RU2045944C1 - Device for implanting artificial crystalline lenses and intracapsular surgery of lens - Google Patents

Abstract

FIELD: medical engineering; ophthalmology. SUBSTANCE: this device is bent forceps having flat branches. Lower branch of forceps is thin-walled irrigation cannula having diameter of 0.6 to 0.7 mm and bulging portion at its end, which is truncated at its top by 1/4 of diameter of sphere having radius of 0.6 to 0.7 mm and irrigation opening of 0.2 to 0.3 mm in diameter in lower portion of sphere communicating with irrigation tube at nonworking end of forceps. Upper branch is shorter than lower one by 0.3 to 0.5 mm. EFFECT: more sophisticated design. 2 dwg

Description

 The invention relates to medicine, namely to ophthalmology, and is intended for implantation of an IOL and intracapsular lens surgery.

 A significant difficulty in the implantation of posterior chamber IOLs, in addition to atraumatic administration of optics, is the implantation of the upper supporting element into a capsular bag or ciliary groove. For this, thin blunt-pointed tweezers with smooth branches that capture the supporting element of the IOL are most often used. (Fedorov S.N. and Egorova E.V. Errors and complications during implantation of an artificial lens, M. 1992); Simcoe Current Concepts in Cataract Surgery Norwalk Forceps, 1984, p. 206-208; Kelman-Me Pherson tweezers (Stoez E 1815 AK catalog; Tennant tweezers. Harper catalog N H 40-331.

 However, these tweezers cannot be connected to the irrigation system, which often causes emptying of the anterior chamber and thereby increases the trauma of implantation and the risk of complications. In addition, sufficiently sharp thin branches of these tweezers can damage the back capsule during manipulations in the capsule bag, especially when emptying the anterior chamber.

 The possibility of using various hooks and manipulators for the IOL is significantly limited. (Fedorov S.N. and Egorova E.V. Errors and complications during implantation of an artificial lens. M. 1992, catalog of the company "Ketena" N K3-2720, catalog of the company "Storz" N SP 7-36431, catalog of the company "Harper" N H 30-310; catalog of the company "Visitec" N 1629, catalog of the company "Moria" N 12960, since it does not allow to securely fix the support element, as a result of which it may slip out of the manipulator when bent and inserted into the eye, especially in case of insufficient mydriasis, which requires repeated manipulations, increases the risk of complications and the morbidity of implantation despite the presence of oryh manipulators irrigation system. In addition, the use of the various hooks and manipulators is possible only with small loops on the support members of the IOL.

 Flat extension tweezers on jaws are convenient for capturing IOL optics, but do not give any advantages when fixing and implanting support elements: Shepard tweezers (Erbe catalog N 207 K3-960), straight Moria tweezers (Moria catalog "N 13233), Simcoe tweezers (" Current Concepts in Cataract Curgery ", Norwalk 1984, p = 206-208).

 For ease of fixation of support elements and their implantation in the posterior chamber or capsule bag, tweezers with jawbones curved downward at the ends diverging in a vertical plane are proposed (Bates. V. Cataract Refract. Surg. 1988, v. 14, p. 670-673) . However, it does not have an irrigation system and thin jaws bent down can damage the posterior lens capsule during manipulations, which is associated with dangerous complications.

 Tweezers for IOL implantation are proposed, similar in design to collet tweezers for external surgery (there are 1 or 2 movable branches in a thin tube that close at the ends when leaving the tube) without irrigation (Erbe catalog N 207 K3-363; catalog Storz firm N E 1961; Katena catalog N K5-8000) or with irrigation, which is fed through the same tube (Simcoe tweezers, Storz catalog N E 2977S).

 However, all of these tweezers have thin, fairly sharp jaws that can damage the back capsule during manipulation. In some of them, in addition, the ends of the branches are bent downwards (catalog of the Storz company N E 1961, N E 2977S, catalog of the company Hans-Geuder N G-19804, catalog of the company Katena N K5-8000). When using them, the same complications are possible as when using the described Bates forceps (Bates, J. Cataract Refract. Surg. 1988, v. 14, p. 670-673). When working with such tweezers, additional ineffective and sometimes even involuntary movements of the working parts are possible due to the fact that they are activated by a special mechanism (most often this or that type of lever).

