RU2139018C1 - Method for performing secondary implantation of posterior chamber intraocular lens with penetrating keratoplastic repair - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves implanting intraocular lens with circular bearing members and binding it to at two-three point to posterior iris surface. Bearing members diameter is equal to 7-8 mm. The intraocular lens is fixed between the greater and lesser arterial circles of the iris. The intraocular lens is hold in the posterior chamber using safety encircling suture after removing corneal disk at the moment of suture fixation. EFFECT: enhanced effectiveness of treatment; high reliability of lens fastening.

Description

 The invention relates to medicine, namely to ophthalmology, and may find application in the surgical treatment of aphakia in cases of complete or significant absence of an posterior lens capsule in area during simultaneous corneal transplantation. Full rehabilitation of patients with post-traumatic or postoperative aphakias is difficult to achieve without implantation of an intraocular lens (IOL).

 World experience of ophthalmic IOL in the posterior chamber of the eye, and with a capsule bag intact. These ways of IOL implantation seem to be the most physiological, allowing to significantly reduce the frequency of complications (bullous keratopathy, iridocyclitis, etc.), characteristic for anterior chamber and intrapupillary IOL fixation. The posterior chamber fixation of the lens is especially important during simultaneous end-to-end corneal transplantation and IOL implantation due to the fact that intra- and postoperative trauma of the very vulnerable corneal transplant endothelium is excluded, leading to the development of bullous keratopathy. This intervention is greatly facilitated by the presence of a fully or partially preserved capsule bag. The most difficult is the IOL implantation in the aphakic eye with significant damage to the posterior lens capsule and the anterior vitreous membrane. In these cases, the fixation of the IOL into the ciliary sulcus appears unreliable due to the high probability of the dislocation of the lens, up to dislocation into the vitreous body. There is a method of posterior chamber implantation of IOL with ruptures or absence of the posterior lens capsule, carried out simultaneously with through keratoplasty (SCR) - a method of suture fixation of the posterior chamber IOL to the posterior surface of the iris with simultaneous SCP. The first report in our country about posterior chamber implantation of IOL with suture fixation to the posterior surface of the iris in patients with post-traumatic / postoperative bullous keratopathy at the same time with through keratoplasty was made by M. M. Krasnov and A. A. Kasparov. at the V Congress of Ophthalmologists of Ukraine. The method of IOL fixation in the posterior chamber of the eye, combined with anterior vitrectomy and iridoplasty, proposed by the authors reliably excluded intra- and postoperative trauma of the vulnerable endothelium of the transplant, contributing to an increase in its survival. The disadvantage of this technique is that they implanted an IOL of the Saturn model, the standard diameter of the circular supporting elements of which was 10.5 mm. Anatomically, along this diameter of the supporting elements of the IOL, a large circle of blood circulation and the adjacent ciliary processes correspond in the iris. With suture fixation of such a lens to the posterior surface of the iris, there is a rather high risk of damage to the ciliary processes and the large circle of blood circulation of the iris at the time of hemming of the lens, followed by bleeding into the vitreous body and the development of hemophthalmus. In addition, difficulties with hemming and centering of the lens are aggravated under conditions of collapse of the eyeball, which often develops after trepanation of the cornea in the eyes, where the trauma was accompanied by loss of the vitreous body earlier.

 The technical result achieved by the invention is to increase the stability of the IOL in the eye, its reliable fixation, avoiding dangerous complications, such as dislocation of the lens, bleeding from the large circle of blood circulation of the iris and ciliary processes. In addition, the center of the IOL is much easier and trauma to the endothelium of the corneal transplant of the IOL and its supporting elements is excluded.

 The technical result is achieved by the method of fixing the IOL of the Saturn type in the aphaktic eye with the complete or significant area absence of the posterior lens capsule, carried out in combination with through keratoplasty, which implies the implantation of the IOL with circular supporting elements (of the Saturn type) with their subsequent fixation in two - three points to the posterior surface of the iris, while IOL is implanted with a diameter of 7-8 mm together with supporting elements, the IOL is fixed in the area between the large and small circles of blood circulation of the iris. In this case, excision of the disk of the affected cornea of the patient, the IOL is held in the posterior chamber using a temporary girdle suture.

