RU2157157C2 - Method for removing dislocated lens from vitreous body - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making corneoscleral incision and sealing it. Vitrectomy is carried out and lens is lifted using vitreotome end piece. The end piece operates in suction mode. Supplying physiological salt solution through irrigation system combined with light guide creates ball-above-spout phenomenon. The lens is brought into the anterior chamber and corneoscleral sutures are taken off. The lens is brought out of the anterior chamber under controlled supply of physiological salt solution. EFFECT: reduced risk of traumatic complications. 3 dwg

Description

 The invention relates to medicine, in particular to ophthalmology.

 In ophthalmic surgery, the treatment of dislocation of the lens into the vitreous body is an urgent and rather difficult task.

 When performing this operation, complications often arise in the form of corneal edema, vitreous hemorrhages, retinal detachment, etc. In addition, existing and newly proposed methods for removing a dislocated lens require the manufacture and use of additional instruments or tools. Known methods for removing the lens - for example, by A. with. 1511259 according to the application 4231441 from 04.15.87, in which the lens is fixed by means of a cold (freezing, followed by freezing), according to a.c. 1597187 according to the application 4437329 from 03.06.88 - a method for removing lens masses by introducing sterile air and others. However, the freezing process itself, followed by freezing, and the process of introducing sterile air significantly complicate the technology, do not exclude eye injury during surgery, complications during and in the postoperative period. In addition, almost every eye needs its own parameters of time and temperature.

 Therefore, recently, in order to raise the lens from the vitreous into the anterior chamber, organofluorine compounds (PFOS) have been widely used. So, a method that includes vitrectomy, the introduction of organofluorine compounds for flotation of the lens from the surface of the retina into the anterior section, and its subsequent removal, may be quite similar in method. (SHAPIRO M.J. Menegement of the dislocated crystalline lens with a perfluorocarbon liguid; Am. J. Ophthalmol. 1991, 112 (4), 401-405). This method can serve as a prototype of the invention, the difference of which is greater simplicity and higher efficiency. A negative aspect of their application is the need to remove PFOS from the eye cavity, which creates certain difficulties for the surgeon, contributes to the occurrence of operational and postoperative complications, and increases the time of surgery.

SUMMARY OF THE INVENTION
Our proposed operation technique is as follows: after a conjunctiva is cut 4 mm from the limb, two punctures are made in the flat part of the ciliary body for vitrectomy in the usual way. Next, a corneoscleral incision is made before opening the anterior chamber for further removal of the lens. This incision is sealed with three knotted seams. Then a vitrectomy is performed to create a channel in the vitreous body and to separate the lens from the cords and adhesions (Fig. 1). Next, the tip of the vitreotome is brought to the upper surface of the lens, which is transferred to the aspiration mode. A lens held under the action of a vacuum rises and a vitreotome optical fiber combined with an irrigation system is brought under it. The physiological saline solution supplied through it creates the effect of a “ball above the fountain” and does not allow the lens to luxate back (Fig. 2). Thus, while manipulating with both hands, the lens is freely displayed in the anterior chamber (Fig. 3). The tip of the vitreotome with an aspiration system is removed, the previously applied corneoscleral sutures are removed and the lens is removed from the anterior chamber under the action of a dosed supply of physiological saline. In FIG. 1-3 shows the main stages of the operation.

 In FIG. 1 shows the moment of vitrectomy for creating a channel in the vitreous body and separating the lens from the cords and adhesions.

 In FIG. Figure 2 shows the moment of supply of physiological saline under the lens and the creation of the “ball over the fountain” effect in order to avoid re-luxation of the lens.

In FIG. 3 shows the moment of self-removal of the lens
Test results
In this way, twenty-four successful operations were performed. Its use made it possible to avoid surgical and postoperative complications, significantly reduce the time of surgery and its invasiveness, and accelerate the rehabilitation of patients. Unlike other methods, it does not require the use of new tools and equipment, and therefore, additional material financial costs.

 Patient A was performed on March 31, 1998 - the results are positive.

Patient B 07/13/1998, the operation was performed - the results are positive
Patient On November 25, 1998 an operation was performed - the results are positive
Patient G 10.12.1998, the operation was performed - the results are positive
Patient D on February 16, 1999; an operation was performed - positive results
In all cases, there were no complications.

Claims (1)

 A method of removing a dislocated lens from the vitreous, including vitrectomy and lens removal, characterized in that a corneoscleral incision is made and hermetically sealed; an irrigation system combined with a light guide is inserted into the anterior chamber and the corneoscleral sutures are removed, the lens is removed from the anterior chamber under Corollary dispensing saline.

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