RU2281736C2 - Method for cataractous extraction - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with ultrasound cataractous extraction: one should make incision of 2.5 mm length followed by ultrasound division of lenticular nucleus into two equal parts, the power of ultrasound impact corresponds to about 17-35 mW, impact time lasts for 0.15-0.25 min, impulse frequency being 1-7 Hz. Then one should remove equal central parts of the obtained halves of lenticular nucleus at applying the following parameters of ultrasound impact: power 3-15, impact time 0.17-0.35 min, impulse frequency 3-10 Hz. After that, one should successively remove remained parts of lenticular nucleus mechanically. Operation should be finished by applying an interrupted suture. The innovation decreases traumatism of ocular tissues and such postoperational complications as the loss of endothelial corneal cells, corneal edema, development of endothelial-epithelial corneal dystrophy at simultaneous decreased period of surgical interference.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, more specifically to ophthalmic surgery, and can be used for partial ultrasonic removal of the lens nucleus in combination with mechanical removal of the remaining parts.

A known method of ultrasonic extraction of cataracts, including ultrasonic destruction of the lens nucleus with its subsequent emulsification and aspiration (described in RU 2197932 C1 of 02/10/2003).

However, this method has significant disadvantages: a sufficiently large trauma to the tissues of the eye due to the use of high power and duration of ultrasonic exposure to completely remove the lens nucleus; the presence of postoperative complications (large loss of endothelial cells, corneal edema, a high incidence of endothelial-epithelial corneal dystrophy) and a long duration of surgical intervention.

An object of the invention is to provide an effective method for ultrasonic extraction of cataracts in order to reduce trauma to eye tissue by reducing the power and duration of ultrasound exposure.

The technical result according to the invention is achieved by the fact that in the method of ultrasonic cataract extraction, including ultrasonic destruction of the lens nucleus with its subsequent emulsification and aspiration, in this case, after a 2.5 mm incision is made, the lens nucleus is ultrasonically divided into two equal parts, and the power ultrasonic exposure lies in the range from 17 mW to 35 mW, in the interval of exposure time from 0.15 minutes to 0.25 minutes and with a pulse frequency of 1 Hz to 7 Hz, then the removal is equal the central parts obtained by half the lens nucleus, and the power of ultrasonic exposure lies in the range from 3 mW to 15 mW, in the interval of exposure time from 0.17 minutes to 0.35 minutes and with a pulse frequency of 3 Hz to 10 Hz, then the remaining parts of the core by mechanical means through a previously performed incision, the operation is completed by applying a nodal suture.

The combination of distinctive essential features of the invention proposed by the authors is necessary and sufficient for a uniquely positive solution to the claimed technical problem.

The proposed method is illustrated by the drawings shown in figures 1-4.

Figure 1. The first stage of the operation. Using ultrasound, the lens core 1 is divided into two halves 2 and 3 through incision 4.

Figure 2. The second stage of the operation. Removing the central equal parts 5, 6 of the obtained halves 2 and 3 of the nucleus 1 of the lens.

Figure 3. View of the lens nucleus after removal of central equal parts 5, 6 of the resulting halves 2, 3 (Fig. 2) of the lens nucleus 1, the remaining parts 7, 8.

Figure 4. View of the nucleus 1 of the lens after removal of one of the remaining parts 7 (figure 3) of the nucleus 1 of the lens and the remaining part 8.

The proposed method according to the invention is as follows.

After neuroleptoanalgesia, treatment of the surgical field, akinesia and dilated pupil mechanically, a frenum suture is applied to the superior rectus muscle. At 3 o'clock paracentesis is performed. At 12 hours of the scleral part of the limb, a 2.5 mm long tunnel incision is made. A solution of mesatone and viscoelastic are sequentially introduced into the anterior chamber. After conducting the anterior circular capsulorexis, the tip of the phacoemulsifier is introduced into the anterior chamber. Using ultrasound, the tip of the phacoemulsifier and chopper, the lens core 1 is divided into two equal parts 2 and 3.

The power of ultrasonic exposure lies in the range from 17 mW to 35 mW, in the interval of exposure time from 0.15 minutes to 0.25 minutes, with a pulse frequency of 1 Hz to 7 Hz.

