RU2234897C1 - Single-step surgical method for treating the cases of cicatricial lacrimal canaliculus lesions combined with cataract and implanting intraocular lens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out lacrimal canaliculus intubation. Opening is produced in Tenon's capsule and conjunctiva 4 mm far from the limbus and haemostatic solution is introduced. The second opening is produced 4 mm far from the first one and viscoelastic solution is introduced. Incision is done in the conjunctiva and Tenon's capsule between the openings. Corneoscleral tunnel incision is produced with an exit into the anterior chamber. Capsulorhexis is carried out. Native lens anterior capsule is placed into physiological salt solution. The native lens is removed and intraocular lens is implanted. Silicon tube is selected in conformance to lacrimal canaliculus dimensions and cylindrical probe is introduced. The tube is wrapped with transplant taken from the anterior chamber of the native lens. The transplant is fixed on the tube. The probe is withdrawn and the tube is attached to lacrimal canaliculus wall. Temporary intubation material is removed before introducing tube with the transplant.

EFFECT: enhanced effectiveness of treatment; reduced risk of postoperative complications.

3 dwg

Description

The invention relates to ophthalmology.

The disease of the lacrimal tubules, namely cicatricial lesions of the lacrimal tubule, is the most common pathology of the tear ducts and is accompanied by cataracts. Stage treatment of these pathologies is traumatic both in terms of psychological and cosmetic, it limits the possibilities of plastic surgery, because a graft from the anterior lens capsule is best taken from the patient himself.

An object of the invention is to create an effective method for the simultaneous treatment of cicatricial lesions of the lacrimal tubule, combined with cataract, with the aim of restoring lacrimation, improving postoperative reparative processes, tissue regeneration and shortening the rehabilitation period due to better adaptation and biocompatibility with the walls of the lacrimal tubules and graft from its own anterior capsules of the native lens of the eye.

The technical result is achieved by the fact that in the method of simultaneous surgical treatment of cicatricial lesions of the lacrimal tubule, combined with cataracts, and implantation of an intraocular lens, including intubation of the obliterated lacrimal tubule, perform the first hole in the conjunctiva and tenon membrane 4 mm from the surgical limb, injected into hemostatic solution and close it, then 4 mm from the first hole and 4 mm away from the surgical limb perform similarly the second hole into which viscoelastic is injected for removing through the first hole part of the hemostatic solution and exfoliation of the tenon membrane from the sclera.

Then, a conjunctiva with a tenon shell is cut between these holes, then a corneoscleral tunnel incision is made with an exit to the anterior chamber, capsulorexis is performed, the anterior capsule of the native lens of the eye is placed in physiological saline, the native lens is removed, the intraocular lens is implanted and the wound is sealed; then, in accordance with the localization and extent of the lesion of the lacrimal tubule, a silicone tube with the appropriate length and diameter is selected, a cylindrical probe is inserted into it, the tube is wrapped with a graft from the anterior capsule of the native lens of the patient’s eye, the graft is fixed to the tube, an antibiotic ointment is applied to its surface and introduced into the previously expanded lumen of the lacrimal tubule, the probe is removed, and the tube is fixed to the wall of the lacrimal tubule.

The method is as follows. In the preoperative period, functional tests are performed for lacrimation and the state of the lacrimal and lacrimal apparatus, then a bacteriological test for the microflora of the conjunctival cavity and instillation preparation are performed.

Under local anesthesia, using a pair of scissors and tweezers, a vertical incision is made of the inner (posterior) edge of the eyelid, 2.0-2.5 mm long, 2-3 mm from the top of the lacrimal papilla.

Disclose the lumen of the tubule. If it is not detected, the vertical incision is repeated 2.0 mm inside the first.

After intraoperative determination of the localization and extent of the lesion of the lacrimal tubule, a temporary intubation of the obliterated lacrimal tubule is made; the first hole is made in the conjunctiva and tenon membrane 4 mm from the surgical limb, a hemostatic solution is injected into it and closed, then 4 mm from the first hole and 4 mm from the surgical limb are made similarly to the second hole into which viscoelastic is injected to remove part of the hemostatic solution and exfoliation of the tenon membrane from the sclera.

Then, a conjunctiva with a tenon membrane is cut between these holes. Next, a corneoscleral tunnel incision is made with access to the anterior chamber, capsulorexis is performed, the removed anterior capsule of the native lens of the eye is placed in physiological saline, the native lens is removed, the intraocular lens is implanted and the wound is sealed. Then, in accordance with the localization and extent of lesions of the lacrimal canal, the silicone tube with the appropriate length and diameter is selected, a cylindrical probe is inserted into it, the tube is wrapped with a graft from the front capsule of the native lens of the patient’s eye, the graft is fixed on the tube, an antibiotic ointment is applied to its surface and a temporary intubation material, and a graft with a tube is inserted into a previously formed lacrimal opening and an expanded lumen of the lacrimal tubule, the probe is removed, and rubochku fixed to the wall of the tear ducts. The operation is completed by laying an antibacterial ointment on the lower eyelid and applying a monocular dressing.

The method is illustrated by drawings, where Fig. 1 shows an intubated lacrimal tubule 1, a formed lacrimal opening 2, a graft 3 on an endotracheal tube 4; figure 2 - holes 5 and 6, teno-conjunctival incision 7, the projection of the puncture 8 of the cornea 9 to enter the anterior chamber, Shlemnov channel 10, limb 11, pupil 12, figure 3 - cylindrical probe 13, endotracheal tube 14 and transplant 15 from the native anterior capsule of the native lens of the eye.

Example

Patient T., 65 years old.

Diagnosis: Right eye - obliteration of the lateral and medial third of the lower lacrimal tubule and senile cataract OD.

Visual acuity - 0.1 n / a.

Tear-suction and tear-nasal samples are slowed down.

Passive patency through the lower lacrimal tubule is absent.

The operation was performed according to the method described above, a soft-elastic IOL 18D was implanted. Visual acuity in the postoperative period 1.0. Positive suction and tear tests.

Claims (1)

A method for the simultaneous surgical treatment of scar lesions of the lacrimal tubule combined with cataracts and implantation of an intraocular lens, including temporary intubation of the obliterated lacrimal tubule, then the first hole is made in the conjunctiva and tenon membrane 4 mm from the surgical limb, a hemostatic solution is introduced into it and closed, then 4 mm from the first hole and 4 mm from the surgical limb, the second hole is made similarly, into which viscoelastic is introduced to be removed through the first hole e parts of the hemostatic solution and detachment of the tenon shell from the sclera, a conjunctiva with a tenon shell is cut between the two openings, then a corneoscleral tunnel incision is made with access to the anterior chamber, capsulorexis is performed, the anterior capsule of the native lens of the eye is placed in saline solution, the native lens of the eye is removed implant an intraocular lens and seal the wound, then in accordance with the location and extent of the scar lesion of the lacrimal tubule p a silicone tube is selected with the appropriate length and diameter, a cylindrical probe is inserted into it, the tube is wrapped with a graft from the anterior capsule of the patient’s own native lens of the patient’s eye, the graft is fixed to the tube, an antibiotic ointment is applied to its surface, it is inserted into the previously expanded lumen of the lacrimal tubule, the probe is removed and the tube is fixed to the wall of the lacrimal tubule, while prior to the introduction of the tube with the graft, temporary intubation material is removed.

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