Fig. 13.29), which is associated with the influx of fluid from the cavity of retinoschisis (detachment of the outer layers of the retina during ophthalmoscopy can imitate detachment of the pigment epithelium, but with FAH there is no hyperfluorescence characteristic of the latter); 4) detachment of the outer layers eventually increases and obliterates the retinoschisis cavity (see Fig. 13.28). At this stage, the complication is clinically indistinguishable from primary serous macular detachment.

The route of the intraretinal fluid has not yet been precisely established. The literature indicates

cavity through the fossa; 2) blood vessels at the base of the fossa; 3) subarachnoid space; 4) al vessels.

Macular retinoschisis and retinal detachment due to disc fossa develop at the age of 10-40 years. The risk of developing macular complications is higher in cases where the fossa of the optic disc is large and localized in the temporal half of the disc. In cases where macular detachment exists for a long time (for 6 years or more), pigment is deposited along the edge of the disc and / or along the border of the detachment. Pigment deposits are caused by disturbances in the retinal pigment epithelium layer, in which extensive fenestrated defects form over time.

G. Theodossiadis et al. (1992) found that with the existence of macular detachment for 10 years or more, the size of the disc fossa increases, and its color becomes gray, which is probably associated with the loss or reorganization of glial tissue within the fossa.

Fluorescent angiography. In the arterial and arteriovenous phases, a gradually increasing leakage of fluorescein in the zone of neuroepithelial detachment towards the macula is determined. In the early phases of FA or indocyanine angiography, the disc fossa usually does not pass the contrast agent. In the late phase of FA or indocyanine angiography, hyperfluorescence of the disc fossa and area of ​​macular detachment occurs.

Psychophysical research. Visual acuity in patients with a pit of the optic disc remains normal until the onset of macular complications. By the age of 16, due to the development of macular detachment of the neuroepithelium, visual acuity of 0.1 or less is noted in 80% of patients. Visual field defects are varied and often do not correlate with the location of the fovea. With persistent macular changes, visual field defects progress. The scotomas detected in the visual field correspond to defects of the retinal pigment epithelium detected by ophthalmoscopy or FAG.

- a congenital anomaly, which is a limited recess in the optic discs. The disease occurs in the population with a frequency 1:10 OOO-11 OOO; first described by T. Wiethe (1882).

Pathogenesis. The pathogenesis of the optic disc fossa is unclear. Some authors suggest that the fossa of the optic disc; is a mild form of optic nerve coloboma, i.e. also due to incomplete closure of the palpebral fissure. Arguments confirming this point of view, its supporters call quite rare cases of a combination of coloboma and fossa of the optic disc.

There are facts that do not agree with this hypothesis: firstly, the disc pits are often located in places related to the embryonic fissure; secondly, disc pits are usually unilateral, sporadic and do not combine with other developmental anomalies; thirdly, disc pits are not combined with colobomas of the iris or retina. Although an optic coloboma may sometimes present as a crater-shaped deformity resembling a pit of the optic disc, and it may be difficult to distinguish a low-segment fossa from a small coloboma, the above facts seem sufficient to demonstrate an apparent difference in the pathogenesis of colobomas and optic pits. nerve. The presence of one or more cilioretinal vessels emerging from most of the fossae of the optic nerve suggests that this fact is also somehow related to the pathogenesis of the anomaly.

Histological studies. There is a defect in the cribriform plate in the area of ​​the fossa. The retinal fibers descend into the fossa, then return and exit in front of the incoming optic nerve. Some pits communicate with the subarachnoid space.

Clinical manifestations. With ophthalmoscopy, the fossa of the optic disc looks like a round or oval depression that has a white, gray or yellow color (Fig. 13.27).

The diameter of the pits of the optic disc varies from 1/3 before 1/8 RD. Usually, the fossa is localized in the temporal half of the disk, but it can also be located in other sectors. The disease is often unilateral. Bilateral fossae of the optic disc are found in 15 % cases. With a unilateral lesion, the abnormal disc appears slightly larger than the normal disc.

With a significant size of the disc fossa, its sagittal section can be obtained using B-sonography; at small sizes - optical coherence tomography.

