Fossa of the disc of the visual nerve. Surgical resection of the fossa of the zogal nerve disc (clinical lesions) Text of a scientific paper on the topic “Our evidence of surgical resection of the fossa of the zocal nerve disc”
Abstract scientific statistics from clinical medicine, author of scientific work - Konyaev Dmitro Oleksandrovich
Pits (burrows) near the disk visual nerve There is a congenital anomaly that often becomes narrower, the pathogenesis of which is not entirely clear. V.M. Arkhangelsky (1960), considering this as a variant of disc hypoplasia with partial blockage of the growth of nerve fibers, other authors attribute the formation of pits to the prolapse of the folds of the rudimentary reticulum in the interphase ri of the visual nerve, I want the authors to evaluate fossa of the disc of the visual nerve(OND) as one of the forms of the colobomy of the visual nerve. Sustricity pits of the disc of the visual nerve in the population 1:10 000 1:11 000. In approximately 45-75% of cases with birth fossa of the disc of the visual nerve serous swelling develops in the macular area. A method of surgical treatment was developed based on the results of surgical patients at the Tambov branch of the MNTK “Eye Microsurgery” named after. acad. CM. Fedorov with the optic disc fossa and the complicated neuroepithelium. The operations went smoothly. The analysis showed that a good functional and morphological result was obtained. Through two Tizhni, Pislya of the Valnoye Rosmotubannoy of Gasovyatryan, Sumyshi, Gostrota Zoro stained, and such a resort was in a reserve of subretinated Rydini until the adherents of the neurorapel through the Moscow Operations.
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Our experiment of optical disc fovea treatment
Fovea (deepening) in the optic disk is a frequent congenital abnormality, the pathogenesis of which is not entirely clear. V.N. Arkhangelsky (1960) notes that this is a variant of optic disc hypoplasia with localized nerves fibers ingrowth. Other astronomers consider the formation of the fovea with the introduction of sections of kitchen retina in the internal parts of the optic nerve, and some authors consider the optic disc fovea (ODF) to form the optic nervecoloboma. Optic disc fovea incidence in population is 1:10,000 1:11,000. Approximately, in 45-75% of cases with congenital optic disc fovea there is a serious development of disc fovea in the macular area. The facts related to the aggressive research method are based on the results of patients with optic disc fovea (ODF) and advanced neuroepithelial detachment operated on in Academician S.N. Fyodorov FSBI IRTC “Eye Microsurgery” Tambov branch. There were no complications. Analysis showed that a good functional and morphological result was achieved. Two weeks later after the gas/air mixture resolution visual acuity improved noticeably. Also resorption of subretinal fluid until neuroepithelium fully being adjoined was noted 1 month after the surgery.
Science text on the topic “Our evidence of surgical resection of the fossa of the disc of the visual nerve”
UDC 617.753
OUR DOSVID OF SURGICAL INCREMENT OF THE FOSSA OF THE SOCIAL NERVE
© D.A. Konyaev
Pits (burrows) in the disc of the visual nerve are a congenital anomaly that often narrows, the pathogenesis of which is not entirely clear. V.M. Arkhangelsky (1960), considering this as a variant of disc hypoplasia with partial blocking of the regrowth of nerve fibers, other authors associate the formation of pits with the prolapse of the folds of the rudimentary mesh in the interspaces of the visual nerve, the authors want to examine the fossa of the disc of the visual nerve. nerve. Congenital disc fossa is present in the population 1:10,000 - 1:11,000. Approximately 45-75% of eyes with a congenital disc fossa develop serous swelling in the macular area. A method of surgical treatment was developed based on the results of surgical patients at the Tambov branch of the MNTK “Eye Microsurgery” named after. acad. CM. Fedorov with the optic disc fossa and the complicated neuroepithelium. The operations went smoothly. The analysis showed that a good functional and morphological result was obtained. Through two Tizhni, Pislya of the Valnoye Rosmotubannoy of Gasovyatryan, Sumyshi, Gostrota Zoro stained, and such a resort was in a reserve of subretinated Rydini until the adherents of the neurorapel through the Moscow Operations.
Key words: fossa of the disc of the visual nerve; centrally located grid; pneumoretinopexy; laser coagulation.
The fossa of the disc of the optic nerve (OND) is a congenital anomaly that is located near the ONH. The optic disc fossa was first described by Wyeth in 1882. in a 62-river woman. The severity of this pathology was calculated as 1:10,000 - 1:11,000. Pathogenesis of sickness of the mentally ill; It is believed that this is caused by disruption of the structural development of the optic nerve disc, and the authors would like to consider the optic disc fossa as one of the forms of colobomy of the optic nerve. However, there are facts that do not agree with this hypothesis. First of all, the disc pits often grow in places where the fetal clefts are pressed. Otherwise, the disc pits are unilateral, sporadic and associated with other developmental anomalies. Thirdly, the pits of the disc are not associated with colobomas of the iris or retina, regardless of the fact that a coloboma of the optic nerve may also be a crater-like deformation, which predicts the fossa of the disc of the optic nerve, and is important in Cut the pit, which is localized in the lower segment, from small colo. Gastrointestinal facts appear sufficient to prove the obvious difference in the pathogenesis of the colobomas and fossae of the visual nerve. There is also a hypothesis about the development of the optic disc pits, which is caused by partial blockage of the growth of nerve fibers at the canal of the visual nerve. The presence of one or a number of cilioretinal vessels that emerge from most of the pits of the visual nerve allows us to assume that this fact is also related to the pathogenesis of the anomaly.
