RU2102952C1 - Pupil dilation method useable in ophthalmic surgical operations - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing ring into the anterior chamber of the eye in the pupil zone. The ring is produced from material having swelling ability and groove running along the outer edge where pupil-adjacent edge of the iris is fixed. Groove size is to correspond to iris thickness on its pupil-adjacent edge. EFFECT: earlier restoration of vision function.

Description

 The invention relates to medicine, namely to ophthalmology and can be used in surgical operations, the implementation of which requires the expansion of the pupil if it is impossible to achieve drug mydriasis.

 A known method of dilating the pupil during ophthalmic surgery, including mechanical expansion of the pupil by introducing a ring of flexible elastic material into the anterior chamber in the pupil region [1].

 The objective of the invention is to develop a more effective and safe way to expand the pupil during ophthalmic surgery.

 The technical result is achieved by the fact that in the method of dilating the pupil during ophthalmic surgery in the anterior chamber of the eye, a ring is made into the pupil region made of a material having a swelling property and provided with a groove along the outer edge, in which the pupil edge of the iris is fixed, while the dimensions of the groove correspond to the thickness of the iris along its pupil edge.

 The outer diameter of the ring is 3.5 - 5.0 mm (depending on the initial pupil diameter), the thickness is not more than 1.0 mm. The swelling of the material from which the ring is made is accompanied by an increase in the diameter of the ring and, consequently, expansion of the pupil.

 Swirling polymers and copolymers of acrylic and vinyl series, for example, polyvinylpyrrolidone, poly-2-hydroxyethylmethacrylate-poly-vinylpyrrolidone copolymer, can be used to make the ring.

 The method is as follows.

 After akinesia and anesthesia, a corneo-scleral incision is performed, with a length of at least 3.0 - 3.5 mm. A ring with a groove is inserted into the anterior chamber of the eye with tweezers, in which the pupil edge of the iris is fixed. The material from which the ring is made gradually swells, its diameter increases to 7.5 - 8.0 mm, the pupil expands. Cataract extraction is performed and an intraocular lens is implanted, after which the ring is removed from the anterior chamber of the eye, the pupil narrows and sealing sutures are applied.

 Example. Patient K., 62 years old. Diagnosis: OD complicated cataract, operated on open-angle glaucoma. Oh - healthy.

 Visual acuity: OD - 0.05, 0 - 1.0.

Ophthalmometry: OD 5 - 40.50 Dptr 95'- 41.50 Dptr
Eye length: 23.37 mm.

The density of endothelial cells: OD = 2820 cells / mm ² .

 The patient was offered cataract phacoemulsification with implantation of an intraocular lens on his right eye. Due to the presence of fusion of the pupil edge of the iris and the anterior capsule of the lens, medication mydriasis was not achieved.

 After carrying out akinesia and anesthesia with a 2% solution of lidocaine, an eyelid expander is applied and the upper rectus muscle is taken on a sting. The conjunctiva incision along the limb in the upper half of the eyeball, the conjunctiva is separated towards the upper arch, the sclera is exposed. Hemostasis is carried out by a bipolar coagulator. Section of the sclera by 2/3 of a thickness of 1.5 mm from the limb. The sclera is stratified by a diamond blade towards the center of the cornea with the formation of a tunnel. The anterior chamber is opened through the scleral tunnel with a spear-shaped knife. The synechia of the pupil is separated by a spatula, a 1% mesatone raster is introduced into the anterior chamber of the eye, but the pupil has not expanded. A ring with a diameter of 3.5 mm was implanted through the incision into the anterior chamber of the eye with a groove along the outer edge, the pupil edge of the iris is fixed in the groove. After 1 minute, the ring increased in diameter to 7.5 mm, thereby expanding the pupil. The front lens capsule was opened with a cystotome, the nucleus was removed by the tip of the phacoemulsifier, the lens masses were aspirated, an intraocular lens with an optical power of 21.0 Dptr was implanted. The ring fixing the pupil in the expanded state is removed, the pupil narrowed spontaneously. The incision is stitched. The operation ended with subconjunctival administration of an antibiotic solution.

 Visual acuity without correction for 1 day after surgery was 0.7. The loss of endothelial cells 1 month after surgery was 9%, which indicates the safety of this method.

 Using the proposed method for pupil dilatation during an ophthalmological operation allows to avoid such intraoperative complications as ruptures of the sphincter of the pupil, bleeding from the iris, incomplete evacuation of the lenses, ruptures of the posterior capsule of the lens, trauma to the corneal endothelium, thereby reducing the number of postoperative complications and lead to earlier recovery in patients with visual functions.

Claims (1)

 A method of expanding a pupil during ophthalmic surgery, including mechanical expansion, in which a ring is introduced into the pupil’s area in the anterior chamber of the eye, characterized in that the ring is made of material having a swelling property and provided with a groove along the outer edge in which the pupil edge is fixed iris, while the dimensions of the groove correspond to the thickness of the iris along its pupil edge.