RU2317052C1 - Method for extracting cataract from narrow rigid pupil eyes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming circular capsulorhexis along the pupil edge without causing its mechanical expansion. Lens nucleus is broken in the pupil center in vertical plane by means of special-purpose chopper. Next, fragment emulsification is carried out.

EFFECT: reduced risk of traumatic complications.

Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in the surgical treatment of cataracts in the eyes with concomitant glaucoma, chronic iritis, pseudoexfoliation syndrome and diabetic iridopathy (Maksimov I.D. et al. Military Medical Journal. 2003, No. 4, p.29).

The presence of a narrow rigid pupil makes it difficult to extract cataracts in the modern, most effective way - phacoemulsification due to the impossibility of visual monitoring of the fracture of the lens nucleus.

A known method of cataract extraction with a narrow rigid pupil (patent RU No. 2177286, IPC ⁷ A61F 9/00, z. 05/04/1999, op. 12.27.2001).

According to the patent, cataract phacoemulsification is carried out under endoscopic control. In this case, the endoscope tip is inserted into the posterior chamber or vitreous at an angle of 45-60 ° with respect to the tip of the phacoemulsifier. The surgeon manipulates the ultrasound handle with one hand, and holds the microendoscope with the other (BM Aznabaev. "Ultrasound cataract surgery - phacoemulsification" M, 2005, p. 116). According to the author, the most effective is the monomanual endocapsular technique with rotation of the nucleus.

The disadvantages of this method are:

- the need for an expensive microendoscope;

- monomanual cataract phacoemulsification technology, as the surgeon’s second hand is occupied by a microendoscope;

- narrow field of view through the endoscope.

There is also a method of cataract extraction with a narrow pupil by removing the lens nucleus into the anterior chamber and then removing it from the eye through a preformed corneoscleral tunnel using a viscoelastic or loop and spatula (A.A. Kozhukhov in the collection of scientific articles on the materials of the scientific and practical conference “Modern technologies of cataract surgery - 2002 ”, p. 162, Moscow, November 21-22, 2002, edited by H.P. Tahchidi. Prototype). The disadvantages of the prototype are:

- an increase in the incision of the eyeball;

- the possibility of rupture of the anterior capsule during dislocation of the nucleus into the anterior chamber;

- the risk of damage to the endothelial layer of the cornea;

- the invasiveness of the procedure.

The objective of the invention is to develop an effective low-invasive and safe method of cataract extraction in the eyes with a narrow rigid pupil.

The essence of the invention lies in the fact that in the eyes with a narrow rigid pupil, a circular anterior capsulorexis is formed along the edge of the pupil without mechanical expansion and the lens is fragmented in the center of the pupil in a vertical plane in the projection of the formed capsulorexis.

The technical result from the implementation of the invention is expressed in the following:

- provides visual control of the manipulation;

- the lens is fragmented in the center of the pupil, which reduces the effect of ultrasound on the capsule and reduces the invasiveness of the procedure;

- the diaphragmatic function of the pupil is maintained;

- the safety of the procedure is ensured - the sphincter of the pupil is not injured, the inflammatory reaction is reduced, the possibility of bleeding is eliminated.

The proposed method for cataract extraction is as follows: after traditional anesthesia, paracentesis is performed at 9 and 15 hours. In the absence of a reflex, the anterior lens capsule is stained with 0.1% trypan blue solution. Before the operation, a medical expansion of the pupil is performed, then an anterior circular capsulorhexis is formed along the edge of the pupil. A 2.75 cm long corneal or scleral incision is made in the plane of the strong meridian, away from the filtering pad. With a subluxation of the lens of the I-II degree or the presence of a pronounced pseudoexfoliation syndrome after hydrodissection, an intracapsular ring is implanted into the capsule bag using an injector.

