RU2368360C1 - Preventive treatment method of children's secondary cataract - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmosurgery and can be used for surgical prevention of children's secondary cataract. Front capsulorexis, aspiration of crystalline lens, introduction of viscoelastic material and implantation of intraocular lens is performed. After intraocular lens has been implanted, there performed are V-shaped cuts of the front capsule of the lens in the area of the front capsulorexis above each supporting element of intraocular lens and from one and more linear cuts of the front capsule between V-shaped cuts; then the cut edge of the front capsule is put under the optic part of intraocular lens.

EFFECT: method allows performing preventive treatment of children's secondary cataract during surgical treatment of congenital cataract by creating a barrier on the way of possible migration of epithelial cells from equatorial part of the capsular bag to optical zone.

3 ex, 1 dwg

Description

The invention relates to ophthalmic surgery and can be used in the surgical prevention of secondary cataract (VC) in children.

The current methods of surgical treatment of congenital cataracts require anterior capsulorexis, followed by cataract aspiration, circular opening of the posterior lens capsule - posterior capsulorexis (ZK), anterior vitrectomy (PV) and intraocular lens implantation (IOL), which are mandatory for the operation. ZK and PV are used to prevent the development in the postoperative period of secondary cataract (WK) and fibrosis of the posterior capsule (FZK) of the lens, which impair the passage of light to the retina and thereby reduce visual acuity. FZK and WTK in children develop in 15-53% of cases and almost always require repeated surgical treatment to eliminate them.

The closest analogue - the prototype is the operational prevention of the development of secondary cataract on artifact eyes in children with congenital cataracts, including ZK, PV, the introduction of viscoelastic implantation, IOL implantation. (Bobrova NF The current state of the problem of surgical treatment of congenital cataracts in children. // News of Ophthalmology - 2005 - No. 2 - p. 45-47; Bobrova NF, Romanova T.V. Effectiveness of surgical prevention of secondary cataract development on pseudophakic eyes in children. // Children's ophthalmology. Results and prospects: Materials of a scientific and practical conference. - M., 2006. - p.27-28).

The disadvantages of the proposed prototype are:

- the possibility of developing secondary cataracts, which leads to impaired vision and reoperation, since there is no barrier to the migration of epithelial cells from the equatorial zone of the capsular bag to the optical zone;

- the possibility of the development of reactive inflammation and hypertension in the postoperative period due to the migration of viscoelastic into the vitreous cavity before and after implantation of the IOL with performed ZK and PV;

- there is the possibility of migration of viscoelastic into the vitreous cavity before and after implantation of the IOL with performed ZK and PV, which leads to the development of reactive inflammation and hypertension in the postoperative period;

- the possibility of developing keratopathy due to the large loss of endothelial cells of the cornea when refusing to use viscoelastic.

Objective: to propose a method for the prevention of secondary cataract in children during surgical treatment of congenital cataract.

EFFECT: possibility of preventing secondary cataract in children during surgical treatment of congenital cataract by creating a barrier to the possible migration of epithelial cells from the equatorial part of the capsular bag into the optical zone.

The technical result is achieved by the fact that during the operation, anterior capsulorhexis, lens aspiration are performed, viscoelastic is administered and an IOL is implanted. After that, V-shaped sections of the anterior capsule are made in the capsulorexis zone above each supporting element of the IOL and from one or more linear sections of the front capsule between the V-shaped sections, 2-3 mm long, with the exit beyond the optical part of the IOL, so that it is possible to edge front capsule under the optical part of the IOL. After that, the dissected edge of the anterior capsule is tucked under the optical part of the IOL. Due to this, in the early postoperative period, a commissure is formed between the anterior and posterior lens capsules, which prevents the penetration of epithelial cells into the central optical zone.

The advantages of the proposed method:

- the impossibility of secondary cataracts, as it creates a mechanical barrier to the migration of epithelial cells due to soldering of capsule leaves;

- the formation of a barrier to the migration of epithelial cells due to soldering of capsule leaves among themselves:

- unimpeded evacuation of viscoelastic from the capsular bag to the anterior chamber, since incisions of the capsule are formed to exit the remains of viscoelastic;

- maintaining the integrity of the posterior capsule prevents the penetration of viscoelastic into the vitreous cavity at the stage of IOL implantation;

- minimizing the risk of intraoperative complications, as the capsule is cut at the final stage of the operation.

Example 1: Patient B. (3 years), for bilateral congenital zonal cataracts, lens aspiration was performed with implantation of an AcrySof Natural IOL on the right eye. After IOL implantation, incisions of the anterior capsule were performed according to the proposed method, followed by transposition of the anterior capsule under the optical part of the IOL. 6 months after surgery, the growth of the lens capsule epithelium was revealed only on the extreme periphery of the capsular sac, mainly along the supporting elements of the IOL. The central zone of the posterior capsule is transparent; visual acuity is 0.5 with correction.

2. Patient D. (5 years old) underwent aspiration of a swelling traumatic cataract in the left eye with transposition of the anterior capsule under the optical part of the IOL. 3 months after the operation, the transparency of the posterior capsule in the center is preserved, the capsule leaves are soldered together for the entire visible extent. Visual acuity of 0.3 with correction, reduced due to a scar of the cornea.

3. Patient I. (1.5 years) underwent lens aspiration with implantation of AcrySof Natural IOL and transposition of the anterior capsule for a half-absorbed monocular cataract in the right eye. After 6 months, a moderate focal growth of the epithelium of the lens capsule between its anterior and posterior leaves in the form of Elshnig spheres was revealed, however, the capsule remained intact in the center.

The method is illustrated in the drawing.

Claims (1)

A method for preventing the development of secondary cataract in children, including anterior capsulorexis, lens aspiration, the introduction of viscoelastic and IOL implantation, characterized in that after IOL implantation, V-shaped sections of the anterior lens capsule are made in the anterior capsulorexis area above each supporting IOL element and from one or more linear sections of the front capsule between the V-shaped sections, then the dissected edge of the front capsule is tucked under the optical part of the IOL.

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