RU2784893C1 - Method for intraoperative examination of the central fundus after removal of the cloudy lens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to ophthalmology. The fundus is examined by installing a microscope with coaxial lighting. After removal of the cloudy lens and prior to the implantation of the intraocular lens, an air lens is created from a syringe using a cannula by injecting sterile air into the anterior chamber of the eye in an amount of 0.7 to 1.1 ml. Then the patient is asked under the supervision of a surgeon to move the right eye to the left or the left eye to the right in order to visualise the optic disc and fix the sight on the light source in order to visualise the macular region.

EFFECT: possibility of preliminary prognosis of the visual functions and higher quality of intraoperative diagnosis of fundus pathology, allowing timely determining of the further strategy of treatment of the patient and reducing the trauma risk of fundus examination.

1 cl, 3 ex

Description

The present invention relates to ophthalmology and can be used for intraoperative examination of the central part of the fundus after removal of the cloudy lens.

The study of the fundus is the most important element of the examination of patients. It is necessary for the diagnosis of diseases that lead to a decrease in visual acuity: central vitreochorioretinal dystrophies and retinal detachments, pigmental abiotrophy and optic nerve atrophy. Fundus changes also occur in common diseases such as hypertension, diabetes mellitus, brain damage, kidney and liver failure. A mature cataract prevents preoperative examination of the fundus and hides comorbidities. Ultrasound research methods cannot replace the examination of the functional state of the optic nerve and the central parts of the retina.

The closest analogue is the method of intraoperative examination of the central and peripheral sections of the fundus after phacoemulsification or laser cataract extraction. After removing the cloudy lens and cortical masses, before implanting the intraocular lens on the surface of the eye, using an irrigation cannula, a water lens is created by obstructing the outflow with the index and middle fingers at the outer edge of the orbit. After that, the coaxial microscope (CM) is tilted to examine the central part of the fundus by 5-7 degrees relative to the vertical axis. Then, under the control of the surgeon, when the eye is moved 4 mm to the right when examining the left eye and to the left when examining the right eye, the optic nerve head, physiological excavation and exit of the central retinal vessels are visualized. To examine the peripheral parts of the fundus from the equator to the dentate line, the KM is tilted 8-12 degrees with the maximum eye abduction to the side. (RF patent for invention No. 2553194).

The disadvantages of this method are the difficulty of creating a water lens on the surface of the eye with the index and middle fingers at the outer edge of the orbit, adjusting the coaxial microscope.

The objective of the invention is to create a method for intraoperative study of the central part of the fundus after removal of the cloudy lens, allowing to assess the state of the macula, the optic nerve head, thereby predicting the optical potential of the eye.

The technical result is a preliminary prediction of visual functions, improving the quality of diagnosing the pathology of the fundus intraoperatively, which will make it possible to timely determine the further tactics of treating the patient, reduce the trauma of the study of the fundus.

The technical result is achieved by the fact that in the method of intraoperative examination of the central part of the fundus after phacoemulsification, including its examination by installing a microscope with coaxial illumination, according to the invention, after removing the cloudy lens and before implanting the intraocular lens using a cannula from a syringe, an air lens is created by introducing into the anterior chamber of the eye with sterile air in the amount of 0.7-1.1 ml, after that, under the control of the surgeon, the patient is asked to take the right eye to the left and the left eye to the right to visualize the optic nerve head, and while fixing the gaze on the light source, to visualize the macular area.

The air lens, created by the above amount of air, replaces the entire volume of the anterior chamber by displacing moisture from it, and stretches the posterior lens capsule to the state of the meniscus facing the vitreous body, while achieving the neutralization of the refractive power of the cornea.

The method is carried out as follows: after removing the cloudy lens by cataract phacoemulsification and before implanting the intraocular lens, an air lens is created using a cannula from a syringe by introducing sterile air into the anterior chamber of the eye, in an amount of 0.7 to 1.1 ml, which then occupies the entire volume of the anterior chamber, and ask the patient to take the right eye to the left and the left eye to the right, while the optic nerve head is visualized, and when looking directly at the light source, the macular area is visualized.

Example 1

Patient S., 62 years old, came to the clinic with complaints of visual impairment in the right eye (OD). From the anamnesis it is known that the complaints appeared a year ago, age-related cataract was diagnosed at the place of residence.

When examining visus OD: 0.1 sph -2.00=0.2

With ultrasound biometrics OD: anterior chamber depth 3.2. The lens thickness is 4.88. The length of the anterior-posterior axis of the eye is 23.35 mm.