 The very small size of the working parts of such devices does not contribute to reliable fixation of the support element, which can lead to its slipping and the need for repeated manipulations, thereby increasing the invasiveness of the operation. When using such devices, it is necessary to use two different tools for implanting the IOL optics and supporting elements, which creates inconvenience during implantation. In this regard, such tweezers are rarely used in the implantation of IOLs.

 The closest in technical essence and the achieved positive effect to the invention is the Sinskey Mc Pherson irrigation tweezers (Storz catalog N E 1815 AKW), which is tweezers bent at an obtuse angle with smooth branches, through one of which a thin irrigation tube is passed, connecting in the non-working part of the tweezers with an irrigation system and ending at the end of the jaw with a hole oriented in the plane of the jaw.

 With these tweezers, both optics and IOL support elements can be fixed when they are implanted in the posterior chamber or capsule bag. By supplying an irrigation solution during implantation, it is possible to maintain the depth of the anterior chamber without using an air bubble that impairs visual control of implantation and to fill the capsule bag by separating the flaps of the anterior and posterior capsules during intracapsular implantation of the IOL. In this case, it is advisable to orientate the tweezers so that the branch with the irrigation tube is lower. With the same tweezers, you can open or fix when scissors excise the flap of the front capsule with the endocapsule technique, introducing the irrigation jaw inside the capsule bag.

 However, the Sinskey-Mc Pherson tweezers are thin and have a sharp profile despite the polished surface, which can cause mechanical damage to the jaw of the posterior lens capsule, which can lead to severe surgical and postoperative complications (vitreous prolapse, retinal detachment, uveitis, macular edema areas, etc.) and makes it impossible or undesirable (if the posterior capsule ruptures without prolapse of the vitreous body) intracapsular implantation of the IOL. Similar damage to the posterior capsule can occur with the use of this forceps when removing the flap of the anterior capsule. One of the main requirements for instruments for intracapsular surgery is the rounded profile of the working part of the instrument inserted into the capsular bag or in contact with the posterior lens capsule.

 The purpose of the invention is to reduce the invasiveness of ocular tissues.

 This is achieved by the fact that the lower jaw of forceps for implantation of the IOL and intracapsular lens surgery is made in the form of a thin-walled irrigation cannula with a diameter of 0.6-0.7 mm with a thickening at the end in the form of a sphere truncated by 1/4 of the diameter of a radius of 0.6-0 , 7 mm and an irrigation hole with a diameter of 0.2-0.3 mm at the lower pole of the sphere, which is connected to the irrigation tube at the non-working end of the tweezers, and the upper jaw of the tweezers is 0.3-0.5 mm shorter than the bottom.

 In FIG. 1 shows the proposed device, a General view; in FIG. 2 working ends.

 Devices for implantation of the IOL and intracapsular lens surgery contain the lower jaw of 1 tweezers, the upper jaw of 2 tweezers (0.3-0.5 mm shorter than the lower), thickening 3 in the form of a sphere truncated by 1/4 of the diameter with a radius of 0.6-0 , 7 mm on the lower jaw, the irrigation hole 4 with a diameter of 0.2-0.3 mm and the irrigation tube 5. The irrigation tube is connected to the non-working end of the tweezers. In this form, the device is ready for use.

 The device operates as follows.

 With his leading hand, the surgeon holds the tweezers and fixes the working part of the IOL tweezers for a closed support element or for optics (if IOL implants with flexible support elements). With tweezers in the other hand, the surgeon slightly raises the corneal lip of the incision and, constantly supplying the amount of irrigation fluid necessary to fill the anterior and posterior chambers of the eye, introduces the lower supporting element and the IOL optics into the posterior chamber (into the capsular bag or ciliary groove). At the same time, good visual control of the IOL implantation is maintained, which is difficult to achieve when filling the anterior chamber with air. The fluid flowing through a downward-oriented opening primarily enters the posterior chamber of the eye during implantation, which ensures filling of the capsule bag, melting of the capsule flaps or enlargement of the posterior chamber during implantation into the ciliary groove, thereby reducing tissue trauma and the risk of complications.

