The squint can be congenital in nature, as well as arise as a result of the impact of various factors. And at least some consider strabismus only an aesthetic problem, in fact, this pathology can provoke the formation of many unpleasant consequences. For the patient, it is very important not only to diagnose the disease in a timely manner, but also to get to solve this problem as early as possible. Speeding operation is a radical and efficient method.

Squint and its consequences

The squint is diagnosed in the presence of existing deviations in the parallelism of the visual axis of the eye. More often the patient mows only one eye. In some cases, the deviation is symmetrically. There are several types of squinting and methods to solve the problem, too, several: wearing special glasses, shutting down one eye body, operation.

Important: Most specialists tend to ensure that surgery is carried out in extreme cases. To begin with, it is recommended to try conservative methods Corrections of strabismus.

What threatens the squint? Full loss of vision of the eye body, which has deviations. In this case, the brain ceases to receive volumetric pictures, and the images do not correspond to each other. The nervous system gradually blocks the data taken from the defective eye organ. The muscular tone is started. The functioning of the eye over time is very worsening and ambulopia develops in 50% of cases.

Causes of Formation of Sturdy

The squint may be acquired or congenital. The formation of each of them has its causes of occurrence. For instance.

Acquired view of Sturbize

Most often, this type of squint develops in children until the six months achieve. A significant role in this case is the existing diseases that provoked such by-effect. But the episodes of the development of stabysma and in the older age-old category are not uncommon. Self frequent reasons Development of the Accessible Space:

• sturdybide as a result of sharply deteriorated vision during astigmatism, hyperopia, as well as myopia;
• disorders of the refraction of the eye can provoke a developing cataract or glaucoma, and as a result, the squint is formed;
• paralysis of the eye muscles are able to cause psychological disorders, as well as somatic diseases (as an example: neurosophilis, encephalitis);
• easy degree of squint can provoke disorders in blood circulation and sharp pressure jumps, and when ignoring pathology - disability;
• proclaiming seproinishing factors, specialists also consider such children's diseases like Scarlatina and Kor.

Important: In the case when the child had a predisposition to squint, pathology is able to manifest itself as a complication after transferred diphtheria or influenza.

Sturdyby is able to develop in children preschool age After a strong frightened, as well as the result of the suffered psychological injury. These reasons for the development of pathology were recorded from older patients. Although in more rare cases.

Congenital view of Sturbizma

In practice, congenital squint is very rare. More rarely, it can be found in its pure form, that is, immediately at the birth of the baby. The manifestation of pathology in the first six months of the life of the kid is established as infantile. More often in the newborn there is imaginary squint. The kids of this age are unable to accurately focus, and at the same time it seems that the child is formed by pathology.

Interesting: imaginary squint can be observed in adults when a person is in a state of intoxication.

Infantile squint is often formed in genetic disorders and at that time when the fruit is still in the womb. This can be caused by such diseases: cerebral palsy, Cruzone or Down syndrome, as well as hereditary predisposition. In cases with heredity, one of the kid relatives also have similar deviations.

In the risk group there are kids, the mothers of which during pregnancy suffered infectious diseases, drugs were used, as well as medications without appointing specialists.

Operation with squinting is the only solution to the problem?

The resolution operation of the squint refers to the radical methods of solving the problem. Immediately after the diagnosis, the specialist will offer conservative treatments that relate to more gentle ways. It can be special glasses. Their task is to make both eye organs focus on one point. Over time, the muscles of the damaged eyes are being developed. Pathology is gradually corrected.

If the patient mows one body, the "Disconnecting Eye Organ" procedure may be proposed. For these purposes, a special bandage is placed on a healthy eye. Thus, the brain begins to receive the image only from the patient. Muscles are gradually developing and pathology is corrected.

The operation is recommended in more trusted cases. It cannot guarantee the complete recovery of the lost vision, but allows you to achieve a more symmetrical relationship between the eye organs. More often, young people agree to the operation, for whom it is very important to externally do not have defects.

Testimony

1. The patient used all conservative methods of treatment, but no improvements were achieved (or they were not achieved in the maximum volume).
2. The patient wishes to eliminate cosmetic defects in the shortest possible time. Conservative treatment can continue for several months, or even years.
3. The patient has strong defects. The doctor considered it expedient to initially restore vision with the help of surgical intervention, and only then apply conservative methods for fixing or improving the result obtained earlier.

Important: The operation may be contraindicated only in cases where the patient has individual characteristics that are pre-negotiated with their specialist.

There are some age restrictions. For example, the optimal age for surgical intervention is considered to be 4-5 years old by a child. Younger patients may refuse. An exception is the congenital form of a squint, which is corrected in 2-3 years. This is simply explained. After the operation, the patient must adhere to a special mode and perform special exercises. For up to 4 years old, they will not be able to do it consciously and independently. The chances of the fact that pathology will come back.

Principles and types of surgical intervention in the elimination of the squint

Surgical reclamation interference is carried out by several types of operations. Sometimes a specialist picks up one optimal option for this situation, but more often during operation, several types are combined with each other. Read more about each form.

