RU2306907C2 - Method for carrying out extracapsular cataract extraction in eye lens subluxation cases of the ii-iii degree - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out corneal incision. Cannula Simcoe is introduced into the anterior chamber and moving the cannula towards posterior lens pole outside of lens equator in continuously feeding irrigation solution. Remaining Zinn ligament fibers are concurrently mechanically destroyed. The irrigation aperture of the cannula is turned towards the posterior lens pole. Corneal scleral lip is compresses and the lens enclosed in capsule is brought out of eye cavity using expression and irrigation, using expression and irrigation, in feeding the solution. Intraocular lens is implanted. Basal iridectomy is carried out and sutures are placed.

EFFECT: reduced risk of intraoperative complications; avoided mechanical corneal epithelium injury; accelerated operation time.

Description

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

Various methods for treating cataracts with lens subluxation are known.

A known method by which a conjunctival flap is cut with a width of 1.0-1.5 mm, the base facing the limb. A scleral notch is made, a provisional suture is applied, the anterior chamber is opened with Barraquer scissors at 100-150 °. Perform basal iridectomy. A chemotrypsin solution is injected into the anterior chamber. Next, the eyeball is compressed with a compression ring. The front and rear chambers are washed with a sterile solution. The iris is pushed back with a retractor in the 12-hour segment and slightly pressed against the scleral lip of the surgical incision. The corneal flap is lifted by the assistant flap assistant. The lens is removed into the surgical wound by rotational movements using a cryoapplicator, which is mounted on the surface of the lens 2 mm from the equator. At the same time, the surgeon separates the remaining fibers of the zinc ligament with a spatula. At the final stage, an IOL of pupillary fixation is implanted. The surgical wound is sealed with sutures. (Fedorov S.N., Egorova E.V. Surgical treatment of traumatic cataracts with intraocular correction. - M., Medicine. - 1985. - S.80-81).

The closest is the way in which a frenum suture is applied to the superior rectus muscle. Conjunctival flap is preliminarily cut with the base to the limb for the entire length of the proposed incision. Spend hemostasis, limbal incision. Impose a provisional seam. Perform basal iridectomy. The lens is removed in a capsule by expression using a loop and spoon. To do this, the assistant pulls the cornea by the provisional suture until the wound gapes, the surgeon presses the scleral lip of the wound with a loop, and with a spoon, pressing on the lower limb, pushes the lens to the exit. As soon as the lens is shown in the wound, the surgeon massages the cornea with a spoon above the limb, moving the lens to the wound. If this fails, then the lens is picked up by a loop. The surgical wound is sutured (see Zolotareva M.M. Eye diseases. - Minsk: Publishing House of Belarus, 1964. - P.387-388).

However, when using known methods, the possibility of mechanical injury to the corneal endothelium, as well as prolapse of the vitreous body and trauma to the iris, is not excluded.

The technical result of the proposed method is to reduce intraoperative complications and reduce the time of the operation.

What is new in achieving the set technical result is that the Simcoe cannula is inserted into the anterior chamber of the eye and, constantly supplying Ringer's solution, the cannula is inserted behind the lens equator towards its posterior pole.

Also new is the fact that the cannula’s irrigation opening is directed towards the posterior pole of the lens and, squeezing the cannula onto the corneal-scleral lip of the surgical incision and constantly supplying the solution, the lens in the capsule is removed from the cavity of the eye by expression and irrigation.

Also new is the fact that at the same time the cannula conducts mechanical destruction of the remaining fibers of the zinc ligament, and after excretion of the lens, an IOL is implanted, basal iridectomy is performed and sutures are applied.

The constant supply of Ringer's solution allows minimizing the mechanical trauma of the corneal endothelium, eliminating the possibility of trauma to the iris, since a constant depth of the anterior chamber of the eye is maintained.

The direction of the irrigation opening of the cannula towards the posterior pole of the crystalline lens avoids damage to the anterior border membrane of the vitreous.

The use of a cannula allows all manipulations when removing the lens to carry out with minimal trauma to the tissues of the eyeball.

Comparative analysis with the prototype shows that the claimed method differs from the known one in that a Simcoe cannula is inserted into the anterior chamber of the eye and, constantly supplying Ringer’s solution, a cannula is inserted behind the lens equator towards its posterior pole, while the remaining zinc fibers are mechanically destroyed ligaments, place the cannula irrigation opening towards the posterior pole of the lens, press on the corneal-scleral lip of the surgical incision and, giving the solution, remove the lens into the capsule le from the cavity of the eye by expression and irrigation, then an intraocular lens is implanted, a basal iridectomy is performed and sutures are applied, which corresponds to the “novelty” criterion.

