RU2310428C1 - Method for carrying out cataract extraction on eyes having earlier implanted phakic posterior chamber intraocular lens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out two corneal paracenteses along two meridians of opposite direction (like 9 and 15 o'clock). One haptic phakic posterior chamber intraocular lens member is dislocated into the anterior chamber onto the iris. Anterior capsulorhexis is carried out through one of the paracenteses under the half-dislocated lens. One of the paracenteses is widened and cataract phakoemulsification is carried out. Next to it, the phakic posterior chamber intraocular lens is withdrawn through the same widened paracenteses and aphakic intraocular lens is implanted.

EFFECT: reduced risk of operative and postoperative complications; enabled additional cornea protection.

Description

The invention relates to medicine, more specifically to ophthalmology, and can be used for cataract extraction in the eyes with a previously implanted posterior chamber phakic intraocular lens (Z-FIOL).

The problem of cataract extraction in the eyes with previously implanted Z-FIOL is relevant, because according to studies conducted by different authors, the incidence of cataracts is from 10 to 33%. It should be noted that these are mainly patients of a young working age who require quick repeated visual rehabilitation.

The closest analogue is the method of cataract extraction in the eyes with previously implanted Z-FIOL, which includes the following steps: two corneal paracentesis, dislocation of the haptic elements of Z-FIOL into the anterior chamber of the eye, surgical incision, removal of the phakic intraocular lens (Z-FIOL), conducting anterior capsulorexis, extraction of the lens nucleus, implantation of an aphakic IOL (Colin at all j. Cataract Refractive Surgery, Vol. 26, 2000 p.2).

However, with a low density of endothelial cells, which in 90% of cases accompanies the development of a cataract process in the eyes with previously implanted corrective lenses, fragmentation of 3-IOL in the anterior chamber of the eye through a 3 mm incision increases the invasiveness of the operation. To reduce it, surgeons most often expand surgical access, while there is a drop in IOP, which in itself already increases the invasiveness of the intervention (helps reduce the density of endothelial cells, causes traction processes of the vitreous body).

The technical result according to the invention is to reduce intraoperative and postoperative complications by minimizing intraocular pressure drops (IOP), additional protection of the corneal endothelium by performing basic manipulations under the phakic lens.

The technical result according to the invention is achieved by the fact that in the method of cataract extraction in the eyes with a previously implanted Z-FIOL, comprising two corneal paracentesis, dislocation of one of the haptic elements of Z-FIOL into the anterior chamber of the eye, removal of the phakic IOL, conducting anterior capsulorexis, nuclear extraction the lens and IOL implantation, after dislocation of one haptic element through one of the paracentesis and the pupil under the Z-FIOL perform anterior capsulorexis, then expand one of the paracentesis, rovodyat phaco the lens nucleus followed by removal of Z-Fiol aphakic lens and implantation.

The method is as follows.

After standard patient premedication and conduction anesthesia, the surgical field is treated, local peribulbar anesthesia is performed and blepharostat is applied to the eyelids. In two opposite meridians (example at 9 and 15 hours) two corneal paracentesis are performed, the anterior chamber is filled with viscoelastic. Then one haptic element Z-FIOL is dislocated into the anterior chamber of the eye through the pupil to the iris. Under a half-dislocated lens, anterior capsulorhexis is carried out through one of the paracentesis, then one of the paracentesis is expanded, phacoemulsification of the lens nucleus is carried out, followed by removal of Z-FIOL and implantation of the aphakic lens. Sealing the surgical wound is done by hydrating the side walls of the tunnel by injecting saline through a cannula. The operation ends with a subconjunctival injection of a corticosteroid with an antibiotic.

Patient K., 30 years old, came to the clinic in 1996 with a diagnosis of High degree myopia in both eyes.

OD 0.02 sph - 12.5 cyl - 2.5 ax 141 = 0.3

OS 0.02 sph - 12.0 cyl 1.5 ax 59 = 0.4

In 1996, negative Z-FIOL from a collagen copolymer of 12 diopters was implanted in both eyes. The operation and the postoperative period are smooth.

After the operation, the visual acuity of the right eye is 0.5 sph + 1.0 cyl - 2.0 ax 20 = 0.6, the intraocular pressure is 18, the field of view is not changed, the anteroposterior axis of the eye is 25.97 mm. The visual acuity of the left eye after surgery 0.4 sph + 0.5 cyl - 3.5 ax 65 = 0.8, intraocular pressure 15, the field of view is not changed, the anteroposterior axis of the left eye is 25.44 mm.

In 2004, the patient felt a deterioration in her right eye vision. Diagnosed with complicated anterior capsular cataract with opalescence of the lens substance. The visual acuity of the right eye decreased to 0.1 (not corrected). The loss of density of endothelial cells was 20% compared with 1996.

In November 2005, a phakic lens was removed with simultaneous phacoemulsification of a cataract and implantation of an aphakic IOL in the right eye according to the invention. The operation, the postoperative period proceeded smoothly. A week after the operation, visual acuity of the right eye = 0.5 sph - 1.0 diopters = 0.6. Throughout the observation period, the obtained functional result is stable. Loss of endothelial cell density within 2%.

Patient L., 49 years old. Diagnosis: OD; high degree hyperopia

OS high degree hyperopia

He went to the clinic in 1999. Vision at admission

OD 0.06 sph + 9.0 = 0.4

OS 0.07 sph + 8.0 = 0.3.

After the 3-FIOL implantation operation from a collagen copolymer in both eyes + 9.0 diopters, OD vision increased to 0.8-0.9, OS - to 0.9, intraocular pressure of the right eye 18 mm Hg, left 20 mm Hg Fields of view are not changed. In 2004, the patient felt visual impairment in his left eye. Diagnosed with complicated anterior capsular cataract with opalescence of the lens substance. The visual acuity of the left eye decreased to 0.1 (not corrected). The loss in the density of endothelial cells was 16% compared with 1996.

In November 2005, a phakic lens was removed to a patient with simultaneous cataract phacoemulsification and implantation of an aphakic IOL on the left eye according to the invention. The operation, the postoperative period proceeded smoothly. One week after the operation, visual acuity of the left eye = 0.8 without correction. Throughout the observation period, the obtained functional result is stable. Loss of endothelial cell density within 1.2%.

Claims (1)

A method for cataract extraction in the eyes with a previously implanted posterior chamber phakic intraocular lens (3-FIOL), including two corneal paracentesis, dislocation of one of the 3-FIOL haptic elements into the anterior chamber of the eye, removal of 3-FIOL, anterior capsulorexis, extraction of the lens nucleus and implantation of an intraocular lens, characterized in that after dislocation of one haptic element through one of the paracentesis and the pupil under 3-FIOL, anterior capsulorexis is performed, then one of the pairs is expanded tsentezov, phaco the lens nucleus is carried out followed by removal of the 3-Fiol and aphakic intraocular lens implantation.