RU2149613C1 - Method for extracting cataract with artificial eye lens implantation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves individually determining power of lens nucleus phacoemulsification for every patient before extracting cataract. Metal rod is introduced into the lens nucleus connected to ultrasonic end piece of phacoemulsifier. Ultrasound power is smoothly incremented until the nucleus center is reached. The rod is taken off. Phacoemulsification is carried out with the power obtained. EFFECT: provided safety of intraocular structures.-

Description

 The invention relates to medicine, namely to ophthalmology, and can be used for cataract extraction by phacoemulsification and implantation of an artificial eye lens.

 A known method of cataract extraction with implantation of an artificial lens of the eye (G. Pirazzoli et al. Effect of phacoemulsification time on the eorneal endothelium using phacofracture and phacodrop techniques (J. Cataract. Refroct. Surg., 1996, vol. 22, p. 967-969 However, the power of the phacoemulsifier device for crushing the patient’s lens nucleus is chosen empirically by the surgeon, which can lead to its overestimation and trauma to the endothelial layer of the cornea, iris, ciliary body.

 The objective of the invention is to develop a method for cataract extraction with implantation of an artificial lens of the eye with the optimal power of the phacoemulsifier device installed individually for each patient.

 The technical result according to the invention is achieved in that in a method for cataract extraction with implantation of an artificial lens of the eye, comprising phacoemulsification of the nucleus of the natural lens of the eye, when a metal rod connected to an ultrasonic tip of the phacoemulsifier is introduced into the lens nucleus with simultaneous gradual increase in ultrasound power before reaching the center of the nucleus, the rod is removed and phacoemulsification is carried out at the received power.

 The method is as follows.

 Under local anesthesia, an eyelid extender is inserted, the upper rectus muscle is taken on a stitch-holder. In the meridian of 12 hours, the conjunctiva is separated from the limb over 5.0 mm. The sclera is cut into 2/3 of the thickness with a dosed diamond knife parallel to the limb and departing from it by 1-1.5 mm, the length of the cut is 5.0 mm. Using a diamond exfoliator, a scleral pocket is formed, which, bypassing the limb, extends into the cornea by 1-1.5 mm. An incision with penetration into the anterior chamber of the eye is completed with a spear-shaped knife 3.2 mm wide. Corneal paracentesis is performed in the meridian of 2 hours, a viscoelastic preparation is injected into the anterior chamber of the eye. An irrigation cystotome is used to open the anterior lens capsule by continuous circular capsulorexis. The lens is hydrosealed with a stream of physiological saline using a cannula on a syringe, while the dense, compact part of the lens is washed from the surrounding lens masses.

 A metal rod, 1.1-1.2 mm in diameter, connected to an ultrasonic tip of the phacoemulsifier is introduced through a corneo-scleral incision. Through a hole in the anterior capsule, a metal rod is inserted into the lens nucleus toward its center. As you move, resistance to movement increases until the lens begins to move. Gradually increase the power of ultrasound and again advance the rod. After the center of the nucleus moves, the rod is removed from the anterior chamber of the eye and is separated from the ultrasound tip. A standard titanium needle is screwed onto the tip and a silicone casing is put on.

 Next, phacoemulsification is carried out according to standard technology (with a power determined by the above method), an ultrasonic tip of the phacoemulsifier is introduced through a corneo-scleral incision and the lens is fragmented. The remains of the lens masses are removed by an irrigation-aspiration cannula. The incision is widened to 5.0 mm and the posterior chamber IOL from polymethylmethacrylate is implanted into the capsule bag. The scleral wound is checked for leaks, the suture is not imposed, the conjunctiva is coagulated at the edges of the incision. The operation is completed by the introduction of a subconjunctival antibiotic solution.

Example
Patient K., 72 years old.

 Diagnosis: OD - immature age-related cataract.

Visual acuity - 0.1
Ophthalmometry - 0 degrees. - 42.00 D, 90 degrees. - 42.75 D
Eye length - 24.00 mm
Intraocular pressure - 17 mm Hg

Field of View - OK
The density of endothelial cells is 2110 cells / mm2.

 The patient was offered an operation - phacoemulsification of cataract with implantation of an intraocular lens according to the invention.

 After local anesthesia and akinesia of the eyeball with 4% rd rum of lidocaine, an eyelid extender was applied and the upper rectus muscle was fixed on the stitch-holder. The conjunctiva was cut off from the limbus for 5.0 mm. A dosed knife made a linear incision of the sclera with a depth of 2/3 of its thickness, retreating from the limb by 1.5 mm, length 5.0 mm. A diamond protector formed a pocket protruding 1.5 mm into the cornea. The front chamber was opened with a spear-shaped diamond knife 3.2 mm wide. Corneal paracentesis was performed with a diamond blade, through which a 0.1% solution of mesatone was introduced into the anterior chamber of the eye. After filling the anterior chamber with a viscoelastic preparation, an irrigation cystotome, an anterior lens capsule was opened. Hydrodissection of the lens was carried out with a stream of physiological saline. At the same time, the dense, compact part of the lens was washed from the surrounding lens masses.

 The phacoemulsifier power was set to 25%. A metal rod was connected through a corneo-scleral incision, connected to an ultrasonic tip of the phacoemulsifier. Through the hole in the anterior capsule, the core was inserted into the lens core towards its center. As the probe advanced, resistance to movement gradually increased. The lens began to shift, after which the power of ultrasound gradually increased and the rod was again advanced. At a power of 42%, the core reached the center of the core. This value has been established as optimal for further lens fragmentation. The rod was separated from the ultrasonic tip, a titanium needle was screwed onto the tip and a silicone casing was installed.

 An ultrasound tip of the phacoemulsifier was introduced through a corneo-scleral incision and the lens was fragmented. The remains of the lens masses were removed by an irrigation-aspiration cannula. The section in the inner layers of the cornea was widened to 5.0 mm, and the posterior chamber IOL of the T-26 model with an optical power of 21 diopters was implanted into the capsule bag.

 The scleral wound was checked for leaks. The suture was not imposed, the conjunctiva was coagulated at the edges of the incision. The operation was completed by the introduction of subconjunctival solutions of dexazone and kanamycin.

 Visual acuity without correction 1 week after surgery was 0.9. Ophthalmometry: 0 degrees - 42.50 diopters; 90 degrees - 42.50 diopters. Intraocular pressure is 15 mm Hg, field of view is unchanged, the number of endothelial cells is 1920 cells / mm. sq. - endothelial loss was only 9%.

 The results obtained allow us to conclude about the effectiveness and safety of our method.

 This technique was used in 32 patients (36 eyes). In no case were specific complications identified.

Claims (1)

 A method of cataract extraction with implantation of an artificial lens of the eye, including phacoemulsification of the nucleus of the natural lens of the eye, characterized in that prior to cataract extraction, a metal rod connected to the ultrasonic tip of the phacoemulsifier is introduced into the lens core with a smooth increase in ultrasound power until the center of the nucleus is reached, the rod is removed and carry out phacoemulsification at the received power.