RU2259183C1 - Method for forming pupil in the cases of congenital iris coloboma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out corneal paracentesis in 8 o'clock position and a needle is introduced via it capturing coloboma edge. The needle is pierced back through the cornea in the opposite segment and thread is drawn. The other thread end drawn from the anterior chamber via the paracentesis with a loop being formed that is wrapped twice around forceps branches. Free thread end is caught with the forceps from the paracentesis and knot is tightened by drawing the threads in opposite directions. Pupil dislocation relative to optical axis is determined after finishing iridoplasty. The upper iris edge being situated 1/3 of distance between the photic stimulus reflex from cornea and limb, wedge-like resection of iris pupil zone is carried out in 12 o'clock segment.

EFFECT: provided pupil centering; reduced risk of postoperative complications; improved vision acuity.

Description

The present invention relates to the field of medicine, namely to ophthalmology.

Pupil ectopy in patients with congenital iris coloboma who require cataract extraction with IOL implantation can lead to the development of monocular diplopia in the postoperative period due to exposure of the edge of the optical part of the IOL in the coloboma.

A known method of suturing congenital colobus iris, in which the anterior chamber is opened with a corneal-limbal incision in the coloboma sector. A provisional suture is placed on the corneal lip, for which the corneal flap is pulled up. Coloboma is sutured with a continuous suture, starting from the pupil edge and further to the root of the iris. At the final stage of the operation, sutures are placed on the corneal-limbal incision to seal the anterior chamber (see Volkov V.V. Surgical treatment of congenital coloboma of the iris in both eyes. / V.V. Volkov, V.N. Chernousenko // Ophthalm. - 1975 - No. 7 - S.548-549).

The closest is a method for correcting traumatic defects of the iris, according to which an additional paracentesis was performed at 8 o’clock. A needle was inserted through it into the anterior chamber, the edges of the coloboma were captured by it, and a puncture was made through the cornea in the opposite segment. The thread was stretched and left the end in paracentesis, and the other end of the thread was removed from the anterior chamber, forming a loop, which was wound on the branches of the tweezers. With tweezers, the end of the thread left in the paracentesis was captured and a knot tied, stretching the ends of the thread through the paracentesis in opposite directions (see RF patent No. 2209055, 2003). However, the known methods do not take into account the degree of ectopia of the pupil with a congenital coloboma of the iris, due to which the centering of the pupil is not achieved, the cosmetic result of the operation is reduced.

The technical result of the proposed method is to achieve pupil centering, restoration of the optical system of the eye, increased visual acuity, reduced postoperative complications, increased cosmetic result of the operation.

New in achieving the technical result is that they determine the degree of displacement of the pupil relative to the optical axis.

Also new is the fact that after iridoplasty with an ectopia of a pupil of the 2nd degree, a wedge-shaped resection of the pupil zone of the iris in the 12-hour segment is performed.

The authors developed the following classification of pupil ectopia:

0 - congenital coloboma of the iris without an ectopia of the pupil - the light reflex that defines the optical center of the cornea is projected below the upper pupil edge;

1 degree - the upper pupil edge of the iris is located on the edge of the light reflex from the cornea;

2 degree - the upper pupil edge of the iris is 1/3 of the distance between the light reflex from the cornea and the limb;

3 degree - the upper pupil edge of the iris is 2/3 of the distance between the light reflex from the cornea and the limb.

Preliminary determination of the degree of pupil displacement relative to the optical axis allows one to plan the volume of the operation already at the stage of preoperative examination and thereby ensure its optimal result.

Performing a wedge-shaped resection of the pupil of the iris in the segment 12 hours after iridoplasty allows you to restore the centering of the pupil and the optical system of the eye, provides a high cosmetic result of the operation.

Comparative analysis with the prototype shows that the inventive method is characterized in that the degree of displacement of the pupil relative to the optical axis is determined, and in case of ectopia of a pupil of the 2nd degree after iridoplasty, a wedge-shaped resection of the pupil of the iris is performed in the 12-hour segment, which meets the criterion of "novelty."

A new set of essential features allows to achieve pupil centering, restore the optical system of the eye, increase visual acuity, eliminate cosmetic defects, avoid diplopia in the postoperative period, which meets the criterion of "industrial applicability".