In approximately 45-75% of eyes with a congenital fossa of the visual nerve disc, serosa develops in the macular area.
Clinically, with ophthalmoscopy, the optic disc fossa appears as a depression of round, oval, or polygonal shape, which has a white, gray or yellow color. It is important that it grows in the crown part of the disc, sometimes in the center and at the edge, rarely in the nasal part, and its diameter varies from 1/3 to 1/8 of the diameter of the optic disc. The vision reveals defects such as widening between the blind spots, similar to those in glaucoma.
Visual acuity in such patients remains normal until the macular retina becomes weaker, which usually occurs until the 16th eyelid. Then the sharpness of the vision can change to 0.1 or more low level. It becomes irrevocable for savings over 6 months. In case of severe established serous abrasion, the retina suffers from pigmented epithelium in the zone of abrasion, and the formation of a cut-through macular hole is described. In some cases, there is choroidal neovascularization at the edge of the visual nerve disc.
With respect to the subretinal region at the optic disc fossae, many authors paid attention to the skeletal body, others - to the cerebrospinal region, and still others - to the choroid or vessels located between the fossa itself. Spontaneous occurrence of serous discharge as a result of resorption of the subretinal tissue occurs in approximately 25% of cases and may last many months and may occur from the moment of its onset. Further research has shown that the role of the central part of the retina is played by the strum of the spine, and the traction from the side of the body. How to prove your hypothesis by describing the fall
successful recuperation of the mesh in case of optic disc tumor with the help of vitrectomy.
With fluorescent and indocyanin angiography, the zone of the serous junction is hypofluorescent in the early phase behind the screening of choroidal fluorescence. The images below show weak hyperfluorescence. The presence of local alterations in the pigment epithelium is indicated by hyperfluorescence on the basis of residual defects. Investigations from optical coherence tomography (OCT) and fluorescein angiography (FA) made it possible to distinguish the interconnections of the optic disc fossa from the central parts of the retina. Based on these data, retinoschisis of the inner retina balls is formed, after which the central distribution of the outer retina ball as a pigment epithelium suddenly develops. Thus, there is a double structure of maculopathy in the optic disc. The optic disc fossa plays a useful role in the struma between the empty retinoschisis and the subarachnoid space. With the help of GCT, it was revealed that fluid from the optic disc pits can flow into the inner and outer nuclear spheres or into the subretinal space, although most often not in the outer nuclear sphere.
Conservative treatment of the optic disc fossa due to the stagnation of corticosteroids does not produce results, since the effect of steroids is temporary, and blocking of the rupture is not carried out. According to the authors, the combination of laser therapy with intravitreal injections of SF6 or C3F8 gas, or with silicone tamponade has a greater clinical effect (up to 70%), equal to laser therapy as monotherapy (the same in 30% of patients).
There was no known wide expansion of the extrascleral sealing of the posterior pole of the eye. The surgical technique involves a sponge sutured to the posterior pole, the correct position of which is indicated by ultrasound B-scan during the operation. Further on, 1 week after the operation, endocyanin angiography was performed to measure blood circulation in the choroid, as well as magnetic resonance imaging of the orbit to clarify the position of the sponge of the visual nerve. Other additional methods of treatment (laser coagulation, cryotherapy, etc.) did not work out. The attractiveness of the mesh was visible to everyone.
Barrier argon laser coagulation of the mesh between the subretinal spaces and simultaneously YAG laser retinopuncture along the lower borders lead to a change in the height of the neuroepithelium and an increase in visual acuity. However, in this case there is an uneven attachment to the atmosphere, steady stream lines under neuroepithelium and paramacular rupture.
Vitrectomy with removal of only the posterior hyaloid membrane, injection of gas without laser coagulation and horizontal position of the face downwards for 7 days led to a positive result. Conducted before and after the operation, GCT showed an effect not only on the improvement of the retina, but also on spherical retinoschisis.
However, then, in some patients, there was a relapse of the reticulum after 8 days, which was associated with tangential traction from the side of the internal pericordon membrane or excess vitreous cortex. This required additional surgical intervention with peeling of the internal cordon membrane and subsequent injections into the real empty gas bag. Thus, at this time, the optimal method of surgical treatment of this even rare pathology has not been established.
Meta-investigation – conduct an analysis of the surgical resection of the fossa of the zocal nerve disc.
MATERIALS AND METHODS
2 patients (2 eyes) were operated on at the Tambov branch of the MNTK “Eye Microsurgery” im. acad. CM. Fedorov with the optic disc fossa, composed of neuroepithelium. Resentment of patients of human status, age of patients 29 and 27 years. The patients presented scars to the lowered gaze and to the dark flame in front of the eye, stretching out one fate. The patients underwent standard follow-up: visometry, autokeratorefractometry, tonometry, perimetry, biometry, B-scan, electrophysiological studies, biomicroscopy, ophthalmoscopy. Additional research was carried out using optical coherence tomography.
Weekend displays are presented in the table. 1 in Fig. 1-2.