Approximately in 45-75 % an eye with a congenital fossa of the optic disc develops a serous detachment of the macula. Lineoff et al. (1988) examined the course of development of macular complications:

The route of the intraretinal fluid has not yet been precisely established. The literature indicates possible moans:

1. vitreal cavity through the fossa;
2. blood vessels at the base of the fossa;
3. subarachnoid space;
4. al vessels.

Disc pit-related macular retinoschisis and retinal detachment develop with age 10- 40 years. The risk of developing macular complications is higher in cases where the optic disc fossa is large and localized in the temporal half of the disc. In cases where macular detachment exists for a long time (during 6 years or more), pigment is deposited along the edge of the disc and / or along the border of the detachment. Pigment deposits are caused by disturbances in the retinal pigment epithelium layer, in which extensive defects are formed over time. G.Theodossiadis et al. (1992) found that in the presence of macular detachment for 10 years and more, the size of the disc fossa increases, and its color becomes gray, which is probably associated with the loss or reorganization of glial tissue within the fossa.

Fluorescent angiography. In the arterial and arteriovenous phases, a gradually increasing leakage of fluorescein in the zone of neuroepithelial detachment towards the macula is determined. In the early phases of FA or indocyanine angiography, the disc fossa usually does not pass the contrast agent. In the late phase of FA or indocyanine angiography, hyperfluorescence of the disc pit and area of ​​macular detachment occurs.

Psychophysical research. Visual acuity in patients with a pit of the optic disc remains normal until the onset of macular complications. To 16 -year-old age due to the development of macular detachment of the neuroepithelium visual acuity 0,1 and below are noted at 80 % patients. Visual field defects are varied and often do not correlate with the location of the fovea. With persistent macular changes, visual field defects progress. The scotomas detected in the visual field correspond to defects of the retinal pigment epithelium detected by ophthalmoscopy or FAG.

Electrophysiological studies. ERG remains normal in most patients even in the case of macular complications. VEP is not changed until the development of macular detachment. With the appearance of macular complications, in all cases, a decrease in the amplitude of the P100 component is noted. less often - lengthening of its latency.

Treatment. Conservative treatment, including dehydration therapy and topical corticosteroids, is ineffective. Previously, laser coagulation of the retina was used to block the flow of fluid from the disc fossa to the macula, but the effectiveness of this technique was rather low and difficult to predict due to the impossibility of adequate overlapping of the retinoschisis cavity using laser coagulation alone. Currently, a combined technique is used, including vitrectomy followed by intravitreal tamponade with expanding perfluorocarbon gas and barrier laser coagulation. Combined treatment allows to achieve an increase in visual acuity in all patients, anatomical success - in 87 % .

The owners of the patent RU 2559137:

The invention relates to medicine, namely to ophthalmology, and can be used for surgical treatment of the fossa of the optic disc. From the temporal side of the fossa of the optic nerve head (OND), by means of circular maculorhexis and peeling of the internal limiting membrane (ILM), an ILM flap is formed and it is separated in the PFOS medium, not reaching the OD ring 0.5-0.8 mm. The separated ILM flap is turned over, the optic disc fossa is covered with it. Carry out a light compression effect on the flap above the optic disc fossa. Replace PFOS with air. In this case, the tip of the vitreotome is placed on the nasal side of the optic disc. EFFECT: method makes it possible to reduce the invasiveness of surgical intervention, create an obstacle to the flow of fluid from the optic disc fossa into the macular zone, ensure sealing of the optic disc fossa, resolve macular detachment, maintain or improve visual functions.

The invention relates to medicine, namely to ophthalmology, and can be used for surgical treatment of the fossa of the optic disc.

Optic disc fossa (ON) is a fairly rare congenital malformation, occurring in 1 in 11,000 ophthalmic patients. Approximately in 85% of cases the disease is unilateral, men and women get sick equally often. It manifests itself between the ages of 20 and 40 with a decrease in vision due to macular disorders.

The most common complication of the optic disc fossa is stratification (schisis) of the retina in the macula. One of the likely causes of the formation of retinoschisis in the macular region is the flow of cerebrospinal fluid from the subarachnoid to the subretinal space. It is possible that intravitreal fluid penetrates through the optic disc fossa, which, with prolonged existence, leads to the development of cystic macular edema and even a through macular hole. Optical coherence tomography clearly illustrates optic disc defects and retinal dissection, changes occurring in the fovea.

