RU2237455C1 - Method for deepening shallow anterior chamber in performing surgical intervention on anterior eye segment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing viscous preparation through paracentesis in cornea. The paracentesis is done shallow portion of ciliary body at depth of 2-3 mm. New portion of viscous preparation is additionally introduced into the anterior chamber. Incision in the flat portion of ciliary body is partially opened by means of instrument and a portion of vitreous body fluid is discharged in continuing viscous preparation supply into the anterior chamber. The action is repeated until optimum depth of the anterior chamber is reached.

EFFECT: reduced risk of traumatic complications in deepening the anterior chamber.

Description

The claimed invention relates to medicine, and more specifically to ophthalmic surgery, and can be used for surgical interventions in the anterior segment of the eye in the case of a shallow anterior chamber.

There is a method of deepening and maintaining for a certain time the volume of the anterior chamber with the aim of atraumatically conducting surgery on the anterior segment of the eye by introducing into the anterior chamber a visco-product with a high molecular weight (sagging, chialon, etc.) (L. Buratto, Cataract Surgery, 1999 , p. 254 - prototype).

The disadvantage of the described method is the inability to use this technique with a shallow anterior chamber, which occurs when there is increased pressure in the posterior segment of the eye, with nanophthalmos, a large swelling lens, and traumatic damage to the anterior segment. Naturally, with a small volume of the anterior chamber when using viscoelastic, a rapid emptying of the chamber will occur, which will prevent the surgeon from atraumatically performing the necessary manipulations in the anterior chamber.

The task of the invention is to develop a method for intraoperative deepening of the anterior chamber to enable further atraumatic management of the main operation.

The technical result obtained by solving this problem is to exclude surgical and postoperative complications and increase the visual function of the eye.

The specified technical result can be obtained if, in the method of deepening the shallow anterior chamber during surgical interventions in the anterior segment of the eye by introducing a viscoelastic preparation with a high molecular weight into the anterior chamber after paracentesis in the cornea of the viscous preparation, paracentesis is performed in the flat part of the ciliary body to a depth of 2- 3 mm, then a new portion of the viscose preparation is added to the anterior chamber and then, using a tool, the incision is opened in the flat part of the ciliary body and, continuing along avat viskopreparat into the front chamber is discharged to the outside portion of the vitreous body, this method is repeated to obtain the optimal depth of the anterior chamber.

Among the essential features characterizing the method, the distinguishing ones are:

- after introduction through paracentesis in the cornea of the viscometer, paracentesis is performed in the flat part of the ciliary body to a depth of 2-3 mm;

- then in the front chamber add a new portion of the viscose product;

- then, using the tool, the incision is opened in the flat part of the ciliary body and, while continuing to feed the viscous product into the anterior chamber, a portion of the vitreous body is released to the outside;

- repeat this technique until the optimal depth of the anterior chamber is obtained.

Between the totality of the essential features of the claimed invention and the achieved technical result, there is a causal relationship.

After opening the anterior chamber, intraocular fluid flows out, the anterior chamber decreases, and the corneal endothelium is damaged. In order to prevent this from happening, after opening the anterior chamber, a viscous product with a high molecular weight and high viscosity is introduced into it, and although it leaks out, it occurs at a much lower speed, which allows for manipulations in the anterior chamber atraumatically. However, in the case when the front camera is small, such actions are not enough.

A method is proposed that allows to deepen the anterior chamber before the start of the main surgical operations due to a smooth, controlled reduction in the volume of the vitreous body (CT). For this, paracentesis in the cornea is first performed and the anterior chamber is filled with a viscous product, the desired deepening is not achieved, after which paracentesis is performed in the flat part of the ciliary body (to a depth of 2-3 mm, i.e. the integrity of the hyaloid is violated), as a result, the liquid fraction is released CT outward, therefore, introducing into the anterior chamber a new portion of the viscous product, it is possible to obtain a small displacement of the iris-lens diaphragm posteriorly. After that, using a tool, such as a spatula, create a lumen of the channel in the flat part of the ciliary body, through which the ST begins to come out under the pressure exerted by the next portion of the viscometer introduced into the front chamber, and the surgeon can adjust the width of the lumen, and therefore the volume of the outgoing ST, . Repeat this technique until the required depth of the anterior chamber is achieved. An optimal depth is usually obtained by administering 0.1-0.15 ml of a high molecular weight viscometer. As a result of such actions, it is possible to obtain a deepening of the shallow anterior chamber without pressure drops in the eye and atraumatic for eye structures.