The proposed method of pupil formation with congenital coloboma of the iris is as follows. The degree of pupil displacement relative to the optical axis is determined according to the classification developed by the authors. After performing phacoemulsification with IOL implantation in patients with congenital iris coloboma, the pupil is formed at the final stage of the operation as follows. Impose 1-2 nodal constricting suture in the projection of the coloboma. Perform additional paracentesis at 8 hours. Through it, a long needle with a thread of propylene 10-00 is inserted into the anterior chamber of the eye, the edges of the coloboma are captured with a needle, forming the lower pupillary edge. The injection is carried out through the cornea in the opposite segment. The thread from the needle is not cut, but stretched, leaving the free end (without the needle) in paracentesis. The other end of the thread with a hook is removed from the anterior chamber through the same paracentesis, forming a loop. The loop is captured with suture forceps and 2 times wound onto the branches of the second forceps, which capture the free end of the thread left in the paracentesis. The ends of the thread are stretched through the paracentesis in opposite directions with the help of these suture forceps, tying a knot. The knot is tied three times. After that, both ends of the thread are cut with Vannas scissors through the corneal tunnel incision. With an ectopia of a pupil of the 2nd degree for centering the pupil with Vannas scissors inserted through the main surgical approach, a wedge-shaped resection of the pupil zone of the iris in the 12-hour segment is performed by eversion with a spatula inserted through corneocentesis at 1.30. Thus, a pupil with a diameter of 3.0-3.5 mm is formed. Next, the viscoprotector is evacuated from the anterior chamber. The anterior chamber is restored with saline. Sutures on the corneal incision do not impose. A subconjunctival solution of gentamicin and dexazone is administered.

The method is illustrated by the following clinical example.

Patient P., born in 1964, was admitted on 10.04.03 with a diagnosis of:

Incomplete complicated cataract, congenital coloboma of the iris OU.

On admission:

St.localis:

OU - the cornea is transparent. Front camera uniform up to 3.0 mm. The pupil is displaced by 6 o’clock in the form of a drop, the ectopia of the pupil is 2 degrees (the upper pupil edge is 1/3 of the distance between the light reflex from the cornea and the limb). The reaction of the pupil to the light is sluggish. The lens has brown opacities in the nucleus, more intense on the left. Details of the fundus are not clearly ophthalmoscopically.

04/11/03, an operation was performed on OD - phacoemulsification of cataract with implantation of IOL, iris plastic.

04/13/03, an operation was performed on OS - phacoemulsification of cataract with implantation of IOL, iris plastic.

The operation was performed under local and neuroleptanalgesia. A stitch-retainer was not applied to the superior rectus muscle. The first stage formed a corneal two-stage self-sealing tunnel incision 3.2 mm long. The front chamber was filled with a viscoprotector. To achieve optimal mydriasis and prevent spontaneous myosis, iris refractors were used during phacotherapy procedures. Two corneocentesis was performed at 1.30 and 10.30 hours on either side of the main surgical approach. Irisretractors were introduced into the anterior chamber through paracentesis, capturing the pupil edge of the iris by bending the working part. After installing iris tractors with two tweezers, they were fixed with a sleeve in the limb area. The next stage was performed phacoemulsification of cataract according to standard technology, implantation of an elastic IOL model in a capsular bag. Then the iris tractors were removed. Performed additional paracentesis at 8 hours. Through it, a slightly curved needle with a thread 10-00 was inserted into the anterior chamber of the eye, with which the edges of the coloboma were captured, a puncture was made through the cornea in the opposite segment. The thread from the needle was not cut, but extended. The free end of the thread (without a needle) was left in paracentesis. The other end of the thread was hooked out of the anterior chamber through the same paracentesis, forming a loop. The loop was seized with suture forceps and 2 times wound on the branches of the second suture forceps, which captured the free end of the thread, left in paracentesis. The ends of the thread are stretched in opposite directions with the help of these suture forceps, tying a knot. The knot was tied up three times. After that, both ends of the thread were cut with Vannas's scissors through the corneal tunnel. Then, to center the pupil, Vannas scissors introduced through the main surgical approach performed a wedge-shaped resection of the pupil zone of the iris (in the 12-hour segment) when it was erected with a spatula inserted through corneocentesis at 1.30. Thus, a pupil with a diameter of 3.0-3.5 mm was formed. Further, the viscoprotector was evacuated from the anterior chamber. The anterior chamber was reconstituted with saline. No sutures were made on the corneal incision. A subconjunctival solution of gentamicin and dexazone was administered.

The postoperative period was uneventful, arreactive. Conducted standard anti-inflammatory therapy. The patient was discharged from the hospital on the 5th day. No complaints of double vision. Visual acuity of the right eye at the time of discharge is 0.4, the left eye is 0.5. In the late postoperative period, in the period from 1 to 6 months, uncorrected visual acuity increased compared with vision at discharge and amounted to: right eye - 0.5; left eye - 0.7. This is due to the positive dynamics of compensatory-adaptive processes in the eyes with a restored optical system.

Visual acuity, iridoplasty and cosmetic effect remained stable throughout the observation period.

Claims (1)

A method of forming a pupil with a congenital coloboma of the iris, comprising performing paracentesis of the cornea at 8 hours, introducing a needle through it into the anterior chamber to capture the edge of the coloboma, puncturing the needle through the cornea in the opposite segment and pulling the thread, removing the other end of the thread from the anterior chamber through paracentesis with the formation of a loop, which is twice wound on the branches of the tweezers, the capture of tweezers of the free end of the thread from paracentesis and tightening the node by pulling the threads in opposite directions, characterized in that predelyayut degree of displacement of the pupil relative to the optical axis and if the upper edge of the iris pupillary is 1/3 the distance between the light corneal reflex and limb after iridoplastika operate wedge resection of the pupil of the iris zone in segment 12 hours.