Surgical treatment of the optic disc fossa consists of vitrectomy and gas-air tamponade of the vitreal cavity. Efficiency this method low, which requires repeated interventions.

A new approach to the treatment of the optic disc pit is to create a barrier to fluid flow into the macular area by filling the pit with autologous sclera. This technique is quite effective, but does not exclude the recurrence of macular detachment and is quite traumatic.

The objective of the invention is to create an effective low-traumatic method of surgical treatment of the fossa of the optic disc.

The technical result of the proposed method is to reduce the trauma of surgical intervention, create an obstacle to the flow of fluid from the optic disc fossa into the macular zone, seal the optic disc fossa, resolve macular detachment, maintain or improve visual functions.

The technical result is achieved by the fact that, according to the invention, from the temporal side of the optic disc fossa, by performing a circular maculorhexis and peeling the ELM, an ELM flap is formed and it is separated in the PFOS environment, not reaching the OD ring 0.5-0.8 mm, the separated ELM flap is turned over, cover the optic disc fossa with it, lightly compress the flap above the optic disc fossa, then replace PFOS with air, while the tip of the vitreotome is placed on the nasal side of the optic disc.

The technical result is achieved due to the fact that:

1) an ILM flap is formed by performing maculorhexis and ILM peeling, which minimizes the traumatic effect on the retina;

2) the ILM section is kept on the temporal side of the optic disc fossa between the ILM peeling zones, which makes it possible to form an ILM flap for sealing the optic disc fossa and creating a barrier to fluid flow into the macular zone;

3) cover the optic disc fossa with an inverted ILM flap and apply a light compression effect on the flap above the optic disc fossa, which makes it possible to seal the optic disc fossa and create a barrier to fluid flow into the macular zone.

The method is carried out as follows.

A transconjunctival 3-port 25 g vitrectomy is preliminarily performed according to the standard technique, the frequency is from 2500 to 5000 cuts per minute, the vacuum is from 5 to 400 mm Hg. Art. Standard stains are used to detail the structure of the posterior cortical layers of the vitreous body and the internal limiting membrane (IMM). The separation of the posterior hyaloid membrane is carried out using aspiration technique, starting from the optic disc, gradually lifting it to the periphery.

Then the ILM is removed in the macular zone, performing a circular macular rhexis. Then proceed to the formation of the ILM flap, which is carried out in several successive steps. At the border of maculorhexis at 6 o'clock, using microtweezers, the tip of the ILM is separated from the retina with a pinch (step 1). Then, having captured the tip of the ILM with tweezers, the membrane is separated by a movement directed towards the lower temporal arcade, not reaching it by 0.5 mm (action 2). Next, the edge of the ILM is intercepted and its separation is carried out along the lower temporal arcade towards the optic disc for 2-3 hour meridians (action 3). After that, the ILM edge is intercepted and a movement similar to action 2 is performed, but in the opposite direction and up to the border of the circular maculorhexis, thus separating the ILM area from the retina (action 4).

After the formation and removal of the first section of the IPM, the formation of the second section of the IPM is started. To do this, they return to the point from which they started to perform action 4, separate the tip of the ILM from the retina with a pinch, then, grabbing the tip of the ILM with tweezers, they separate the membrane with a movement directed along the lower temporal arcade towards the ONH over 2-3 hour meridians (action 5) , after which the edge of the ILM is intercepted and from this point action 4 (action 6) is repeated, as a result of which the second part of the ILM is separated from the retina.

After the formation and removal of the second section of the ILM from the point where step 6 was started, a circular movement is carried out towards the inferior temporal arcade as far as the membrane allows to separate (step 7).

As a result of the above actions, an ILM flap is preserved between the ILM peeling zones.

