RU2179426C2 - Method for performing intraocular aphakia correction in the cases of lacking posterior crystalline capsule - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves implanting intraocular eye lens. Four laser iridotomy cuts are produced near the iris root in 11 and 5 o'clock position pair-wise at a distance of not less than 2 mm one from another. Threads tied to anchoring lens members are pulled through the cuts in diagonal opposite points of supporting members. Implantation is carried out under no iritis and intraocular hypertension conditions at least one day later after performing iridotomy. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to ophthalmology, and can be used in the surgical method of intraocular correction of previously performed aphakia in the absence of a posterior lens capsule.

 There is a method of intraocular correction of aphakia in the absence of a posterior lens capsule (see Ophthalmosurgery 3 magazine 1997, p. 33), which consists in performing a scleral incision, attaching pairwise threads to the intraocular lens from two opposite sides, implanting an intraocular lens by pulling the threads and removing their outward and fixing lenses. The pulling of the threads is carried out in the meridians of 9 and 3 hours using atraumatic needles attached to the ends of the threads.

 The disadvantage of this known method is its invasiveness by piercing the iris with a needle at several points according to the number of ends of the thread. One of the possible complications in the postoperative period is the inflammatory reaction of the iris with corneal edema. In addition, intraoperative hemorrhage into the anterior chamber of the eye is possible.

 The present invention solves the problem of developing a new method for intraocular correction of aphakia in the absence of a posterior lens capsule. The technical result obtained in this case is to reduce the morbidity of the aphakia correction operation due to the preliminary formation of iridotomy through which the threads are held to fix the lens to the iris.

 The specified technical result is achieved by the fact that in the method of intraocular correction of aphakia in the absence of a posterior lens capsule, including implantation of an intraocular lens, consisting of performing a scleral incision, fixing pairwise filaments on the intraocular lens from two opposite sides, introducing the intraocular lens by pulling the filaments and removing them outside and fixing the lens to the iris in pairs by tying the removed threads, at the root of the iris at 11 and 5 hours in pairs at a distance of at least 2 mm from each other four laser iridotomies are pulled out, the threads are pulled through them, tied to the lens support elements at diagonally opposite points of the support elements, and implantation is carried out in the absence of iritis and increased intraocular pressure no less than a day after iridotomy is performed.

 The method of intraocular correction of aphakia in the absence of a posterior lens capsule is as follows.

 At the root of the iris at 11 and 5 hours four laser iridotomies are performed in pairs at a distance of at least 2 mm from each other. For thin irises, iridotomy is performed with a YAG laser, and in patients with a thick iris, they are combined: an argon laser and a YAG laser. An argon laser performs laser coagulation, and a YAG laser iridotomy.

 In the absence of iritis and increased intraocular pressure, not less than a day after iridotomy, they begin implantation of an intraocular lens. To do this, after local anesthesia, carried out according to the usual method, a conjunctiva is cut along the limb with a length of 6 mm and separated. Hemostasis. A keratotomy diamond knife performs a scleral incision 5.0-5.5 mm long to a depth of 350 microns of the sclera thickness, departing from the limbus by 3.0-4.5 mm. Using the pheonite exfoliator, towards the limb, a scleral-corneal tunnel is formed. The introduction into the anterior chamber of the eye is carried out with a diamond spear-shaped knife 3 mm wide. Then the incision is expanded to 5.5 mm. A mesatone and Visiton viscoelastic are introduced into the anterior chamber of the eye.

 In the limb, at 11 and 5 hours, corneal paracentesis is performed. If required, anterior vitrectomy is performed when the vitreous prolapse occurs.

 On the supporting elements of the intraocular lens from two opposite sides at diagonally opposite points of the supporting elements, pairwise threads are fixed. An intraocular lens is implanted, for which its lower supporting element is inserted through the prepared tunnel into the posterior chamber. Micro hook through paracentesis at 5 o’clock and previously performed iridotomy capture one thread from the pupil area, fixed on the lower support element and, pulling it out. Similarly, through the second iridotomy, spaced from the first at a distance of not less than 2 mm, the second thread fixed to the lower support element is brought out. Both threads are tied together by a preliminary knot. In the anterior chamber through the scleral-corneal tunnel, the threads of the upper lens support element are introduced. Then, alternately through paracentesis at 11 o'clock, the iridotomy of the thread of the upper supporting element is brought out and tied together by a preliminary knot. The upper support element is led behind the iris into the posterior chamber of the eye. Threads pre-tied to one knot are tightened and finally tied. From the front camera, the eyes are washed away.

 Through any paracentesis, the anterior chamber of the eye is filled with saline until a slight hypertension is created. Having ascertained the reliability of the self-sealing section of the scleral-corneal tunnel, they do not impose a suture on the sclera. On the conjunctiva impose one nodal suture near the limb.

 Clinical example.

