Method for treating stage 1 macular hole without vitectomy and the instrument for realisation thereof

Abstract

The invention relates to ophthalmology, in particular to the surgical treatment technique of macular holes at the early stages without vitrectomy. The method for treating stage 1 macular hole without vitrectomy comprises peeling the posterior hyaloid membrane away from the foveola, wherein an ophthalmological instrument is inserted through the vitreous body until it comes into contact with the posterior hyaloid membrane in the macular area, the posterior hyaloid membrane then being gripped by said instrument and peeled away from the foveola, in accordance with the invention, and after the contact between the instrument and the posterior hyaloid membrane an opening is made therein, whereby the edge of the opening is then used to lift the posterior hyaloid membrane and peel it away from the foveola until the layers are separated; wherein the instrument used is an ophthalmological membrane spatula comprising a handle 1 and a pointed working part 2 with a tip 3 shaped as a hook. The improved grip of the posterior hyaloid membrane, better visual control and maintaining the hold of said membrane continuously through the manipulations until the peeling from the foveola is complete, made it possible to reduce the trauma associated with surgical management of stage 1 macular hole without vitrectomy and to decrease the number of related complications.

Description

TECHNICAL FIELD[0001]The invention relates to ophthalmology, in particular to the surgical treatment technique of macular holes at the early stages without vitrectomy.BACKGROUND ART[0002]A method for treatment of the first stage of macular holes by intravitreal administration of enzymes, in particular microplasmin, is known from the prior art (see, for example, Stalmans P et al.) «Intravitreal injection of microplasmin for treatment of vitreomacular adhesion:results of a prospective, randomized, sham-controlled phase II trial (the MIVI-IIT trial)>, Retina, 2010 July-August; 30(7): 1122-7, http: / / www.ncbi.nlm.nih.gov / pubmed / ?term=Stalmans+P.%2C+Delaey=C.[0003]When the enzyme enters the vitreous body, the collagen protein dissolves, providing the strength of vitreophoveolar adhesion.[0004]The disadvantage of this method is the need to repeat the operation for a number of times. The efficiency of the process as a whole does not exceed 50%. In addition, the drugs used in the implemen...

AI Technical Summary

Benefits of technology

[0013]The improved grip of the posterior hyaloid membrane, the better visual control and maintaining the hold of the said membrane continuously through the manipulations until the peeling from the foveola is complete, makes it possible to reduce the trauma associated with surgical management of stage 1 macular hole without vitrectomy and to decrease the number of related complications, which is the object of the invention. Another objective of the invention is to provide a tool that ensures a non-traumatic insertion through the vitreous body before contact with the macula, a reliable grip of the posterior hyaloid membrane and its retention.

Problems solved by technology

The disadvantage of this method is the need to repeat the operation for a number of times. The efficiency of the process as a whole does not exceed 50%.

In addition, the drugs used in the implementation of the method have a very high cost.

Its disadvantage, as well as in the case of other well-known methods envisaging vitrectomy, is the fact that in the course of vitrectomy up to 80% of the vitreous body is removed.

At that in more than 80% of cases, cataracts develop intensively (in the next six months), the risks of retinal detachment, glaucoma and loss of visual fields are significantly increased.

The drawback of the prototype method is the unreliable separation of the posterior hyaloid membrane from the foveola, due to the following circumstances: the tweezers do not allow the delicate entry into the retrohyaloid space; due to the fact that the rods of the tweezers slide off the posterior hyaloid membrane, the tweezers do not allow for its secure grip, as a result of which the separation of the posterior hyaloid membrane from the foveola is not always possible.

In addition, the described method does not allow for visual control over the operation, since tweezers overlap the foveola area, making it difficult to visualize the separation of the posterior hyaloid membrane, which leads to uncontrolled ruptures of the wall of the phaeolar cyst.

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