The next step is to replace the fluid with air and drain the subretinal fluid in the zone of the optic disc fossa. Then, 1.5-2.0 ml of PFOS is injected, and in the PFOS medium, the ILM flap saved between the peeling zones of the ELM is separated, not reaching the OD ring 0.5-0.8 mm. The separated ILM flap is turned over, the optic disc fossa is covered with it, with the help of tweezers a light compression effect is applied to the flap above the optic disc fossa. After that, PFOS is replaced with air in a vacuum of 30-40 mm Hg. Art., avoiding a sharp jump in pressure during aspiration of PFOS, while the tip of the vitreotome is placed on the nasal side of the optic disc, trying to remove the liquid from under the flap as much as possible and exclude its displacement. At the final stages of PFOS removal, a compression effect is applied to the flap above the optic disc fossa, thereby squeezing out the remains of PFOS from under the ILM flap.

The operation is completed by applying transconjunctival interrupted sutures 7-00 vicryl to the areas of sclerotomy, 1 mm 3 20% SF6 gas is injected transsclerally valve into the eye cavity using a 30 g needle until slight hypertonicity is achieved.

The invention is illustrated by the following clinical data.

According to the proposed method, 4 patients with optic disc pit aged 15 to 37 years were treated. Visual acuity before surgery ranged from 0.01 to 0.25. In all cases, the intervention was performed in full, intraoperative complications, including iatrogenic damage to the retina, were not observed in any patient.

The observation period is 12 months. In all cases, according to optical coherence tomography, a reduction in macular detachment and sealing of the optic disc fossa were observed. Visual acuity by the end of the observation period ranged from 0.1 to 0.8.

Thus, the claimed method provides a reduction in the trauma of surgical intervention, creating an obstacle to the flow of fluid from the optic disc fossa into the macular zone, sealing the optic disc fossa, resolving macular detachment, maintaining or improving visual functions.

A method of surgical treatment of the fossa of the optic disc, characterized in that on the temporal side of the fossa of the optic disc (ON) by means of circular maculorhexis and peeling of the internal limiting membrane (ILM), an ILM flap is formed and it is separated in the PFOS medium, not reaching the OD ring 0.5-0.8 mm, the separated ILM flap is turned over, the optic disc fossa is covered with it, a light compression effect is applied on the flap above the optic disc fossa, after that, PFOS is replaced with air, while the tip of the vitreotome is placed on the nasal side of the optic disc.

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The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of corneal opacities of various etiologies, which are accompanied by cataracts. Perform trepanation of the cornea of ​​the recipient. The nucleus of the lens is removed extracapsularly. The donor graft is placed in the recipient's bed. Four interrupted sutures and a continuous twisting suture are applied. Tighten the loops of the twisted seam and tighten the ends of the thread with a temporary knot. Viscoelastic is introduced into the anterior chamber, bimanual tips of the aspiration-irrigation system of the phacoemulsifier are inserted into the gaps between the loops of the twisting suture. The lens masses are removed, the temporary knot connecting the ends of the thread of the twisted suture is unraveled, the viscoelastic is re-introduced, an intraocular lens (IOL) is implanted using an injector. The viscoelastic is removed and the graft is completely fixed. EFFECT: method allows to reduce the number of operational and postoperative complications associated with the stage of removal of the lens masses, such as rupture of the posterior capsule and vitreous prolapse, as well as to prevent complications associated with insufficiently thorough removal of the lens masses from the equatorial zone. 2 Ave.

The invention relates to medicine, namely to ophthalmology, and can be used for implantation of an intraocular lens using the Monarch injection system. Place the lens in the cartridge. The cartridge is placed in the injector bed without tight fixation with the possibility of one-sided movement of the cartridge towards the injector handle. The lens is advanced by the piston of the injector to the outlet of the cartridge in contact with the corneal incision. Fix the eyeball. The translational movement of the intraocular lens into the anterior chamber of the eye through the corneal incision is carried out by shaking movements of the injector system. The injector system is held by the handle while being fed in the direction of the corneal incision. At the same time, the cartridge is displaced in the injector bed towards its handle. The lens is squeezed out in the direction of exit from the cartridge by the injector piston. EFFECT: method makes it possible to effectively implant an intraocular lens, perform manipulations with one hand without an assistant, and also allows to control the implantation process by using a small corneal incision, placing the cartridge in the injector bed without tight fixation, and the possibility of influencing the lens passage rate by the applied piston pressure force. 1 ave.

