RU2197932C1 - Method for performing phacoemulsification - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing capsulorrhexis, introducing viscoelastic filler into the anterior chamber, hydrodelineation of lens nucleus with irrigation fluid via irrigation system of phaconozzle in phacoemulsifier irrigation and suction mode. The nozzle is set with bevel (tangentially) adjacent to lens nucleus edge in plunging the working bevel of the phaconozzle needle into the lens body. Ultrasonic lens nucleus phacoemulsification is carried out in pulsating mode. EFFECT: enhanced effectiveness of treatment; single instrument applied; reduced risk of traumatic complications. 1 dwg, 1 tbl

Description

 The invention relates to medicine, namely to ophthalmology, and can be used for phacoemulsification of the lens.

 A known method of conducting a rotational operation called "carousel", developed at the ISTC "Eye Microsurgery" (journal "Ophthalmology", 1998, 2, pp. 5-7), adopted as a prototype. In this method, a phaco-needle is introduced into the equatorial layers of the nucleus tangentially to it, the end of the needle is directed toward 6 hours. The irrigation cannula rotates the core clockwise, while at the same time "cutting off" its equatorial part with ultrasound. The ultrasound needle is almost motionless, the non-removed layers of the lens are directed towards it by rotating the nucleus with an irrigation cannula inserted into the anterior chamber through paracentesis. Thus, the peripheral parts of the nucleus are gradually cut off with a gradual approach to its center, the central part is removed by pressing the irrigation cannula to the tip of the phacoemulsifier. Then, slightly increasing the aspiration upon contact of the phaco-needle with the epinucleus, it is separated from the capsule bag and removed.

The disadvantages of this method:
- bimanuality, that is, the use of two phonar tip tools and an irrigation cannula;
- two cuts are required for the phono-tip and the irrigation cannula, which increases the invasiveness of the operation;
- pushing the lens of the irrigation cannula towards the phonar tip, especially when removing the central part, increases the risk of trauma to the posterior lens capsule, and manipulations increase the trauma of the edges of the incision;
- during mechanical rotation of the lens nucleus with an irrigation cannula, the vacuum created in the aspiration system counteracts the rotation, which reduces the effect of the carousel.

The tasks are set:
- reducing the invasiveness of the operation;
- reduction of operation time;
- the use of pulsed ultrasound and vacuum phacoemulsifier without mechanical rotation of the lens nucleus;
- monomonuality.

 The problem is solved by the proposed method of phacoemulsification of the lens, including capsulorexis, the introduction of viscoelastic into the anterior chamber and ultrasonic emulsification of the lens nucleus. What is new is that the lens nucleus is hydrodelineated with an irrigation fluid through the phaco-tip irrigation system in the irrigation and aspiration mode of the phacoemulsifier, the tip is set tangentially to the edge of the crystalline nucleus by immersing the working bevel of the phaco-tip needle in the thickness of the crystalline lens, and the ultrasound is pulsed by ultrasound.

 The hydrodelineation of the lens nucleus allows the lens nucleus to separate from the epinuclear masses located between the lens nucleus and the posterior capsule, which facilitates the free rotation of the lens nucleus without mechanical impact (e.g., irrigation cannula).

 Hydrodelineation of the lens nucleus by irrigation fluid through the phaco-tip irrigation system in the irrigation and aspiration mode of the phacoemulsifier without the use of an irrigation cannula reduces trauma and shortens the time of surgery.

 The installation of the tip tangentially to the edge of the lens core, immersing the working bevel of the phaco-tip needle into the thickness of the lens and the pulsed ultrasound mode of the phacoemulsifier provide free rotation of the crystalline nucleus, since the suction action (vacuum) of the phacoemulsifier aspiration system creates a rotational moment, which allows monomanuality.

 The drawing shows schematically the phacoemulsification methods according to the prototype "a" and according to the claimed method - "b", where 1 is the lens core, 2 is the phaco-needle (phaco tip), 3 is an irrigation cannula.

