视网膜脱离后恢复视网膜解剖完整性的方法和工具的选择与改进

Inter Collegas Pub Date : 2022-10-31 DOI:10.35339/ic.9.2.sas
O. Saoud, A. Serhiienko
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引用次数: 0

摘要

介绍。视网膜脱离(RD)是一种常见的病理状况,如果不及时手术治疗,会导致视力丧失。有明显RD的患者接受三种再治疗方法中的一种:充气视网膜固定术、巩膜屈曲和/或玻璃体切割。这些手术的技术和工具已经开发出来,但是这些方法本身仍然有相当多的并发症。一种可能的替代方案可能是一种全新的治疗方法,用高频电流(HFEC)凝固视网膜,对这种工具进行重大改进仍然是可能的。本研究的目的是确定一种更安全的RD治疗方法,并改进在两种情况下恢复分离视网膜解剖完整性和重新定位的医疗工具:首先,获得可靠的绒毛膜视网膜粘连,其次,最大限度地减少手术干预的附带效应。材料和方法。采用文献语义学法、系统分析法、实验动物(兔)RD模拟实验及HFEC凝血法、手术动物安乐死后第7天组织活检及组织微制剂制作。为了满足改进方法的条件,采用脉络膜上通道的脉络膜视网膜高频电凝手术,提出了一种改进型EK-300M1发生器(乌克兰基辅),其电极为25规格的金半球形电极,发电参数为66 kHz, 10-16 V, 0.1 a,导致电极使用处的脉络膜视网膜粘连。选择了电凝工具对眼睛组织和液体传热参数的计算方法:建议使用傅里叶-基尔霍夫方程和牛顿-里奇曼方程。注意到组织凝固的热效应在视网膜中的破坏性现象,其形式是杆状细胞、锥状细胞的破坏、囊肿的发展、双极细胞、无突细胞、水平细胞和神经节细胞的丧失。在10-12 v电压下,视网膜的萎缩变化最小。修复视网膜层解剖位置的方法的改进问题已经存在了几十年,但它并没有导致并发症数量的显著减少。所提出的方法及其应用工具在手术干预后的短时间内以最小的热组织损伤产生可靠的绒毛膜视网膜粘连。建议在迫切恢复视力的情况下使用脉络膜上通路的脉络膜视网膜高频电凝方法,但不建议用于预防视网膜病变的视网膜脱离。关键词:视网膜脱离,脉络膜视网膜粘连,高频电凝,脉络膜上通路。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment
Introduction. Retinal detachment (RD) is a common pathological condition that without timely surgical treatment leads to vision loss. The patients with significant RD undergo one of three retreatment procedures: Pneumatic Retinopexy, Scleral Buckling, and/or Pars Plana Vitrectomy. Techniques and tools for these procedures have been developed, but the methods themselves still have a significant number of complications. A possible alternative to their further improvement may be a fundamentally new method of treatment, coagulation of the retina with high-frequency electric current (HFEC), for which significant improvement of the tool is still possible. The purpose of the study was to determine a safer method of RD treating and to improve medical tools for restoring anatomical integrity and repositioning a detached retina under two conditions: firstly, obtaining a reliable chorioretinal adhesion, and secondly, minimizing the number of incidental effects of surgical intervention. Materials and methods. The bibliosemantic method, the system analysis method, an experiment on laboratory animals (rabbits) with RD simulation and its coagulation by HFEC, tissue biopsy of operated animals after their euthanasia on the 7th day after surgery, and the production of histological micro-preparations were used. Results. To fulfill the conditions for improving the method, a chorioretinal high-frequency electrocoagulation operation with suprachoroidal access, a modified EK-300M1 generator (Kyiv, Ukraine) with an electrode with a gold hemispherical tip of 25 gauge and electrical generation parameters of 66 kHz, 10‒16 V, 0.1 A was proposed, which causes chorioretinal adhesion in the place where the electrode is used. The method of calculating the parameters of heat transfer from the electrocoagulation tool to the tissues and fluids of the eye was selected: it was proposed to use the Fourier-Kirchhoff and Newton-Richmann equations. Destructive phenomena in the retina from the thermal effect of tissue coagulation in the form of the destruction of rods, cones, the development of cysts, the loss of bipolar, amacrine, horizontal and ganglion cells were noted. Atrophic changes in the retina were minimal at a voltage of 10‒12 V. Conclusions. The problem of improving the methods of restoring the anatomical position of the retinal layers has been relevant for many decades, but it does not lead to a significant reduction in the number of complications. The proposed method and tool for its application causes the creation of a reliable chorioretinal adhesion in a short period of time after surgical intervention with minimal thermal tissue damage. The use of the method of chorioretinal high-frequency electrocoagulation with suprachoroidal access is recommended in conditions of urgent restoration of vision, but not recommended for the prevention of retinal detachment in retinopathies. Keywords: retinal detachment, chorioretinal adhesion, high-frequency electrocoagulation, suprachoroidal access.
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