OPERATIONAL TECHNIQUE
Treatment was performed with central 25 Ga vitrectomy, removal of the posterior hyaloid membrane, laser coagulation, gas tamponade. Patient B. additionally received removal of the internal cordon membrane. Laser coagulation was carried out on the Izumrud device of Alcom Medica, St. Petersburg. Laser photocoagulants were applied in the 3rd row on the nasal side of the optic disc, pressure intensity 0.2 W, exposure 0.15 s. After 2 days, after complete examination of the gas mixture, the patient underwent laser coagulation in the macular area using a Quantel medical Supra 577 Y. Laser infusion parameters: intensity 0.1 W, exposure 0 ,1 s, diameter is 125 µm.
The term of caution for patient A. became 4 years old, for patient B. – 2 months.
Table 1
Weekend showings of patients
Indicators Patient A. Patient B.
Vik, rokiv 29 27
B-scan data In the central zone there is retinoschisis In the central zone there is retinolysis
Mounting height, microns 667 604
Table 2
Visual acuity and height of the neuroepithelium after surgery
Term Patient A. Patient B.
guard Visus Mounting height, µm Visus Mounting height, µm
after 2 years 0.25 78 0.4 102
after 1 month 0.25 outside fit 0.5 outside fit
after 2 months 0.35 outside fit 0.6 outside fit
after 6 months 0.5 external fit
after 3 rocks 0.7 outside
RESULTS AND DISCUSSION
The operations went smoothly. Two years later, after the gas bag was completely examined, the patients showed increased severity of vision. GCT data indicate resorption of the subretinal tissue until full adherence to the neuroepithelium one month after surgery. The results are presented in table. 2 in Fig. 3-4.
VISNOVOK
Thus, the results of the investigation show that microinvasive vetrectomy with removal of the posterior hyaloid and internal cordon membranes, endolaser coagulation, gas tamponade and Frequent" laser coagulation after two years gives a good morphological (according to GTT data) and functional result ( ) in early in further terms.
REFERENCES
1. Avetisov S.E., Kashchenko T.P., Shamshinova A.M. Healthy functions and correction in children of the age. M.: Medicine, 2005. 872 p.
2. Tron J.Zh. Illness of the dawn way. L., 1968. pp. 313-322. Section 13.4.
3. Bayborodov Ya.V., Rudnik A.Yu. Minimally invasive removal of the ILM in the treatment of the fossa of the optic nerve disc // Current technologies for treatment of vitreoretinal pathology: materials of scientific-practical science. conf. M., 2012. pp. 27-30.
4. Apple DJ, Rabb MF, Walsh P.M. Congenital anomalies of the optic disc. //Surv. Ophthamol. 1982. V. 27. No. 1. P. 3-41.
5. Ganichenko I.M. Liquefaction of the fossa of the visual nerve and its compaction using photo-laser coagulation // Ophthalmological Journal. 1986. No. 4. P. 199-203.
6. Malakyan N.Yu., Sdobnikova S.V. Treatment of the mesh for the pits of the disc of the visual nerve // Vestn. ophthalmology. 2012. No. 3. P. 62-64.
7. Shamshinova A.M. Decline and congenital illness of the retina and visual nerve. M., 2001. S. 487-489.
8. Akiba J., Kakehashi A. and in. Vitreous finding in the optic nerve pits and serous macular detachment // Am. J. Ophthalmol. 1993. V. 116. No. 1. P. 38-41.
9. Gass J.D. Serious identification of sores. Vuzka to constitutional pit with optic nervehead // Am. J. Ophthalmol. 1969. V. 67. No. 6. P. 821-841.
10. Montegro M, Bonnet M. Optic nerve pits: clinical and therapeutic understanding of 21 types // J. Fr. Ophthalmol. 1989. V. 12. No. 6-7. P. 411-419.
11. Gordon R., Chatfield R.K. Drinking into the optic disc is associated with basic degeneration // Br. J. Ophthalmol. 1969. V. 53. No. 7. P. 481-489.
12. Hirakata A., Odaka A.A., Hida T. Long-term results of vitrectomy si laser treatment for macular detachment associated with optic disc pit. // Ophthalmology. 2005. V. 112. No. 8. P. 1430-1435.
13. Lincoff H., Schiff W., Krivy D., Ritch R. Optical coherence tomography optic disc pit maculopathy // Am. J. Ophthalmol. 1996. V. 122. No. 2. P. 264-266.
14. Theodossiadis G.P. Treatment of maculopathy associated with optic disc optic by sponge explant // Am. J. Ophthalmol. 1996. V. 121. No. 6.
15. Yanyali A., Bonnet M. Complicating optic disc coloboma pits. Long-term results of photocoagulation-gas combination // J. Fr. Ophthalmol. 1993. V. 16. No. 10. P. 523-531.
Konyaev Dmitro Oleksandrovich, Tambov branch of MNTK "Eye Microsurgery" im. acad. CM. Fedorova, m. Tambov, Russian Federation, ophthalmologist of the 3rd ophthalmological department, e-mail: [email protected]
DOI: 10.20310/1810-0198-2016-21-1-214-218
OUR EXPERIENCE OF THE OPTIC DISC FOVEA TREATMENT
Fovea (deepening) in the optic disk is a frequent congenital abnormality, the pathogenesis of which is not entirely clear. V.N. Arkhangelsky (1960) notes that this is a variant of optic disc hypoplasia with localized nerves fibers ingrowth. Other astronomers consider the formation of the fovea with the introduction of sections of kitchen retina in the internal parts of the optic nerve, and some authors consider the optic disc fovea (ODF) to form the optic nervecoloboma. Optic disc fovea incidence in population is 1:10,000 - 1:11,000. Approximately, in 45-75% of cases congenital optic disc fovea serous detachment develops in the macular area. The facts related to the aggressive research method are based on the results of patients with optic disc fovea (ODF) and advanced neuroepithelial detachment operated on in Academician S.N. Fyodorov FSBI IRTC "Eye Microsurgery" Tambov branch. There were no complications. Analysis showed that a good functional and morphological result was achieved. Two weeks later after the gas/air mixture resolution visual acuity improved noticeably. Also resorption of subretinal fluid until neuroepithelium fully being adjoined was noted 1 month after the surgery.
