RU202658U1 - CANNULA FOR REMOVING SILICONE OIL FROM THE VITREAL EYE CAVITY THROUGH THE BACK CAPSULOREXIS - Google Patents

Abstract

The utility model relates to medicine, namely ophthalmosurgery, and can be used to remove light silicone oil of increased viscosity, for example OXANE 5700, after the cataract phacoemulsification stage. A cannula for removing silicone oil through the posterior capsulorhexis from the vitreous cavity of the eye consists of body 1 and connected to it is a hollow tube 2. The distal end of the tube has a bend along a radius of 6.0 mm, the working end of the tube has a cut at an angle of 45 degrees, the cut edges are blunt and have a conical expansion. The declared design of the cannula makes it possible to simplify the procedure for removing silicone oil, to reduce the operating time, improve visual control and reduce trauma to eye tissue. 2 ill.

Description

The utility model relates to medicine, namely ophthalmic surgery, and can be used to remove light silicone oil (LSM), for example OXANE 5700, after the cataract phacoemulsification stage.

Tamponade of the vitreous cavity of LSM is widely used in the treatment of retinal detachments. Silicone oil, being in the vitreous cavity, undergoes emulsification over time, with the formation of many free small drops. In addition, the contact of LSM with the posterior capsule of the lens can cause opacification of the latter, which is an indication for combined surgical treatment: phacoemulsification of cataract and removal (extraction) of silicone oil.

Traditionally, LSM removal is performed through two ports with a diameter of 23 or 25 Ga (gauge) installed with trocars through a puncture of the conjunctiva, sclera and choroid in the projection of the flat part of the ciliary body. Through one port, fluid is irrigated (supplied) into the vitreous cavity, through the second port, LSM is actively aspirated, replacing the oil with a balanced saline solution (Microsurgery of the vitreous body and retina: an illustrated guide / Steve Charles, Jorge Calzada, Byron Wood; translated from English .; under the editorship of Prof. A.N.Samoilov. - M .: MEDpress-inform, 2012. - S. 110-111).

One of the disadvantages of removing LSM through the scleral approach is a low degree of visual control over the remaining drops of oil during its emulsification.

To remove silicone oil (SM), various cannulas of larger or smaller diameter can be used (Makhrunenko A.M., RF Patent No. 2702302 dated 02.10.2019, Bulletin No. 28: "Cannula for removing residual silicone oil").

There is another way to remove CM through posterior capsulorhexis after cataract phacoemulsification (Yu-Cheng Zhu, Dong-Qing Yuan, Ping Xie et al // Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation // Int. J. Ophthalmol. - 2017. - Vol. 10, No. 11. - p. 1693-1697). Phacoemulsification is performed using the traditional method through a 3.0 mm corneal incision, then posterior capsulorhexis with a diameter of 2.5-3.5 mm is performed using forceps for capsulorhexis. For infusion (irrigation), a 22-gauge intravenous needle with an illuminator is inserted into the corneal paracentesis and connected to a balanced saline solution. As a suction cannula, a 20-gauge intravenous catheter without a needle is used, connected to a vitrectomy system, a negative vacuum level of 500 mmHg. The infusion is carried out into the anterior chamber of the eye. Oil removal is performed through the posterior capsulorhexis.

The disadvantages of this method are the use of instruments that are not intended for ophthalmic surgery (intravenous catheter, intravenous needle), which can damage the capsule bag. The second negative point is the supply of irrigation fluid into the anterior chamber of the eye, which makes it difficult for it to enter the posterior chamber of the eye.

The closest (prototype) is a cannula with catalog number M980.8 produced by OOO Medin Ural for removing silicone oil through a scleral incision in the projection of the flat part of the ciliary body. As a working part, a hollow tube with a diameter of 18 gages is used, the cannula is straight, the distal end of the cannula has a cut at an angle of 30 degrees, the edge is sharpened, the length of the working part is 8 mm. On the other hand, the tube is connected to the cannula body by crimping. The cannula body has a Luer landing cone (product catalog on the website http://www.medin-ural.ru).

Currently, such a cannula is not used in wide clinical practice, given its large diameter, which requires a larger incision of the conjunctiva, sclera and choroid and increases tissue trauma and suture sealing.

The objective of the invention is to develop a special cannula for removing silicone oil through the posterior capsulorhexis from the vitreous cavity of the eye.

The technical result that will be obtained from the use of the proposed cannula will simplify the procedure for removing silicone oil, reduce the operating time, provide visual control, and reduce trauma to the tissues of the eye.

The technical result is achieved by the fact that in the cannula for removing silicone oil through the posterior capsulorhexis from the vitreous cavity of the eye, including the body and the hollow tube connected to it, the distal end of the tube has a bend along a radius of 6.0 mm, the working end of the tube has a cut at an angle of 45 degrees , and the edges of the cut are made blunt and have a conical expansion.

The essence of the utility model lies in the design of the cannula.

