METHOD OF ENDOVITREAL REMOVAL OF PARAMYLIC MELANOMA OF MUSHROOM-SHAPED CHOROID (VARIANTS) Russian patent published in 2018 - IPC A61F9/08 A61M36/00 A61N5/67 A61K31/282 A61P35/00 

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to ophthalmology. For treatment of paramytic melanoma choroid (MX) mushroom form, its endovitreal removal (endorespection) with minimal anatomical and functional damage to the retina with the help of an ophthalmic endoscopic system. In the first variant of the method, with a distance from the fovea to the edge of the base, MX is less than 2 mm, subtotal vitrectomy is performed using instruments of 25 G; there is a complete tamponade of VP PFOS with the creation of increased intraocular pressure (IOP) up to 50 mmHg; perform diathermocoagulation of the retina and the vascular membrane around the boundaries M visible in the operating microscope; perform a retinotomy along the diathermocoagulation boundary followed by a retinectomy of the obtained zone over MX, with the removal of part MX, turned to the periphery of the fundus, the frequency of the cuts of vitreotom 2,000 cuts/min is used, and when removing part of MX closer to the posterior pole of the eye – 5,000 cuts/min, along the perimeter of the colophony, 1 mm of the surrounding tissue layer is additionally resected when the vitreotome is 6,000 cuts/min. In the second variant of the method, with a distance from the fovea to the edge of the MX base greater than or equal to 2 mm, subtotal vitrectomy is performed using instruments of 25 G; perform a complete tamponade of VP PFOS with the creation of elevated IOP to 50 mmHg; perform diathermocoagulation of the retina and choroid around the available visualization in the operating microscope of the boundaries of the MXZ base, then install an additional port through the flat part of the ciliary body, through which the tip of the ophthalmic endoscope is inserted into the VP, lead it to the boundary of the MX base, inaccessible visualization in the operating microscope, perform diathermocoagulation of the retina and vascular membrane around the base of the tumor under video endoscopic control; perform a retinotomy along the diathermocoagulation boundary followed by a retinectomy of the obtained zone over MX, with the removal of part MX, facing the periphery of the fundus, use the cut-off frequency of vitreotom 2,000 cuts/min, and when the MX part is removed closer to the posterior pole of the eye – 5,000 rez/min, 1 mm of the surrounding tissue is also resected along the whole perimeter of the colophony when the vitreotome is 6,000 cuts/min.

EFFECT: group of inventions increases efficiency of treatment by completely removing the paramyacular MX of the mushroom form with maximum preservation of surrounding tissues, reduces dissemination of tumor cells and reduces the risk of intraoperative bleeding.

2 cl, 2 dwg, 2 ex