1. The muscle recession involves cutting off the tissues from its physiological attachment. After cutting down the muscle is fed. The specialist picks up an optimal place for its future fastening. It may be a tendon, as well as a sclera. According to the result, fiber shifts back and its action is weakening. In the event of a fiber displacement, the effect of muscles is intensified.
2. Operation MEETTOMICA implies similar manipulations with cutting muscle. The difference from the previous species is the lack of procedures for overlapping seams.
3. Smaller injury to the eye body can be achieved using Faden operation. In this case, manipulations with cutting muscles are not made. The fabric immediately shakes to the scler. With this procedure, non-restering threads are used.
4. In case the muscle is weakened and it is required to increase its action, a shortening operation is used. During the surgical intervention, part of the muscle is removed.
5. It will also help a similar effect of the operation. It implies the creation of folds between tendon and muscle. A variant is possible when this fold is formed inside the body of the muscle itself.

Any of the selected correction operations of the squint is carried out in compliance with the main principles. Correction must be phased. The operation is carried out only on one eye body. On the second procedure repeated after a few months (approximately 3-6). Although with a small corner of the cat, the surgeon can be made to make a correction at the same time on two eyes, but this is more often an exception.

Features of the operation

If a patient has a strong squint, the operational intervention is performed in several receptions. The fact is that it is undesirable to carry out more than two muscles at a time.

The elongation or shortening of the muscle must be evenly carried out from all sides. For example, if the muscle on the right is reduced in size, then it should be reduced to the left. At the same time, the size of the excision and increasing is necessarily identical.

Observing all the main principles of surgery, the specialist is trying to maximize the connection of the eyeball and the operated muscle.

For adult patients, correction is carried out under local anesthesia. Upon completion, the patient is superimposed by the patient. You can go home after a few hours. For children (any age), general anesthesia is always applied. In mandatory, the child is hospitalized for a day, but cases and with a longer stay in the hospital are not excluded.

Those who have the opportunity to correct pathology in foreign clinics is worth paying attention to German and Israeli specialists. Their approach to such correction is more radical. Almost all types of pathologies are corrected into one reception. Another plus is the possibility of carrying out the kids to a year.

Rehabilitation period

Though the correction operation is carried out in one day and the patient is immediately released home, this does not mean that there is no rehabilitation period. For quick recovery, you need to adhere to certain recommendations of the doctor and perform special exercises for the eyes.

The first day after surgery the eye body will be hurting, lightly flies and inflaces. This is a natural state. Also possible short-term impairment. During this period, each of its movement needs to be monitored, as any touch touch attempts can end only with reinforcing pain syndrome.

Important: Restoration of the fabrics of the eye organ and binocular vision It comes a month later. Most patients all this time see a twofal picture. If, after this period, the vision is not restored, you need to contact an ophthalmologist.

In children, adaptation time is significantly reduced. The main thing is to fulfill the exercise prescribed by a specialist and visit an ophthalmologist.

For active recovery, a specialist can recommend to take advantage of special correction glasses, and from time to time to cover a healthy eye. This will help create a load on the operated organ. Muscles are faster and acquired the necessary norm.

What complications should be expected after surgery

The most frequent complication that is found in medical practice after a surveillance operation is hypercorrection. It is formed with an excessive elongation or sewing of the muscles of the eye organ. The main reasons for such an undesirable effect:

• surgeon error;
• incorrect preliminary calculations;
• natural patient growth, which affects the increase in the eye body in size.

Recently, experts have found an optimal way to minimize the risk of such a complication. Increasingly, operations are carried out with non-cut, but inserting muscle folds. In this case, the superimposed seam is regulated and correcting the undesirable effect can be a minimally invasive way.

The formation of a coarse scar at the place of cut-off of the muscle and the subsequent sewing. Such a method of surgical intervention deprives the tissue of muscle mobility and elasticity, which are partially replaced by fibrous. The only alternative is at the moment is to reduce the size of the excised area.

The squint is returned through time (recurrence). This complication most often arises due to the fault of the patient himself, who neglects the observance of all rules in the postoperative period. Children recurrence may occur due to sharp increases in the load on the eye body. For example, a correctional surgery was carried out at the age of five or six years, and after a couple of months later, the child began to attend school.

The most serious, but very rare complication is damage during the operation of a wandering nerve that is responsible for the work of lungs, gastrointestinal organs and heart muscles.

Patient reviews

Muchly a lot of negative reviews can be heard from parents who decided to surpass their Chad in domestic clinics. They substantiate their discontent with the following comments.

1. In most clinics, there is no individual approach to each patient and the problem.
2. Failure of specialists to conduct operational intervention in early ageAnd the delay turns into a small patient with the progression of the disease and impairment of vision.
3. Basically, all clinics during surgery and diagnostics use outdated techniques and equipment. This does not make it possible to get a 100% result from the first operation. Correction of the strainship is performed with an insufficient result and through time it is necessary to conduct repeated surgical interventions.
4. Little specialists in this profile, which strongly limits patients in choosing.

Most parents noted only a temporary positive result. As soon as the academic year begins and the child goes to school, the vision again begins to fall, and the squint returns. This is explained by an increase in eye load. Many children refuse to wear special corrective glasses. In order not to laugh classmates, they secretly remove them and hide them. Less time is given and special exercises. All these negative factors lead to the fact that young people are solved on the re-operation only at the end of the school.

IMPORTANT: The older the patient, the smaller the result of success gives the rechargement operation.

How much will cost a reclamation operation

The cost of rechargement operation in different clinics is different. For example, if it state Institution And a minor child, surgery can spend free. Free treatment will be both adults, but only who has an OMS policy. It is worth noting that some private clinics also work with compulsory medical insurance. Operation itself will be free, but you may need additional services to pay.