Next, equal central parts 5 and 6 of the obtained halves 2 and 3 of the lens nucleus 1 are removed. Moreover, the power of ultrasonic exposure lies in the range from 3 mW to 15 mW, in the range of exposure from 0.17 minutes to 0.35 minutes, with a pulse frequency of 5 Hz to 10 Hz. Emulsification and aspiration are carried out.

Next, the remaining parts 7, 8 of the core 1 are subsequently removed mechanically, the operation is completed by the position of the nodal suture. An intraocular lens is implanted as indicated.

The method is illustrated by clinical examples.

Example No. 1. Patient K., 62 years old.

Diagnosis: OS - overripe age-related cataract, open-angle glaucoma 2 A unstabilized. Initial cataract OD, Visual acuity: OS - the correct projection of light.

OD - 0.7 not corr.

The density of endothelial cells OS - 1250 cells / mm ² .

The patient underwent surgery according to the invention. In this case, when separating the lens nucleus, ultrasonic treatment was performed with a power of 17 mW for 0.15 minutes with a pulse frequency of 1 Hz. Then, ultrasound was applied to central equal parts with a power of 3 mW, exposure time of 0.17 minutes and a pulse frequency of 5 Hz, and the remaining parts of the lens nucleus were removed mechanically.

The operation and the postoperative period without complications.

At discharge:

Visual acuity: OS - 0.9

OD - 0.7 not corr.

Optical media are transparent.

The density of endothelial cells is 1110 cells / mm ² (loss of 7.5%).

Example No. 2. Patient C., 65 years old.

Diagnosis: OS - complicated cataract, open-angle glaucoma 2 A operated unstabilized.

Visual acuity: OS - 0.07 not corr.

OS - 0.5 not corr.

The density of endothelial cells OS - 1750 cells / mm ² .

The patient underwent surgery according to the invention. In this case, when the lens core was divided into two equal parts, ultrasonic treatment was carried out with a power of 20 mW for 0.2 minutes and with a pulse frequency of 5 Hz. Then, ultrasound was applied to central equal parts with a power of 10 mW, exposure time of 0.25 minutes and a pulse frequency of 6 Hz, and the remaining parts of the lens nucleus were removed mechanically.

The postoperative period was uneventful. No adverse changes in the tissues of the eye were detected. An intraocular lens was implanted.

At discharge:

Visual acuity: OD - 0.7 not corr.

OS - 0.5 not corr.

Optical media are transparent.

The density of endothelial cells OD - 1550 cells / mm ² (loss of 11.5%).

Example No. 3. Patient F., 49 years old.

Diagnosis: OD - complicated cataract, open-angle glaucoma 1 A unstabilized.

Visual acuity: OD - 0.1 not corr.

OS - 0.7 not corr.

The density of endothelial cells OD - 1700 cells / mm ² , OS-2100 cells / mm ² .

The patient underwent surgery according to the invention. In this case, when the lens nucleus was divided into two equal parts, the ultrasonic effect was carried out with a power of 35 mW, 0.25 minutes and with a pulse frequency of 7 Hz. Then, ultrasound was applied to the central equal parts of the lens core with a power of 15 mW, 0.35 minutes at a frequency of 10 Hz, and the remaining parts of the lens core were removed mechanically. A lens was implanted - D.

The operation and the postoperative period were uneventful. At discharge: visual acuity OD-0.8, OS-0.6 is not corr.

The density of endothelial cells OS - 1650 cells / mm ² (loss of 3.1%).

The proposed method allows to reduce trauma to the eye tissue and postoperative complications (loss of endothelial cells, corneal edema, the incidence of endothelial-epithelial corneal dystrophy) while reducing the time of surgery.

Claims (1)

A method of ultrasonic extraction of cataracts, including ultrasonic destruction of the lens nucleus with its subsequent emulsification and aspiration, characterized in that after a 2.5 mm incision is made, the lens nucleus is ultrasonically divided into two equal parts, and the ultrasonic exposure power ranges from 17 to 35 mW, in the interval of exposure time from 0.15 to 0.25 minutes, with a pulse frequency of 1 to 7 Hz, then the equal central parts of the obtained halves of the lens nucleus are removed, and the power the ultrasonic exposure lies in the range from 3 to 15 mW, in the exposure time interval from 0.17 min to 0.35 min, with a pulse frequency of 3 to 10 Hz, then the remaining parts of the lens nucleus are sequentially removed mechanically, the operation is completed by applying a nodal seam.

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