RU2271788C1 - Method for implanting posterior chamber intraocular lens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making surgical incision and anterior capsulorhexis. Capsulorhexis diameter is greater than intraocular lens optical part diameter for not more than 1 mm. Lens masses are withdrawn. Viscoelastic is introduced between lens capsule leaflets. Additional anterior capsule flap excision is carried out at 3 or 9 o'clock position shaped as triangle having its base and altitude, equal to 1.5-2.0 mm, turned towards the center. A supporting member of the lens is introduced into the capsule sack by smoothly bending and rotating the lens. Bending and setting the second intraocular lens-supporting member is carried out in the vicinity of triangular anterior chamber incision. The lens is centered. Viscoelastic is removed from the anterior chamber and the surgical incision is sealed.

EFFECT: facilitated intraocular lens members setting; reliably fixed and centered intraocular lens; reduced risk of traumatic complications.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used to correct aphakia.

A known method of implantation of a posterior intraocular lens (Fedorov S.N., Egorova E.V. - Errors and complications when implanting an artificial lens. - M. - 1992. - S. 110-117). The essence of the method is to conduct an operative incision, dissection and excision of the anterior capsule of the lens, removal of the lens masses, the introduction of viscoelastic between the leaves of the capsule of the lens, the introduction of one supporting element of the intraocular lens into the capsular bag until it stops in the lower equatorial arch, and the second supporting element is inserted into the capsular bag by its smooth bending and rotation of the intraocular lens, centering the lens, removing viscoelastic from the anterior chamber, sealing the surgical incision.

The disadvantages of the method are the high probability of rupture of the fibers of the zinc ligament, posterior capsule, prolapse of the vitreous body, due to the difficulty of dosed dissection of the front capsule; torn, randomly formed flaps of the anterior capsule create an obstacle for the complete evacuation of the lens masses and the intracapsular implantation of an intraocular lens, injure the iris in the postoperative period, contributing to the occurrence of iridocyclitis.

The closest technical solution is the method of implanting a posterior intraocular lens (Gimbel HV, Neuhann T. - Development, advantages and methods of the continuous circular capsulorhexis technique. - J Cataract Refract Surg. - 1990. - Vol.16. - No. 1. - P .31-37), adopted as a prototype. According to the specified method, an operative incision is performed, a circular opening of the anterior lens capsule (capsulorexis) with a diameter of 5 to 9 mm is performed, lens masses are removed, viscoelastic is inserted between the lens capsule leaves, one supporting element of the intraocular lens is inserted into the capsular bag until it stops in the lower equatorial arch, the second supporting element is inserted into the capsular bag by smoothly bending and rotating the intraocular lens, the lens is centered, viscoelastic is removed from the anterior chamber, and the surgical discharge is sealed h.

However, with a minimum diameter of capsulorexis, it is difficult and time-consuming to remove the lens masses and to direct the supporting elements of the intraocular lens into the capsular bag, causing a risk of damage to the posterior capsule, prolapse of the vitreous body and trauma to the corneal endothelium. At the same time, with a wide opening of the anterior capsule due to its thinning in the peripheral zone, the risk of rupture of the fibers of the zinc ligament, posterior capsule, and prolapse of the vitreous body also increases; the small size of the flaps of the anterior capsule excludes the possibility of fixing the intraocular lens in the capsular bag, increasing the likelihood of postoperative complications. In addition, in children with a large diameter of the anterior capsulorhexis, which does not provide the location of the supporting elements completely between the capsule bag leaves, and the implantation of folding intraocular lenses in the distant postoperative period, due to the often fibrous fusion of the front and rear sheets, the support elements are “pushed” from the capsule bag with subsequent decentration and dislocation of the lens.

Based on the disadvantages of the prototype, the task was to develop a method for implanting a posterior intraocular lens, which allows:

- facilitate the process of setting the supporting elements of the intraocular lens into the capsular bag;

- reduce the risk of rupture of the fibers of the zinc ligament, damage to the posterior capsule, prolapse of the vitreous body and trauma to the corneal endothelium;

- to ensure proper centering and reliable fixation of the intraocular lens in the capsular bag.

To solve this problem, we proposed a method for implanting a posterior intraocular lens, which consists in performing an surgical incision, performing anterior capsulorhexis, removing the lens masses, introducing viscoelastic between the lens capsule leaves, introducing one supporting element of the intraocular lens into the capsular bag until it stops in the lower equatorial area, into the capsule bag of the second support element by smoothly bending and rotating the intraocular lens, centering the lens, removing it from the the middle chamber of viscoelastic, sealing the surgical incision, characterized in that the diameter of the capsulorexis does not exceed more than 1 mm the diameter of the optical part of the intraocular lens; carry out additional excision of the flap of the anterior capsule at 3 or 9 hours in the form of a triangle with the base facing the center and a height of 1.5-2.0 mm after the introduction of viscoelastic between the capsule leaves; bending and reduction into the capsule bag of the second supporting element of the intraocular lens is carried out in the region of a triangular section of the front capsule.

The advantage of this method in comparison with the prototype is to facilitate the procedure for the support elements of the intraocular lens into the capsular bag through increased access in the front capsule, which minimizes the risk of rupture of the zinc ligamentous fibers, damage to the posterior capsule, prolapse of the vitreous body and trauma to the corneal endothelium. Preservation of sufficient peripheral flaps of the anterior capsule ensures proper centering and reliable fixation of the intraocular lens in the capsular bag, which reduces the likelihood of postoperative complications and allows the folding of intraocular lenses in children.