Execution of the distal end of the tube with a bend along a radius of 6.0 mm, the working end of the tube with a cut at an angle of 45 degrees, the cut edges are blunt and with a conical expansion, allows with the least trauma for the corneal incision and the posterior lens capsule to insert the cannula into the vitreous cavity of the eye and remove silicone oil after the stage of phacoemulsification of the cataract through the corneal incision and posterior capsulorhexis. In this case, the corneal incision does not require suture sealing. All stages of the operation with such a cannula are performed under visual control over the removal of oil. The surgeon can, if necessary, reduce the vacuum parameters during aspiration of oil, especially at the stage of removing its final portion, which is important for the prevention of collapse of the eyeball, as well as for a more thorough removal of emulsified drops of small diameter oil, which cannot be done without visual control.

Thus, there is a causal relationship between the set of essential features and the achieved result.

From the analysis of scientific, technical and patent literature, we did not find a similar constructive implementation of devices for removing silicone oil through the posterior capsulorhexis, which allows us to conclude that the proposed technical solution meets the criteria of "novelty" and "industrial applicability".

The utility model is illustrated by the following figures, where

in fig. 1 shows a general view of a cannula for removing silicone oil;

in fig. 2 shows the technique for removing silicone oil through the posterior capsulorhexis.

The cannula consists of a body 1 and a hollow tube 2 connected to it by crimping. The distal end of the tube has a bend along a radius of 6.0 mm, the working end of the tube has a cut at an angle of 45 degrees, the cut edges are blunt and have a conical expansion (see Fig. one).

The utility model is implemented as follows.

Indications for use are cataract against the background of tamponade of the vitreous cavity of the CM, accompanied by either clouding of the posterior capsule of the lens, or the presence of silicone oil in the space between the posterior capsule of the lens and the anterior hyaloid of the vitreous body, or increased emulsification of the CM.

Previously, the body (1) of the cannula is connected to the syringe (3). After that, an irrigation port (4) of 25 gage is installed 3-4 mm from the limb.

Cataract removal is performed through a 2.2 mm corneal incision (9), through which viscoelastic is introduced into the anterior chamber (5) of the eye, anterior (6) capsulorhexis is performed in the anterior lens capsule, phacoemulsification of cataracts, then posterior capsulorhexis in the posterior lens capsule (7) with a diameter of not more than 2.5 mm, after which the silicone oil (8) is removed through the incision of the cornea (9) and posterior capsulorhexis (7) by aspiration through the working end of the cannula tube (2) under visual control using a linear vacuum up to 600 mm Hg. Art. The working end of the tube (2) has a cut at an angle of 45 degrees, the cut edges are blunt and have a conical expansion. The diameter of the hollow tube is 18 Ga.

Clinical example. Patient T., born in 1969, was admitted on March 16, 2020 with a diagnosis of Complicated cataract of the right eye, avitria, condition after microinvasive vitrectomy, tamponade of the vitreous cavity with silicone oil. Myopia 3 degrees of both eyes. On examination, the anterior chamber is deep, the nucleus is cloudy, visual acuity is 0.05. On 17.03.20 the operation was performed. Local anesthesia. A 2.2 mm tunnel cut is made (9). Viscoelastic is introduced into the anterior chamber (5). Anterior circular capsulorhexis (6) is performed, ultrasonic phacoemulsification of cataract, aspiration of lens masses is performed. Viscoelastic is injected into the anterior chamber and capsule bag. A port (4) is installed 3-4 mm from the limbus with an irrigation line and a balanced saline solution supply to the posterior chamber of the eye. Collet tweezers perform posterior capsulorhexis (7) with a diameter of 2.5 mm. A cannula is inserted through the corneal incision (9) and posterior capsulorhexis (7) to remove the silicone oil into the vitreous cavity of the eye. Silicone oil is removed by aspiration (8). An intraocular lens is implanted with a force of 5 diopters. Remove viscoelastic. The incision is sealed by hydrating the corneal stroma. After removal of the port, a 10/0 suture is applied to the sclerotomy opening. The operation is over. At discharge on 20.03.20, the visual acuity of the right eye with correction was 2.5 diopters 0.5.

Using this design (cannulas for removing silicone oil through the posterior capsulorhexis from the vitreous cavity of the eye), 17 similar operations were performed in the Sverdlovsk Regional Clinical Hospital No. 1.

The advantages of the inventive cannula with a prototype cannula are shown in Table 1.

As can be seen from the table, the claimed design reduces trauma to the eye tissues, provides good visual control during the operation, and reduces the time for removing silicone oil and its residues by 2-3 times.

Claims (1)

A cannula for removing silicone oil through the posterior capsulorhexis from the vitreous cavity of the eye, including a body and a hollow tube connected to it, characterized in that the distal end of the tube has a bend along a radius of 6.0 mm, the working end of the tube has a cut at an angle of 45 degrees, the cut edges are made blunt and have a conical extension.

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