Key words: optical disc fovea; central retinal detachment; pneumoretinopexia; laser coagulation.
1. Avedisov S.E., Kashchenko T.P., Shamshinova A.M. Visual functions and their correction in children. Moscow, Meditsina Publ., 2005. 872 p.
2. Tron E.Zh. Visual illness. Leningrad, 1968. 394 p.
3. Bayborodov Ya.V., Rudnik A.Y. Minimally invasive removal of VPM in the treatment of oslozhnennyhh yamok disk zritelynogo nerva.
Current technologies for the treatment of vitreoretinal pathology: materials of scientific and practical concepts. Moscow, 2012, pp. 2730.
4. Apple DJ, Rabb MF, Walsh P.M. Congenital anomalies of the optic disc. Survey of Ophthalmology, 1982, vol. 27, no. 1, pp. 3-41.
5. Ganichenko I.N. Lifting of the optic nerve fossa and its weakening using photo- and laser coagulation. Oftalymologicheskiy zhurnal, 1986, no. 4, pp. 199-203.
6. Malakyan N.Y., Sdobnikova S.V. Lifting of the retina for pits of the optic nerve head. Bulletin oftalymologii, 2012, no. 3, pp. 62-64.
7. Shamshinova A.M. Advent and congenital diseases of the eye and optic nerve. Moscow, 2001. 528 p.
8. Akiba J., Kakehashi A. and in. Vitreous finding in the optic nerve pits and serous macular detachment. American Journal of Ophthalmology, 1993, vol. 116, no. 1, pp. 38-41.
9. Gass J.D. Serious identification of sores. Narrow to constitutional pit with optic nervehead. American Journal of Ophthalmology, 1969, vol. 67, no. 6, pp. 821-841.
10. Montegro M., Bonnet M. Optic nerve pits: clinical and therapeutic concepts of 21 types. Journal Francais D "Ophtalmologie, 1989, vol. 12, no. 6-7, pp. 411-419.
11. Gordon R., Chatfield R.K. Drinking into the optic disc is associated with underlying degeneration. British Journal of Ophthalmology, 1969, vol. 53, no. 7, pp. 481-489.
12. Hirakata A., Odaka A.A., Hida T. Long-term results of vitrectomy sith laser treatment for macular detachment associated with optic disc pit. Ophthalmology, 2005, vol. 112, no. 8, pp. 1430–1435.
13. Lincoff H., Schiff W., Krivy D., Ritch R. Optical coherence tomography optic disc pit maculopathy. American Journal of Ophthalmology, 1996, vol. 122, no. 2, pp. 264-266.
14. Theodossiadis G.P. Positivity of blood circulation is associated with the optical disc and the optical path of descent. American Journal of Ophthalmology, 1996, vol. 121, no. 6, pp. 630-637.
15. Yanyali A., Bonnet M. Complicating optic disc coloboma pits. Long-term results of photocoagulation-gas-combination. Journal Francais D "Ophtalmologie, 1993, vol. 16, no. 10, pp. 523-531.
Konyaev Dmitriy Aleksandrovich, Academician S.N. Fyodorov FSBI IRTC "Eye Microsurgery", Tambov branch, Tambov, Russian Federation, Ophthalmologist of the 3rd Ophthalmologic Department, e-mail: [email protected]
The fossa of the disc of the visual nerve is a congenital pathology of the visual nerve, which is characterized by deepening of the optic disc and serous expansion of the macular lobe, which results in a decrease in visual functions. The frequency of this pathology is 1 episode per 10-11 thousand population. Macular damage usually occurs between the ages of 20 and 40; this pathology was first described by White in 1882. in a 62-river woman.
There is a theory of migration of the radius to the macular zone: from the corpus corpus, cerebrospinal region, choroidal vessels or optic disc vessels. The region from the optic disc fossa expands into the macular zone, usually at the inner or outer nuclear balls, which create the schizu of the macular zone. Many authors pay special attention to the influx of the macular body in the pathogenesis of swelling of the macular zone.
Conservative treatment of the optic disc fossa is not effective, the use of steroidal and non-steroidal anti-inflammatory drugs does not lead to a decrease in macular plaque, and the opening of the optic disc does not close.
Various methods of surgical debridement of the optic disc fossa have been proposed: intermediate laser coagulation of the mesh between the subretinal space with YAG laser retinopuncture along the lower border of the scar, a combination of laser debridement with intravitreal gas injections, vitrectomy with remote ILM and gas tamponade. In the meantime, new methods of surgical debridement will be introduced, such as the suction of the inverted ILM valve. The current technique of opening the clap of the internal cordon membrane allows not only to close large holes in the macular area, but also to cover the optic disc fossa.
In our opinion, the most promising methods in this regard are the methods of vicarious platelet mass. Currently, this mask is effectively used for the treatment of patients with idiopathic macular holes.
