RU2320303C2 - Method for fragmenting lens nucleus in carrying out cataract phacoemulsification - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming central furrow and two lateral furrows branching from the central one to its right and left without lens nucleus rotation. The furrows have depth of 2/3 of nucleus thickness protruding beyond capsulorhexis. The nucleus is broken first along the central furrow into two pieces and then, each half is broken into two unequal pieces along lateral furrows. Phacoemulsification is carried out in turn, first on small fragments and then on large ones. The latter are moved into empty capsule space with spatula.

EFFECT: avoided nucleus rotation; reduced risk of capsule sack and ligaments injuries; accelerated emulsification process.

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Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in surgical treatment of eyes for cataracts.

A known method of fragmentation of the lens nucleus, providing for the formation of mutually perpendicular grooves in the nucleus during its rotation by 90 °, using ultrasound, and the subsequent destruction of each of the fragments (Lucio Buratto MD "Cataract surgery. Transition from extracapsular cataract extraction to phacoemulsification." Fabiano Editore).

This method is quite traumatic due to the high power and duration of the used ultrasonic exposure, as well as because of the risk of damage to the ligamentous apparatus of the lens due to rotation of the nucleus by 90 °.

There is also known a method of cataract extraction, which involves ultrasonic separation of the lens into two equal parts, successive rotations of the lens by 90 and 180 ° with the removal of lateral segments using ultrasound, the formation of central segments and their mechanical removal through the incisions of the limb.

This method is also traumatic due to the rotation of the lens and the mechanical removal of the central segments. (Patent RU No. 2260411, A61F 9/007, з 04.03.2004, op. 20.09.05, BI No. 26).

The closest in technical essence and the result obtained is the "Method of segmental fracture of the nucleus during phacoemulsification of cataracts", proposed by I.E. Ioshin and colleagues (I.E. Ioshin, A.V. Vitovsky, I.A. Harutyan and others. VI international scientific-practical conference "Modern technologies of cataract and refractive surgery-2005", p.123, prototype).

In accordance with the prototype, the lens core is broken and split into two parts using the tip of the phacoemulsifier, then the first radial fragment is chopped off using a chopper, sequentially turning the remaining parts by 10-30 °, the following fragments are broken off until the core is completely removed, while for very dense nuclei up to 12 faults may be required.

The disadvantages of the prototype are:

- the need for repeated repetition of rotation of the core fragments, chopping the chopper and chipping off the next fragment;

- the complexity, duration and risk of the procedure.

The objective of the invention was to develop a simple, safe method for fragmentation of the cataract nucleus of the lens through phacoemulsification, which reduces the risk of damage to the capsular bag and its ligamentous apparatus, as well as minimize postoperative complications.

The essence of the invention lies in the fact that without rotation of the core, a central groove and two lateral half-furrows are formed at an angle of 40-50 ° to the central, depth 2/3 of the core thickness, extending beyond the edges of the capsulorhexis, break the core along the furrows, sequentially destroy and remove smaller fragments , then large fragments are transferred to the vacant space of the capsular bag and phacoemulsification is continued until the fragments are completely removed.

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

- eliminates the need for a nuclear turn in the formation of furrows and subsequent manipulations;

- eliminates pressure on the ligamentous apparatus and capsule bag;

- the number of formed fragments of the nucleus decreases and the process of emulsification is accelerated;

- all manipulations are performed with the help of the phaco spatula within the capsulorexis, which reduces the risk of endothelial damage;

- the safety of breaking the core into fragments is ensured;

- reduced risk of intraoperative complications;

- the method is also effective and safe when manipulating on subluxated lenses.

