RU2775192C9 - Method for reposition of a dislocated posterior chamber intraocular lens with transcleral reinforced suture fixation without opening the conjunctiva and exposing the sclera - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology. Two haptic elements of the intraocular lens (IOL) are captured by bayonet nodes. Next, transscleral suture fixation of the IOL in the ciliary furrow is carried out, the nodes are pinched and the ends of the threads are covered in the thickness of the sclera. Double non-resorbable threads with a cross section from 10-0 to 6-0 are used to fix IOLs. In this case, the threads are passed opposite through the ciliary furrow using the ab externo or ab interno transscleral method, without opening the conjunctiva, and the IOL is centered by thread tension. Then the threads are passed in the intrascleral manner paralimbally for 2-4 mm, then each of the needles is injected into the sclera at the exit points of the threads from the conjunctiva, the threads are brought out again through the conjunctiva, the threads are cut off with the free ends left. Nodes are formed with tension for their immersion into the scleral channels. Further, at the exit points of the ends of the threads from the conjunctiva, additional needles with double threads are again inserted in the form of a loop, which are again passed in the intrascleral manner paralimbally for 2-4 mm and the ends of the threads are brought out through the conjunctiva, fixing the IOL, captured in loops and immersed in the scleral channels formed by additional needles.

EFFECT: method provides the reposition of a dislocated posterior chamber IOL with its transscleral fixation with reinforced sutures without opening the conjunctiva and exposing the sclera.

1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended for repositioning a dislocated posterior chamber intraocular lens (IOL) with its transscleral fixation without opening the conjunctiva and exposing the sclera with two reinforced (with a double thread in the form of a loop on one needle) sutures with infringement of their nodes in the scleral channels.

A known method of repositioning a dislocated posterior chamber IOL without opening the conjunctiva and exposing the sclera of Dr. Kozhukhov A.A. et al. (Kozhukhov A.A., Unguryanov O.V., Abramov S.I., et al. Method for repositioning the posterior chamber intraocular lens with suturing through the flat part of the ciliary body. RF patent application No. 2018133979 dated 09/27/2018; RF patent for invention No. 2691925 dated 06/18/2019), which consists in passing double threads (with a loop on one needle), fixing two IOL haptic elements, in the scleral canals and infringing their nodes in the thickness of the corneal paracentesis.

The disadvantages of this method include the possible depressurization of the anterior chamber and the development of corneal astigmatism due to the tension of the sutures that tractionally displace the posterior lip of the corneal paracentesis.

As the closest analogue (prototype), the method of repositioning a dislocated posterior chamber IOL with its transscleral suture fixation by Dr. Oscala P. (Oscala P. Friction knot to fixate scleral sutures. J. Cataract Refract. Surg. 2015; 41: 497-500) was chosen. , consisting in the infringement of the nodes, and then in the immersion of the ends of two single threads (polypropylene, 9-0), fixing both haptic lens elements, in the scleral canals.

The disadvantages of the closest analogue (prototype) include the need to open the conjunctiva and expose the sclera, as well as the possibility of biodegradation of single threads (polypropylene, 9-0).

The objective of the invention is to reposition a dislocated posterior chamber IOL with its transscleral fixation with reinforced sutures without opening the conjunctiva and exposing the sclera.

The problem is solved due to the fact that in the method, including suture fixation of the IOL haptic elements, infringement of the thread knots and their ends in the scleral canals, the following differences are provided: the conjunctiva is not opened, and the sclera is not exposed.

In addition, the proposed method is distinguished by the use of reinforced sutures - two double (in the form of a loop) non-resorbable threads (from 10-0 to 6-0) on one needle.

The essence of the proposed method is as follows. Two oppositional corneal paracentesis are performed, two haptic elements of the deployed IOL (regardless of whether it is in the capsular bag or not) are captured by one of the variants of the bayonet knot (for example, a cow knot, cow hitch, English, or stirrup knot, clove hitch, English), using double non-resorbable threads with a cross section from 10-0 to 6-0 (each of the double threads is in the form of a loop on one needle), then the threads are passed outward oppositionally through the ciliary sulcus using the ab externo or ab interno technique transsclerally without opening conjunctiva, the IOL is centered by the tension of the threads, then the threads (or thread) are held intrasclerally paralimbally over a sufficient distance (2-4 mm), each needle is injected into the sclera at the exit points of the threads from the conjunctiva, again brought out through the conjunctiva, the threads are cut off leaving free ends, then knots (2-1-1) are formed with the tension necessary for their immersion (retraction) into the scleral canals, then, at the exit points of the of threads from the conjunctiva, additional needles with double threads in the form of a loop are again injected, which are again held intrasclerally paralimbally over a sufficient distance (2-4 mm) and brought out through the conjunctiva, the ends of the threads fixing the IOL (IHD, VKK or VKS) are captured in loops, and they are immersed in the scleral canals formed by additional needles.

