RU2201730C2 - Method for removing cataract on eyes possessing no vision functions with initial subatrophy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making transciliary incisions at 10 and 2 o'clock positions. Solution irrigation into vitreous cavity is carried out. Thin double-edged sharp knife is introduced via the 2 o'clock incision in transecting crystalline capsule and cortical layers. Cannula is introduced into the built canal for performing endocapsular irrigation and bimanual manipulations. Flask for performing endocapsular irrigation is set 10 cm above the flask for performing endovitreous irrigation. Thin double-edged sharp knife is introduced via the 10 o'clock incision and the second canal is formed in the lens. Phacoemulsifier needle is directed into the canal. Vitreotome end piece is introduced into the 10 o'clock incision. The anterior and posterior chambers, anterior layers of the vitreous body and its base are removed. Circular retinotomy is carried out. EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; high quality of cosmetic repair; prevented subatrophy progress.

Description

 The invention relates to medicine, and more particularly to ophthalmology, and can be used to remove cataracts with a cosmetic purpose in the eyes without visual functions, with initial subatrophy.

 A known method of treating cataracts in the eyes without visual function, with initial subatrophy, which consists in treating subatrophy of the eyeball by extraction of the natural lens with subsequent implantation of an artificial lens (RU 2102047 G, 01.20.1998).

 However, this method is characterized by significant disadvantages. It does not exclude the progression of subatrophy of the eyeball due to the capsule bag of the lens contracting over time. In addition, progressive collapse and significant excursions of the vitreous lead to increased traction of the retina and ciliary body, their detachment and the progression of subatrophy.

 The technical task of the invention is to reduce the invasiveness of surgical intervention, achieve a cosmetic effect, prevent the progression of subatrophy of the eyeball while reducing treatment time.

 The specified technical problem is solved by the fact that in the method of removing cataracts in the eyes without visual functions with initial subatrophy, which consists in acting on the anterior surface of the eyeball, the exposure is initially performed on the anterior surface of the sclera by making its incisions in the projection of the flat part of the ciliary body, removing the natural lens, vitreous humor and circular retinotomy, and the nucleus of the lens is removed by transciliary bimanual phacoemulsification , the tip of the vitreotome removes the lens masses, the front and rear capsules of the lens and performs a circular retinotomy.

 The method is as follows.

 In the upper half of the eyeball, two sections of the conjunctiva are made 2 mm from the limbus at 10 and 2 hours, the conjunctival flaps are separated, releasing the sclera. In the meridian of 1 hour, 4 mm from the limb, a micro incision is performed and a 4 mm cannula is sutured to the sclera for independent intraocular irrigation. A vial with irrigation solution is set 20 cm above the patient’s eye level and physiological saline is supplied into the vitreous cavity during the entire intervention. 1.5 mm long transciliary micro incisions are performed at 10 hours and 2 hours with a disposable blade. The incisions are located 3.5 mm from the limb with the aim of the instruments entering the lens through its equator. A thin double-edged knife is introduced through the incision at 2 hours towards the center of the lens nucleus, dissecting its capsule and cortical layers. A cannula is introduced into the formed channel for endocapsular irrigation and bimanual manipulations. The vial for endocapsular irrigation is fixed 10 cm above the vial for intraocular irrigation.

 A thin double-edged knife is inserted through the incision at 10 o'clock and a second channel is formed in the lens in the direction toward the center of the nucleus. A phacoemulsifier needle (without an irrigation cuff) is directed into the formed channel, holding the lens from excessive displacements of the irrigation cannula. Instruments are introduced into the lens through its equator, phacoemulsification is performed endocapsularly and quite tightly, as the instruments densely plug the incisions.

 Then, the tip of the vitreotome is inserted into the incision at 10 hours. Remove the anterior and posterior lens capsule. To remove the equatorial part of the capsular bag, sclerocompression is used and the iris is pushed back with a thin bifurcated dovetail retractor or S-shaped tool inserted into the opposition incision. Then, an optical fiber is introduced into the incision at 2 hours and vitrectomy is started. A bottle with a solution for independent intraocular irrigation is raised 10 cm higher than in the previous stages of the operation (up to 30 cm above eye level) to achieve a tone of about 22 23 mm Hg.

 After removal of the anterior layers of the vitreous, a contact fundus lens is placed on the cornea and vitrectomy is performed in the deep layers. When the removal of the vitreous in the optical zone was completed, peripheral vitrectomy is started. The basis of the vitreous body is in a difficult to reach area and sclerocompression is used for the most complete removal of the vitreum. Then, using the tip of the vitreotome, the retina is cut around the circumference, as close as possible to its periphery. Bleeding from retinal vessels is stopped using an endocoagulator. Thus, traction and detachment of the ciliary body are prevented by the exfoliated retina during contraction.

 Transciliary sections were sealed by suturing (8/0 silk), conjunctival sections were compared and coagulated with bipolar forceps. Under the conjunctiva, a mixture of a solution of kanamycin and dexamethasone in a volume of 0.3 ml is injected.

 The method is characterized by the following clinical examples.

 Example 1. Patient O., 35 years old, was admitted to the clinic with a diagnosis of traumatic cataract, organized hemophthalmus, total retinal detachment, initial subatrophy of the eyeball.

 Visual acuity of the right eye is 0, the left eye is 1.0 without correction. Tonometry of the right eye 5 mm RT. Art., left eye - 20 mm Hg Ultrasonic biometry, the length of the optical axis of the right eye is 20.4 mm, the left eye is 23.7 mm. History of dull injury to the right eye (3 months ago).

 For cosmetic purposes and in order to prevent the progression of subatrophy, the patient underwent surgery on his right eye according to the method proposed in this invention.

 The operation and the postoperative period proceeded without complications. When discharged from the hospital on the 4th day of IOP of the right eye, 7 mm Hg, length - 20.6 mm. 3 months after the operation of IOP of the right eye -12 mm Hg, length 21.8 mm.

 Example 2. Patient T., 56 years old, was admitted to the hospital with a diagnosis of traumatic cataract, total retinal detachment, subatrophy of the eyeball.

 History (4 months ago) blunt trauma to the left eye, subconjunctival rupture of the sclera, primary surgical treatment.

 Visual acuity of the right eye 1.0 with a correction of +1.0, the left eye -0. IOP of the right eye -18 mm. Hg, left eye 4 mm Hg According to ultrasound, the length of the right eye is 23.3 mm, the left eye is 19.2 mm.

 For cosmetic purposes and in order to prevent the progression of subatrophy, the patient underwent surgery on his left eye according to the method proposed in this invention.

 The operation and the postoperative period proceeded without complications. When discharged from the hospital on the 5th day, IOP of the left eye is 8 mm Hg, length is 19.3 mm. 3 months after the operation of IOP of the left eye - 15 mm Hg, length - 21.4 mm.

 The use of this invention allows to achieve a cosmetic effect and prevent the progression of subatrophy of the eyeball while reducing treatment time.

Claims (1)

 A method for removing cataracts in the eyes without visual functions with initial subatrophy of the eyeball, which involves removing the natural lens, characterized in that the incision is initially made in the projection of the flat part of the ciliary body, then the natural lens, vitreous are removed and circular retinotomy is performed, with the nucleus the lens is removed by bimanual transciliary phacoemulsification, the tip of the vitreotome removes the lens masses, the anterior and posterior capsules of chrus Alec, together with an irrigant flow in the capsular bag and the vitreous cavity, having a bottle of irrigation solution for endokapsulyarnoy 10 cm above the vial for intraocular irrigation then operate circular retinotomy.