By method Our investigation was an assessment of the effectiveness in various ways surgical debridement of the optic disc fossa
Material and method
We analyzed 3 types of cancer diseases in the Cheboksary branch of the Federal Scientific Institution “MNTK “Eye Microsurgery” named after academician S.M. Fedorov" in 2016-2017.
Vipadok No. 1
Patient S., 58 years old. Skargi to reduce the severity of the vision of the left eye for the remaining 3 months. When necessary Vis OS=0.2 cyl -0.5D ax 101°=0.3; on the OST of the macular zone OS there is a cystic lesion of the retina, height at the level of the fovea = 538 µm, adjacent to the neuroepithelium; on OST ONH OS there is a decrease in the ball of nerve fibers.
Vikonano surgical treatment: OS – intravitreal injection of C3F8 gas with a relaxed head position “downward” in the postoperative period.
Vipadok No. 2
Patient K., 68 years old. In the anamnesis there is a daily eye pathology - pro/v glaucoma Ia; in 2011 surgical debridement of OD was performed – FEC+IOL+trabeculotomy.
When presenting for control in 2015, the result was Vis OD=0.7n/k; IOP = 20 mm Hg. With perimeter – arcuate thinness; on OST Mac. zones without features, OST ONH - a decrease in the ball of nerve fibers. Hypotensive drops do not drip.
The patient came for control after 1 year (2016) due to problems with decreased vision in the right eye Vis OD=0.3 n/k; IOP = 21 mmHg; on OST Mac. The zone is highly enriched with neuroepithelium in the fovea and parafoveolar, which expands to the optic disc, splitting of the retinal globules.
Surgical treatment was performed: OD – vitrectomy with PGM, ILM, ELKS and vitreous tamponade.
The patient arrived for follow-up within 1 month. Vis OD=0.3 n/k; IOP = 20 mmHg; OST mac. zone - weak positive dynamics due to savings in the macular zone.
Then the patient arrived for control within 3 months. after the operation. Vis=0.2-0.3n/k; IOP = 20 mm Hg; on OST Mac. zone - swelling, irritation of the neuroepithelium at the fovea and parafoveolar. The advance was due in 6 months. after the operation. Vis=0.2 n/k; IOP = 21 mm. Hg; on OST Mac. zones - surrounded by neuroepithelium, the maximum height of the papilla is 762 µm, at the level of the fovea - 618 µm (Fig. 1).
The doctor confirmed the recurrence of macular plaque, as well as the negative dynamics in the gastrointestinal tract, repeated surgical debridement was performed: OD - revision of the vitreous cavity with time-lapse tamponade PFOS, retinopuncture 30 G with subretinal drainage and, subretinal injection.
Vipadok No. 3
Patient R., 35 years old. Skargi on the lower vision of the left eye stretches out the remaining rock, appearing as a dark blur in front of the eye. With proper Vis OS=0.3 sph+0.75D=0.4; on the OST of the macular zone - retinal swelling, height at the level of the fovea = 644 µm, adjacent to the neuroepithelium; on the OST of the optic disc – the bend of the lower ball of nerve fibers.
Surgical debridement was performed: OS – vitrectomy with remote cervical implant and molding with VMP of the inverted valve at the posterior fossa of the optic disc. To press the valve into the disc pit, an hourly tamponade of PFOS was applied with the subsequent application of platelet mass to fix the valve.
After exposure in the 3rd phase, PFOS was removed and tamponade of the sterile sternum was removed. In the postoperative period, the “downward” period lasts 7 days.
Results
Vipadok No. 1
The patient arrived for control within 3 months. after the operation. There was no indication of the dynamics of the celebration.
Vis OS=0.3 n/a; on the OST of the macular zone OS - positive dynamics of change in the cystic plaque of the retina, height at the level of the fovea = 482 µm; on the OST of the optic disc OS – a decrease in the ball of nerve fibers.
As a result of the liquidation, the macular plaque was removed by 56 µm (Fig. 2).
In order to ensure positive dynamics, patients are recommended to undergo dynamic monitoring with monitoring of the OST. zones in 3 months. If the situation is severe, there is nutrition for vitrectomy.
Vipadok No. 2
The patient arrived for follow-up within 6 months. after repeated surgery. I felt the positive dynamics of the surgical treatment and spoke about the brightened vision.
Vis OD=0.3 cyl-0.75D ax130°=0.5; IOP = 19 mm Hg. On the OST of the macular zone OS - positive dynamics, the presence of swelling in the macular zone, the height at the level of the fovea = 210 µm. The performed bath allowed the poppy to be put into place. zone 408 µm (Fig. 3).
Vipadok No. 3
The patient arrived for control within 5 months. after the operation. She spoke at the enlightened “spits” in front of her left eye. Vis OS=0.4 n/k; on the OST of the macular zone OS - positive dynamics, almost complete absence of the retina, height at the level of the fovea = 278 µm; on the OST, the optic disc is the portal valve of the ILM, which covers the optic disc (Fig. 4).
As a result of the liquidation, the macular plaque in this area was removed by 366 µm (Fig. 5).
Visnovok
Thus, vitrectomy with remote breast implantation and ILM is effective method Lifting the optic disc fossa, which allows you to change the macular plaque and brighten the blurred vision.
Closing the pits with an inverted clamp, the ILM has also proven to be an effective and safe method of healing. I would like to inform safe and sound doctors about the need for retinotomy and additional manipulations with subretinal replacement. The use of platelet mass for additional fixation of the valve may reduce the risk of recurrence of macular plaque. However, more caution is required.
