RU2263495C2 - Method for laser cataractous extraction - Google Patents

Abstract

FIELD: medicine, ophthalmosurgery.

SUBSTANCE: the present innovation deals with surgical treatment of cataract at different degrees of density. One should form two mutually perpendicular diametral grooves at the surface of lenticular nucleus, followed by nucleus' breaking, fragmentation and aspirating. On breaking the nucleus one should form a crater in the center of nucleus to decrease each nuclear fragment twice. One should perform aspiration of each fragment successively. While forming perpendicular grooves and a crater it is necessary to apply laser radiation at energy of 150-200 mJ, and while breaking each fragment of lenticular nucleus one should decrease radiation energy up to 100 mJ. The method enables to shorten time for laser impact and total duration of operation, and, also, to conduct operation upon eyes with narrow pupils and apply capsulorhexis of lower diameter, as well.

EFFECT: decreased traumatism of operation performed.

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Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in the surgical treatment of cataracts with various degrees of density.

A known method of cataract extraction (RF patent No. 2102048, A 61 F 9/007, A 61 N5 / 06, z. 20.03.95, on. 20.01.98, BI No. 2), providing for exposure to laser radiation at the end of a working needle with energy a pulse of 10-800 mJ and a pulse frequency of 50-500 μs and subsequent aspiration of the resulting small fragments.

The disadvantages of this method are the difficulties associated with the complexity of fragmentation and aspiration of large fragments formed during the destruction of the nucleus, as well as the risk of damage to the posterior lens capsule.

The closest in technical essence and the achieved effect is one of the options for laser cataract extraction proposed by Fedorov S.N., Kopaeva V.G., Andreev Yu.V. and others (J. "Ophthalmosurgery" No. 1/99, p.3, prototype).

In accordance with this method, two mutually perpendicular grooves are formed on the surface of the lens nucleus with a laser beam, break the nucleus into four large fragments, and subsequently destroy and aspirate them.

The disadvantages of this known method are the complexity of the destruction of fragments of the core with large sizes and the risk of damage to the posterior lens capsule.

The task of the invention was the development of an effective safe method for laser destruction of the lens nucleus with varying degrees of density.

The essence of the invention lies in the fact that two mutually perpendicular grooves are formed on the surface of the lens core using laser radiation with a power of 150-200 mJ, then the core is mechanically broken into fragments, after which a crater is formed with a laser beam in the center of the core. When each fragment is reduced by approximately half, the laser energy is reduced to 100 mJ and each fragment is subsequently destroyed and aspirated.

The technical result achieved by the implementation of this method of cataract extraction is expressed in the following:

- reduction of the time of exposure to laser radiation ≈ by 20% and the total duration of the operation;

- reducing the invasiveness of the operation, in particular, reducing the risk of damage to the posterior lens capsule during fragmentation of both hard and viscous lens masses;

- it is possible to use capsulorexis of smaller diameter;

- reduction of laser radiation power;

- the ability to perform operations on the eyes with narrow pupils.

The proposed method for cataract extraction is as follows. After appropriate anesthesia, a corneal tunnel incision is formed, and capsulorexis and lens nucleus rotation are performed sequentially. Using laser radiation with an energy of 150-200 mJ, a diametrically located groove is formed on the surface of the lens nucleus, directed from 10 to 16 hours. The depth of the groove should be at least _^3/4 the thickness of the core, the length must cover substantially the entire lens dense part. After the formation of the grooves, the core is turned 90 ° and a second diametrical groove is formed perpendicular to the first, in the same way, after which the formed grooves are revised, if necessary, they are deepened and lengthened. Two hooks are introduced into the depth of the grooves, with the help of which, resting on the edges of the grooves, the core is broken into four fragments without leaving jumpers between them. Then, using the same energy, a wide crater is formed, moving the tip with the laser beam in circular motions from the center of the nucleus to the periphery and reducing the volume of each fragment by about half. In this case, the walls of the formed crater bowl protect the posterior lens capsule from damage.

After the formation of the crater, the laser radiation energy is reduced to 100 mJ, the petal of the irrigation-aspiration tip is alternately brought under each lens core fragment, they are destroyed by laser energy and aspirated. At the end of the aspiration of the fragments of the nucleus, the remains of the epinucleas are aspirated, the IOL is implanted, the viscoelastic is washed out and the surgical access is sealed.

The proposed method for laser cataract extraction is illustrated by the following clinical examples.

Clinical example No. 1. Outpatient card number 123326.

Patient X. 73 years old, with a diagnosis of brown complicated cataract of the right eye, before surgery, visual acuity of the right eye - the correct projection of light, intraocular pressure - 20 mm Hg ease of outflow of intraocular fluid - 0.15 mm ³ / mm Hg x min, keratometry data - 42.25; 41.75, strong meridian - 136 °, anteroposterior size of the eyeball - 23.12 mm, electrophysiological parameters within the age norm.

September 30, 2003, laser cataract extraction was performed in accordance with the proposed method with implantation of the HANITA model IOL through a corneal tunnel 3.5 mm wide, capsulorexis diameter 4.5 mm, laser time: 150 mJ - 139 seconds, 100 mJ - 152 seconds.

On the first day after surgery, the right eye is calm, the cornea is transparent, the anterior chamber is of medium depth, drug mydriasis, IOL has intracapsular fixation, the reflex from the fundus is pink.

On the fourth day after surgery, visual acuity of the right eye 0.65, intraocular pressure 22 mm RT.article, ease of outflow of intraocular fluid - 0.14 mm ³ / mm RT.article x min, keratometry data 42.00; 41.50, strong meridian 144 °.

Clinical example No. 2. Outpatient card number 123278.

Patient Ch., 78 years old, with a diagnosis of overripe age-related cataract of the right eye, prior to surgery, visual acuity of the right eye - correct projection of light, intraocular pressure - 22 mm Hg, ease of outflow of intraocular fluid - 0.18 mm ³ / mm RT .art. x min, keratometry data - 43.75; 43.25, strong meridian 93 °, anteroposterior size of the eyeball 22.76 mm, electrophysiological parameters within the age norm. September 24, 2003. Laser cataract extraction was performed in accordance with the proposed method with implantation of the HANITA model IOL through a corneal tunnel 3.5 mm wide, capsulorexis diameter 4.5 mm, laser radiation time: 150 mJ - 96 seconds, 100 mJ - 132 seconds. On the first day after surgery, the right eye is calm, the cornea is transparent, the anterior chamber is of medium depth, drug mydriasis, IOL has intracapsular fixation, the reflex from the fundus is pink. On the fourth day after the operation, visual acuity of the right eye is 0.7, intraocular pressure is 23 mm Hg, ease of outflow of intraocular fluid is 0.17 mm ³ / mm Hg. x min, keratometry data - 43.75; 43.00, strong meridian 107 °.

The proposed method operated on 25 patients (25 eyes) with dense (III-IV degree) cataracts aged 65-80 years. All patients received high visual acuity (from 0.6 to 1.0).

Claims (1)

A method of laser cataract extraction, which provides for the formation of two mutually perpendicular diametrical grooves on the surface of the lens nucleus, breaking the nucleus, fragmentation and aspiration, characterized in that after breaking the nucleus, a crater is formed in the center of the nucleus, halving each fragment of the nucleus, and each fragment is aspirated sequentially moreover, when forming grooves and a crater, laser radiation with an energy of 150-200 mJ is used, and when each fragment is destroyed, the core lens to reduce radiant energy 100 mJ.