RU2844259C1 - Method of intraoperative increase of depth of anterior eye chamber - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. Cataract phacoemulsification is performed with intraocular lens implantation. Under local anaesthesia, toothed forceps are used to grasp episclera through conjunctiva at 6-7 mm from a limb in a projection of an external eye muscle. Back-and-forth movements are performed with span of 30-35 degrees from place of capture of conjunctiva with repetition of 3-4 times, then the main access and paracentesis are made at the second stage, bent spatula is introduced into anterior chamber to surface of crystalline lens, making oscillatory movements.

EFFECT: method increases space for manipulations, provides reduction of pupillary block, anatomical restoration of eye structures, reduces probability of occurrence of mechanical damages and postoperative complications, provides the fast rehabilitation period and improves quality of life of the patient.

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Description

The proposed invention relates to medicine, namely to ophthalmology, and can be used for intraoperative increase in the depth of the anterior chamber as a means of stopping pupillary block and in planned surgical intervention in patients with hyperopia accompanied by posterior vitreous detachment (PVD).

Pupillary block is diagnosed based on a combination of ultrasound biomicroscopy (UBM) and ultrasound scanning (B-scan) and is characterized by abnormal production and accumulation of fluid in the posterior segment of the eye, thereby creating increased pressure and occlusion, pressing the lens against the root of the iris with the formation of planar synechiae.

The small anterior chamber of the eye during cataract extraction makes it difficult for the surgeon to perform manipulations, which results in mechanical damage to the corneal epithelium, leading to postoperative complications: swelling, opacities and the formation of corneal leukoma.

A method for increasing the depth of the anterior chamber by implanting a drain that ensures the outflow of intraocular fluid from the anterior chamber into the sclera is known (Patent of the Russian Federation No. 2107481). However, this method is difficult to implement.

There is also a known method of increasing the depth of the anterior chamber in patients with a shallow anterior chamber using dosed partial removal of the vitreous body with simultaneous supply of fluid to the anterior chamber (Patent of the Russian Federation No. 2271787). The disadvantage of this method is the complexity of dosing the vitreous body and the risk of expulsive hemorrhage, the likelihood of damage to the posterior capsule of the lens.

The objective of the invention is to develop an effective method for intraoperative increase in the depth of the anterior chamber of the eye in patients with an anatomically shallow anterior chamber during planned surgical intervention and for the purpose of stopping pupillary block.

The technical result is an increase in the space for manipulation, relief of pupillary block, anatomical restoration of eye structures, a decrease in the likelihood of mechanical damage and postoperative complications, a quick rehabilitation period and an improvement in the patient's quality of life.

The technical result is achieved as follows: intraoperatively, after installing the eyelid speculum, under local anesthesia, the episclera is grasped with serrated tweezers through the conjunctiva 6-7 mm from the limbus in the projection of the external eye muscle. Reciprocating movements are performed with a range of 30-35 degrees to the left and right sides from the place of conjunctiva grasp, repeated 3-4 times.

A sharp rotation of the eyeball leads to the separation of the vitreocrystalline synechiae and the posterior displacement of the lens and iris under their own weight and tension and the exit of the liquid portion of the vitreous body fraction from the posterior chamber into the anterior chamber of the eye.

After performing rotational movements, an increase in the depth of the anterior chamber is observed, which is determined visually.

After deepening the anterior chamber, the second stage involves performing primary access and paracentesis. A curved spatula is inserted into the anterior chamber and the lens surface is stepped on, performing oscillatory movements to maximize fluid movement into the anterior chamber. Next, cataract phacoemulsification is performed with implantation of an intraocular lens (IOL) using standard technology.

The method is illustrated with clinical examples.

Example 1

A 60-year-old female patient came to the MNTK complaining of low vision in the right eye (OD). History: farsightedness since childhood.

During examination Vis OD = 0.2 n/c. Intraocular pressure (IOP) 22 mm Hg (pneumometry).

Objectively: OD: The eye is calm. The cornea is transparent, the anterior chamber is 1.1 mm, the aqueous humor is transparent, the pupil is round, 3.0 mm in diameter. The lens is cloudy in the nuclear and cortical layers. The underlying structures are not ophthalmoscoped.

Before performing cataract phacoemulsification, in accordance with the above description, having grasped the episclera through the conjunctiva with tweezers 6 mm from the limbus in the projection of the external eye muscle, we performed rapid reciprocating movements with a 30-degree swing from the place of conjunctiva grasp, repeating 3 times, as a result of which the anterior chamber deepened to 3 mm. The second stage included the main access and paracentesis. A curved spatula was inserted into the anterior chamber and stepped on the surface of the lens, performing oscillatory movements in order to maximally move the fluid into the anterior chamber of the eye. After that, the patient underwent cataract phacoemulsification with subsequent implantation of an intraocular lens.

The next day Vis OD = 0.7, IOP OD = 17 mmHg (pneumotonometry).

Objectively: OD: The cornea is transparent, the anterior chamber is 3 mm, the aqueous humor is transparent, the pupil is round, 3.0 mm in diameter. The IOL in the capsular bag is in the correct position. The optic disc is pale pink, the borders are clear, the macular area is unremarkable. The patient was discharged from the hospital.

Example 2

A 68-year-old patient came to the Scientific and Technical Complex with complaints of low vision in the left eye (OS). History: farsightedness since childhood.

During examination Vis OS = 0.3. Intraocular pressure (IOP) 20 mm Hg (pneumometry).

Objectively: OS: The eye is calm. The cornea is transparent, the anterior chamber is 1.3 mm, the aqueous humor is transparent, the pupil is round, 3.0 mm in diameter. The lens is cloudy in the nuclear and cortical layers. Deeper structures are not ophthalmoscoped.

Before performing cataract phacoemulsification, in accordance with the above description, having grasped the episclera through the conjunctiva with tweezers 7 mm from the limbus in the projection of the external rectus muscle, sharp reciprocating movements were performed with a swing of 35 degrees to the left and right sides from the place of grasping 4 times, as a result of which the anterior chamber deepened to 3.3 mm. Then the main access and paracentesis were performed. A curved spatula was inserted into the anterior chamber and stepped on the surface of the lens, performing oscillatory movements in order to move the fluid into the anterior chamber of the eye as much as possible. Subsequent stages of cataract phacoemulsification with implantation of an intraocular lens were performed using standard technology.

The next day Vis OS = 0.6 n/c, IOP OS = 18 mm Hg (pneumotonometry).

Objectively: OS: The cornea is transparent, the anterior chamber is 3 mm, the aqueous humor is transparent, the pupil is round, 3.0 mm in diameter. The IOL in the capsular bag is in the correct position. The optic disc is pale pink, the borders are clear, the macular area is without features. The patient was discharged from the hospital.

Claims (1)

A method for intraoperative increase in the depth of the anterior chamber of the eye, including performing cataract phacoemulsification with implantation of an intraocular lens, characterized in that under local anesthesia, the episclera is grasped with serrated tweezers through the conjunctiva 6-7 mm from the limbus in the projection of the external eye muscle, reciprocating movements are performed with a span of 30-35 degrees from the place of conjunctiva capture with a repetition of 3-4 times, after which the main access and paracentesis are performed in the second stage, a curved spatula is inserted into the anterior chamber to the surface of the lens, performing oscillatory movements.