RU2689028C1 - Method for surgical management of cataract using a femtosecond laser with prevention of intraoperative miosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For the surgical management of cataract using the FSL energy, performing the main incision, paracenteses, capsulorhexis and lens fragmentation using the FSL energy, opening of main incisions, performing hydrodissection and hydrodeliniation, phacoemulsification of lens mass and implantation of intraocular lens. Fragmentation of the crystalline lens is performed using the FSL energy in the form of four parts, in two mutually perpendicular planes passing through the lens centre, in the middle one-third of the thickness of the crystalline lens bounded by planes parallel to each other and perpendicular to the sagittal plane.

EFFECT: method enables achieving stable mydriasis after femtosecond tracking, eliminating the use of additional apparatus for intra-chamber administration, provides comfortable conditions for the surgeon during the subsequent stages of cataract extraction and reduced traumatic effect on eye tissues.

1 cl, 1 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used for the prevention of intraoperative miosis during surgery for both complicated and uncomplicated cataracts using femtosecond laser energy (FLS).

The femtosecond laser energy was first used in ophthalmology in the 70s of the last century. During this time, technology has undergone multiple changes. Currently, phacoemulsification with femtolaser maintenance has a number of advantages, such as the exact location of the incisions, the predicted shape and size of capsulorhexis, its precise centering in relation to the pupil, the reduction of ultrasound costs during phacofragmentation with FLS (Pashtaev NP, Kulikov I.V Ophthalmosurgery №3 2016). Despite all the advantages of this technology, it has several disadvantages, one of which is the occurrence of intraoperative miosis caused by exposure to laser energy and pressure on the tissue of the eyeball during applanation of the femtosecond laser interface (Kendall E. et al. "Femtosecond laser-assisted cataract surgery "Cataract Refract Surg 2013; p. 39).

Methods are known for the prevention of intraoperative miosis during femtolaser maintenance of cataract extraction by introducing high molecular viscoelastic, for example, Healon G (Abbott Medical Optics) (Donnenfeld E. et al., J Cataract Refract Surg. 2006, page 32), intracameral injection of devices mechanically increasing iris diameter, for example, retractor hooks, Malugin Ring pupil dilatation implants (Microsurgical Technology) and Perfect Pupil (Milvella) (Goldman JM, et al. Ophthalmol. 2007 p. 18; Chang DF. J Cataract Refract Surg. 2008 p. 34) and intracameral administration of a 1% solution of Sol Phenylefrini (Mezaton).

The closest analogue is a method of surgical treatment of cataracts using femtosecond laser energy (FSL), which includes carrying out a femto-step, opening the main incisions, performing hydrodissection, fragmentation and phacoemulsification of the lens masses and implantation of an intraocular lens, characterized by the fact that after performing femto-stage lens mass and implantation of an intraocular lens, characterized by the fact that after performing femto-stage lens mass and implantation of an intraocular lens, characterized by the fact that after performing femtotherapy, and after intracranial lens implantation, an intraocular lens is used. nuclei, making efforts in the horizontal plane along the line of a notch formed after the fragmentation of the nucleus with the help of the energy of FSL and passing through the center of the nucleus of the lens, then after the release of the bubbles of intra- and retro-lens gas, the hydrodissection of each half of the lens nucleus is alternately performed, after which the operation is traditionally continued (RF patent for invention No. 2642263).

The disadvantage of the closest analogue is that when femtolaser support of cataract extraction is performed at the stage of lens fragmentation, the FSL energy occurs at a critically close distance from the iris, which entails a pupil of myocardium, which is not influenced by medicamentous drugs, the appearance of which indicates a traumatic effect on iris.

The task of the invention is to develop a method of surgical treatment of cataracts using a femtosecond laser, which provides prevention of intraoperative miosis.

The technical result of the proposed method is to achieve a stable mydriasis after performing femtolaser support, excluding the use of additional devices for intracameral administration, providing comfortable conditions for the surgeon when performing the subsequent stages of cataract extraction and reducing the traumatic effect on eye tissue.

The technical result is achieved by the fact that in the method of surgical treatment of cataract using FSL energy, including making the main incision, paracentesis, capsulorhexis and lens fragmentation using FSL energy, opening the main incisions, performing hydrodissection and hydrodilining, phacoemulsification of the crystalline lens mass and implanting an intraocular lens the invention, the fragmentation of the lens is performed using FSL energy in the form of four parts, in two mutually perpendicular planes, passing through lens center, in the middle third of the thickness of the lens, limited by planes parallel to each other and perpendicular to the sagittal plane.

