METHOD FOR REMOVING EPIMACULAR MEMRANE-LIKE STRUCTURES IN SURGERY OF PROLIFERATIVE DIABETIC RETINOPATHY Russian patent published in 2012 - IPC A61F9/07 

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology. It involves inserting ports, introducing a light guide, carrying out vitrectomy, detaching an epiretinal membrane (ERM), unbending it, cutting and removed by using a vitreous cutter. It is combined with matching a longitudinal axis of the port for the vitreous cutter directed towards an edge of the ERM with generating a surgical axis (SA), matching a vitreous cutter axis and a longitudinal symmetry axis of the ERM with generating a surgical plane (SP); an external surface of a vitreous cutter tip is delivered under a retinal surface of the ERM to perform asynchronous oscillatory movements about a centre of oscillation with the positive to negative amplitude ratio within the range 1.5 to 1.0; the centre of oscillation is moved along an external curvilinear surface of the ERM; each stage of discrete movement involves moving the vitreous cutter tip along the SA and in the SP 2-3 mm front, then 1-2 mm; with the vitreous cutter tip advanced along the retinal surface of the ERM to an opposite edge of the ERM, increasing an area of the detached retinal surface of the ERM to start thereby formation of a rectilinear tunnel; in a vacuum mode of 200-300 mm Hg, an upper wall of the ERM tunnel is fixed in a vitreous cutter window, while the ERM is pulled upwards; then the vacuum level is dropped to zero, and the vitreous cutter tip is moved along the SA and in the SP again forward to formation of the tunnel 4-5 mm long; the vitreous cutter tip is delivered under an external border of the tunnel; the vitreous cutter window is brought to contact with an upper wall of the tunnel; then the vitreous cutter tip is advanced in a cutting mode along the tunnel in the EMR with dividing the EMR on two equal flaps; further a bleeding is directed from a new vessel found close by a macular region coated with connective tissue bridges and membrane-like structures towards the macula with turning an eyeball in relation to the surgical plane with using the vitreous cutter and the light guide introduced in the eye cavity to cover it with blood completely to ensure complete retraction of a blood clot in 15-30 seconds; further the eye ball is set in an initial position; then the vitreous cutter is delivered under an edge of the blood clot and pulled up and aspirated in an vacuum mode 300-400 Hg mm with removing the blood clot with underlying connective tissue bridges and membrane-like structures.

EFFECT: method allows reducing operative injures, using an effect of blood fibrin adhesion with epimacular membrane-like structures enables one-step removal of membrane-like structures eliminating any mechanical effect of an instrument on the macula, provides cutting surgery time, extent of the anaesthesia care, a risk of developing individual side effects of the anaesthesia in the patients suffering diabetes for a long period of time and having severe comorbide background.

2 dwg, 1 ex