Keratometry OD: 43.50-100, 43.00-30.

Objectively: OD: the eye is calm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is clean, the pupil is round, 3 mm, the lens is cloudy in the nuclear and cortical layers. The reflex from the fundus is pink, intraocular pressure (IOP) is normal by palpation. Deep-lying structures are not ophthalmoscoped.

According to the invention, a study of the central part of the fundus was carried out according to the proposed method, while introducing 0.7 ml of sterile air. When examining the central part of the fundus with an air lens, it was revealed that the macular area is normal, when the left eye is retracted to the right by 3 mm, a dark-colored pigment focus with clear boundaries is visualized at the optic nerve head (OND), with a correct course of blood vessels. Given the data of the examination of the fundus, we assume low visual functions.

The screening study prompted a detailed examination in the postoperative period.

A consultation in the department of ophthalmo-oncology was recommended. A week later, the patient was consulted, diagnosed with Melanocytoma. Treatment is not required, the patient is under the systematic supervision of an ophthalmic oncologist.

At discharge visus 0.7, IOP - 19 mm Hg.

Example 2

Patient N., 57 years old, came to the clinic with complaints of visual impairment in the left eye (OS). From the anamnesis it is known that the complaints appeared a year ago, age-related cataract was diagnosed at the place of residence.

When examining visus OS: 0.01 sph -7.50 cyl -2.00 Dax170=0.1

With ultrasound biometrics OS: anterior chamber depth 3.34. The thickness of the lens is 4.87. The length of the anterior-posterior axis of the eye is 29.27 mm.

Keratometry OS: 39.20-1, 42.00-91.

Objectively: OS: the eye is calm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is clean, the pupil is round, 3 mm, the lens is cloudy in the nuclear and cortical layers. Reflex from the fundus pink, intraocular pressure (IOP) 17 mm Hg. Deep-lying structures are not ophthalmoscoped.

Before intraocular lens (IOL) implantation, after removal of the cloudy lens OS, an air lens was created in the anterior chamber of the eye by cataract phacoemulsification using an irrigation cannula.

According to the invention, a study of the central part of the fundus was carried out according to the proposed method, while introducing 1.1 ml of sterile air. When examining the central part of the fundus in the macular region with an air lens, a redistribution of the pigment was found, and when the left eye was moved to the right by 3 mm, a pale pink optic disc with clear boundaries was visualized, myopic staphyloma, with the correct course of blood vessels.

Given the data of the examination of the fundus, we assume low visual functions.

At discharge visus 0.2 sph -2.00=0.6, IOP corresponds to normal values.

A consultation with the Department of Laser Retinal Surgery was recommended. A week later, the patient was consulted and diagnosed with high myopia. Treatment is not required, the patient is under the systematic supervision of a laser surgeon.

Example 3

Patient K., 69 years old, came to the clinic with complaints of deterioration in vision in the right eye (OD). From the anamnesis it is known that the complaints appeared a year ago, age-related cataract was diagnosed at the place of residence.

When examining visus OD: 0.1

With ultrasound biometrics OD: anterior chamber depth 3.14. The lens thickness is 4.37. The length of the anterior-posterior axis of the eye is 23.54 mm.

Keratometry OD: 42.63-93, 44.26-3.

Objectively: OD: the eye is calm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is clean, the pupil is round, diffuse clouding of the lens. There is no reflex from the fundus, IOP is normal by palpation. Deep-lying structures are not ophthalmoscoped.

According to the invention, a study of the central part of the fundus was carried out according to the proposed method, while introducing 0.9 ml of sterile air. When examining the central part of the fundus with an air lens in the macular area, solid white-yellow foci with clear contours are scanned, and when the left eye is moved to the right by 3 mm, a pale pink optic disc with clear boundaries is visualized.

Given the data of the examination of the fundus, we assume low visual functions. A consultation in the laser surgery department is recommended.

At discharge visus 0.4, IOP 17MMHg.

Claims (1)

A method for intraoperative examination of the central part of the fundus after phacoemulsification, including its examination by installing a microscope with coaxial illumination, characterized in that after removing the cloudy lens and before implanting the intraocular lens with a cannula from a syringe, an air lens is created by introducing sterile air into the anterior chamber of the eye into amount of 0.7 - 1.1 ml, after that, under the supervision of the surgeon, the patient is asked to take the right eye to the left or the left eye to the right to visualize the optic nerve head and fix the gaze on the light source to visualize the macular area.