Keywords
high-frequency electrocoagulation
electric instrument for vitreoretinal surgery
How to Cite
Abstract
Retinal detachment is a pathological condition that leads to vision loss without timely surgical treatment. To restore the anatomical integrity of the detached retina, a number of surgical interventions (Scleral Buckling, Pars Plana Vitrectomy, a combined Pars Plana Vitrectomy/Scleral Buckling, Pneumatic Retinopexy, cryo-, laser-, and electropexy) and approaches to the damaged area are traditionally used, among which one of the new and promising are monopolar high-frequency electrocoagulation with suprachoroidal access. The advantages of this method and access are the possibility of manipulations on hard-to-reach structures of the eye (choroid, outer parts of the retina and macula), to introduce medical drugs into the suprachoroidal space without side effects. To carry out such an operation, we developed (manufactured and tested) a new surgical electrical instrument capable of restoring the anatomical integrity of a detached retina. The tool is a working electrode, which consists of a handle, a terminal (for connecting the electric cord to the active phase of the high-frequency electric current generator) and a working tip. The rounded tip is made of gold and ends in a sphere with a diameter of 25 G. The radius of the round is 29.0 mm, the diameter of the cross section is 0.5 mm. The tool allows you to reach the damaged area of the retina through both suprachoroidal and endovitreal accesses. The rounded shape of the working part of the tool repeats the anatomical curvature of the fundus of the eye. The materials chosen for the manufacture of the new tool take into account the need for its sterilization, electrical safety and ergonomics of work.
Keywords: retinal detachment, high-frequency electrocoagulation, electric instrument for vitreoretinal surgery.
References
Global data on visual impairments 2010. World Health Organization. Available from: https://www.iapb.org/wp-content/uploads/GLOBALDATAFINALforweb.pdf
Nemet A, Moshiri A, Yiu G, Loewenstein A, Moisseiev E. A review of innovations in rhegmatogenous retinal detachment surgical techniques. J Ophthalmol. 2017;2017:4310643. DOI: 10.1155/2017/4310643. PMID: 28584664.
Sena DF, Kilian R, Liu S-H, Rizzo S, Virgili G. Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments. Cochrane Database of Systematic Reviews. 2021, Issue 11. Art. No.: CD008350. DOI: 10.1002/14651858.CD008350.pub3.
Antaki F, Dirani A, Ciongoli MR, Steel DHW, Rezende F. Hemorrhagic complications associated with suprachoroidal buckling. Int J Retina Vitreous. 2020;6:10. DOI: 10.1186/s40942-020-00211-6. PMID: 32318273.
Gottlieb M, Holladay D, Peksa GD. Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis. Acad Emerg Med. 2019;26(8):931-9. DOI: 10.1111/acem.13682. PMID: 30636351.
Znaor L, Medic A, Binder S, Vucinovic A, Marin Lovric J, Puljak L. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2019;3(3):CD009562. DOI: 10.1002/14651858.CD009562.pub2. PMID: 30848830.
Bentivoglio M, Valmaggia C, Scholl HPN, Guber J. Comparative study of endolaser versus cryocoagulation in vitrectomy for rhegmatogenous retinal detachment. BMC Ophthalmol. 2019;19(1):96. DOI: 10.1186/s12886-019-1099-9. PMID: 31023285.
Cranwell WC, Sinclair R. Optimising cryosurgery technique. Aust Fam Physician. 2017;46(5):270-4. PMID: 28472571.
Dimopoulos S, William A, Voykov B, Bartz-Schmidt KU, Ziemssen F, Leitritz MA. Results of different strategies to manage complicated retinal re-detachment. Graefes Arch Clin Exp Ophthalmol. 2021;259(2):335-41. DOI: 10.1007/s00417-020-04923-1. PMID: 32926193.
Gili NJ, Noren T, Törnquist E, Crafoord S, Bäckman A. Preoperative preparation of eye with chlorhexidine solution significantly reduces bacterial load prior to 23-gauge vitrectomy in Swedish health care. BMC Ophthalmol. 2018;18(1):167. DOI: 10.1186/s12886-018-0844-9. PMID: 29996791.
Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117(1):93-102.e2. DOI: 10.1016/j.ophtha.2009.06.043. PMID: 19880185.
