RU2248775C2 - Method for destroying lenticular nucleus in the cases of overripe cataract with laser applying tunnel access - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming tunnel access and corneal paracentesis. Viscoelastic agent is introduced. Capsulorhexis, lenticular nucleus rupture is carried out by applying laser power using Nd:Yag laser at wavelength of 1.44 mcm. The central portion of the nucleus is fixed in lens capsule bursa to suction-irrigation end piece due to vacuum acting. Laser action is first applied to peripheral portion of the nucleus with concentric actions directed from periphery to the center following in concurrently rotating the nucleus about fixation point due to the suction-irrigation end piece being rotated about its axis with laser treatment and concurrent suction being applied to formed nucleus fragments.

EFFECT: enhanced effectiveness of treatment.

Description

The invention relates to the field of ophthalmic surgery.

A known method of laser extraction of cataracts with laser destruction of the lens nucleus (S.N. Fedorov, V.G. Kopaev, Yu.V. Andreev, A.V. Belikov. Results of 1000 laser cataract extractions // Ophthalmosurgery. 1999, No. 3. - C.3-14.) Nd: Yag laser with a wavelength of 1.44 μm, which consists in the formation of a “bowl” in the central part of the nucleus with subsequent destruction of the peripheral parts and the removal of fragments.

However, this method has significant drawbacks, it is not effective enough for overripe cataracts with the presence of a dense, small size, spherical or disk-shaped nucleus freely moving in the capsule bag.

The technical task is to create an effective method of destruction of the lens nucleus with overripe cataract tunnel access.

The specified technical problem is solved by the fact that in the method of laser destruction of the lens nucleus with overripe cataract, which consists in the formation of tunnel access and corneal paracentesis, the introduction of viscoelastic, capsulorexis, the destruction of the lens nucleus by laser energy Nd: Yag laser with a wavelength of 1.44 μm, the central part of the nucleus is fixed in the capsule bag of the lens to the aspiration-irrigation tip due to vacuum, laser action is carried out initially on the periphery of the nucleus, followed by and concentric effects from the periphery to the center while rotating the nucleus around the fixation point due to rotation of the aspiration-irrigation tip around its axis, followed by laser exposure to the resulting fragments of the nucleus while simultaneously aspirating.

The set of essential distinguishing features of the invention proposed by the authors is necessary and sufficient for an unambiguous positive solution of the claimed technical problem: the creation of an effective method of capsulorexis when removing an overripe cataract.

The proposed invention is as follows.

The method of laser destruction of the lens nucleus in overripe cataracts consists in the formation of tunnel access and corneal paracentesis, the introduction of viscoelastic, and capsulorexis. The lens nucleus is then destroyed by means of a laser energy of Nd: Yag with a wavelength of 1.44 μm. The central part of the nucleus is fixed in the capsule bag of the lens to the aspiration-irrigation tip due to vacuum. Laser exposure is initially performed on the periphery of the nucleus, followed by concentric influences from the periphery to the center. At the same time, the core is rotated around the fixation point due to the rotation of the aspiration-irrigation tip around its axis, followed by laser action on the formed fragments of the nucleus while their aspiration.

The method is illustrated by clinical examples.

Example 1. Patient K., 68 years old

On admission: The lens is homogenously cloudy, in the stage of swelling. Departmental departments are not ophthalmoscopically.

Vis = correct light projection

IOP = 22 mmHg

PZO = 24.5 mm

Keratometry 41.24 ax 90 g.

41.56 ax 0 gr.

Sonography: additional unstable echoes in the vitreous body.

Diagnosis: Overripe cataract of the right eye.

The operation was performed according to the method proposed by the authors.

On discharge: The right eye is the palpebral fissure, the eyelids are not changed, the conjunctiva is pale pink with a pronounced vascular pattern, the cornea is transparent, on the periphery arcus senilis is peripheral dystrophy of the cornea, in the meridian 13 hours at the limb meridian, a 4 mm tunnel incision with adapted walls, p / the chamber is deep, the moisture in the chamber is clean, transparent, the iris is a subatrophy of the II st., the pigment border is leached, the pupil is 5 mm in diameter, round, exfoliation along the edge of the pupil. The IOL in the correct position, in the capsular bag, is centrally located, filiform destruction in the vitreous. The fundus of the eye: The optic nerve disc is pale pink with clear boundaries, the arteries are slightly narrowed, A: B = 1: 2. In the macular region, the reflex is preserved. On the periphery without gross focal changes.

