RU2564755C2 - Method of intraocular lens implantation in presence of defect of posterior crystalline lens capsule - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to microsurgery of the eye, and deals with the implantation of IOL of the T-26 model in the presence of the posterior capsule defect. For this purpose the lens is introduced into the posterior chamber with the following fixation of one or both bearing elements on near-equator residues of the capsule sac. Models RAYNER C FLEX 570 C, curved loops of which are preliminarily cut, with a 2 mm indent from the top of the bearing element are applied as IOL. The bearing element is brought in such a way, that one of the near-equator leaves lies on the capsule and the other - under the capsule.

EFFECT: method ensures the reduction of post-operative complications and improvement of vision in case of vast defects of the posterior capsule due to reliable fixation in this zone with the elimination of the lens sewing.

2 ex, 1 tbl, 7 dwg

Description

The present invention relates to medicine, in particular to eye microsurgery and implantology in the presence of extensive defects of the posterior lens capsule.

A known method of implanting an intraocular lens (IOL) model T-26, when there are extensive defects of the posterior capsule from fifty or more percent. To fix one of the supporting elements, the remains of the posterior capsule are used, and the opposite supporting element is fixed with two sutures to the iris (V.V. Chuprin “Through keratoplasty and posterior correction of aphakia.” Abstract of thesis, MD, Moscow, 1994) - analogue.

The disadvantage of this method is the invasiveness of fixation (the supporting element is sutured to the iris) and, therefore, postoperative complications are possible: secondary pigment glaucoma, dislocation of the IOL as a result of eruption of sutures.

There is another method for implanting an IOL of the T-26 model in the presence of a defect of the posterior capsule on aphakic eyes, by introducing the lens into the posterior chamber with subsequent fixation, where the lens is fixed with one or both supporting elements on the equatorial remains of the capsular bag, for this, the supporting element is wound so that the near equatorial capsule sheet was sandwiched between the arches of the hinge of the support element (RU, patent No. 2132667, IPC 61F 9/007, publ. 07/10/1999) - prototype.

This method allows you to implant the IOL into the area of the capsular bag with an extensive defect and fix it.

The disadvantage of this method is the implantation of a rigid lens of polymethyl methacrylate (PMMA) through a large incision (5.5 mm), which causes higher postoperative astigmatism due to a large operating injury.

The objective of the invention is to develop a method that allows, in the presence of an extensive defect of the posterior lens capsule (posterior capsule of the capsule bag), to implant a flexible IOL into the area of the capsule bag and to securely fix it in this zone, eliminating the hemming of the lens.

The technical result that will be achieved from the use of the invention is to reduce postoperative complications and to improve vision.

The technical result is achieved by the fact that the method of implanting an intraocular lens in the presence of a defect of the posterior lens capsule is carried out by introducing the lens into the posterior capsule with subsequent fixation by one or both supporting elements on the equatorial remains of the capsular bag. As IOLs, RAYNER models are used, the concave parts of the support (haptic) elements are pre-cut. And the lens is fixed so that the equatorial remainder of the front capsule is located between the outer and inner parts of the supporting (haptic) element. In this case, one part of the supporting (haptic) element is in the capsule bag, and the other part of the supporting (haptic) element is located on the front capsule.

The essence of the invention lies in the totality of the methods of operation.

RAYNER model type lenses are structurally optical and have diametrically arranged symmetrical monolithic support (haptic) elements in the form of a curved loop. The diameter of the entire IOL for the haptic elements is about 12 mm. Diameter of the optical part: 5.25-6.0 mm. The angle of the haptic is absent. It is this design of the support (haptic) element that allows, after its cutting, to obtain two parts, between which there will be an anterior equatorial part of the capsular bag.

Fixing the lens so that the equatorial remainder of the anterior capsule is located between the outer and inner parts of the support (haptic) element, while one part of the support (haptic) element is in the capsule bag, and the other part of the support (haptic) element is located on the front capsule, provides reliability and eliminates its dislocation to the front or rear camera of the eye due to the correct position of the lens relative to the optical axis of the eye.

The presence of the optical part of the lens and supporting (haptic) elements in the area of the capsular bag excludes mechanical effects on the ciliary body and iris. This reduces the risk of postoperative inflammation and increased intraocular pressure (IOP), due to the fact that implantation with a flexible IOL injector through 2.5 mm incisions provides a minimal degree of postoperative astigmatism, reduces the degree of trauma and inflammatory reaction in the postoperative period.

From an analysis of the scientific, technical and patent literature of the claimed combination of features that ensure the reduction of postoperative complications and improve vision due to reliable fixation of the implantable flexible IOL in the area of the capsular bag, excluding the hemming of the lens, we have not identified, which allows us to conclude that the claimed technical solution meets the criteria " novelty ”and“ inventive step ”.

The invention is illustrated by drawings, where:

figure 1 shows the IOL model RAYNER with an external section of the supporting elements (top view);

figure 2 and 3 shows the position of the IOL of figure 1 in the capsule bag (top view);

figure 4 shows the IOL model RAYNER with an internal section of the supporting elements (top view);

5 and 6 show the position of the IOL of FIG. 4 in a capsule bag (top view);

Fig.7 shows the fixation of the RAYNER IOL in the capsule bag (side view).