In case of relapse of macular plaque, subretinal administration of platelet mass is possible.
The pits of the disc of the visual nerve are a congenital deficiency of tissue in the head of the visual nerve. In 50% of people who suffer from this anomaly, ranging from 20 to 40 years, serous swelling of the retina of the macular region is to blame. The incidence rate is 1 in 1,1000. 10-15% of patients suffer from eye pain. The disease was first described by T. Wiethe.
Pathogenesis
Pathogenesis of the fossa of the disc of the visual nerve of the immature. Some authors assume that the fossa of the disc of the visual nerve is a mild form of colobomy of the visual nerve. It is also covered with uneven eyelid closures. Arguments that support this point of view are the rare occurrences of colobomas and pits of the disc of the optic nerve.
There are facts that do not agree with this hypothesis:
- First of all, the disc pits often grow in places that may extend to the fetal gap;
- in another way, the disc pits are unilateral, sporadic and not associated with other developmental anomalies;
- thirdly, the disc pits do not merge with the colobomas of the iris or retina.
Regardless, a coloboma of the optic nerve can sometimes be a crater-shaped deformation that resembles the fossa of the disc of the optic nerve, and it is important to cut out the fossa, which is localized in the lower segment as a small coloboma, Most of all, the facts are sufficient to prove the obvious difference in pathogens. The presence of one or a number of cilioretinal vessels that emerge from most of the pits of the visual nerve allows us to assume that this fact is also related to the pathogenesis of the anomaly.
In approximately 45-75% of eyes with a congenital fossa of the visual nerve disc, a serous macular disc develops. How to develop macular deformities:
- retinoschisis of the inner balls of the mesh is formed, the empty part of which appears directly behind the disc fossa
- a rupture of the outer balls of the mesh below the empty retinoschisis occurs;
- The expansion of the external balls develops near the macular hole, which is associated with the influx of retinoschisis (the swelling of the external balls of the mesh during ophthalmoscopy may have destruction of the pigment epithelium, but in FAG is not characteristic of the remaining hyperfluorescence);
The soaking of the outer balls will increase in size and remove the empty retinoschisis. At this stage of development, it does not differentiate clinically from the primary serous macular lesion.
Clinical manifestations
With ophthalmoscopy, the fossa of the disc of the visual nerve appears as a depression of a round, oval, or polygonal shape, which has a white, gray or yellow color. Sometimes it develops at the crown part of the disc, sometimes in the center and at the edge, rarely at the nasal part.
The diameter of the pits of the disc of the optic nerve varies from 1/3 to 1/8 RD. The illness is most often one-sided. The bilateral fossae of the optic nerve disc become constricted in 15% of cases. With a unilateral disease, the abnormal disc appears slightly larger than the normal one.
Seriously inspired The mesh is important when the disc pit is localized. This formation takes a droplet-like shape and begins at the crown edge of the disc, expanding to the area of the macula, sometimes covering the entire posterior pole, without extending beyond the temporal arcades.
- Zgodom on back surface The spherical meshes may develop precipitates.
- In case of severe drying, treatment in this zone can prevent alteration of the pigmented epithelium,
- creation of microcysts in a woman infected with neuroepithelium,
- in single episodes there are severe macular holes.
This disc anomaly is often associated with congenital overgrowth of the pigment in the peripapillary segment and the presence of the cilioretinal artery (59% of cases). The pit area can be covered with a gray membrane with no openings.
Diagnostics
With significant dimensions of the disc fossa, it is possible to remove the sagittal section, vicoristic and B-echography; for small sizes – optical coherence tomography.
Gostrota Zora in patients it remains normal at the time of macular deformation. Until the 16th century, through the development of the macular fusion of the neuroepithelium, visual acuity of 0.1 or lower is observed in 80% of patients.
Field defects Various and often do not correlate with the localization of the fossa, they often reveal various damage to the appearance of widened blind spots or the appearance of small paracentral or crescent-shaped thinness. With persistent macular changes, defects in the field of vision progress. Scotomas detected in the early stages are consistent with defects in the pigment epithelium of the retina, which are detected by ophthalmoscopy or FA.
On angiography The disc pit appears as a zone of hypofluorescence in the early and intermediate phase. Most patients exhibit hyperfluorescence in the late phase. Diffusion of barvnik between the fossae, into the area of serous drainage of the mesh on a daily basis.
The serous zone is hypofluorescent in the early phase behind the screening of choroidal fluorescence. The images below show weak hyperfluorescence. The presence of local alterations in the pigment epithelium is indicated by hyperfluorescence on the basis of residual defects.
ERG remains normal in most patients with macular problems. VEP does not change until the development of macular expansion. The appearance of macular deformation first indicates a decrease in the amplitude of the P 100 component, and, at first, a decrease in its latency.
Histologically the fossa of the disc of the visual nerve is located in the hernial ridges of the elements of the neurosensory retina in the area of the defect of the scleral plate. The retinal fibers descend into the middle of the fossa, then rotate and exit before the visual nerve enters. The pits emerge from the subarachnoid space.
The original mesh is connected with the passage of the internal oropharynx to the mesh in the fossa of the visual nerve or the penetration of liquor from the subarachnoid space into the interpaponic spaces of the visual nerve.
Differentiate This is associated with other serous lesions of the macula, primarily with central serous choriopathy.