 The constant supply of irrigation fluid during implantation facilitates all manipulations on the filled anterior chamber and the substantially equalized pressure in the anterior and posterior lens capsules. Filling the anterior chamber reduces trauma to the iris and endothelium of the cornea. The location of the irrigation hole at the lower pole of the sphere, unlike the Sinskey Me Pherson tweezers, which has an opening at the end of the jaw, virtually eliminates the entry of a liquid stream directly onto the endothelium, which reduces endothelial loss. The liquid supply through the lower jaw promotes the formation of a liquid layer between the IOL and the capsule, separates the capsule and the IOL, improves the sliding of the supporting elements and optics along the back capsule and, along with the thickening in the form of a truncated sphere, on the lower jaw prevents damage to the back capsule during the introduction of the optics and the lower supporting element. Filling the back chamber with liquid promotes a faster introduction of additional manipulations and thereby less traumatic pigment epithelium of the iris, the introduction of the lower support element into the ciliary groove during fixation of the IOL in the ciliary groove.

 With the introduction of the upper supporting element (closed or flexible), the surgeon fixes the supporting element with the proposed device and inserts it into the capsular bag or by the iris (when fixed in a ciliary groove). The flat inner surface of the jaw contributes to the reliable fixation of the support element, even when it is significantly bent in case of insufficient madriasis. In this case, the thickening on the lower jaw and the flow of fluid through the downwardly oriented opening help to prevent rupture of the posterior capsule and related complications. The upper jaw of the tweezers shortened by 0.3-0.5 mm does not protrude during implantation of the lower jaw with a spherical thickening, which prevents damage to the posterior capsule when the upper support element is inserted into the capsule bag.

 Tweezers can also fix the excised flap of the anterior lens capsule during surgery according to the endocapsular technique without IOL implantation. In this case, the supply of fluid through the lower jaw introduced into the capsular bag with a thickening prevents damage to the posterior capsule and ensures filling of the anterior chamber during excision of the anterior capsule.

 The radius of the spherical thickening at the end of the lower jaw less than 0.6 mm does not prevent rupture of the posterior capsule due to insufficient contact area of the lower jaw with the lens capsule. A radius of spherical thickening of more than 0.7 mm makes manipulation with the instrument less convenient and can increase the volume of irrigation fluid. The thickening of the elongated (olive-shaped) shape makes it difficult to manipulate, since when the upper supporting element is inserted, the pupil edge of the iris is pressed against the posterior capsule, which can prevent the upper supporting element from entering the upper capsular arch or ciliary groove and increase the duration and morbidity of the manipulations.

 A truncation of the spherical thickening on the lower jaw larger than 1/4 of the diameter contributes to a certain sharpening of the profile of the lower jaw, which is undesirable since it is associated with an increased risk of damage to the posterior capsule and corresponding complications.

 Jaws of the same length or shortening of the lower jaw by less than 0.3 mm increases the risk of damage to the posterior capsule of the upper thin jaw during manipulation in the capsule bag. Shortening the upper jaw by more than 0.5 mm complicates the manipulation of the introduction of the upper supporting element.

Bending Branche tweezers at an obtuse angle ^(about 135-150) in a vertical plane allows serried jaws administered into the eye in the horizontal plane, which is optimal when the manipulation of the lens capsule and IOL implantation.

 Clinical testing showed that as a result of the use of the device, a decrease in the invasiveness of the operation and a decrease in the number of complications, as well as facilitating manipulations inside the eye, especially in the capsule bag, were noted. Complications associated with the use of the device were not noted.

 When performing an operation using a viscoprotective endothelium, it is possible to supply the required volume of a viscoprotector through the lower jaw into the capsule bag and the anterior chamber.