In the case of the rest of private clinics, then the price may vary within 20,000 thousand rubles. The price fluctuates depending on the availability of modern equipment in the institution, professionalism of the doctor, the complexity of the operation itself, etc.

Patients who think to contact the German or Israeli clinic will have to count on about 7 thousand euros. But there is also one nuance. Appeal to the overseas clinic through an intermediary will increase in price (about 2 times).

Because the disease occurs due to the imbalance of the glasses of the eye muscles, the goal of the operation is their strengthening or weakening. Surgical intervention is carried out in the presence of serious complications or with the ineffectiveness of other vision correction techniques.

Indications and contraindications

The essence of the operation with squinting is the strengthening of weak muscles, by shortening them, as well as the elongation of short fibers. During the surgical intervention, all 6 glasses are affected, which hold the eye in the natural position.

Most effectively treat strabismus in childhood (5-6 years), when a child can perform orthoptic exercises. With a congenital disease, if the angle of curvature is more than 45˚, the operation is carried out far earlier, in 2-3 years.

In children, the reconnaissance surgery is carried out less often, since the child has it easier to cure, rather than in an adult.

Indications:

• correction of a cosmetic defect;
• pronounced squint;
• paralysis of the o'cloth muscle;
• squint caused by injury;
• the ineffectiveness of other techniques to improve binocular vision, such as the laser correction of the squint;
• twist in the eyes.

Contraindications for surgical treatment may be individual patient features. Using common anesthesia Contraindicated with severe diseases of any organ, stroke, as well as allergies to anesthetic.

Views

With stabysme, several varieties of surgery are possible. When weakening the tense muscle:

• Recession. This is the cutting down of the fabric at the place of its attachment and the sewing to the sclera, after which the muscle is relaxing.
• Partial myopia. This is the excision of a piece of muscle tissue.
• Plastic muscle, that is, its elongation.

When strengthening weak glasses:

• Resection. This shortening muscle, followed by fixation to enhance its action.
• Tenorraphia. This is the formation of folds inside the muscle or in the muscular tendon zone.
• Anteposition. This moves muscle fixation site.
• Faden operation. It is not absorbing muscles.

Sometimes the correction of the squint requires the simultaneous use of recession and resection.

The surgeon is determined with the choice of the method when the patient lies on the operating table. The view depends on the corner of the squint, the age of a person, the location of the ooo muscle, as well as the state of the eye.

Stages of holding

The surveying operation in adults is carried out under local anesthesia. The patient does not need hospitalization and already on the same day can return home. The procedure lasts 30 minutes.

In children, operational intervention is carried out under general anesthesia.

Before the operation is important preparation that can last up to 6 months.

The preparatory period involves alternately opening and closing the eye. The reclamation surgery is as follows:

1. The eye is fixed in the same position, the eyelid is inserted.
2. Cuts the sclera and conjunctivation to access the muscles. At this point, the eye is wetting.
3. Through the resulting incision draws out the outward muscle. Depending on the problem, it is invented or cut off from the place of fixation.
4. The seams are superimposed.

At the corner of deviation more than 45 in children under 5 years old, operational intervention is carried out in 2-3 stages. First you need to reduce the angle of the squint, and the final correction is possible from 4 years.

If after the operation remains squinting, which is not eliminated by self-correction, then need re-operational intervention. It is carried out no earlier than 6-8 months.

Postoperative period

In the first few days after the operation, the eye will be root, two can appear.

Restoration of vision occurs in 4 weeks. During this period, it is important to teach eyes to see correctly, so after surgery it is necessary to perform orthoptic exercises 1-2 weeks. You also need to be bought by an ophthalmologist.

To teach the operated eye to see, you need to cover healthy with a bandage. We may need wearing.

In children, recovery happens faster.

Complications

After surgery, such complications may occur:

• Hypercorrection. Such a complication occurs if the operation was carried out in childhood, then squinting may appear in adolescence again.
• Damage to the wandering nerve, which is responsible for the work of the heart, lungs and gastrointestinal organs. Such a consequence can even lead to death.
• The appearance of scars, which makes the mobility of the eye.
• Repeated seproincing. This happens if after surgery the patient does not comply with the recommendations of the doctor.

Cost

In the presence of polis Oms This type of surgical intervention in state clinics is absolutely free. In private ophthalmological centers for treatment will have to pay up to 20 thousand rubles.

Operational treatment with squinting is carried out as a last resort. There are other, more gentle mind correction techniques.

Useful video about the treatment of strabismus by the operational method

Currently, the generally accepted method is comprehensive treatment Friendly Space, which consists of the optical correction of AMETROPI, activities to combat ambulopia (pleoptics), operations on the eye muscles and the fulfillment of orthonity and diplopetic exercises in pre-and postoperative periods. The need for surgical treatment of stralasia arises in cases where a constant and sufficiently long-term (at least a year) wearing properly designated points and orthoptic exercises do not lead to the elimination of deviation.

In the process of treating patients before surgery, the main attention must be paid to the correction of visual fixation and an increase in the visual acuity of the ambulapious eye, the development of the ability visual analyzer Mix the fusal images of objects, obtaining sufficient width of fusion and eye mobility.

The ultimate goal of treating friendly squint is the restoration of binocular vision. The operation should contribute, and not to prevent the achievement of this purpose. In this regard, the current tactics of surgical treatment of the squint is characterized by refusing to perform forced interventions, uniform distribution of the effect of operations into several muscles and the use of such types of operations in which the muscle remains in its plane and retains reliable communication with the eyeball.