Evolution and forecast
The culprit of serous expansion of the mesh leads to a significant decrease in vision. It becomes irrevocable for savings over 6 months. Spontaneous occurrence of serous discharge as a result of resorption of the subretinal tissue occurs in approximately 25% of cases and may last many months and may occur from the moment of its onset. In case of severe established serous abrasion, the retina suffers from pigmented epithelium in the zone of abrasion, and the formation of a cut-through macular hole is described. Possible complications include choroidal neovascularization at the edge of the visual nerve disc.
Likuvannya
Conservative treatment, which includes dehydration therapy and local administration of corticosteroids, is ineffective. Previously, to block the struma from the disc fossa to the macula, laser coagulation of the retina was used, but the effectiveness of this technique was low and was important due to the impossibility of adequately blocking the empty retinoschisis with the help of laser coagulation. agulation.
Currently, a combined technique is being tested, which includes vetrectomy with further intravitreal tamponade with perfluorocarbon gas, which expands, and barrier laser coagulation. Combined treatment allows for improvement of visual acuity in all patients, anatomical success – in 87%.
Relevance.
The disc fossa of the optic nerve (OND) is characterized by a rare congenital anomaly of development, occurring in one in 11 thousand ophthalmological patients. In approximately 85% of cases, the illness is unilateral; men and women, however, get sick more often. Appears at ages 20 to 40 due to decreased vision, blurred macular damage.
The most common folding of the optic disc fossa is the disarticulation (schiza) of the retina in the macula. One of the obvious reasons for the formation of retinoschisis in the macular area is the struma of the cerebrospinal region from the subarachnoid to the subretinal space. The penetration of the intravitreal tissue through the optic disc fossa is not excluded, which, with excessive sleep, can lead to the development of a cystoid macular plaque and lead to a cutting macular hole.
Surgical debridement of the optic disc fossa is performed following vitrectomy, endolaser coagulation and gas tamponade of the vitreous emptying. The effectiveness of this method is low, but it depends on repeated handings.
One of the approaches to liquating the optic disc fossa is to create a barrier strum of the optic disc into the macular zone by filling the fossa with autologous sclera. This technique is effective, does not prevent recurrence of macular defects, and is traumatic.
In the near future, expanded technology of vikoristan internal autologous pericordon membrane (ILM) to close defects in the central region of the mesh has emerged.
Purpose.
Development of a new technique for surgical lichenation of the fossa of the disc of the visual nerve with the visceral ILM.
Material and methods.
2 patients with optic disc fossa were examined at ages 25 and 37. The visual acuity before surgery was 0.01 and 0.25 per day.
Operating technique: forward transconjunctival 3-port 25G vitrectomy following the standard technique, frequency - from 2500 to 5000 times per spine, vacuum - from 5 to 400 mm Hg. To detail the structure of the posterior globules of the cortical skeletal body and ILM, standard bar marks are used. The separation of the posterior hyaloid membrane is carried out using additional aspiration techniques, starting at the optic disc, gradually lifting it to the periphery.
Then the ILM is seen near the macular zone, followed by circular maculorrhexis. Then proceed to the molding of the ILM valve, which is carried out at the beginning of the last steps. At the age of 6 years between maculorrhexis, use additional microtweezers to pinch the tip of the ILM from the mesh (step 1). Then, having grasped the tip of the ILM with tweezers, separate the membrane with a hand straightened to the lower crown arcade, not reaching it 0.5 mm (action 2). Next, dig over the edge of the ILM and carry out the separation of the lower crown arcade at the back of the optic disc along 2-3 annual meridians (action 3). After this, go over the edge of the ILM and make a row similar to step 2, but at the reversal straight line and right up to the boundary of the circular maculorrhexis, in this way, strengthen the section of the ILM from the mesh (step 4).
After molding the first plot of the ILM, proceed before molding the other plot of the ILM. To turn to the point, the stars began to reach point 4, pinch the tip of the ILM from the mesh, then, burying the tip of the ILM with tweezers, separate the membrane with a hand, straightening the bottom and the crown arcade in the back of the optic disc extending 2-3 annual meridians (after which they will the edge of the ILM and from this point repeat step 4 (step 6), as a result, another section of the ILM is reinforced from the mesh.
After molding and removing another section of the ILM from the point, the stars began to finish step 6, creating a circular ruffle at the bottom of the crown arcade of the flooring, as far as the membrane allows to be waterproofed (step 7).
As a result of the above-described actions between the ILM peeling zones, the ILM valve is preserved. Turn this valve over and place it on the optic disc.
At the next stage, replace the liquid on the surface, then inject 1.5-2.0 ml of PFOS and in the middle of the PFOS, using additional tweezers, apply a light compression infusion to the valve above the optic disc pit. Afterwards, replace the PFOS by airing it in a vacuum of 30-40 mm Hg, not allowing a sharp squeeze during the aspiration of PFOS, trying to remove the area as much as possible and turn off the displacement of the valve.
Complete the operation by injecting 1 mm of 20% SF6 gas empty until the lung reaches hypertonicity.
Results.
In both cases, the delivery was confirmed by constant observation, intraoperative complications, including iatrogenic injuries of the mesh, were not identified.
Caution term – up to 12 months. In both patients, optical coherence tomography data were used to monitor the reduction of macular thinning and sealing of the optic disc fossa. The sensitivity of the gaze until the end of the term of caution became 0.1 and 0.5 per day.