 The proposed method is as follows.

 Perform a micro incision in the cornea at 10 or 14 hours. A viscoelastic is introduced into the anterior chamber, capsulorexis is performed, a phakonet is introduced into the incision, and the lens nucleus is hydrodelineated in the irrigation and aspiration mode of the phacoemulsifier. After that, the tip is set tangentially to the edge of the lens core, immersing the working bevel of the phaco-tip needle into the thickness of the lens, the pulsed ultrasound mode is activated, and the lens is phacoemulsified.

 Conducting hydrodelineation of the lens nucleus provides separation of the lens nucleus from the epinuclear masses, which contributes to the free rotation of the lens nucleus without mechanical impact.

 The location of the tip tangentially to the edge of the lens with the immersion of the working bevel of the phaco-tip needle into the thickness of the lens and the use of the pulse mode ensure rotation of the lens core, since the suction action (vacuum) of the aspiration system of the phacoemulsifier creates a torque.

 Emulsification begins from the periphery with cortical layers in a circle to the center. In pulsed ultrasound mode, the core begins to retreat freely, layer by layer is cut from the outer layers to the center of the nucleus. In this method, the force is not transmitted to the posterior lens capsule, the nucleus is freely retreated due to the hydrodelineation of the separation of the nucleus from the cortical layers, using a pulsed ultrasound mode.

 Removing the remains of the lens masses and cleaning the back capsule is carried out by an aspiration-irrigation system.

 When carrying out a rotation technique, the duration of the ultrasound does not exceed the permissible parameters.

 The ultrasound parameters for rotational technology are presented in the table.

The proposed rotational method of phacoemulsification has several advantages:
- the risk of damage to the posterior capsule is minimal, since the intact cortex in the capsule bag during removal of the nucleus itself serves as a pillow, protecting the capsule;
- rotational emulsification prevents the uncontrolled movement of sharp nuclear fragments during surgery;
- during the action of ultrasound, the tip of the phacoemulsifier is always in the zone of better visibility, far from the ultrasound-sensitive structures of the anterior segment.

 Examples 1. Patient P., born in 1932, was admitted with a diagnosis of right eye-incomplete cataract, left eye - almost complete cataract.

Vision at admission:
right eye - 0.3 n.k.,
left eye - 0.02 n.k.

 Fields of view: no change.

EFI data:
e / h - 80/80
e / l - 30/30
PZO - 22.4 mm.

 Performed phacoemulsification on the left eye by rotational technique.

 Parameters of phacoemulsification: power - 60, vacuum - 75, time - 1 min 10 s. Operation, postoperative period without complications.

Vision at discharge:
OD is the same
OS - with aperture 1.0
OS is calm, the environment is transparent, IOL in the center, the fundus without features.

 Example 2. Patient P., born in 1979, was admitted with a diagnosis of the right eye — healthy, the left eye — complete complicated cataract.

 Vision at admission: right eye -1.0, left eye - correct light perception.

 Fields of vision with OD are normal, with OS not defined.

 EFI data: e / h - 80/80, e / l - 30/30; PZO: 2.3 mm.

 Performed phacoemulsification on the left eye by rotational technique.

 Operation, postoperative period without complications.

 Vision at discharge: OD is the same, OS with a diaphragm of 0.9.

 OS is calm, the cornea is transparent, the pupil is round d - 7 mm, the lens in the capsular bag, the fundus is unchanged.

 The practice of applying the proposed method in the clinic UV Research Institute of GB showed that the method solves the tasks in full.

Claims (1)

 A method of phacoemulsification of the lens, including capsulorexis, introduction of viscoelastic into the anterior chamber and ultrasonic emulsification of the lens core, characterized in that the lens nucleus is hydrodelineated with an irrigation fluid through the phacon tip irrigation system in the mode of irrigation and aspiration of the apical pulverizer, needles of a phono-tip in the thickness of the crystalline lens; in the pulsed mode, they produce ultrasonic emulsification of the crystal core ka.

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