RU2192210C2 - Method for removal of postoperational corneals astigmatism - Google Patents

Abstract

FIELD: medicine, ophthalmology. SUBSTANCE: after clinical examination of a patient and approval of astigmatism caused by tightening corneal sutures under out-patient conditions one should cross a deep tightened implanted corneal suture in corneal stroma with the help of neodymium YAG laser. The method enables to obtain good results in removing corneal astigmatism, keratitis, corneal dystrophy by not destroying the integrity of corneal surface layer in the course of surgical operation. EFFECT: higher efficiency of operation. 1 ex

Description

 The invention relates to medicine, namely to ophthalmology, and can be used to eliminate corneal astigmatism caused by deformation of the cornea in the area of excessive tension of the suture.

 It is known that most of the works on cicatricial deformity of the cornea are devoted to astigmatism of the cornea after cataract extraction and through keratoplasty (Avetisov S.E. - On the peculiarities of evaluating eye refraction after operations that change the shape of the cornea. // Ophthalmological Journal, - 1985, - 7, - p. 428-430).

 According to one of the points of view (Alekseev BN - The influence of methods for sealing the surgical wound during cataract extraction on postoperative corneal astigmatism. // Bulletin of Ophthalmology, - 1998, - 1, - p. 13-16), the severity of postoperative astigmatism does not depend on localization of the incision and methods of sealing the wound - after removing the sutures, a decrease in the degree of astigmatism is possible. Of great importance in the development of astigmatism is noted with improper suturing and pulling it (Avetisov S.E. - Case of contusion of the keratotomy incision in the "late" postoperative period. // Bulletin of Ophthalmology, -1985, - 4, - pp. 21-24) .

 Uneven suturing and pulling, the use of various types of suture material increase the degree of post-traumatic astigmatism (Sinelshchikova I.V. - Prediction and prevention of post-traumatic cicatricial astigmatism of the cornea. // Diss .... Candidate of Medical Sciences, -M., - 1999 , - p. 103-117). With astigmatism of more than 1.5 diopters and a combined suture consisting of a continuous twisting and nodal guides, the guiding nodal sutures are removed or intersected 3-4 weeks after the initial surgical treatment, the remaining sutures are removed within 8-9 weeks. At the same time, astigmatism is reduced due to the expansion of corneal tissue.

 Corneal sutures are removed using microsurgical instruments: tweezers, blades or scissors. If it is impossible to remove suture material on a slit lamp, they are manipulated under an operating microscope (Krasnov M.L. - Guide to eye surgery. // M., 1988.). This method is taken as the closest analogue.

 The above methods allow you to remove or cut the seams with corneal astigmatism to weaken the tension of the corneal tissue. But for this it is necessary to open the cornea and it is not always possible to dissect the deep sutures that pass in the stroma due to neovascularization, corneal dystrophy, conjunctival covering over the scar or other reasons.

 The proposed method allows you to cut deep seams of the cornea without violating the integrity of the surface layers of the cornea, with changes in the outer layer of the cornea, under the supervision of an ophthalmic surgeon and with the help of gentle non-invasive laser techniques.

 The technical result of the proposed method is the expansion of corneal tissue with the subsequent elimination of postoperative astigmatism.

 The technical result is achieved due to the intersection of deep immersion sutures within the stroma of the transparent cornea using YAG laser without violating the integrity of the surface layer of the cornea.

 The method is as follows.

 After a clinical examination, confirmation of astigmatism caused by traction of the corneal sutures, on an outpatient basis under local anesthesia by instillation of dicaine solution, under the control of a short-focus lens such as Abraham, YAG laser actions are performed in low energy conditions on the suture passing in the stroma of the cornea. After crossing the suture, a control keratometric examination is performed. If necessary, add YAG laser intervention.

 Example. Patient Zheg-ov, 33 years old, turned to the ophthalmology department with complaints of visual impairment of OD. From the anamnesis: suffered from congenital cataract; three months ago, cataracts were extracted with IOL implantation at the place of residence, immediately after the operation, visual acuity OD = 0.6 n / k; IOP OD-22 mm RT. Art. Now I noticed a distortion of vision in a vertical plane. With spectacle correction noted - visual acuity OD = 0.6 with sp. + 1.5 diopters cylinder + 2.0 with a vertical axis.

 Objectively: OD - slightly irritated. The sutures are clean, submersible, slightly cut into the corneal tissue, with a node in the stromal part of the cornea, pronounced vessels from the conjunctiva, and corneal edema above the seams and the node. The anterior chamber is of moderate depth, the pupil in the center reacts adequately to light. IOL stands flat. The fundus reflex is uniformly pink. With keratometry, the development of astigmatism along the vertical component is noted.

 To eliminate the phenomena of astigmatism, the patient is recommended to remove corneal sutures, which the patient abstained from due to the possible development of corneal dystrophy while removing the immersion corneal sutures. When trying to dissect with a blade of corneal sutures in the stroma of the cornea, profuse bleeding from superficial vessels was noted. The patient refrained from further manipulations. Then it was proposed to try the dissection of deep immersion cornea sutures directly in the stroma using neodymium YAG laser exposure. After the instillation of the dicain solution, a contact lens is put on (short-focus type of Abraham to influence the structures of the anterior chamber). The laser sight is focused in the stroma of the cornea on the suture tissue in the area of greatest tension. When exposed to a single-pulse YAG laser radiation with a force of 1.6 mJ, the suture was crossed without visible damage to the stromal part of the cornea and the crossed ends diverged 1.3 mm from each other. During control keratometry, the result was obtained that astigmatism phenomena disappeared.

 2 days after surgery, OD is calm, the suture area is clean, the cornea is unchanged. Visual acuity of 0.6 n / a. IOP OD-22 mmHg

 7 days after the YAG laser operation, there is no negative dynamics of the state of the cornea. Visual acuity OD = 0.7-0.8. IOP OD - 22 mm Hg Keratometric indices are the same.

 An indication of the method are cases of tight, deep immersed corneal sutures that cause astigmatism and are unfavorable for their intersection with microsurgical instruments with a violation of the integrity of the cornea.

 The method has no contraindications.

 As a result of the application of this method, the elimination of corneal astigmatism is possible. Cutting with the help of a neodymium YAG laser of a deep submerged, tightened corneal suture allows straightening the cornea in the area of the suture constriction.

Claims (1)

 A method of eliminating postoperative corneal astigmatism, characterized in that they cross the deep part of the immersion suture located in the stroma of the cornea using a neodymium YAG laser.