Global Pediatric Ophthalmology Congress

Biography

Biography: Igor Aznauryan

Abstract

Background: Current techniques used in strabismus surgery are associated with a considerable injury caused to eye tissues. Thus the development of alternative tissue-sparing techniques is very much relevant. Here we present a minimal invasive surgery technique that involves the use of high-frequency radio-wave knife to cut eye tissues. Our study demonstrated that the use of this technique decreases the post-operative edema, hyperemia and scarring processes and reduces patients’ overall rehabilitation time. Introduction: Minimal invasive surgery technique is attracting increasingly more attention in strabismus surgery. An injury caused to ocular muscles is a result of manipulations on connective and covering tissues of the eye. These manipulations lead to post-operative edema and tissue scarring. A complete uncovering of the muscle tissue and its surgical detachment from the sclera cause a vascularization disorder not only in the muscle itself but also in the vascular pools of the corresponding ciliary arteries. Thus, the development of tissue preserving and minimal invasive surgery techniques is very much relevant. We have developed a technique that uses high-frequency radio-wave knife, which allows to preserve the eye’s covering tissues and vessels, significantly reduce the injury caused to muscle during surgery and dose the surgery with maximal accuracy. An increase in precision of strabismus surgery is also achieved by using a mathematical model for esotropia surgery dosage that we have developed. This model was presented by our group at ESA 2011 and AAPOS 2012 and includes 4 anthropometric parameters of patients’ eyes needed for the dosage: strabismus angle, refractive error, axial length and inter-pupillary distance. Methods: A retrospective study was conducted on almost 2500 patients. 1500 patients were treated with conventional surgery method and 1000 patients - with our minimal invasive surgery technique. Two groups were compared by the following criteria: Conjunctival and eyelid edema, hyperemia and post-operative rehabilitation time. We used a high frequency 10 micronradio-wave knife to cut through covering and muscle tissues of the eye. The use of this knife allows making very precise cuts, coagulating the vessels and sterilizing the wound at the same time. Vessel coagulation with radio-wave knife reduces the hemorrhage and reduces the soaking of tissues with blood. The cut is made in such a way that connective tissues covering muscles are preserved, which allows minimizing the scarring process. In our surgeries we use vicryl 7/0 and a silicon protector on a hook for extra tissue preservation. The strengthening of the muscle is achieved by tucking the muscle, without excising it from the eyeball, preserving vessels, nerves and connective tissues of the muscle. The sutures are passed through the muscle and the sclera in such a way that the tuck is equally distributed under the muscle. While conducting a strengthening surgery we also suggest using a fixating suture, which will help sink the tuck beneath the muscle. Results: Our proposed method allows reducing post-operative tissue edema and hyperemia in more than 95% of cases. Also, we reduced the rehabilitation time to up to 7 days in 60% of cases and in 30% of cases patients were able to attend school after 3 days. Discussion: Overall this investigation has demonstrated that a significant reduction in hyperemia and tissue edema post-operatively can be achieved with our minimal invasive surgery technique. Additionally, the rehabilitation time was reduced significantly, while the scarring process was reduced to minimum and the vessels were preserved. Additional steps should be taken to help reduce the post-operative tissue injury and increase surgery precision even further.