Thus, between the set of essential features and the achieved technical result, there is a causal relationship.

The method is as follows.

The beginning of surgery in the anterior segment of the eye is traditional. Corneal paracentesis is performed, mydriatic is introduced, the anterior chamber is filled with viscoelastic and, if the surgeon sees that it does not go deep to the optimal size, the claimed method is used. Those. paracentesis is performed in the flat part of the ciliary body, while a small amount of CT liquid fraction is released to the outside, a viscous preparation (sag) is added to the anterior chamber, and under its action, the iris-lens diaphragm is displaced posteriorly (since CT is partially released). Further, continuing to feed a viscous product into the anterior chamber, a spatula is inserted into the scleral incision and, deploying it, form a lumen through which another portion of the vitreous body comes out, while the anterior chamber is deepened. If the depth of the chamber is not enough, then the action to remove the portion of CT to the outside is repeated. Having received the optimal size of the anterior chamber, they proceed to the main stage of surgical intervention.

Example. Patient N. was admitted with a diagnosis

OD: Stage III angle-closure glaucoma previously operated on with decompensated (> 32 mmHg) pressure using antihypertensive drops.

OS: stage II angle-closure glaucoma, previously operated on with subcompensated (26-32 mmHg) pressure using antihypertensive drops.

Complicated cataract OU.

On admission:

VOD = 0.3 n / k

VOS = 0.3 sph - 1.5D - cyl - 1.5D × 5 ° = 0.7

IOP Po OD = 49 mm Hg; Po OS = 28 mmHg

On UBM, the depth of the anterior chamber is OD 1.15 mm.

Surgery was performed on the right eye.

Operation progress:

According to the claimed invention, an intraoperative deepening of the anterior chamber to an optimal value (3.5 mm) was carried out, which allowed atraumatic cataract phacoemulsification with implantation of the posterior chamber IOL of the T-26 model and reconstruction of the anterior chamber angle without damaging the corneal endothelium.

On the first day after surgery:

VOD = 0.5 sph + 0.5D⊂cyl + 0.5D × 95 ° = 0.7

IOP Po OD = 16 mm Hg

Depth of the anterior chamber 3.84 mm.

The eye is calm, the cornea is transparent, the moisture of the anterior chamber is transparent, the IOL in the capsule bag is centered.

When appearing after 1 month:

VOD = 0.6 sph + 0.5D = 0.8

IOP Po OD = 17 mmHg

The eye is calm, the cornea and optical media are transparent, the IOL is centered. Changes in the vitreous body are not observed. Thus, the used method of introoperative deepening of the anterior chamber made it possible to atraumatically perform complex manipulations on the anterior segment of the eye. The intraocular pressure drop during the actions to deepen the anterior chamber was not observed.

Using the proposed method in the Yekaterinburg Center MNTK "Eye Microsurgery" operated on 44 patients. In all cases, the proposed method allowed to deepen the anterior chamber to the optimum size and to perform the planned surgical procedures successfully.

Claims (1)

A method for deepening the shallow anterior chamber during surgical interventions on the anterior segment of the eye by introducing a viscoelastic preparation with a high molecular weight into the anterior chamber, characterized in that after introduction through paracentesis in the cornea of the viscous preparation, paracentesis is performed in the flat part of the ciliary body to a depth of 2-3 mm, then in the front chamber add a new portion of the viscose preparation and then with the help of the tool open the incision in the flat part of the ciliary body and, while continuing to feed the viscose preparation into the front camera, release a portion of the vitreous to the outside, repeat this technique until the optimal depth of the anterior chamber is obtained.