The drawing shows a front capsule after capsulorexis and excision of a triangular flap, where d is the diameter of capsulorexis, l is the base length of the excised triangular flap, h is the height of the excised triangular flap.

The method is as follows. An operative incision is performed, anterior capsulorrhexis is performed with a diameter not exceeding 1 mm in diameter of the optical part of the implantable intraocular lens, lens masses are removed, viscoelastic is inserted between the lens capsule leaves, an additional dissection of the anterior capsule flap is carried out for 3 or 9 hours in the form of a triangle with inverted to the center with a base and a height of 1.5-2.0 mm, one supporting element of the intraocular lens is inserted into the capsular bag until it stops in the lower equatorial arch, and it is inserted into the capsular m shock second supporting member by rotation of the intraocular lens and smooth bending of the support member in the region of the triangular section of the anterior capsule, the lens is centered, is removed from the anterior chamber viscoelastic, sealed operating section.

The method is illustrated by the following examples:

Example 1. Patient C., 10 years old, was admitted with a diagnosis of OD - traumatic (post-concussion) cataract. Complaints on admission to low vision OD. Visual acuity OD: 0.08 not corr. Biomicroscopy data: incomplete opacification of the lens OD, lens capsule is not damaged.

The implantation of the posterior intraocular lens of polymethylmethacrylate with an optical diameter of 6 mm was carried out according to the proposed method. An operative incision was made, anterior capsulorexis was made with a diameter of 7 mm, lens masses were removed, viscoelastic was inserted between the lens capsule sheets, an additional excision of the anterior capsule flap was performed at 9 o’clock in the form of a triangle with a base facing the center and a height of 2.0 mm. One supporting element of the intraocular lens is inserted into the capsular bag until it stops in the lower equatorial arch, the second supporting element is inserted into the capsular bag by rotating the intraocular lens and smoothly bending the supporting element in the region of the triangular section of the anterior capsule. Due to the increased access in the front capsule, the insertion of the supporting elements of the intraocular lens into the capsule bag was carried out quickly and did not cause technical difficulties. There were no intraoperative complications (rupture of the fibers of the zinc ligament, damage to the posterior capsule, prolapse of the vitreous body, etc.). The lens is correctly centered and securely fixed in the capsule bag, the viscoelastic is removed from the anterior chamber, and the surgical incision is sealed.

In the postoperative period, antibacterial and anti-inflammatory therapy was used. At discharge: OD - almost calm; visual acuity of 0.7; the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, the pupil is round, mobile, the intraocular lens is located intracapsularly and occupies a central position.

After 6 months and 1 year after surgery - visual acuity OD 0.9. The eye is calm, the cornea is transparent, the pupil is round, mobile, the intraocular lens is located in the capsular bag, occupies a stable central position.

Example 2. Patient D., 6 years old, was admitted with a diagnosis of OS - congenital cataract. Amblyopia. Complaints on admission to low vision OS. Visual acuity OS: 0.1 is not corr. Biomicroscopy data: partial opacification of the lens of the OS.

The implantation of a folding posterior intraocular lens with an optical diameter of 5 mm was carried out according to the proposed method. An operative incision was made, the anterior capsulorexis was made with a diameter of 6 mm, the lens masses were removed, a viscoelastic was inserted between the lens capsule sheets, an additional excision of the anterior capsule flap was performed for 3 hours in the form of a triangle with the base turned to the center and a height of 1.5 mm. One supporting element of the intraocular lens is inserted into the capsular bag until it stops in the lower equatorial arch, the second supporting element, without causing technical difficulties, is inserted into the capsular bag by rotating the intraocular lens and smoothly bending the supporting element in the triangular section of the front capsule. The lens is correctly centered and securely fixed in the capsule bag, the viscoelastic is removed from the anterior chamber, and the surgical incision is sealed. No intraoperative complications were observed.

In the postoperative period, antibacterial and anti-inflammatory therapy was used. At discharge: OS - almost calm; visual acuity of 0.2 (due to amblyopia); the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, the pupil is round, mobile, the intraocular lens is located intracapsularly, in the center.

2 years after the operation, OS is calm, the cornea is transparent, the pupil is round, mobile, the intraocular lens is located in the capsular bag, occupies a stable central position.

The proposed method for the implantation of a posterior intraocular lens allows us to solve the problem: to facilitate the procedure for the positioning of the supporting elements of the intraocular lens into the capsular bag; reduce the risk of rupture of the fibers of the zinc ligament, damage to the posterior capsule, prolapse of the vitreous body and trauma to the corneal endothelium; ensure proper centering and reliable fixation of the intraocular lens in the capsule bag, which reduces the likelihood of postoperative complications and allows the folding of intraocular lenses in children.

Claims (1)

A method for implanting a posterior intraocular lens by performing an surgical incision, performing anterior capsulorhexis, removing the lens masses, introducing viscoelastic between the lens capsule sheets, introducing one support element by smoothly bending and rotating the intraocular lens, centering the lens, removing viscoelastic from the anterior chamber, incision, characterized in that the diameter of the capsulorexis does not exceed more than 1 mm the diameter of the optical part of the intraocular lens; conduct additional excision of the flap of the anterior capsule at 3 or 9 hours in the form of a triangle with the base facing the center and a height of 1.5-2.0 mm, after the introduction of viscoelastic between the capsule leaves; bending and reduction into the capsule bag of the second supporting element of the intraocular lens is carried out in the region of a triangular section of the front capsule.