FIELD: medicine, ophthalmology.
SUBSTANCE: following is determined preliminary ophthalmoscopically: the type and localization of areas of peripheral retinal dystrophy, their length along the hourly meridians and distance from the dentate line, retinal detachment, its extent along the hourly meridians, prevalence, and localization of the retinal rupture or ruptures. Then, a wide-field photographic recording of the fundus is carried out with the capture of the structures of the posterior pole of the eye of the optic nerve disk (OND) and the macula, the middle periphery of the retina circularly and the retina in the nasal segment in the 3 o'clock meridian before the dentate line. Photographic registration of all areas of obligate pre-detachment types of peripheral retinal dystrophy is performed in those segments that were identified during ophthalmoscopy. Next, the obtained images are combined and a general image is obtained with a wide-field photograph of the fundus, the general image is transferred to Photoshop program and a line is drawn from the center of the ONH to the dentate line in the nasal segment: for the right eye in the 3 o'clock meridian, for the left eye in the 9 o'clock meridian. Then the resulting segment is divided into three equal parts by two points: the first and second, from which two circles are drawn through the center of the ONH, thus forming 3 zones: the first zone conditionally corresponding to the posterior pole of the eye, from the middle of the ONH to the first point. The second zone conditionally corresponding to the middle periphery of the retina — from the first point to the second point. The third zone conditionally corresponding to the extreme periphery of the retina — from the second point to the dentate line, on the resulting scheme the following is determined: the zone where the areas of obligate pre-detachment types of retinal dystrophy are localized, the said types requiring transpupillary delimiting laser coagulation of the retina (RLC), as well as retinal ruptures that caused development of rhegmatogenous retinal detachment (ROD), and localization and extent of retinal detachment by zones. Then, navigational transpupillary laser coagulation of the retina is performed with the help of Navilas 577s navigational laser device, while around the zone of peripheral vitreochorioretinal dystrophy (PVCRD), coagulates are applied in three rows with an interspot distance of 0.5 coagulate diameter, with preliminary testing until obtaining a coagulate of the III degree of intensity according to classification of L`Esperance. Then, a surgical stage of treatment, episcleral filling is carried out, while a circling silicone tape or sponge is fixed to the sclera in the equatorial zone with U-shaped sutures, drainage of the subretinal fluid is performed at the height of the retinal detachment bubble, the drainage site is localized under the filling, cryocoagulation is performed in the projection of the rupture on the sclera retina. In a particular case, if the areas of PVRD are located in the second zone of the retina, or on the border of the second and third zones, before the episcleral filling the patient is immediately given a delimiting navigation LCS of such areas that are not included in the area of the proposed imposition of the circling tape or sponge during episcleral filling.
EFFECT: method allows to block pre-detachment types of PVRD on the middle periphery of the retina, and eliminate the risk of new retinal tears and recurrent RRD.
2 cl, 2 ex