 The method is as follows: treatment of the surgical field is usual, akinesia, anesthesia with 2% novocaine solution. The upper and lower rectus muscles are taken on the frenum. Make a trepanation of the cornea with a trepan and with the help of corneal scissors, they cut out the corneal disk. In case of presence, the anterior chamber or iris-clips are removed. They produce economical vitrectomy and basal iridactomy in 2-4 sectors to avoid pupillary block. A lens of the "Saturn" type, with a diameter of 7.6-8.5 mm along with supporting elements, is prepared for implantation. In order to prevent the IOL luxation in the vitreous body during implantation, one safety shingles 8/0 are placed on the IOL, which is held by an assistant during the establishment and fixation of the IOL in the posterior chamber. The circular support element is fixed to the iris with one synthetic nodal suture along the radius of 6 hours and two nodal at 10 and 13 h 8 / 0-10 / 0. Remove the safety shingles. The anterior chamber is filled with a viscoelastic graft and fixed with 4 nodal and one continuous synthetic sutures. Bridle sutures from the rectus muscles are removed. Under the conjunctiva, injections of antibiotic and dexazone solutions were made, a binocular bandage was applied.

 Clinical example. Patient L-s V.V., born in 1922. Medical history N 144 \ 93. In 1988, cataract extraction with the implantation of iris-clip lenses was performed on the right eye (U). In the postoperative period, six months later, bullous keratopathy developed in O.

 Consulted at the Research Institute of GB RAMS 3.02.93

 On examination 02/03/93

 Visual acuity: O = hand movement in the face.

 OC = 0.2 is not corrected.

 With biomicroscopy, OD: the surrounding tissue is not changed. The conjunctiva is calm. The cornea is cloudy, swollen, pronounced degree of bullous keratopathy. The anterior chamber of medium depth and details of the structures of the anterior chamber cannot be considered due to insufficient transparency of the cornea.

 Diagnosis: OD-bullous keratopathy.

 Artifakia. OC is an immature cataract.

 02/03/93, on OD, the operation was performed according to the method described above - secondary implantation by the posterior chamber of the IOL with its fixation to the posterior surface of the iris in combination with through keratoplasty. A cloudy edematous corneal disk and irisclips lens were removed, and an economical vitrectomy was performed. Basal iridectomy in 4 sectors and iridoplasty (the pupil is narrowed with two sutures). An IOL of the Saturn model with a diameter of supporting elements of 8 mm was inserted into the back chamber using a girdle safety seam, then centered and fixed to the iris with three interrupted sutures (for 6.10, 13 h). The disk of a fresh donor cornea is strengthened by 4 nodal and one continuous suture.

In a month (03.03.93 g.)
Visual acuity OD = 0.1 (0.2) not corr. The eye is calm, the corneal transplant is transparent, fixed with a continuous nylon suture. Front camera of medium depth. The pupil with a diameter of 4 mm, the correct form, the position of the IOL is central.

A year later (March 6, 94)
Visual acuity OD = 0.5 (0.6) s corr. Spheres. - 1, OD. He reads newspaper font freely. The eye is calm. The corneal transplant is transparent.

 The advantages of the method. Secondary implantation of the posterior chamber IOL in combination with UPC according to the proposed method was carried out in 60 patients aged 5 to 75 years with severe outcomes (cataracts on artifact and aphakic eyes) of traumatic, inflammatory, dystrophic nature, as well as the state after keratoplasty, which ended in clouding transplant.

 Saturn-type IOL was implanted to all patients, the distinguishing feature of which is that the diameter of its supporting elements is 7-8 mm. Prior to this intervention, visual acuity ranged from light perception to a few hundredths. In the postoperative period, a year later, visual acuity in 45 out of 60 patients increased and was in the range of 0.05-0.8. Neva visual acuity was associated with the effects of eye damage, such as macular degeneration, optic nerve atrophy, vitreous clouding, retinal detachment, glaucoma, expressed by postoperative astigmatism or transplant clouding. It should also be noted that in all patients with a follow-up period of 5 years or more, lens dislocation did not occur.

Claims (1)

 A method for secondary implantation of a posterior intraocular lens in the aphakic eye with a complete or significant area absence of the posterior lens capsule, carried out in combination with through keratoplasty, which implies the implantation of an intraocular lens with circular support elements of the Saturn type with their subsequent fixation in two or three points to the back the surface of the iris, characterized in that they implant an intraocular lens (IOL) with a diameter of circular supporting elements of 7-8 mm, fixing the IOL to the back surface of the irises and in the area between the large and small circles of blood circulation of the iris with the preliminary formation of 2-4 basal colobas, while after removing the corneal disc at the time of suture fixation, the IOL is held in the posterior chamber using a temporary safety girdle.