An ultrasonic tip is introduced into the lens core by 1-1.5 mm and, holding it with a vacuum, using a special hook (“chopper”), the lens core is fractured in a vertical plane along the edge of the ultrasonic tip. Manipulation is performed in the center of the pupil under the visual control of the surgeon. Next, the ultrasonic tip is introduced into one of the halves of the core in the middle of its thickness (≈ 1 mm), it is lifted and, holding it with the help of a vacuum, a chopper breaks in a vertical plane. The obtained fragments are divided in the same way into 4-8 small parts, they are brought out to the center of the pupil and emulsified. Then do the same with the second half of the core. After removing fragments of the nucleus, the cortical layer of the lens mass is removed and an IOL is implanted using an injector, the viscoelastic is washed out and the sections are closed by hydration of the stroma. This ends the operation. The proposed method is illustrated by the following clinical examples:

Example 1

Patient X., a.k. No. 174466, born in 1923.

Upon receipt of a complaint about the lack of vision OD and OS.

V OD -1. in certa, V OS - 0.05 n / a.

IOP: OD - 43 mmHg, OS - 25 mmHg

Echobiometry: mm

OD - ASD - 2.79 OS - ASD - 2.73 L-4.83 L-4.19 AL-23.13 AL-22.79

The threshold of electrical sensitivity, μA: OS - 320

Electrical lability, Hz: OD - 0, OS - 31

Objective: OD - 0

OD - the cornea is transparent, the anterior chamber is of medium depth, dystrophy of the pupil border of the iris, pseudoexfoliation, pupil is round, 2 mm in diameter, subluxation of the lens of the 1st degree, opacification in the cortex and nucleus of the lens, the fundus is not ophthalmoscopic.

OS - the cornea is transparent, the anterior chamber is of medium depth, dystrophy of the pupil border of the iris, pseudoexfoliation along its edge, the pupil is round, 3 mm in diameter, the lens is cloudy, pseudoexfoliation on the anterior lens capsule, the fundus is not ophthalmoscopic.

Diagnosis: terminal pain, IV “c” glaucoma OD, open-angle III “a” glaucoma OS, complicated cataract, lens subluxation of the 1st st. At maximum drug mydriasis, the pupil diameter of the OS was 3.5 mm.

The patient underwent surgery on the OS according to the proposed method with the implantation of IOL "Aquasens". Postoperative course without complications.

At discharge:

V OD - pr.l in certa

V OS - 0.7

The cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the position of the IOL is correct, in the center. DZN pale, clear boundaries. In the macular zone dystrophic foci, the caliber of the vessels is not changed.

Example 2

Patient P., a.k. No. 174466, year of birth 1936.

Upon enrolment

V OD - 0.06 n / a

V OS - 0.9

IOP: OD - 22 mmHg, OS - 21 mmHg

Echobiometry: mm

OD - ASD - 1.74

L - 5.62

AL - 23.81

The threshold of electrical sensitivity, μA:

OD - 200, OS - 200

Electrical lability, Hz:

OD - 37, OS - 38

Complaints about low vision OD.

Objectively:

OD - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, diameter is 2.5 mm, atrophy of the iris of the I degree, the lens is cloudy, the fundus is not ophthalmoscopic.

OS - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, diameter is 2.5 mm, atrophy of the iris is I degree, the position of the IOL is correct, the optic disc is pale pink, the borders are clear, the caliber of the vessels is not changed.

Diagnosis: mature cataract OD, artifact OS.

The patient underwent OD surgery (with maximum drug mydriasis, pupil diameter = 4 mm) according to the proposed method with the Hanita brand IOL injection implantation.

The postoperative period was uneventful.

At discharge:

Vis OD - 0.6 n / a

Vis OS - 0.9

IOP, mmHg OD - 19, OS - 20

OD: the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the IOL is central, the optic disc is pale pink, the borders are clear, the caliber of the vessels is not changed.

Claims (1)

A method of cataract extraction in the eyes with a narrow rigid pupil, which involves the formation of an anterior circular capsulorexis and phacoemulsification of the lens nucleus, characterized in that the nucleus is fragmented in the center of the pupil in a vertical plane in the projection of capsulorexis formed along the edge of the pupil without mechanical expansion.