EFFECT: invention makes it possible to reposition a dislocated IOL with its transscleral fixation without opening the conjunctiva and exposing the sclera with two reinforced (double threaded) sutures having a greater strength and durability resource, with infringement of their knots in the scleral canals.

The possibility of carrying out the claimed invention is shown by the following examples.

Clinical example No. 1. Patient L.M., aged 76, was admitted with a diagnosis of: OD - decentration of the posterior chamber IOL with a capsular bag; OS - initial cataract; OU - pseudoexfoliative syndrome.

status localis

VOD=0.07sph -3.0D; cyl -2.0Dax 90°=0.4.

VOS=1.0.

IOP OD=16 mmHg

IOP OS=14 mmHg

0D: calm, cornea is transparent, anterior chamber is deeper than average, its moisture is transparent, iris is calm, pseudoexfoliation along the edge of the pupil, destruction of the iris pigment border, iridodonesis, monoblock IOL made of hydrophobic acrylic SA60AT +21.0D (Alcon, USA) with decentered capsular bag downward due to an extensive defect in the zinn ligaments;

OS: calm, the cornea is transparent, the anterior chamber is of medium depth, its moisture is transparent, the iris is calm, pseudoexfoliation along the edge of the pupil, destruction of the iris pigment border, initial opacities in the lens cortex on the periphery;

OU: the vitreous body is transparent, the optic disc is pale pink, its boundaries are clear, the retinal vessels are not changed, focal and diffuse changes in the retina and vascular are not detected.

The patient proposed and performed the operation according to the above method: OD - reposition dislocated posterior chamber IOL with transscleral suture fixation.

Operation progress. After medical dilatation of the pupil, the surgical field was treated as standard. Under local drip and retrobulbar anesthesia, two corneal paracentesis 1.0 mm were performed in the 3:00 and 9:00 meridians, the anterior chamber was filled with cohesive viscoelastic, both haptic elements of the IOL were symmetrically captured by bovine knots using a double thread (in the form of a loop) made of polypropylene 9 -0 on one curved spatula needle 15.0 mm (art. 2452L, MANI, Japan), stitching the capsular bag sequentially under and above the haptics, both double threads are drawn outward in opposition in the meridians 3:00 and 9:00 through the ciliary sulcus ab interno transsclerally without opening the conjunctiva, IOLs with a capsular bag are centered by pulling up the threads, then, according to the method described above, the threads are held intrasclerally paralimbally for 3.0 mm, knots are formed on each of the double threads, immersed in the scleral canals, the ends of the threads are also immersed in the scleral canals paralimbally, the viscoelastic was removed from the anterior chamber by aspiration and irrigation, the anterior chamber was sealed by hydration and corneal paracentesis with a balanced saline solution, an antibiotic and a corticosteroid were introduced under the conjunctiva in standard dosages, an aseptic sticker was applied to the eye.

The next day after the operation: VOD=0.6 n.c., IOP=14 mmHg, the eye is almost calm, intrascleral sutures fixing the IOL are not visualized, the edges of the paracentesis are adapted, slight corneal edema and folds of the Descemet's membrane, the anterior chamber is deeper than the middle one, its moisture is transparent, the iris is not changed in color and pattern, the pupil is round, drug-induced mydriasis, the position of the IOL is correct, the optic disc is pink, the boundaries are clear, the retinal vessels are not changed.

1 week after surgery: VOD=1.0, IOP=18 mmHg, eye is calm, intrascleral sutures fixing the IOL are not visualized, the cornea is transparent, the anterior chamber is deeper than the middle one, its moisture is transparent, the iris is in color and pattern not changed, the pupil is round, the position of the IOL is correct, the optic disc is pink, the boundaries are clear, the retinal vessels are not changed.

Clinical example No. 2. Patient IG, aged 78, was admitted with a diagnosis of OD - dislocation of the posterior chamber IOL with a capsular bag into the vitreous body; OS - initial cataract; OU - pseudoexfoliative syndrome.

status localis

VOD=0.02 sph+10.0D=0.9.

VOS=0.7.

