RU2801476C1 - Method of fixation of the lens capsule in case of zinn ligament defect - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: corneal paracentesis is formed, intraocular lens (IOL) is fixed using a straight suture needle with a loop. If there is a defect in the zonium ligament at 12 o'clock position and an intracapsular ring (ICR) is in the capsular bag, corneal paracentesis is formed at 6 o'clock position; to fix the IOL-capsular bag block, a loop is used, which is wound over the IOL. Then, 1.5 mm from the limbus at 12 o'clock position, a guide needle used to capture the loop is inserted transsclerally, passed under the ICR, and through the duplication of the lens capsule is removed into the anterior chamber. The suture needle is inserted into the lumen of the guide needle and brought out, thus forming a “cow hitch” knot on the ICR. The IOL is centered relative to the plane of the pupil. The free ends of the loop are fixed to the sclera with the help of a Z-shaped suture, the ends of which are immersed under the conjunctival flap.

EFFECT: method allows to obtain a stable clinical effect and minimize the risks of intra- and postoperative complications in patients with a defect in the ligamentous apparatus of the lens.

1 cl, 1 ex, 2 dwg

Description

The invention relates to ophthalmic surgery and can be used for intraocular lens (IOL) dislocation in patients with a defect in the ligamentous apparatus of the lens at 12 o'clock in the presence of an intracapsular ring (ICR) in the capsular bag.

Defects in the ligamentous apparatus of the lens can be due to a number of reasons, which include: the presence of pseudoexfoliation syndrome, high myopia, genetically determined diseases, and various consequences of traumatic exposure.

To date, there are many ways to reposition the IOL, each of which has its own advantages and disadvantages.

A known method of repositioning the IOL, in which the IOL block-capsular bag is centered and fixed by suture fixation of the ICL, wound to the equator of the bag between the capsule and the body of the lens, in the form of an open ring with holes at the ends. One of the ends is spirally bent inward, it is it that is fixed with a suture in the ciliary groove, where the middle of the defect of the ligamentous apparatus is projected (RF patent for invention No. 2375996).

The disadvantages are that the implementation of this method is traumatic, since before implantation of the ICC, it is necessary to separate the capsular bag from the anterior surface of the IOL and separate the anterior and posterior sheets of the capsule. Also, to perform this method, it is necessary to have in the arsenal, in addition to standard VKK tools, in the form of an open ring with one spirally bent end.

The closest analogue is the method of transscleral fixation of the posterior chamber intraocular lens, according to which two paracentesis are performed, a cow hitch is tied, only the loop is fixed, it is brought under the haptics, the loop is brought out through the paracentesis, then it is brought back into the eye chamber with a hook and then it is passed over the haptics, again removed through paracentesis (Can E. et al. Ab-interno scleral suture loop fixation with cow-hitch knot in posterior chamber intraocular lens decentration. Indian J Ophthalmol. 2016 Feb; 64 (2): 124-6 doi: 10.4103/0301-4738.179712).

The disadvantage of this method is the large number of manipulations performed, which makes it difficult to perform this fixation. This significantly increases the risk of intra- and postoperative complications.

The objective of the invention is to develop a reliable method for repositioning the IOL deployed together with the capsular bag, which initially contains the ICC, when the Zinn ligament fibers are torn off at 12 o'clock, by suture fixation of the IOL-capsular bag block to the sclera.

The technical result is to achieve a stable clinical effect and minimize the risks of intra- and postoperative complications.

The technical result is achieved as follows: the IOL-capsular bag block is fixed using a straight suture needle with a polypropylene 10/0 loop; for which a micro-incision of the conjunctiva and Tenon's membrane was previously performed, 5×5 mm in size, 2 mm from the limbus at 12 o'clock. A loop is inserted through the corneal paracentesis at 6 o'clock, which is placed over the IOL. At 1.3-1.5 mm from the limbus at 12 o'clock, a guide needle is inserted transsclerally, with the help of which the loop is captured, passed under the ICC and brought out through the duplication of the lens capsule into the anterior chamber; the suture needle is inserted into the lumen of the guide needle and brought out, thus forming a “cow hitch” knot on the ICC; center the IOL relative to the plane of the pupil; the free ends of the loop are fixed to the sclera by applying a Z-shaped suture, the ends of which are immersed under the conjunctival flap.