 PRI me R 1. Patient B. 58 years old, the diagnosis of immature cataract of the left eye. Extracapsular cataract extraction (ECEC) was performed with IOL implantation according to the following procedure. The limbal incision is from 10 to 2 hours. The anterior horizontal capsulotomy is from 10 to 2 hours. The core has been removed. The remains of the lens masses were removed by irrigation-aspiration. An IOL was implanted inside the capsule bag (B.N. Alakseev model). The implantation was performed using the proposed device with a thickening on the lower jaw in the form of a sphere with a radius of 0.7 mm truncated on top by 1/4 of the diameter of the sphere with an irrigation hole of 0.3 mm at the lower pole of the sphere and shortened by 0.5 mm compared to the lower upper jaw . IOL is fixed at the upper edge of the optics. With a constant supply of irrigation fluid, the IOL is introduced into the capsule bag. The lower support element is fixed in the lower vault of the capsular bag. Then, the proposed device in the upper arch of the capsule bag implanted upper support element. Emptying the chambers of the eye during manipulations was not noted. Nodal sutures were imposed on the edges of the incision. In the postoperative period, no complications were noted. The patient was discharged on the 4th day with a visual acuity of 0.9.

 PRI me R 2. Patient K. 72 years old, the diagnosis of mature cataract of the left eye. ECEC was performed with IOL implantation using the following procedure. Paracentesis for 12 hours. A circular capsulotomy was made along the edge of the dilated pupil. Corneoscleral incision from 10 to 2 hours. The core is removed. The remains of the lens masses were removed by irrigation-aspiration. Two key joints were laid with a distance of 7 mm between them. An IOL was implanted with fixation in a ciliary sulcus (model M.L.Dvali) with 4 flexible support elements. Implantation was performed using the proposed device with a thickening on the lower jaw in the form of a sphere with a radius of 0.6 mm truncated on top by 1/4 of the diameter of the sphere with an irrigation hole with a diameter of 0.2 mm at the lower pole of the sphere and shortened by 0.3 mm compared to the lower upper jaws. IOL is fixed at the upper edge of the optics. With constant moderate flow of irrigation fluid, the IOL optics are inserted into the rear chamber, and the lower support elements are fixed below in the ciliary groove without any additional manipulations or rotational movements of the IOL. Then, the proposed device is alternately introduced for the iris (with a constant moderate flow of irrigation fluid), both upper supporting elements. Emptying of the anterior and posterior chambers during implantation was not noted. Nodal sutures were imposed on the edges of the incision. In the postoperative period, no complications were noted. The patient was discharged on the 4th day with a visual acuity of 0.8.

 PRI me R 3. Patient R. 64 years old, diagnosis: immature cataract of the left eye, aphakia of the right eye. Produced by ECEC according to the endocapsular method. The limbal incision is from 10 to 2 hours. The anterior linear horizontal capsulotomy is from 10 to 2 hours. The core is removed. The remains of the lens masses were removed by irrigation-aspiration. The flap of the front capsule with a constant supply of irrigation fluid is fixed by the proposed device with a thickening on the lower jaw in the form of a truncated sphere with a radius of 0.6 mm, an irrigation hole of 0.3 mm at the lower pole of the sphere and the upper jaw shortened by 0.4 mm compared to the lower , and after filling the capsular bag is excised in the pupil with blunt scissors. Nodal sutures were imposed on the edges of the incision. In the postoperative period, no complications were noted. The patient was discharged on the 4th day with a visual acuity of 0.8.

 Thus, the use of the proposed device for implantation of the IOL and intracapsular lens surgery reduces the invasiveness of the operation and reduces the number of complications.

Claims (1)

 DEVICE FOR IMPLANTING ARTIFICIAL CRYSTALS AND INTRICAPSULAR SURGERY OF THE CRYSTAL, consisting of curved tweezers with flat jaws and an irrigation connecting tube, characterized in that the lower jaw of the tweezers is made in the form of a thin-walled and 0.7 mm thick walled gauge 1/4 of the diameter of the sphere from above with a radius of 0.6 0.7 mm and an irrigation hole with a diameter of 0.2 0.3 mm at the lower pole of the sphere connecting to the irrigation tube at the non-working end of the tweezers, and the upper branch is shorter izhney 0.3 to 0.5 mm.

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