The feasibility of compliance with the above principles is confirmed by the results of histological studies, which show that the degree of muscle tension has a great influence on the regeneration process. Both excessively strong and weak tension negatively affects the normal recovery Process in the muscle.

The most ophthalmologists consider the optimal age to perform an operation on a friendly strabismus, most of the ophthalmologists consider 4-6 years, when the effect of optical correction of the refraction anomalies is already clearly visible and when active orthoptic exercises can already be carried out in pre-and postoperative periods.

It should be borne in mind that in the event of an area at an early age (in the first year of life), the development of the binocular visual system is incorrectly, from the very beginning adapting to the asymmetric position of the eyes. In such cases, an early and perfectly dosed surgery on eye muscles can create conditions for the formation of normal binocular vision, if there is no contraindications from the retina. Based on these considerations, a number of authors propose to conduct operations about the squint and during early childhood, especially with very large deviation and the presence of eye terticolis.

When examining patients before surgery, it is necessary to obtain full-fledged data about visual acute and visual fixation, eye refraction, the size of the corner of the area, the nature of the vision at two open eyes, eye mobility, the ability of the visual analyzer to merge the fusal images of objects and fusion reserves at an area of \u200b\u200bspace. Analysis of this data will reflect the testimony for the operation, determine the rational tactics of its conduct and predict the likely outcome.

If, after active pleoptic treatment, a low visual acuity (less than 0.3) preserves, which prevents the formation of binocular bonds, it should not be hurry with the operation. In the presence of pronounced deviation (more than 10 °), it is advisable to make it even before the child's admission to school, but take into account the possibility of re-operation in the case of recurrence of the squint. This should be warned by the parents of the child. Such a corrective operation is better to produce aged 10-12 years, when the development of the facial skeleton and the orcasers almost ceases, which in the absence of binocular vision can contribute to the deviation of the eyes.

The presence of hyperhemeterol with converging seeds and myopia with divergent seproinations gives reason to expect to appear after the operation of the "partial accommodatory" properties of the squint. In such cases, the optical correction of refractive anomalies can have a stabilizing effect on the position of the eyes in the postoperative period.

Simultaneous vision indicates a smaller tendency to brake visual perceptions Rejected eye than monocular vision. This creates more favorable conditions for the joint activity of both eyes. However, the state of fusion is of paramount importance in the specified sense. Detected before the operation, the ability of the visual analyzer to merge the fovyal images of objects significantly increases the efficiency of postoperative orthoptic exercises and the possibility of restoring normal binocular vision. Due to this ability, which acts as a reliable "ally" surgeon, a small angle of squinting remained after surgery can even be eliminated.

The constant angle of the squint, as a rule, is better and more stable the results of the operation. With a varying corner, the squint into the calculation should take its average magnitude. If during the examination of the patient, the deviation periodically disappears and appears, and the range of eye deviation is significant, then the operation should not be available.

With small angles, the strabismus must be especially carefully examined by the state of the binocular functions. The ability to merge at the zero position of the objects of the synopophor and the binocular vision, detected on the color instrument, indicate that the patient has a so-called asymmetric binocular vision. In these cases, which, however, are found very rarely, the operation does not make sense, since after it will either be preserved the previous position of the eyes, or a resistant branch will appear.

With enhanced adduction, it is considered advisable to produce an operation with the aim of weakening the effect of internal direct muscles. If the adduction is reduced, then the operation should be performed on the outermost muscle.

With a monolateral seducing, it is more logical first to perform an operation on a jamming eye, based on the fact that pathological disorders are usually more pronounced on it. Such tactic finds more understanding in the patient and its loved ones, therefore is justified and psychologically.
When alternating the seproinacy, the question of choosing a eye to perform the operation, of course, loses its meaning, but in this case it is better to initiate an operation on the eye that has large deviations from the norm (for example, according to the degree of mobility or by visual sharpness).

Based on physiological considerations, you should give preference to operations that reinforce the effect of weakened. It is also necessary to take into account the width of the eye slit, remembering that the operations that enhance the effect of the muscle, slightly narrow the eye slot, and weaken - somewhat expand. This recommendation refers to the squint without local muscle defects (fibrosis, contracture, hypertrophy, anomalies of attachment sites), which in some cases underlie the congenital strabismus. In such cases, the enhancement of the antagonist without the prior or simultaneous liberation of such enhanced muscles is ineffective.

Even with significant corners, the squint should not simultaneously perform operations of more than two muscles, since the difficulties of dosing and the likelihood of obtaining a hype effect increase many times. If, after the first stage of the operation, the residual angle of the squint will continue, then the second stage of the operation on another muscle of the same eye or on another eye is produced after 6-8 months. It is best to prevent the patient or his parents, otherwise even spent in accordance with the plan, the first stage of the operation, which did not fix the squint, can be regarded as a failure.

With a combination of a pronounced horizontal deviation of the eye with a vertical, it is advisable to first produce an operation on horizontal muscles, given that vertical deviation may not only be a consequence of the pan of muscles, but also by the manifestation of vertical fori, which in the primary position of the eye often disappears. If the vertical deviation is significant and the study of the oculomotory apparatus indicates a predominant damage to the muscles of vertical action, then the operation should be operated on these muscles.

Types of surgical interventions

To eliminate the strabismus, operations of two types are used - reinforcing and weakening muscle action.

