RU2180541C1 - Method for carrying out intraoperative fixation of subluxated lens - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing central portions of the vitreous body, introducing air sideways from the posterior lens poles axis. Intraocular artificial lens is implanted into capsule sack or posterior chamber after performing extraction. EFFECT: enhanced effectiveness of treatment. 1 dwg

Description

 The invention relates to medicine, namely to ophthalmology, and can be used for intraoperative fixation of a subluxated lens.

 Until now, a subluxation of the lens of any degree was doomed either to intracapsular removal with all the surgical and postoperative complications resulting from this, or to very complex manipulations with the introduction of a special ring into the capsular bag to fix the bag.

 Known methods for intraoperative fixation of the capsule bag with subluxation of the lens during extraction followed by implantation of an intraocular lens (IOL). Thus, it is proposed to introduce a special ring into the capsular bag without hemming or hemming the capsule to the sclera through the ciliary groove (Pascal Pitrini, Robert J. Cionni et al. Suturing the Ring // Videojournal of Cataract and Refractirce Surgery. - 1998, - Vol. XIV. - 4).

The disadvantages of the described method are:
- the need for a sufficiently complex structure, like a capsule ring; -
- the complexity of the procedure for introducing the ring into the capsular bag and especially its hemming with the capsular bag to the sclera;
- high risk of postoperative complications.

 The method of intraoperative fixation of a subluxated lens by introducing air behind the lens is not described in the literature.

 The objective of the proposed method is to increase the efficiency: (reducing trauma and simplifying the technique) operations of fixation of the subluxated lens.

 The problem is solved in that for the first time for fixing the subluxated lens, air is applied behind the lens, followed by extracapsular extraction of the lens and implantation of the IOL into the capsular bag or posterior chamber.

 The invention is illustrated in the drawing, where 1 is the lens; 2 - anterior hyaloid membrane; 3 - air bubbles; 4 - vitreous body; 5 - cannula; 6 - a syringe with sterile air.

 The method is as follows. A preliminary incision is made of the cornea in the upper limb. The conjunctiva and tenon shell are dissected over 2 mm at a distance of 4-5 mm from the upper limb in one of the meridians convenient for the surgeon. A meridional incision of the sclera and the flat part of the ciliary body with a length of 1.5 mm or a puncture with a needle for intramuscular injection is performed in the same area with a diamond knife. Through this incision, the tip of the vitreotome is inserted into the eye cavity and a partial vitrectomy of the central parts of the vitreum to Tn-1 is performed, or a sharp intramuscular needle is inserted into the vitreum cavity and the vitreous is aspirated in an amount of 0.1-0.2 ml.

 Then, through the same scleral incision, sterile air is introduced into the vitreous chamber under the anterior hyaloid membrane near the posterior lens capsule through a thin cannula on the sides of the posterior pole of the lens in such a way that the intraocular pressure rises to normal or mild hypertension.

 Since the patient is in a horizontal position facing up and the air bubbles tend to rise up as well, they maintain the lens in a suspended and fixed state, pulling the weakened fibers of the zinc ligament, and do not allow the lens to "fall" into the vitreous body and the fundus.

 As you know, air is subject to compression, therefore, air bubbles, being between a dense crystalline lens and a vitreum, take an oval shape (3) and thus, as it were, surround the crystalline lens behind.

 Next, a corneal incision along the limb, capsulorexis, mechanical removal of the nucleus or phacoemulsification, leaching and aspiration of the lens masses and careful implantation of the posterior chamber IOL into a capsular bag or posterior chamber are performed. All this time, air bubbles push out, or rather support the lens, and then the capsule bag in a suspended fixed state.

 After IOL implantation, air bubbles can either be aspirated from the vitreous body under the control of a microscope through a previously made sclera incision in the flat part of the ciliary body or left in the vitreous chamber, where they dissolve 2-3 days after the operation.

 The application of the proposed method in clinical practice has shown that it is quite simple to perform, does not require the use of special instruments and equipment, reduces the invasiveness of surgery and, thus, improves the efficiency of treatment and optical rehabilitation of patients with lens subluxation.

Clinical observation:
Patient J., 74 years old. Case history 1326, entered the Department of Eye Microsurgery of the Road Clinical Hospital of the October Railway 01/31/2000

 Diagnosis: Senile immature cataract, subluxation of the lens of the II stage. right eye.

 02/01/2000, the operation was performed (protocol 42). Air injection behind the lens, extracapsular cataract extraction, posterior chamber IOL implantation (model 26) of the right eye.

 The introduction of air behind the lens was carried out according to the method described above. Vitreous prolapse was not noted. IOL is implanted in a capsule bag. Postoperative course without features.

 Visual acuity on day 7 after surgery 0.5 without correction.

Claims (1)

 A method for extracapsular extraction of a subluxated crystalline lens, characterized in that first the central parts of the vitreous are removed, air is introduced on the sides of the posterior pole of the crystalline lens, and after extraction, an intraocular lens is implanted in a capsular bag or posterior chamber.