The proposed method is as follows: after traditional anesthesia on viscoelastics, circular capsulorhexis is performed, a tunnel incision is made at 12 hours in the corneal part of the limb with a diameter of 2.75 mm and a length of 2.0 mm. Hydro-viscodissection is performed, phacoemulsification is performed on devices Legasy 20000 (f.Alkon) or Infinity (Alkon). The phono-tip is inserted into the capsule through the corneal incision and a deep central groove is formed, slightly longer than the diameter of the capsulorhexis (Fig. 1) and two lateral grooves (Fig. 2), extending from the central at an angle of 40-50 ° to the left and right. The depth of the furrows is 2/3 of the thickness of the core, the width is 1.5 diameters of the needle, along the length of the furrow they go beyond the edge of the capsulorexis. Ultrasound power - up to 70% in order to reduce pressure on the lens, vacuum - 100 mm Hg

The core is first broken into two halves along the central furrow with an ultrasonic tip and a phaco spatula, then each half along the side furrows into two unequal parts. Phacoemulsification of small fragments is carried out, which does not cause any difficulties. After the removal of small fragments, one of the large fragments is moved with a spatula and put into phacoemulsification with a spatula, and then the second large fragment is destroyed (Fig. 4).

The power of ultrasound is 30-50 °, the vacuum is 300 mm Hg.

the operation is completed according to the standard method, bimanual leaching of the lens masses and implantation of the IOL are carried out.

The proposed method is illustrated by the following clinical examples:

Example 1

Patient D., 76 years old, a.k. No. 171393.

Diagnosis: OS - complicated nuclear cataract with subluxation of the lens.

Vis OS - 0.04 n / c, IOP - 23 mmHg

Keratometer data - 41.00; 39.87.

The strong meridian is 167 °, the anteroposterior size of the eyeball is 23.56 mm.

Electrophysiological indicators within the age limits.

The patient underwent phacoemulsification in accordance with the proposed method with the implantation of the Acrisof Natural model IOL, through a corneal tunnel 2.75 mm wide, through a cartridge, capsulorexis diameter 4.5 mm. Phacoemulsification was performed on a Legasy 20000 apparatus. The intracapsule ring was not implanted.

After surgery: on the first day, the eye is calm, the cornea is transparent, the anterior chamber is of medium depth, drug mydriasis, has intracapsular fixation, the reflex from the fundus is pink.

At discharge: Vis OS - 0.8, IOP - 21 mm Hg

Keratometry data - 41.5; 41.0.

The strong meridian is 159 °.

After 6 months, no complications were detected, eye parameters did not change.

Example 2

Patient N., 55 years old, a.k. No. 171401.

Diagnosis: nuclear cataract with a subluxation of the lens of the 2nd degree of the right eye.

Vis OD - correct light projection, IOP - 19 mm Hg

Keratometry data: 42.66; 42.87.

The strong meridian is 151 °, the anteroposterior size of the eyeball is 22.78 mm.

Electrophysiological indicators within the age limits.

The patient underwent phacoemulsification of cataracts in accordance with the proposed method.

An Akwasens-III model IOL was implanted through a 2.75 mm wide corneal tunnel, through a cartridge, 4 mm capsulorexis diameter. Phacoemulsification was performed on a Legasy-20000 apparatus, the intracapsule ring was not implanted.

After surgery: on the first day, the eye is calm, Vis OD is 0.7, the cornea is transparent, the diameter of the pupil is 3.5 mm, the IOL has intracapsular fixation, the reflex from the fundus is pink. At discharge: Vis OD - 0.7, IOP - 20 mm Hg, keratometry data - 42.5; 42.7; strong meridian - 148 °.

After 6 months, no complications were detected, eye parameters did not change.

Claims (1)

A method of fragmentation of the lens nucleus during cataract phacoemulsification, including the formation of grooves and breaking of the nucleus in the presence of viscoelasticity, characterized in that without rotation of the nucleus, a central groove and two lateral grooves extending from the left and right sides extend 2/3 of the core thickness beyond the edges of the nucleus capsulorexis, break the core first along the central furrow into two halves, and then each half along the lateral grooves into two unequal parts, small fragments are subjected to phacoemulsification, ATEM large, with large fragments previously transferred spatula vacated space capsule.

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