• Amplifying
• resection - shortening the muscles by excised its site at the attachment site to the scler and the label to this place;
• netherophia - shortening by forming folds from her tendon;
• proraphy - Strengthening the degree of tension of the muscle as a result of moving its tendons of the Kepened (with interventions on direct muscles) or the post (with interventions on oblique muscles) with the formation of or without folds;
• twisting - reinforce the degree of tension of the muscle with the help of the screw-like rotation around its axis after the intersection followed by the launching to the anatomical attachment site.
• Weaken
• free (or complete) tenotomy - the intersection of muscle tendon at the attachment site without launching it to the scler;
• tenotomy with restrictive (safety) seam - fixation of the tentomed muscle at some distance from the place of anatomical attachment using a seam passing through this place and edge of crossed tendon;
• partial tenotomy - applying muscle tendon from opposite edges of 2-3 incomplete cuts, several separated from each other;
• recession - Movement of the muscles crossed by the attachment site, for the post (with interventions on direct muscles) or the kleon (with intervenesses on the oblique muscles) with the crossing of it to the scler;
• prolongation - the lengthening of the muscles by full of its tendons in different directions and crosslinking converted areas;
• fadedoperation - Muscle fixation to the scler behind the muscle fit plot to the eyeball.

To enhance muscle action, resection usually produce. Netorephy and proraphi are rarely performed, mainly with interventions on oblique muscles. From operations that weaken the effect of muscles, recession received the greatest distribution. Significantly apply prolongation, tenotomy with safety seam and especially rarely partial tenotomy. Free tenotomy is performed only with some atypical odds forms and during operation on oblique muscles.

Methods for each of these operations are distinguished by a large variety. However, this relates mainly to technical details, and not to the principle of the operation itself. The use of many of these methods is low-excited: they are either not contributed to the operation of significant changes, or overly complicate it.

Anesthesia

In children under the age of 10-14 years, the operations on the eye muscles should be carried out under anesthesia, preferring a mixture of nitrogen and fluorotan. Adults and older children use local infiltrator-conductive anesthesia. It should be remembered that painful sensations usually occur when there is a tension of glasses with rich innervation. To eliminate these sensations, it is necessary to introduce anesthetic substance into the area of \u200b\u200bthe muscular funnel.

After a triple installation in a conjunctive bag of 0.5-1%, the dicaine solution is injected with 1.5-2 ml of 2% novocaine solution under the muscle operated, and then, slightly changing the direction of the needle, for the eyeball. A small amount (0.3-0.5 ml) of the novocaine solution should be introduced under the conjunctival at the site of attaching the muscle.

Dosing the effect of the operation

"Question Question" in Surgery Acrosspathy is the correct dosing effect of the operation. It has been established that there is a high direct correlation between the degree of shortening or moving the muscle and the resulting value of the corner of the angle. This suggests that the estimated preliminary plan for dosing the effect of the operation on the glasses is possible.

Dosing diagram with converging seeds in Avetisov-Makhkamova.

• Dev.<10° - рецессия внутренней прямой (MRM) = 4 мм
• Dev 10 ° - recession MRM + resection of the outer straight line (MRL) \u003d 4-5 mm
• Dev 15 ° - recession MRM + resection MRL \u003d 6mm
• DeV 20 ° - Recession MRM + resection MRL \u003d 7-8 mm
• DeV 25 ° - recession MRM + resection MRL \u003d 9 mm
• Dev\u003e 30 ° - 2-3 stage of the operation, depending on the initial value of the angle, the presence of residual deviation and the state of the binocular functions.

With divergent seducing, the opposite is MRL, resection MRM.

It is advisable during the operation to make some adjustments to dosing. If the muscle to be resected looks like a flabby, the degree of proposed shortening increases by 1-2 mm.

It is known that under the influence of narcotic substances, the eyes deviate up and the duck, and the magnitude of this deviation varies greatly. In this regard: when conducting anesthesia on the position of the eyes on the operating table, it is impossible to judge the effect of interventions on the eye muscles. Under these conditions, the principle of pre-dosing operation is the only possible.

To use the dosing table, the correction of the squint should also be carried out in cases where it is produced under local anesthesia. In this case, you can estimate the result of surgical intervention directly on the operating table and make some adjustments to the planned dispensing scheme. However, such an assessment is difficult due to the fact that, under the influence of Novocaine, the angle of the squint also changes in fairly wide limits. It is desirable during surgery to give the sickness of a sick position of some hype effect.

Tools

For operations on the eye muscles, the eyelid, fixative, anatomical and surgical tweezers, special scissors curved under a stupid angle, muscle hooks, measuring device (millimeter line, circulatory, etc.), needle holder, stupid scissors for cutting seams, spatula, sharp A spoon for scraping scraps, needles for imposing ligature on the muscle and seams on the conjunctival, thin curved (better atraumatic) needles for imposing episcleral seams. Clamps for muscles may also be required, the hook for the upper oblique muscle and tweezers to form a fold on this muscle.

As a suture material with surgical interventions on the muscles, the eyes use fine and durable ketgut 1.0 and 2.0, silk 2.0 and 3.0 for conjunctiva, silk 1.0 for firmware of muscles and silk 3,0 and 4.0 To impose ligature on the muscle. Biological seams are also used. Especially comfortable synthetic seams that are not needed after surgery.

Postoperative period

After surgery, 1-2 drops of a 30% solution of sulphacyl sodium or other antiseptic solution are installed and impose a bandage, as a rule, binocular. Dressing make daily. Seams with conjunctivans are removed on the 4-5th day. If silk seams were imposed on the muscle, they are removed on the 6-7th day.