Between the set of essential features and achievable technical result there is a causal relationship.

The impact of FSL on the middle third of the lens, bounded by planes parallel to each other and perpendicular to the sagittal plane, and its crushing into four parts, minimizes the traumatic effect on the iris tissue due to the increased distance between the iris and the lens exposed to FSL. Since the traumatic effect on the iris tissue is minimized, a stable mydriasis is achieved during the entire surgical procedure, which excludes the introduction of additional viscoelastic and devices for expanding the pupil into the anterior chamber of the eye.

The method is as follows. The surgical field is processed and drip anesthesia is performed. Next, docking of the LenSx femtosecond laser interface (Alcon, USA) is performed, after a sufficient vacuum level has been reached, correction of the location of the caplorexis, the main incision and paracentesis is performed. After checking the optical coherence tomography (OCT) of the anterior capsule of the lens and the profile of the cut corneal incisions proceed to determine the depth of impact of PSL on the lens. Then, using FSL energy, the formation of notches is performed in two mutually perpendicular planes passing through the center of the lens, for its subsequent division into four parts. The formation of notches produced in the middle third of the thickness of the lens, bounded by planes parallel to each other and perpendicular to the sagittal plane. Next, the patient is transferred to the operating table, re-perform the processing of the surgical field. The main incision and paracentesis are opened by means of a sharp chopper. Fill the anterior chamber with a Viscoat Viscoat (Alcon) and remove the anterior lens capsule. Then, hydrodissection and hydrodelining are performed, reaching the exit of bubbles into the anterior chamber, which are formed after exposure of the lens to FSL. After that, with the help of phakonakonechnik and a blunt chopper, the lens is divided into four parts by incisions formed after exposure to FSL, then the parts of the lens are removed using phacoemulsification. After that, cortex removal, intraocular lens (IOL) implantation and incision hydration are performed. The operation can be considered complete. The invention is confirmed by the following example.

Example 1: Patient K., 62 years old

The diagnosis of the right eye: Complicated immature cataract. Pseudoexfoliation syndrome.

Before operation: Vis OD - 0.3 sph +2.5 D cyl -0.75 D ax 100 = 0.5 not correctable

IOP - pneumotonometry:

OD - P0 = 14 mmHg;

Echobiometry: OD - Axl - 23,11

ACD - 2.95

Lens - 4.50

The density of endothelial cells - SD OD - 1590 cells / mm2

Status opthtalmicus: OD - the cornea is transparent, the anterior chamber is of medium depth, atrophy of the pigment border of the iris of the I degree, the pupil is 3.0 mm round, pseudoexfoliation at the edge of the pupil. Blurred lens in the nucleus. The optic nerve disc is pale pink, the boundaries are clear, in the macular area the retina is not changed.

The patient underwent cataract phacoemulsification with femtolaser accompaniment with Acrysof IQ IOL implantation (optical power 23.0) with focusing FSL energy and lens nucleus splitting according to the proposed invention, while the effect was performed in the middle third of the lens, 1.5 mm from the anterior lens capsule and at a distance of 1.5 mm from the posterior lens capsule. Before the operation, the diameter of the pupil after instillation of mydriatics was 6.0 mm and remained so during the whole surgical intervention.

On discharge: Vis OD = 0.8 sph - 0.5 = 1.0

IOP OD P0 = 15 mm Hg

The density of endothelial cells SD OD - 1576 cells / mm2

Objective: OD - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the position of the IOL is correct. The optic nerve head (optic disc) is pale pink, clear boundaries, in the macular region of the retina is not changed. According to OCT, the retina in the area of the macula is not changed. During the operation, no intraoperative miosis was observed after femtolaser follow-up.

According to the proposed method, 98 operations were performed, in all cases a stable mydriasis was achieved during the entire surgical intervention, no additional devices were used to expand the pupil, thereby the time of operations was minimized.

Claims (1)

A method of surgical treatment of cataracts using femtosecond laser energy (FSL), including making the main incision, paracentesis, capsulorhexis and lens fragmentation using FSL energy, dissecting the main incisions, performing hydrodissection and hydrodilution, phacoemulsification of the lens mass and implantation of an intraocular lens. lens fragmentation is performed using FSL energy in the form of four parts, in two mutually perpendicular planes passing through the center of the lens, with the third third of the lens thickness bounded by planes parallel to each other and perpendicular to the sagittal plane.