The key stage of the proposed technique, which achieves favorable anatomical results, is the molding of the ILM valve and closing behind it the optic disc fossa, which allows them to be sealed and creates a barrier of the struma of the middle into the macular area.
Visnovok.
The technique of surgical resection of the fossa of the zocal nerve disc has been developed; it is promising and requires further research on large clinical material for a reliable assessment of its effectiveness.
The fossa of the disc of the visual nerve is a congenital anomaly, which is enclosed in the dis-
visual nerve.
Sickness is increasing in the population with a frequency of 1; 10000-11000 [Tron E.Zh., 1968]; First described by T. Wiethe (1882).
І І:ікж.’іч. Pathogenesis of the fossa of the disc of the visual nerve of the immature. Some authors assume that I have a mild form of colobomy of the visual nerve, which is also caused by an uneven closure of the eyelid. There are no symptoms of colobotomy or disc pits. , which do not satisfy this hypothesis: firstly, the disc pits are often pinkish in places and do not extend to the fetal gap; otherwise, the disc pits appear unilaterally, sporadically and do not join with other developmental anomalies; , the pits of the disc are not connected with colobomas of the iris or retina. Regardless of the fact, a coloboma of the optic nerve may also be a crater-shaped deformation that resembles the fossa of the disc of the optic nerve, and it is important to the threads are localized in the lower segment of the fossa in a small circle, the facts are sufficient for The evidence of an obvious difference in the pathogenesis of colobomas and pits of the visual nerve. The presence of one or a few cilioretinal vessels that emerge from most of the fossae of the visual nerve allows us to assume that this fact is also related to the pathogenesis. oh anomalies.
Histological investigations. In the area of the fossa there is a defect of the scarf. The retinal fibers descend into the middle of the fossa, then rotate and exit before the visual nerve enters. The pits emerge from the subarachnoid space.
Clinical manifestation. With ophthalmoscopy, the fossa of the disc of the visual nerve looks like a buried stake.
loy or oval shape, which comes in white, gray or yellow color (Fig. 13.27). The diameter of the pits of the disc of the optic nerve varies from RD to. Therefore, the hole is localized at the lateral half of the disc, or it can spread in other sectors. The illness is most often one-sided. The bilateral fossae of the disc of the visual nerve become constricted in 15% of cases [Tron E.Zh., 1968; Theodossiadis G.P. et al., 1992; Jonas J.B., Freisler K.A., 1997]. With a unilateral disease, the abnormal disc appears slightly larger than the normal one.
With significant dimensions of the disc fossa, it is possible to remove the sagittal section, vicoristic and B-echography; for small sizes – optical coherence tomography.
In approximately 45-75% of eyes with a congenital fossa of the disc of the visual nerve, serous macular lining develops [Ganichenko I.M., 1986;
Schartz N., McDonald H.R., 1988;
Theodossiadis G.P. et al., 1992]. LincoffH spivat. (1988) followed the development of macular folds: 1) retinoschisis of the internal retinal balls is formed, the emptyness of which indicates -
Results of optical coherence tomography in a patient with a disc fossa of the visual nerve, which was complicated by the development of retinoschisis and the breakdown of the external retinal globules.
located directly behind the disc fossa (Fig. 13.28); 2) a rupture of the outer balls of the mesh below between the empty retinoschisis occurs; 3) the expansion of the external balls develops near the macular hole (Fig. 13. 29), which is associated with the influx of retinoschisis (the swelling of the external balls of the retina during ophthalmoscopy is possible It does not have an effect on the pigment epithelium, but is not observed in FAG); 4) the drainage of the outer balls becomes larger and obliterates the empty retinoschisis (div. Fig. 13.28). At this stage of development, it does not differentiate clinically from the primary serous macular lesion.
The way of intraretinal radini is still definitely not established. Literature is ordered to
empty through the hole; 2) blood vessels on the base of the fossa; 3) subarachnoid space; 4) alni sudini.
In the disc fossa, macular retinoschisis and retinal retina develop between 10 and 40 years of age. The risk of development of macular deformities is greater in cases where the fossa of the disc of the visual nerve is large in size and is localized at the lateral half of the disc. In these episodes, when the macular lining lasts for an hour (lasting 6 days or more), pigment is placed along the edge of the disc or between the lining. The pigment is formed by the damaged ball of the pigment epithelium of the retina, in which large residual defects are formed over time.
G. Theodossiadis and spivat. (1992) found that when a macular extension of 10 or more lengths is established, the size of the disc fossa increases, and the color of it becomes gray, which is probably associated with the loss of or redundant tissue glial between the fossa.
Fluorescein angiography. In the arterial and arteriovenous phases, there is a progressively increasing leakage of fluorescein in the zone of contact with the neuroepithelium directly to the macula. In the early phases of FA or indocyanine angiography, the disc fossa does not allow contrast to pass through. In the late phase of FAG or indocyanin angiography, hyperfluorescence of the disc fossa and the area of macular adhesion is observed.
Psychophysical investigations. Visual acuity in patients with a fossa of the disc of the visual nerve remains normal at the time of the appearance of macular deformities. Until the 16th century, through the development of the macular fusion of the neuroepithelium, visual acuity of 0.1 or lower is observed in 80% of patients. Visual field defects vary and often do not correlate with the localization of the fossa. With persistent macular changes, defects in the field of vision progress. Scotomies detected in the early stages are consistent with defects in the pigment epithelium of the retina, which are detected by ophthalmoscopy or FA.