Orthoptic and diploptic exercises according to indications begin perhaps before, as soon as the condition of the eye allows. These exercises improve eye mobility, contribute to the elimination of residual deviation and restoration of binocular vision. Displays patients from the hospital for the 5-7th day after the operation.

Neither before nor after surgery should be appointed medication toolsacting on accommodation and indirectly on convergence, such as an atropine solution. Such preparations have a temporary effect on the position of the eyes, sometimes cause a paradoxical effect and create additional difficulties in assessing the effect of the operation.

It is better to affect the position of the eye using a dressing. If after the correction of a converging squint, a hypooeffect is observed, it is advisable to leave a binocular bandage for several days. Such a natural elimination of accommodation also eliminates the pulse to the convergence, thereby determining the trend towards the discrepancy between the visual axes. With a pronounced hype effect, it is advisable to leave a monocular bandage to connect accommodation and convergence.

After the surgical correction of the diverging squint come, on the contrary: during hypo effect, they prefer a monocular bandage, with hype effect - binocular. Other types of "orthoptic" bandages do not justify themselves.

Strabismus - This is a pathological condition in which the eyeballs have a different position in orbit and cannot carry out synchronous movements or, simply speaking, to work to work in a team. In people suffering from this disease, one eye looks directly to the desired object, and the other can be rejected inward or medial (condensed squint or ezotropy), outward or laterally (exotropium - diverging strabismus), as well as up (hypertropy) or down (hypotropy ). The squint can be permanent or intermitting. An incorrect movement may be subject to one eye (unilateral rally) or both alternatingly (alternating sturdy).

To prevent the bone with congenital and early children's strapment, the brain begins to ignore visual information from an incorrectly directed eye, which leads to amblyopia or the effect of the "lazy eye". In no severe cases, children are conservative to the correction of the problem through a complex of individually designed visual exercises. But the most effective and radical treatment of strabismus is a surgical operation.

Indications for the operation

Traditionally, the goal of surgical treatment of the squint is the restoration of the normal visual axis, the elimination of diplopia, as well as the restoration or maintenance of normal binocular vision. Consider the testimony for this operational intervention. Read more:

1. Restoration of binocular vision. Specialists are currently considering that early surgical intervention can contribute to the restoration of binocular vision in children.
2. Diplopia or twin in the eyes. This is especially characteristic of older children and adults, first faced with deviation eye apples. The degree of visual discomfort directly depends on the frequency of deviations from the main axis. Moreover, significant deviations are concerned with patients less than small.
3. Paralytic squint. Surgical treatment is most effectively for therapy of pronounced paralytic squint with symptomatic diplopia. A well-planned operation helps to cope with the tops of the upper oblique muscles, which also returns binocular vision to patients.
4. Even rare deviations can lead to such an unpleasant state as asthenopia. Clinical picture It makes up of difficulties with reading, headaches, weakness with long-term voltage.
5. Correction of cosmetic defects in children Often, most worried parents. To achieve such a goal, several interventions may be needed.

It is necessary to understand that the choice of the method of treatment and outcomes are strongly dependent on the type of stroke, the angle of deviation and such factors as the insufficiency of convergence or amblyopia. The essence of the operation consists in exposure to the glasses, motor signals to which sends the brain, the impact methods on which are currently unknown. That is why the deviation of eyeballs may be observed and after surgical correction. To achieve the desired goal, a series of interventions may be needed.

Conducting an operation

In the course of preoperative training, a specialist conducts a sensorial examination. It lies in the external stimulation of the glasses. Such a diagnostic procedure is necessary in order to determine which muscle structures make a major contribution to the squint, which of them need to be influenced (to relax, strengthen or move). Also finds the degree of squint. Thus, the surgeon thoroughly examines the situation and determines the operation plan for itself. Often both eyes require interventions, although the deviation from the axis is present only on the one hand.

Corporate correction operation is rarely associated with massive bleeding. However, for the purpose of precaution, the doctor may recommend temporarily stop taking anticoagulants, disagregantes, ibuprofen. Standard laboratory and instrumental surveys are also needed - general and biochemical analysis blood, fluorography or x-ray, electrocardiogram.

On the eve of the intervention, a decision is made on the method of anesthesia. Most often, children and adults are general endotracheal anesthesia. If there are contraindications or unwillingness of the patient as an alternative, retrobulbar injections of local anesthetic are used in combination with intravenous sedation.

In the operating room, the patient is in the lying position. The skin of the convertible region is carefully processed by iodine-containing antiseptic. Surgeon and operating nurse after pre-handling hands dress sterile bathrobes and gloves. A sterile napkin with a hole for the operating field is placed on the face. All these activities are necessary for the prevention of infectious complications in the postoperative period.

Principles of surgical intervention

In humans, there are 6 outdoor oily eye muscles controlling the movements of eyeballs within the orbit. Four of them are called straight (top, bottom, medial and lateral). They are attached to the appropriate pole of the eye and move it up, down, knutrice and the duck, respectively. The two remaining muscular structures are responsible for complex movements and are called oblique. The work of all listed muscles is coordinated by the brain neurons.

The purpose of the operational intervention is the impact on the described muscular structures:

• Recession - Operation, weakening the direct muscles of the eye, due to the transplanting of the muscles of the Pump from the place of its attachment.
• Resection or muscle shortening - Operation at which, due to shortening the length of the muscle, its gain occurs.