Vis = 0.8

IOP = 22 mmHg

Keratometry 41.15 ah 90 gr.

41.45 ah 0 gr.

Conclusion. This example confirms the high efficiency of this method by the absence of surgical and postoperative complications, a short rehabilitation period, and a high functional result.

Example 2. Patient E., 81 years old.

On admission: The right eye is the palpebral fissure, the eyelids are not changed, the conjunctiva is pale pink, pasty, the cornea is transparent, pronounced dystrophy on the periphery, the anterior chamber is deep, the moisture is clean, transparent, the pupil is 4 mm round, the pigment border is leached, on the front capsule crystalline lens; pronounced exfoliative deposits; crystalline lens homogeneous turbid. Departmental departments are not ophthalmoscopically.

Vis = correct projection of light.

IOP = 20 mm.

Keratometry 40.92 ax 58 gr.

41.42 ah 148 gr.

Sonography: there are no additional echo signals.

Diagnosis: The right eye is the palpebral fissure, the eyelids are not changed, the conjunctiva is pale pink with a pronounced vascular pattern, the camera is deep, the moisture is clean, transparent, the pupil is 5 mm in diameter with exfoliation elements. The IOL in the correct position, in the capsule bag, is located centrally. The fundus of the eye: The optic nerve disc is pale pink with clear boundaries, in the macular region the reflex is smoothed, small focal blotches of a sclerotic nature, angiosclerosis. On the periphery without gross focal changes.

Vis = 0.7 n / a

IOP = 22 mm.

Keratometry 40.92 ax 58 gr.

41.42 ah 148 gr.

Conclusion.

This example confirms the high efficiency of this method by the absence of surgical and postoperative complications, a short rehabilitation period, and a high functional result.

Example 3. Patient J., 69 years old.

On admission: The left eye is the palpebral fissure, the eyelids are not changed, the conjunctiva is pale pink, with a pronounced vascular pattern, the cornea is transparent, the anterior chamber is deep, the moisture is clear, transparent, the pupil is 4 mm round, the pigment border is leached, on the anterior lens capsule are pronounced exfoliation, lens homogenously cloudy, the phenomenon of light phacodonesis. Departmental departments are not ophthalmoscopically.

Vis = correct projection of light.

IOP = 18 mm.

Keratometry 42.24 ax 116 gr.

 42.76 ax 26 gr.

Sonography: there are no additional echo signals.

Diagnosis: overripe cataract of the left eye.

The operation was performed according to the method proposed by the authors.

On discharge: The left eye is the palpebral fissure, the eyelids are not changed, the conjunctiva is pale pink with a pronounced vascular pattern, the cornea is transparent, the limb in the meridian has a 13-hour tunnel incision 4 mm with adapted walls, the camera is deep, the moisture is clear and transparent, the pupil 6 mm in diameter with exfoliation elements. The IOL in the correct position, in the capsule bag, is located centrally. The fundus of the eye: The optic nerve disc is pale pink with clear boundaries, vessels A: B = 2: 3, the reflex is preserved in the macular region. On the periphery without gross focal changes.

Vis = 1.0

IOP = 20 mm.

Keratometry 42.24 ax 116 gr.

42.76 ax 26 gr.

Conclusion.

This example confirms the high efficiency of this method by the absence of surgical and postoperative complications, a short rehabilitation period, and a high functional result.

Using the method proposed by the authors allows to increase the efficiency of the method and reduce surgical and postoperative complications.

Claims (1)

The method of laser destruction of the lens nucleus in overripe cataracts, which consists in the formation of tunnel access and corneal paracentesis, the introduction of viscoelastic, capsulorexis, the destruction of the lens nucleus by means of Nd: Yag laser with a wavelength of 1.44 μm, characterized in that the central part of the nucleus is fixed in the capsule bag of the lens to the aspiration-irrigation tip due to vacuum, laser action is carried out initially on the periphery of the nucleus with subsequent concentric effects from the periphery to the center while rotating the nucleus around the fixation point due to the rotation of the aspiration-irrigation tip around its axis, followed by laser exposure to the formed fragments of the nucleus while simultaneously aspirating.