RU2173127C2 - Method for removing eye lens from vitreous body cavity - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing the eye lens through and incision in flat part of the ciliary body by means of phacoemulsification. Artificial eye lens is implanted through the same incision. EFFECT: reduced risk of traumatic complications. 6 dwg

Description

 The invention relates to medicine, namely to ophthalmology, and can be used to remove the patient’s own lens, completely dislocated into the vitreous body.

 A known method for removing the lens of the eye from the cavity of the vitreous body, including an incision in the flat part of the ciliary body, subtotal vitrectomy, filling the vitreous cavity with a perfluororganic compound (PFOS), raising the lens to the pupil area, removing PFOS (RU patent 2064785, A 61 F 9/00 )

 However, to remove the lens from the eye and implant the artificial lens, a large corneal or sclero-corneal incision is required, which increases the invasiveness of the operation and increases the risk of surgical and postoperative complications (bleeding, iridocyclitis, astigmatism, etc.).

 The objective of the invention is to develop an atraumatic method for removing the patient’s own lens, completely dislocated into the vitreous body, and implantation of an artificial lens.

 The technical result achieved by using the invention is to reduce surgical and postoperative complications by reducing the surgical incision and, accordingly, reducing trauma to the retina, corneal endothelium, iris and anterior chamber angle zone.

 The method is as follows.

 Under local anesthesia, an eyelid extender is inserted, the upper rectus muscle is taken on a stitch-holder. The conjunctiva is separated from the limbus in the upper and outer quadrants of the eyeball. At 4.0 mm from the limb, three micro incisions of the sclera (sclerotomy) of 1.0 mm are made, which are located in the lower outer, upper inner and upper outer quadrants. In a sclerotomy in the lower external quadrant, cannula 1 is hemmed for intraocular irrigation - FIG. 1. The two remaining sclerotomies serve to introduce the fiber 2 and vitreotome 3. Subtotal removal of the vitreous 5 is performed, and the lens 6 is especially carefully freed from the vitreous fibers. PFOS 7 is introduced into the vitreous cavity using cannula 1 (Fig. 2). The dislocated lens as a result of the distribution of surface tension forces appears at the top of the PFOS bubble - FIG. 2. With an additional supply of PFOS, the lens 6 is placed behind the iris - FIG. 3. The light guide and the vitreot are removed. The tip of the phacoemulsifier 8 and a tool 9 for manipulating the lens nucleus are introduced into the sclerotomy openings. Transciliary phacoemulsification is performed - FIG. 3. After that, the sclerotomy 10 in the upper-internal quadrant is expanded to 3 mm and an elastic artificial lens 11 is inserted through it - FIG. 4. The latter is fixed with sutures 12 in the ciliary groove - FIG. 3. PFOS is aspirated through cannula 13 - FIG. 6. Paracentesis in the sclera and conjunctiva is sutured with interrupted sutures (silk 8/0). The operation is completed by the introduction of a solution of an antibiotic and a corticosteroid subconjunctival.

 Example: Patient Sh., 62 years old, was admitted with a diagnosis of complete traumatic dislocation of his own lens into the vitreous body in his right eye, traumatic cataract, high myopia. Visual acuity is 0.01 sph + 11.0 = 0.8, IOP 21 mm Hg, field of view is normal, eye length is 24.00 mm, ophthalmometry is 0 degrees - 41.00 D, 90 degrees - 41.75 D. During biomicroscopy: the eye is calm, the cornea is spherical, transparent, the anterior chamber is 4.0 mm, uniform moisture is transparent, the pupil is in the center, the reaction to live light, iridodonez. In the vitreous body, pronounced destruction. The fundus of the eye: the optic disc is pink, the borders are clear, the vessels are somewhat narrowed, the macular region without focal pathology. The own lens is diffuse-cloudy and is located in the equator in the lower half of the vitreous cavity near the retina, is not fixed, changes its position with eye movements. In the preoperative period, the patient underwent transpupillary peripheral argon-laser coagulation of the retina. 1 month after the formation of laser coagulates, they started surgical treatment.

 The progress of the operation. After local anesthesia and ankinesia of the eyeball with a 4% lidocaine solution, an eyelid extender was applied and the upper rectus muscle was fixed on the stitch-holder. The conjunctiva was separated from the limbus in the upper and outer quadrants of the eyeball. 3 microcuts of sclera 1.0 mm long were performed 4 mm from the limbus, which were placed at 2, 11 and 7 hours. An irrigation cannula was hemmed into a sclerotomy in the lower outer quadrant at 7 o’clock. Through sclerotomy at 2 and 11 hours a fiber guide and vitreotome were introduced. Subtotal vitrectomy was performed using a beveled silicone fundus lens. The lens was carefully freed from vitreous fibers. PFOS was introduced into the vitreous cavity using a cannula. As the PFOS vitreous cavity fills, the dislocated lens is located at the upper PFOS / fluid interface. As the PFOS bladder increased (a total of 3.5 ml was used), the lens advanced toward the anterior segment of the eyeball and was placed behind the iris. The light guide and vitreotome removed. The scorotomy holes were inserted with the tip of the STORZ PREMIER phacoemulsifier and a tool for manipulating the lens nucleus. Performed transciliary phacoemulsification. The remains of the lens masses from the PFOS interface were removed with a vitreotome. The scleral incision was expanded to 3 mm and implantation of an elastic artificial lens was performed through it. The latter is fixed with sutures in the ciliary groove.

 Then a light guide and a thin-walled cannula were introduced and PFOS was aspirated. Paracentesis in the sclera and conjunctiva was sutured with interrupted sutures (8/0 silk). The operation was completed by the administration of a solution of an antibiotic (kanamycin) and a corticosteroid (dexamethasone) subconjunctival.

 Visual acuity at discharge 1 week after surgery was 0.7. The intraocular pressure was 15 mm Hg, the field of view was unchanged, the loss of the corneal endothelium was only 7.6%. Visual functions were stable throughout the observation period (1 year). The results obtained allow us to conclude that the proposed method of treatment is effective and safe.

 We used this technique in 9 patients (9 eyes). In no case were specific complications identified. Using the proposed method has significantly reduced the number of intra- and postoperative complications and, thereby, accelerate the visual and social rehabilitation of patients.

Claims (1)

 A method for removing the eye lens from the vitreous cavity, including an incision in the flat part of the ciliary body, subtotal vitrectomy, filling the vitreous cavity with an organofluorine compound (PFOS), raising the lens to the pupil area, removing PFOS, characterized in that the eye lens is removed by phacoemulsification through that the same incision in the flat part of the ciliary body, and then through the same incision IOL is implanted.

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