The invention relates to medicine, namely to ophthalmic oncology, and can be used in the removal of neoplasms of the iridociliary zone. A superficial scleral flap is cut out to a depth of 350 µm in the form of a rectangular flap on a stem, which is the base of the flap and is located perpendicular to the limbus, and one of the sides of the flap runs along the limbus. After the flap is separated and folded to the side of the stem, a deep scleral flap is formed, which is removed after cutting out, while it is formed less than the surface flap by 0.5 mm in length and 0.5 mm in width, and the lateral side of the deep flap, which runs along the limbus is formed by attaching to the tissues a deep flap of a part of the Schlemm's canal, which lies in the tumor zone. To do this, after the formation of the side of the deep flap located opposite the base of the flap and the side side located opposite the limbus, the anterior chamber is opened at the edge of the limbal incision on the side of the tumor, a viscoelastic is introduced into the anterior chamber, then using a stratifier, at the level of the depth of the formed surface flap, expansion of access to the anterior chamber, dividing the tissues of the limbus in the plane of the iris above the trabecular zone within the extent of the flap, after which the deep scleral flap is finally cut and removed. Through paracentesis performed in the opposite sector from the operation area, a viscoelastic is inserted behind the iris, providing it with the supply of the root of the iris along with the tumor in the formed scleral access, after which the protruding tissue of the iris is incised in the zone of healthy cells and begin to excise, and first the tumor of the iris is excised, and after pulling the mobilized tissue of the iris towards the arch, the tumor of the ciliary body is excised. The tumor is removed, the superficial scleral flap is placed on the scleral step obtained after removal of the deep scleral flap, and it is fixed with separate interrupted sutures, starting from the side opposite to the base of the flap, then the incision along the limbus is sutured and then the opposite incision. The method allows to reduce postoperative complications and the likelihood of recurrence of neoplasms. 1 z.p. f-ly, 2 pr.

The invention relates to medicine, namely to ophthalmology, and is intended for the formation of a mobile musculoskeletal stump during eviscero-enucleation. A scleral-muscular ring is formed by removing the cornea and cutting out the scleral disk from the posterior pole of the eye, 2-4 notches are applied to the walls of the ring, and the implant is inserted. Polytetrafluoroethylene material "Ecoflon" is used as an implant. The scleral disc is sutured with a continuous suture with notches to the anterior section of the scleral-muscular ring. EFFECT: method provides good mobility, volume of the stump, necessary sealing of the scleral wound, which prevents the implant from being exposed, reduces trauma and reduces the time of the operation. 1 pr.

The invention relates to medicine, ophthalmology, and is intended for the surgical treatment of perforated corneal ulcers, severe corneal burns with the threat of perforation and corneal perforation. Excised disc from the cartilage of the auricle. A basal iridectomy is performed at 12 o'clock by excising a 1.0-1.2 mm iris section of the basal section. A disk of cartilage is placed on the iris, covering the defect of the cornea along the perimeter by 1 mm, fixed to the sclera with 10-12 U-shaped sutures with a 7/0 thread. Between the seams, viscoelastic is injected into the anterior chamber in the amount of 0.2-0.3 mm. Temporary blepharorrhaphy is performed in the outer third of the eyelids with a 6/0 U-shaped suture, an injection of a solution of 10 mg of gentamicin and 4 mg of Dexon is performed under the conjunctiva, floxal ointment is placed in the conjunctival cavity, and tobradex drops are instilled. EFFECT: method allows in the absence of transplant material in case of emergency perforated to save the eyeball from anatomical death, restoring its shape and turgor. 1 ave.