The invention is carried out in the following way. During cataract surgery, if there is an extensive defect in the posterior lens capsule (posterior capsule of the capsular bag), before implanting the IOL (1) of the RAYNER model, for example, the RAYNER C FLEX 570 C, both supporting (haptic) elements 2 are cut from the outside or inside 2 mm from the top of the support element. The result is two parts of the support element (2): conditionally external and internal relative to the optical part of the IOL (1) (see figures 1, 4). The lens is installed in the capsular bag (3) and fastened with its supporting (haptic) elements 2 to the front capsule 4, more precisely, to its equatorial part so that the outer part of one supporting (haptic) element 2 and the inner part of the other (supporting) haptic element 2 located on the front capsule 4, and other parts of the loop under the front capsule (in the capsule bag 3) (Fig.2, 3, 5, 6).

Thus, the equatorial parts of the anterior capsule 4 are located between the two parts of each supporting (haptic) element 2. The IOL 1 is thus securely fixed to the front capsule of the bag 4. The asymmetric arrangement of the parts of the supporting (haptic) elements (Figs. 2, 3, 5, 6), when the upper part of the loop of one supporting (haptic) element and the lower part of the loop of another supporting (haptic) element are located on the front capsule 4, and the other parts under the capsule (in the capsular bag 3), allows IOL 1 to occupy the correct position, that is, strictly perpendicular to the optical axis of the eye.

Example 1. Patient A., 72 years old, was admitted in June 2012 with a diagnosis of immature senile cataract. Visual acuity - 0.1 was not adjusted. Ultrasonic cataract phacoemulsification was performed through a 2.5 mm incision. During aspiration of the cortical masses, the posterior capsule ruptured with the formation of an extensive defect from the center to the periphery. IOL implantation was performed according to the claimed method: supporting (haptic) elements are pre-cut from the outside of each supporting element, departing 2.0 mm from the apex. IOLs are injected into the anterior chamber of the eye using an injector, then the upper part of one supporting (haptic) element and the lower part of the loop of another supporting (haptic) element are placed above the front capsule, and the other parts of the supporting elements are inserted into the capsule bag. Viscoelastic is removed from the anterior chamber. Eye tone is restored by the introduction of a balanced saline solution. The operation is completed. At discharge, the IOL occupied a central position and had no deviations in the frontal plane. Visual acuity - 0.9. When re-examined after 3 months, visual acuity is 1.0. The eye is calm, the lens is centered, and there is no dislocation.

Example 2. Patient S., 62 years old, was admitted in November 2012 with a diagnosis of immature senile cataract. Visual acuity - 0.2 was not adjusted. Ultrasonic cataract phacoemulsification was performed through a 2.5 mm incision. During aspiration of the cortical masses, the posterior capsule ruptured with the formation of an extensive defect from the center to the periphery. IOL implantation was carried out according to the claimed method: supporting (haptic) elements are pre-cut from the inside of each supporting element, departing 2.0 mm from the apex. IOLs are injected into the anterior chamber of the eye using an injector, then the upper part of one supporting (haptic) element and the lower part of the other supporting (haptic) element are placed above the front capsule, and other parts of the supporting elements are inserted into the capsule bag. Viscoelastic is removed from the anterior chamber. Eye tone is restored by the introduction of a balanced saline solution. The operation is over. At discharge, the IOL occupied a central position and had no deviations in the frontal plane. Visual acuity - 0.7. When re-examined after 3 months, visual acuity is 0.7. The eye is calm, the lens is centered, and there is no dislocation.

In the hospital of war veterans, by the claimed method, 4 RAYNER IOLs were implanted. In the remote period (after 6 months) in all four cases, the IOL occupied the correct position, visual acuity with correction - from 0.7 to 1.0. The inventive method allows the implantation of a flexible acrylic IOL model RAYNER and fixation of the lens to the anterior capsule of the lens in the absence of a posterior capsule.

Comparative data of the invention are shown in table 1.

Table 1 Method Differences The implantation method of the RAYNER IOL (inventive method) The implantation method of the IOL model T-26 (prototype) Cut length 2.5 mm 5.5 mm Possibility of IOL implantation through an injector Yes No Postoperative astigmatism, diopters <0.5 1.0-3.0 Suture incision sealing Not required Is required Method invasiveness + +++ Material biocompatibility High (hydrophilic acrylic) Normal (polymethyl methacrylate) The risk of postoperative inflammation + +++

As can be seen from the table, the invention allows to reduce postoperative complications due to greater biocompatibility of the lens material and implantation of the IOL through a smaller surgical incision using an injector. The incision does not require suture sealing, which reduces the invasiveness of the method, reduces the degree of postoperative inflammation. Vision improves 2-6 times compared with the prototype by reducing the magnitude of postoperative induced astigmatism.

Claims (1)

The method of implanting the IOL of the T-26 model in the presence of a defect of the posterior lens capsule by inserting the lens into the posterior chamber with subsequent fixation by one or both supporting elements on the equatorial remains of the capsular bag, characterized in that RAYNER C FLEX 570 C models are used as IOLs, curved loops which are pre-cut, 2 mm apart from the top of the support element, and the support element is inserted so that one of the equatorial leaves rests on the capsule, and the other under the capsule.

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