The technique is as follows: the incision is made on the conjunctiva. Muscles are located just under the conjunctival structures, which is why in the dissection of the skin there is no need.

In the process recession The muscle is separated from the place of her attachment to the eyeball. Then it moves the post, after which it is fixed to the eye. Moving the stop from the place of anatomical attachment relaxes the muscle, which allows the eye to take a smooth position.

Resection - This is a strengthening procedure, which is the excision of a piece of muscle fibers, followed by muscle fixation in an anatomical position. During the preoperative training, the surgeon determines which specific extracular muscles will be exposed to. The time required for such intervention depends on the set of factors. As a rule, working with one muscle takes about 20-30 minutes from the surgeon.

To date, the method of adjustable seams is widely used. After resection or recession, the locking of the muscles to the surface of the eyeball is carried out by special nodes. At the end of the operation, the surgeon can easily access them. This is necessary in order to correct the position of the muscles in the postoperative period to achieve a better effect.

Postoperative period

The early postoperative period implies careful observation of the patient, controlling its cardioresis indicators. This is especially true after general anesthesia. Patient or his parents (such operations are often performed in children) receives detailed recommendations on postoperative care. Normal is moderate soreness, hyperemia or itching in the area of \u200b\u200bthe operated eye. Conjunctive is usually hyperemic and edema, permanent sense of the foreign body is possible. It is permissible to increase in the amount due to the edema of the upper and lower eyelid.

Such symptoms are resolved within 2-3 days. In pronounced pains, we will admit the technique of non-steroidal anti-inflammatory funds (nimesulide, ketorolac) in adults. Children are prescribed paracetamol or ibuprofen in the age dosage.

The full recovery is usually required 1-2 weeks. After this time, adults can return to their daily activity, and children go to school. It is important to comply with precautions - to ensure that the eye does not contact with foreign bodies, not rub it with dirty hands, as well as avoid all sorts of injuries of the organ.

Possible complications

The probability of complications exists after any surgical operation, this intervention is no exception. You can face with the following undesirable scenarios:

1. Infectious complicationsAs a rule, take place in the early postoperative period, but they are rarely found. For the prevention of bacterial contamination, patients are prescribed eye drops from antibacterial drug. The first postoperative visit to the clinic is aimed at assessing the patient's condition and identifying similar complications. With the appearance of severe pain syndrome, swelling, redness is necessary to immediately turn to the doctor.
2. Perforation sclera. During the sewing of extracular muscles to the surface of the eye, there is a chance of damage to the needle sclera. This usually ends with minor bleeding. In rare cases, during massive damage, retinal detachment is possible or a need for cryotherapy appears. The use of modern needles allows you to avoid similar situations.
3. Such complications are possible as redness, itching, bias in the eyes (diplopia). Such signs are usually transit and stop as recovered.
4. Moderate reducing visual acuitySometimes requiring additional selection of points or contact lenses is associated with a slight change in the shape of the eyeball after the operation.
5. Full loss of view is rare - 1 case by 10,000 operations. It is associated with endophthalmits, retinal detachment or massive hemophthalm. Modern possibilities of ophthalmology allow us to notice the above-mentioned complications in time and take the necessary measures.

Sometimes patients mistakenly consider the incomplete or insufficient correction of the squint with complication. This is not entirely true. According to statistics, from 20 to 40% of such operations are not fully justified by expectations. As mentioned above, a series of interventions may need to achieve a reference cosmetic effect.

Cost of operation

The price of this operation depends on reputation and equipment ophthalmologic clinic, qualifications of a specialist and used consumables. There are also various categories of complexity of operation. The cost of correctional correction surgery is from 25 to 40,000 rubles and is determined individually for each patient. Peri operational diagnostic manipulations are paid separately.

Despite the fact that lifebide is usually detected in preschool children, some adults also suffer from this ailment. The squint is a defeat at which the visual axis of one eye deviates from the joint point of fixation. It looks like this looks as if the eyes of a man look in different directions. Conservative therapy gives improvements only if the deviation was detected on time. In other cases, only surgical intervention will help to correct the situation. How effective is the correction of the strabismus in adults, the prices for which vary from 35,000 - 40,000 rubles, and what methods are the correction?

Causes of Sturdy's development

Before trying to figure out, which provoked the development of stabysma, you need to identify, with what form of the defeat a person faced. The squint is congenital and acquired. Each forms develop for various reasons.

Congenital squint is quite rare and is often found immediately after the appearance of a baby into light. But experts warn that such a violation is often "false." Due to the weakness of muscle fibers, some children cannot focus on their own. At the same time, it seems that the child develops pathology. As for the real innate stabysma, the disease can develop against the background of the children's central paralysis or Down syndrome. Also, the violation may be caused by genetic predisposition. Pathology is often evolving if a woman was sick during pregnancy infectious diseases and took potent drugs on a permanent basis.

The acquired form of the squint is also more often manifested by 12 months, but there are often cases when pathology makes itself felt in an older age. Most often, in the role of a provocating factor, they are:

In adults, the squint is often developing as a complication after heavy influenza. But this is possible only if a person has a predisposition to pathology since childhood.

If a strong form of squint is diagnosed to the adult patient, it is possible to correct the situation only with surgical intervention. Conservative methods give effect only at the initial stages. Most specialists are recommended to conduct an operation for the correction of stabysma in several receptions. This is due to the fact that the operation of more than 2 muscles can be dangerous for 1 time, and increases the risk of complications.