The method is carried out as follows.

If there is a defect in the ligamentous apparatus of the lens at 12 o’clock and ICC in the capsular bag, standard processing and delimitation of the surgical field under local anesthesia are performed, a micro-incision of the conjunctiva and Tenon’s membrane is performed 5 × 5 mm in size 2 mm from the limbus at 12 o’clock, corneal paracentesis is formed at 6 hours. To fix the IOL-capsular bag block, a straight suture needle with a polypropylene 10.0 loop is used. Through paracentesis of the cornea at 6 o'clock, a loop is introduced, which is wound over the IOL with a spatula. At 1.3-1.5 mm from the limbus at 12 o'clock, a 27G guide needle is inserted transsclerally, with which the capsular bag is pierced on the periphery while capturing the suture loop.

A suture needle is inserted through paracentesis at 6 o'clock into the lumen of the guide needle and brought out, thus forming a "cow hitch" directly on the ICC. The IOL is centered relative to the plane of the pupil, followed by fixation of the thread to the sclera by applying a Z-shaped suture, the ends of which are immersed under the conjunctival flap.

The method is illustrated by figures 1-2, figure 1 shows the formation of a "cow hitch", using a suture needle with a loop and a guide needle 27G, figure 2 - formed "cow hitch".

Position 1 indicates the block IOL-capsular bag; 2 - VKK; 3 - guide needle 27G; 4 - loop of a suture needle; 5 - suture needle; 6 - corneal paracentesis at 6 o'clock, 7 - formed "cow hitch".

The invention is confirmed by the following example.

Example 1

Patient A. 71 years old. He went to the clinic with complaints of decreased vision in the right eye. From the anamnesis of the disease, it is known that five years ago the patient underwent phacoemulsification of a cataract in the right eye with implantation of an IOL and an intracapsular ring.

The results of the examination before the operation:

VisOD=0.07 sph -3.0D; cyl -2.0Dax 90°=0.5.

IOP OD (according to Maklakov)=17 mm Hg.

0D: the eye is calm, the cornea is transparent, the anterior chamber is of medium depth, the moisture is transparent, the iris is subatrophic, pseudoexfoliation along the edge of the pupil, iridodonesis, monoblock IOL made of hydrophobic acrylic SA60AT + 22.0D (Alcon, USA) with a capsular bag decentered downwards due to a Zinna defect ligaments at 12 o'clock; fundus of the eye: destruction of the vitreous body, the optic disc is pale pink, its boundaries are clear, the retinal vessels are narrowed, the macular zone is without gross pathology.

The patient underwent surgery according to the proposed method: OD - reposition dislocated block IOL-capsular bag with fixation to the sclera. The operation and postoperative period proceeded without complications. Visual acuity at discharge on the 2nd day after surgery - 0.7 without correction due to concomitant dystrophic changes in the fundus. Visual acuity did not change throughout the entire period of observation, intraocular pressure remained compensated for the entire period of observation of the patient.

Claims (1)

A method for fixing the lens capsule in case of a zinn ligament defect, including the formation of corneal paracentesis, fixation of an intraocular lens (IOL) using a straight suture needle with a loop, characterized in that in the presence of a zinn ligament defect at 12 o'clock and an intracapsular ring (ICR) in the capsular bag, corneal paracentesis is formed for 6 hours; to fix the IOL-capsular bag block, a loop is used, which is wound over the IOL; then, at 1.5 mm from the limbus at 12 o'clock, a guide needle is inserted transsclerally, with which the loop is captured, passed under the ICC and brought out through the duplication of the lens capsule into the anterior chamber; the suture needle is inserted into the lumen of the guide needle and brought out, thus forming a “cow hitch” knot on the ICC; center the IOL relative to the plane of the pupil; the free ends of the loop are fixed to the sclera by applying a Z-shaped suture, the ends of which are immersed under the conjunctival flap.