Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment

Abstract

Introduction. Retinal detachment (RD) is a common pathological condition that without timely surgical treatment leads to vision loss. The patients with significant RD undergo one of three retreatment procedures: Pneumatic Retinopexy, Scleral Buckling, and/or Pars Plana Vitrectomy. Techniques and tools for these procedures have been developed, but the methods themselves still have a significant number of complications. A possible alternative to their further improvement may be a fundamentally new method of treatment, coagulation of the retina with high-frequency electric current (HFEC), for which significant improvement of the tool is still possible. The purpose of the study was to determine a safer method of RD treating and to improve medical tools for restoring anatomical integrity and repositioning a detached retina under two conditions: firstly, obtaining a reliable chorioretinal adhesion, and secondly, minimizing the number of incidental effects of surgical intervention. Materials and methods. The bibliosemantic method, the system analysis method, an experiment on laboratory animals (rabbits) with RD simulation and its coagulation by HFEC, tissue biopsy of operated animals after their euthanasia on the 7th day after surgery, and the production of histological micro-preparations were used. Results. To fulfill the conditions for improving the method, a chorioretinal high-frequency electrocoagulation operation with suprachoroidal access, a modified EK-300M1 generator (Kyiv, Ukraine) with an electrode with a gold hemispherical tip of 25 gauge and electrical generation parameters of 66 kHz, 10‒16 V, 0.1 A was proposed, which causes chorioretinal adhesion in the place where the electrode is used. The method of calculating the parameters of heat transfer from the electrocoagulation tool to the tissues and fluids of the eye was selected: it was proposed to use the Fourier-Kirchhoff and Newton-Richmann equations. Destructive phenomena in the retina from the thermal effect of tissue coagulation in the form of the destruction of rods, cones, the development of cysts, the loss of bipolar, amacrine, horizontal and ganglion cells were noted. Atrophic changes in the retina were minimal at a voltage of 10‒12 V. Conclusions. The problem of improving the methods of restoring the anatomical position of the retinal layers has been relevant for many decades, but it does not lead to a significant reduction in the number of complications. The proposed method and tool for its application causes the creation of a reliable chorioretinal adhesion in a short period of time after surgical intervention with minimal thermal tissue damage. The use of the method of chorioretinal high-frequency electrocoagulation with suprachoroidal access is recommended in conditions of urgent restoration of vision, but not recommended for the prevention of retinal detachment in retinopathies. Keywords: retinal detachment, chorioretinal adhesion, high-frequency electrocoagulation, suprachoroidal access.