A new set of features allows to reduce intraoperative complications, since the possibility of mechanical injury to the corneal endothelium, damage to the anterior border membrane of the vitreous body, trauma to the iris by maintaining a constant depth of the anterior chamber of the eye is virtually eliminated, the time of the operation is reduced, additional technical equipment and special tools are not required, which meets the criterion of "industrial applicability".

The method is as follows.

The operation is performed under local and antipsychotic. The upper rectus muscle is fixed with a suture-holder. A corneal incision is made in traditional sizes (9-10 mm). A Simcoe cannula, dressed on a syringe with a balanced solution (Ringer's solution), is inserted into the anterior chamber of the eye. Constantly supplying the solution, the cannula is inserted behind the equator of the lens so that it is under the posterior pole (in the retrolental space). At the same time, mechanical destruction of the remaining fibers of the zinc binder is carried out. The irrigation opening of the cannula is directed towards the lens. Then, by applying a balanced solution and simultaneously slightly pressing a cannula on the corneal-scleral lip of the surgical incision, the lens in the capsule is removed from the cavity of the eye by expression and irrigation. In this case, the cannula simultaneously performs the function of the Weber loop and the function of the iris detector. After removal of the lens, an IOL is implanted, basal iridectomy is performed. At the final stage of the operation, the surgical incision is sealed with a continuous seam.

The method is illustrated by the following clinical example.

Patient S., born in 1948, was admitted to the Irkutsk branch of the State Medical and Technological Center "Eye Microsurgery" with a diagnosis of complete complicated cataract, subclusion of the lens 2-3 degrees, pseudoexfoliation syndrome OD. From the anamnesis: the vision of the right eye decreased gradually over 1 year, and after an injury (fell, hit his head) monocular double vision appeared. Upon enrolment:

Visual acuity: OD - 0.08 n.k. OS - 0, 7 n.k. IOP: OD - 21 mmHg OS - 19 mmHg Echobiometry: OD - 23.58 mm OS - 24.03 mm Keratophthalmometry: OD - 42.35 ax 171 43.09 ax 81 OS - 42.65 ax 170 42.95 ax 80 EFI:

OD OS Phosphene 110 110 Lability 41 43 CFSM 33 31

St.localis

OD - the cornea is transparent. The front camera is uneven 3.0-3.5 mm. The pupil is medically dilated to 5.5 mm. On the pupil edge of the pseudoexfoliation. The lens is diffusely turbid, shifted downward. In the area of the pupil, the equator of the lens is determined. Iridofacodenesis. According to the B-scan, the posterior segment of the eyeball without gross pathology.

An operation was performed on OD - intracapsular cataract extraction with IOL implantation.

The operation was performed under local and neuroleptanalgesia. The superior rectus muscle is fixed with a suture-retainer. The lens with the patient lying down has taken its usual position. A general surgical knife with a diamond blade made a corneal incision from 2 to 10 hours. A Simcoe cannula, dressed on a syringe with Ringer's solution, is inserted into the anterior chamber of the eye. With a constant supply of the solution, the cannula starts up behind the lens equator, as if outlining (repeating) its contour in the meridian for 9 hours towards the back pole. The cannula is set at 12 o’clock so that its opening is directed towards the posterior pole of the lens. Then, slightly increasing the flow of the solution and simultaneously squeezing the cannula onto the corneal-scleral lip of the surgical incision, the lens in the capsule is removed from the cavity of the eye by expression and irrigation. At the next stage of the operation, an IOL is implanted. A basal iridectomy is performed. The corneal incision is fixed with a continuous seam along Pierce. The anterior chamber is restored by Ringer's solution. The operation ends with a subconjunctival injection of a solution of dexazone and gentamicin.

The postoperative period was uneventful. Conducted standard anti-inflammatory therapy, visual acuity of the right eye on the 5th day - 0.5 with sphero-cylindrical correction. IOP - 20 mmHg After 5 months, the corneal suture was removed. Visual acuity of the right eye of the right eye after 10 months was 0.8; IOP - 19 mmHg

Claims (1)

A method for intracapsular cataract extraction during lens subluxation, including performing a corneal incision, removing the crystalline lens from the eye cavity, implanting an intraocular lens, characterized in that a "Simcoe" cannula is inserted into the anterior chamber of the eye, and a cannula is inserted through the lens equator to constantly irrigate the solution; towards its posterior pole, mechanical destruction of the remaining fibers of the zinc ligament is simultaneously carried out, the cannula’s irrigation opening is directed towards the posterior pole of the lens, above pour-on Corneal scleral incision lip and feeding solution is withdrawn from the lens capsule in the eye cavity expression and irrigation, more implanted IOL, operate basal iridectomy and sutured.