The invention relates to medicine, namely to ophthalmology, and is intended for the surgical treatment of eye diseases. Before the operation, first regional and then local topical anesthesia and standard treatment of the surgical field are performed. Produce the first and second paracentesis of the cornea with a width of 0.5-1.5 mm along the meridians of 1-3 and 7-9 hours, respectively. 0.1-0.2 ml of a 1% solution of Mezaton is injected into the anterior chamber of the eye and this chamber is filled with viscoelastic, surgical hooks are used alternately, with different parties soft stretching of the pupillary edge of the iris. A tunnel incision 2.0-2.5 mm long and 1.5-2.0 mm wide is made along the 10-11 o'clock meridian, and through this tunnel incision, after additional introduction of viscoelastic into the chamber, continuous circular capsulorhexis, hydrodissection and hydrodelineation are performed. The lens is fragmented and the position of the iris is fixed by placing a portion of small fragments of the lens nucleus between the iris and the cornea, some of which block the paracentesis and the tunnel incision. The remnants of the lens masses are removed and the capsular bag is polished. It and the anterior chamber are filled with viscoelastic and implanted through the tunnel incision into the IOL capsular bag. In case of prolapse of the iris, its reduction against the background of hypotension is carried out with the help of viscoelastics with increased viscosity, the anterior chamber is washed and sealed with saline. At the end of the operation, a solution of a glucocorticoid drug and an antibiotic is injected subconjunctivally. The method provides balanced stretching and stabilization of the iris tissue during the operation. 4 w.p. f-ly, 2 pr.

The invention relates to ophthalmic surgery and can be used to eliminate mydriasis. Three corneocentesis are formed at an equidistant distance from each other. The needle is inserted into the anterior chamber through corneocentesis and the pupillary edge of the iris is lifted with a spatula - “fork”, stitching it from the side of the pigment sheet, the needle is punctured from the side of the anterior chamber at a distance of 1.0-1.5 mm from the pupillary edge and a circular twisting suture is applied with a step between injections of 1.5 mm along the pupillary edge to the place corresponding to the localization of the next corneocentesis. The needle is inserted sequentially through corneocentesis, starting at 10 o'clock counterclockwise, and removed using a guide cannula. EFFECT: method allows to reduce traumatism, to provide high visual acuity.

The invention relates to medicine, namely to ophthalmology. Through a two-stage self-sealing puncture of the sclera using a 30G injection needle, ranibizumab is injected into the vitreous body 3.5-4.0 mm from the limbus. After 2-3 weeks, control optical coherence tomography of the retina and fluorescein angiography of the retina are performed. In areas of persistent ischemia and extravasation, paravasal transpupillary laser coagulation of the retina is performed. Exposure parameters: wavelength 659 nm, power 0.13-0.15 mW, 100-250 coagulates, exposure 0.1-0.15 s, spot diameter 200 µm. Impact on the retina is carried out along the vessels of the temporal arcades. EFFECT: method makes it possible to obtain a lasting effect from the treatment due to the reduction or disappearance of macular edema with an increase in visual functions due to the suppression of extravasation and blocking of ischemic zones while reducing the inflammatory and hemorrhagic reactions. 2 Ave.

SUBSTANCE: group of inventions relates to medicine, namely to ophthalmology, and is intended for the treatment of primary and secondary glaucoma. Obtaining a carbon fiber microdrainage for ophthalmic surgical interventions includes heat treatment of a viscose-based thread, activation of the obtained carbon thread in a gas stream and its impregnation in a glucose solution. The heat treatment temperature of the yarn is 1700°C. Activation is carried out in a stream of air at a temperature of 600°C for 45 minutes. Thus obtained carbon fibrous microdrainage is a bundle of 1000-1200 carbon threads with a diameter of 7-9 microns. The use of the group of inventions provides a stable hypotensive effect and preservation of visual functions in patients with advanced, advanced and terminal stages of glaucoma, prevention of postoperative complications, and reduction of trauma. 2 n. and 1 z.p. f-ly, 2 pr.

The invention relates to medicine, namely to ophthalmology, and can be used for surgical treatment of the fossa of the optic disc. On the temporal side of the fossa of the optic nerve head, by means of circular maculorhexis and peeling of the inner limiting membrane, an ILM flap is formed and it is separated in the PFOS medium, not reaching the OD ring 0.5-0.8 mm. The separated ILM flap is turned over, the optic disc fossa is covered with it. Carry out a light compression effect on the flap above the optic disc fossa. Replace PFOS with air. In this case, the tip of the vitreotome is placed on the nasal side of the optic disc. EFFECT: method makes it possible to reduce the invasiveness of surgical intervention, create an obstacle to the flow of fluid from the optic disc fossa into the macular zone, ensure sealing of the optic disc fossa, resolve macular detachment, maintain or improve visual functions.