The elongation or shortening of the amazed muscles is always carried out evenly on both sides. The dimensions of the excision should also be identical. If there is an indication for the intervention, the patient needs to be very careful about the choice of the clinic and the surgeon, since the result depends largely on the experience and qualifications of the physician.

If financial opportunities allow, to carry out an operation to eliminate pathology better from German and Israeli specialists. In these countries, the technology of correction of eye muscle fibers is more perfect, due to which eliminate the disease is possible 1 time.

Is the operation dangerous

The eyes are one of the most vulnerable organs, so any ophthalmological operation implies some risks. As medical practice shows, the most common complication after the recreation of the squint is the appearance of a double image. More than 70% of cases, this deviation disappears independent after some time after the operation, but sometimes the complication remains.

It is also worth considering that the course of the operation and the continued condition of the patient will largely depend on the initial state of human health. Than younger and healthier patient, the faster the restoration will go and the lower the risk of development postoperative complications. If the operation is carried out in a modern clinic with high-quality equipment under the control of an experimental doctor, the risk of negative consequences will be minimized.

Indications for holding

Correction Acrosspathy Operation is usually assigned if:

• the patient was appointed different methods conservative treatment of stabysma, but they did not bring positive changes or improvements were insignificant;
• the patient wants to get rid of Sturboism as soon as possible. If conservative therapy usually lasts 2-4 years, the operation will help to eliminate the defect literally in a couple of months (together with the rehabilitation period);
• the patient is diagnosed with a strong stage of stagidation. In the launched cases, doctors advise first to make an operation, and only after that are prescribed conservative treatments. Most often, they apply to secure the result achieved.

Before carrying out the operation, the patient must complete a full inspection and make sure the absence of contraindications, since some individual characteristics are restricted to carry out such a correction.

Types of surgical intervention

The main task to eliminate stabysma in adults is to change the wrong position of the eyeballs in the visual apparatus. The correction method is selected individually for each patient. The doctor at the same time takes into account the initial state of the person and the degree of defeat. Also, the technique is selected taking into account what it is necessary to do is to loosen or strengthen the muscles.

Correction of strabismus in adults whose goal is to enhance muscle fibers, is carried out in one of the following ways:

• resection - shortening of the affected muscle with further fixation;
• proraphy - muscle strengthening by shifting tendon forward or backward;
• netherophia - formation of a small fold of tendons. Such an operation is carried out so that a person can see better.

To date, the most popular way to enhance the eye muscles is resection. This is due to the fact that the rest of the correction methods of the squint are more directed to correcting the oblique muscles of the eyes.

If you need to weaken the muscles, the surgeon disconnects them and fixes away from the cornea. Such an operation is carried out using the following techniques:

With primary consultation, many patients are interested in whether it is possible to correct the squint with the help of laser correction. It should be borne in mind that laser techniques are applied only for the correction of visual acuity, but it is impossible to change the eye position using it.

Postoperative period and complications

Since the operation to eliminate Sturbizm is carried out outpatient, it is not even necessary to go to the clinic for its patient. In most cases, a person is released home after a few hours after surgery. The patient is left in the hospital only in the presence of certain problems with health or the emergence of postoperative complications.

The postoperative period is usually no more than a week, but the rate of recovery of vision depends largely on the body itself. 4-6 hours after surgery, a person can feel the pronounced discomfort and a feeling of an extraneous object in the eyes, minor headaches. Such symptoms are usually preserved for 3-4 days, after which the condition begins to normalize and the person can return to the usual life. To minimize the risk of complications, at first after surgery, the patient should avoid active recreation and heavy physical exertion.

Full recovery usually lasts from 4 to 5 weeks. To speed up the process of regeneration, you need to use special ointments and gels appointed by the doctor. Also in the postoperative period it is useful to make gymnastics for the eyes.

As for the complications, after the operation to eliminate Sturboism, they are quite rare and more often due to negligence or medical errors. The most common complication is hypercore. Pathology develops with excessive elongation or eye muscles. Such a violation appears as a result of such reasons:

• medical error;
• incorrect initial calculations.

To minimize the risk of complications, today the operations are often carried out without cutting, but with muscle sewing. This technique allows you to adjust the superimposed seam. If the patient is manifested unwanted consequencesThey can be eliminated by a minimally invasive method.

Also, the patient may encounter such pathologies:

• formation of the scar in the field of excision of muscle fibers. Pathology is dangerous in that with her muscle loses elasticity and mobility, and in its place begins to form fibrous fabric;
• secondary squint. Usually occurs if the patient ignores medical recommendations in the recovery period;
• injurization of a wandering nerve during operating. This injury is very dangerous because nervus vagus Responsible for the functioning of myocardium, lungs and gastrointestinal organs.

Cost of operation

The price of surgical correction of stabysma depends on the type medical institutionas well as from the selected technique. If a person appeals to the municipal hospital, the procedure will be free. The service is carried out for patients of all ages, regardless of the shape and stage of the lesion. In private clinics, the cost of the service depends on the complexity of the operation. The average cost of such interference in Moscow and other major cities of Russia is 38,000 rubles.

In order for the treatment of stabysma to be productive, you need to carefully approach the choice of the clinic and the surgeon. Also, success depends largely on how the rehabilitation period passed. To minimize the development of complications and consolidate the result, the patient must necessarily need to strictly comply with all medical recommendations and regularly undergo a prophylactic examination from an ophthalmologist.