Tayyab H, Khan AA, Sadiq MAA, Karamat I. Comparison of 23 Gauge Transconjunctival releasable Suture Vitrectomy with standard 20 gauge Vitrectomy. Pak J Med Sci. 2018;34(2):328-32. DOI: 10.12669/pjms.342.14234. PMID: 29805402.
Stoika VI. Electrosurgical treatment of liver cysts (clinical-experimental study). Diss ... Cand Med Sc spec 14.01.03 (surgery). National Pirogov Memorial Medical University, 2017. Available from: https://www.vnmu.edu.ua/downloads/other/diser_Stoika1.pdf [in Ukrainain].
El Rayes EN, Oshima Y. Suprachoroidal buckling for retinal detachment. Retina. 2013;33(5):1073-5. DOI: 10.1097/IAE.0b013e318287daa5. PMID: 23612022.
El Rayes EN. Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data. Retina. 2014;34(1):129-35. DOI: 10.1097/IAE.0b013e31828fcb77. PMID: 23615349.
Paton BE, Lebedev VK, Lebedev OV, Ivanova ON, Zakharash MP, Furmanov YuA, Masalov YuA. (Inventors). A method of biological tissue welding, a method of controlling the biological tissue welding (options) and a device for biological tissue welding (options). Patent of Ukraine for the invention No.77064 on 16 Oct 2006, published in the Bulletin of the Ukrpatent "Industrial Property" No.10/2006. Not valid on 01 Jul 2021. Available from: https://sis.ukrpatent.org/uk/search/detail/389704/ [in Ukrainain].
Syvets AIu. A model of welded anastomosis of the small intestine under longitudinal loading in SolidWorks environment. Dissertation... master's degree spec 163 (Biomedical Engineering). Kyiv: National Technical University " I. Sikorsky Kyiv Polytechnic Institute"; 2020. Available from: https://ela.kpi.ua/bitstream/123456789/38627/1/Syvets_magistr.pdf [in Ukrainain].
Mikhail M, El-Rayes EN, Kojima K, Ajlan R, Rezende F. Catheter-guided suprachoroidal buckling of rhegmatogenous retinal detachments secondary to peripheral retinal breaks. Graefes Arch Clin Exp Ophthalmol. 2017;255(1):17-23. DOI: 10.1007/s00417-016-3530-8. PMID: 27853956.
Umanets N, Pasyechnikova NV, Naumenko VA, Henrich PB. High-frequency electric welding: a novel method for improved immediate chorioretinal adhesion in vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol. 2014;252(11):1697-703. DOI: 10.1007/s00417-014-2709-0. PMID: 25030235.
Umanets MM, Naumenko VO, Dumbrova NIe, Molchaniuk NI, Nazaretian RE. Ultrastructural changes in the choroid and retina of the rabbit eye immediately after exposure to different modes of high-frequency electrowelding of biological tissues. Journal of the National Academy of Sciences of Ukraine. 2014;20(3):359–64. Available from: https://is.gd/fDXnZq [in Ukrainain].
Tominaga A, Oshima Y, Wakabayashi T, Sakaguchi H, Hori Y, Maeda N. Bacterial contamination of the vitreous cavity associated with transconjunctival 25-gauge microincision vitrectomy surgery. Ophthalmology. 2010;117(4):811-7.e1. DOI: 10.1016/j.ophtha.2009.09.030. PMID: 20097429.
Kunimoto DY, Kaiser RS; Wills Eye Retina Service. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology. 2007;114(12):2133-7. DOI: 10.1016/j.ophtha.2007.08.009. PMID: 17916378.
Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy causes and prevention. Ophthalmology. 2008;115(12):2215-20. DOI: 10.1016/j.ophtha.2008.07.015. PMID: 18930557.
Scott IU, Flynn HW Jr, Dev S, Shaikh S, Mittra RA, Arevalo JF, et al. Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes. Retina. 2008;28(1):138-42. DOI: 10.1097/IAE.0b013e31815e9313. PMID: 18185150.
Lin Z, Feng X, Zheng L, Moonasar N, Shen L, Wu R, Chen F. Incidence of endophthalmitis after 23-gauge pars plana vitrectomy. BMC Ophthalmol. 2018;18(1):16. DOI: 10.1186/s12886-018-0678-5. PMID: 29361927.