 Patient R., 62 years old, was admitted with a diagnosis of immature posterior capsular cataract OD, aphakia, uncomplicated vitreous hernia, macular degeneration "dry" form of OS.

 Vis OD = 0.1 n / k. Vis OS = 0.05 s corr. sph + 10.0D = 0.6.

 IOP OD - 19 mmHg

 OS - 21 mmHg

 Phacoemulsification of the cataract on the right eye was performed with a sclero-corneal tunnel incision and the T-26 IOL was implanted. The operation and the postoperative period without complications. On the third day, VOD = 0.8 n / k. On the fourth day, prophylactic peripheral laser coagulation was performed in the laser department on the left eye to prevent retinal detachment as a preparation stage for abdominal surgery - implantation of the posterior chamber IOL model T-26. Inspection on the fourteenth day of OS - on the periphery of laser coagulation with pigmentation of the II degree.

 One month after prophylactic peripheral laser coagulation, four laser iridotomies were performed in pairs at a distance of at least 2 mm from each other at the root of the iris at the root of the iris at 11 and 5 hours, and four hours later. Since the iris is thin, an iridotomy is performed simultaneously by a YAG laser with an energy of 6-8 mJ per pulse. The number of pulses for each iridotomy ranged from one to three. The place for iridotomy was chosen, if possible, in the thinnest places of the iris - in the gaps. 2 hours after the iridotomy, the eye is calm, a light pigment suspension in the moisture of the anterior chamber.

 IOP OS - 28 mm RT. Art.

 To stop reactive changes in the left eye, it was prescribed: diclof 0.1%, 2 drops 3 times, arutimol 0.5% - 1 time per day with a turnaround in a week, and the day before turnout do not drip arutimol.

 When appearing, the left eye is calm. Intraocular pressure without myotics 20 mm RT. Art., on the iris are visible four iridotomy size of approximately 50 microns. This is the minimum amount required to pass the micro hook to grab the thread. The retinal periphery examined is without features.

 The next day, in the morning before surgery, IOP control is 19 mm Hg.

Preoperative preparation and anesthesia. Operation progress:
Vekorashiritel. Upper rectus muscle on the grip. The conjunctiva was cut along the limbus from 10 to 12 hours, which was separated from the episclera along with the tenon membrane. Diathermocoagulation of superficial episcleral vessels was performed, sclero-corneal tunnel was marked with a scribe. A keratotomy diamond knife made a scleral incision in the form of a "back arc" 5.5 mm long to a depth of 350 microns of the sclera thickness, retreating from the limbus by 3.5 mm. Using a diamond spear-shaped knife 3.0 mm wide, a sclero-corneal tunnel was formed with the introduction of an eye into the anterior chamber. Visited to maintain eye tone in the anterior chamber of the eye. In the limb, at 11 and 5 hours, corneal paracentesis was performed. A special metal double-edged knife with a width of 5.5 mm widened the cut.

 An anterior vitrectomy of a vitreous hernia was performed. A 1% mesatone was introduced into the anterior chamber of the eye to moderate dilatation of the pupil and facilitate the implantation of a posterior intraocular lens.

 On the supporting elements of the intraocular lens from two opposite sides at diagonally opposite points of the supporting elements, paired filaments are fixed that are non-absorbable from Alcon polypropylene. For implantation of an intraocular lens, its lower supporting element is inserted through the prepared tunnel into the posterior chamber of the eye. A micro-hook through paracentesis at 5 o’clock and a pre-performed iridotomy, one thread captured from the pupil region, fixed on the lower supporting element, is brought out. Similarly, through the second iridotomy, spaced from the first at a distance of not less than 2 mm, the second thread is brought out, fixed on the lower supporting element. Both threads are tied together by a preliminary knot. The front camera through the scleral-corneal tunnel introduced the thread of the upper support element of the lens. Then, alternately through each paracentesis at 11 o'clock, the iridotomy of the thread of the upper supporting element is brought out and tied together by a preliminary node. The upper supporting element is inserted behind the iris into the posterior chamber of the eye. The threads previously tied to one knot are pulled up and finally tied. From the front camera his eyes washed visited.

 Through paracentesis at 5 o’clock, the anterior chamber of the eye is filled with saline until a slight hypertension is created.

 The conjunctiva has one nodal suture at the limb.

Claims (1)

 A method for intraocular correction of aphakia in the absence of a posterior lens capsule, including implantation of an intraocular lens, comprising performing a scleral incision, attaching pairwise filaments to the intraocular lens from two opposite sides, introducing the intraocular lens by pulling the threads and exposing them to the outside and fixing the lens to the iris of the pop filaments, characterized in that at the root of the iris at 11 and 5 hours in pairs at a distance of at least 2 mm from each other perform four laser iridotomy, pulled therethrough thread, fastened to the supporting lens elements in diagonally opposite points of support elements, wherein the implantation is carried out in the absence iritis and elevated intraocular pressure is not less than a day after the iridotomy.