IOP OD=15 mm Hg

IOP OS=16 mmHg

OD: calm, the cornea is transparent, the anterior chamber is deeper than the average, its moisture is transparent, the iris is calm, pseudoexfoliation along the edge of the pupil, destruction of the iris pigment border, iridodonesis, monoblock IOL made of hydrophobic acrylic SN60AT + 19.0D (Alcon, USA) with a capsular bag deployed into the vitreous body;

OS: calm, the cornea is transparent, the anterior chamber is of medium depth, its moisture is transparent, the iris is calm, pseudoexfoliation along the edge of the pupil, the destruction of the pigment border of the iris, initial opacities in the cortex and the nucleus of the lens, the vitreous body is transparent;

OU: the optic disc is pale pink, its borders are clear, the retinal vessels are not changed, focal and diffuse changes in the retina and vascular are not detected.

The patient was offered and performed the operation according to the above method: OD - microinvasive 23g subtotal vitrectomy, removal of the capsular bag, reposition of the dislocated posterior chamber IOL with transscleral suture fixation.

Operation progress. After medical dilatation of the pupil, the surgical field was treated as standard. Under local drip and retrobulbar anesthesia, three transconjunctival transciliary 23g ports were installed 3.5 mm from the limbus in the 1:30, 7:30 and 10:30 meridians, subtotal vitrectomy was performed, two corneal paracentesis 1.0 mm were performed in the 3:00 meridians and 9:00, the capsular bag is removed, the IOL is lifted from the fundus with tweezers, both haptic elements of the IOL are sequentially externalized through corneal paracentesis, symmetrically captured by the stirrup knots using a double thread (in the form of a loop) of polypropylene 9-0 on one curved spatula needle 15 0 mm (art. 2452L, MANI, Japan), both double threads were passed outward in opposition in the 3:00 and 9:00 meridians through the ciliary sulcus ab interno transsclerally without opening the conjunctiva, the IOL was centered by pulling the threads, then, according to the method described above, the threads were carried out intrasclerally paralimbally for 3.0 mm, knots immersed in the scleral canals were formed on each of the double filaments, the ends of the filaments were also immersed in scleral canals paralimbally, all transciliary 23 g ports were removed, the anterior chamber was sealed by corneal paracentesis hydration with a balanced saline solution, an antibiotic and a corticosteroid were introduced under the conjunctiva in standard dosages, an aseptic sticker was applied to the eye.

The next day after surgery: VOD=0.3 n.c., IOP=12 mmHg, the eye is almost calm, intrascleral sutures fixing the IOL are not visualized, the edges of the paracentesis are adapted, moderate corneal edema and folds of the Descemet's membrane, the anterior chamber is deeper than the middle one, its moisture is transparent, the iris is not changed in color and pattern, the pupil is round, drug-induced mydriasis, the position of the IOL is correct, the vitreal cavity is optically transparent, the optic disc is pink, the boundaries are clear, the retinal vessels are not changed.

1 week after surgery: VOD=0.9 n.c., IOP=15 mmHg, eye is calm, intrascleral sutures fixing the IOL are not visualized, the cornea is transparent, the anterior chamber is deeper than the middle one, its moisture is transparent, the iris in color and pattern is not changed, the pupil is round, the position of the IOL is correct, the vitreal cavity is optically transparent, the optic disc is pink, the boundaries are clear, the retinal vessels are not changed.

Claims (1)

A method for repositioning a dislocated posterior chamber intraocular lens (IOL) with transscleral suture fixation without opening the conjunctiva and exposing the sclera, including capturing two IOL haptic elements with bayonet knots, transscleral suture fixation of the IOL in the ciliary sulcus, pinching the knots and covering the ends of the threads in the thickness of the sclera, characterized in that that for fixation of the IOL, double non-resorbable threads with a cross section from 10-0 to 6-0 are used, while the threads are passed out in opposition through the ciliary sulcus according to the ab externo or ab interno method transsclerally, without opening the conjunctiva, the IOL is centered by tensioning the threads, then the threads are passed intrasclerally paralimbally for 2-4 mm, then each of the needles is injected into the sclera at the exit points of the threads from the conjunctiva, the threads are again brought out through the conjunctiva, the threads are cut off leaving free ends, knots are formed with tension for their immersion in the scleral canals, then, at the points the exit of the ends of the threads from the conjunctiva is again injected until additional needles with double threads in the form of a loop, which are again passed intrasclerally paralimbally for 2-4 mm and the ends of the threads fixing the IOL are brought out through the conjunctiva, captured in loops and immersed in the scleral canals formed by additional needles.