RU2322219C2 - Method and device for fastening posterior chamber intraocular lenses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making tunnel cornea incision in 12 o'clock position in implanting posterior chamber intraocular lens, and along the strong meridian in implanting toric intraocular lens. The anterior and posterior chambers are filled with visco-elastic. Supporting lens members are fastened by suturing them with threads one of which is connected to rounded needle and the others to direct atraumatic needles. Devices for implanting posterior chamber intraocular lenses are arranged on cutting needle parts. The threads are in turn introduced using the needles, under the iris to limb meridians preset in advance. When the device has got to ciliary sulcus, the needle is moved further in piercing the device and underlying tissues and creating pressure acting from outside until needle end appears on the external sclera surface. The needle end is caught and the needle is brought in parallel to sclera surface while turning eyes in opposite direction. Rounded needle direction matches tunnel cornea incision direction. Intraocular lens is set into the posterior chamber. Device has spherical conducting tip of 0.3-1.0mmin diameter. It is produced from biologically inert material allowing needle introduction into it.

EFFECT: reduced risk of complications.

3 cl

Description

The invention relates to medicine, namely to ophthalmology, and can be used to fix posterior intraocular lenses (IOLs) on phakic and aphakic eyes during refractive surgery to correct myopia, hyperopia, including in combination with astigmatism.

All known methods for correcting myopia are mainly the introduction of various IOLs. One of the problems with IOL implantation is its fixation.

The closest in technical essence to the proposed one is the method of fixing the posterior chamber IOL into the ciliary sulcus (see RU 2180544, 03.20.2002), including preliminary localization of the projection of the ciliary sulcus on the sclera and production of through scleral incisions in the limb, as well as the production of a standard limbal incision in the upper parts of the limb, insertion of filaments into the through scleral incisions, fixing the filaments on the lens support elements outside the eye, pulling the filaments and implanting the lens into the posterior chamber of the eye through the standard limbal a section with subsequent stitching of the threads to the sclera, while the localization of the projection of the ciliary sulcus on the sclera and the production of through scleral sections are performed at the 6th and 12th hours, about 1 mm long, 1 mm below and above the limb, the threads are fixed on the lens support elements before being inserted into the scleral sections, the introduction of threads into the through scleral sections is carried out by introducing through the through scleral section at VI hours a special straight microneedle with an eye near the tip, the end of which, passing under the iris, is removed through a standard limbal incision outside the eye, where a thread is inserted into the eye of the needle attached to one of the lens support elements, and with the help of a needle, the thread is brought out into the through scleral section at VI hours and brought out, then through the through scleral section at XII hours is inserted from the outside side of the sclera, a special curved microneedle with an eye near the tip, the end of which is carried out under the iris and brought out through the standard limbal incision outside the eye, where a thread fixed to another lens support element is inserted into the eye of the needle and the needle is brought out with the thread outside, after which the threads at VI and XII hours are pulled up and the lens is implanted through a standard limbal incision into the posterior chamber and the ends of the threads are sutured to the sclera.

However, the scope of the known method is limited, since it is intended for the implantation of IOLs on the aphakic eye, the use of this technique for hemming the IOLs is impossible in the presence of a clear crystalline lens, since there is a high risk of damage to it.

A device is known for trans-scleral conduction of a thread for fixing intraocular lenses RU No. 2189803 C2, 11/20/2003, containing a handle and a working element made of an elastic biologically inert material, with the possibility of sticking a needle with a thread into it. The working element has a wedge-shaped shape with curvature at the distal end corresponding to the curvature of the iridociliary sulcus or arch of the lens bag of the eyeball.

However, the use of the known device does not create sufficiently good conditions to ensure accurate puncture of the needle and holding the thread into the space between the iris and the posterior lens capsule or between the lens capsules simultaneously, also requires a large incision, which leads to excessive tissue trauma and increases the risk of bleeding in the rear camera also extends the operation time

A new technical task is to reduce complications, expand the scope of the lens fixation method for the correction of myopia, hyperopia and astigmatism in phakic eyes.

To solve the problem in a method for fixing a posterior intraocular lens, including through-cuts near the limb, inserting filaments into them, securing the filaments on the lens support elements outside the eye, pulling the filaments and implanting the lens into the posterior chamber of the eye, followed by stitching the filaments to the sclera, during implantation of the posterior chamber IOL produce a corneal incision at XII hours, and during the implantation of a toric IOL, a strong meridian is used, then the anterior and posterior chambers are filled with viscoelastic, supporting elements the lenses are fixed by flashing with threads, one of which is connected to a rounded, and the rest with straight atraumatic needles, on the cutting part of which there are tips - conductors according to claim 2, then the threads with needles are alternately carried out under the iris to the previously designated meridians on the limb, if hit the needle tip-conductor into the iridociliary sulcus the needle is further advanced by piercing it and the underlying tissue, creating back pressure from the outside, until the end of the needle appears on the outer surface of the sclera, after which the needle end vatyvayut and further by rotation of the eye needle in the opposite direction parallel to the surface of the sclera outputted, then rounded needle is advanced in the direction corresponding to the projection of the corneal tunnel incision, then into the posterior chamber IOL set. Also, the conductor tip is made spherical in shape with a diameter of 0.3-1.0 mm.

The essence of the method is as follows. The implantation of the posterior chamber IOL with two or more haptics (the number of needles corresponds to the number of supporting elements) is performed under anesthesia, against the background of mydriasis, through a corneal tunnel incision at XII hours or along a strong meridian (in the presence of astigmatism in the case of implantation of a toric IOL), the anterior and posterior chambers filled with viscoelastic, then the ends of the haptic elements are flashed with threads connected to long needles, on the cutting part of which they put on the tip-conductors made of an elastic inert material - a silicone ball with a diameter of 0.3-1.0 mm, the end of the needle in this case, it is desirable to enter to the Central part of the tip-conductor. One thread is connected to a rounded atraumatic needle 5 mm long, the rest to straight atraumatic needles 10 mm long. The threads are made of non-absorbable monophilic material, such as prolene. The tip-conductor placed on the cutting part of the needle makes it possible to atraumatically hold the needle between the iris and the anterior capsule of the lens, visualize the end of the needle in the iridociliary sulcus. Next, the needles with the threads attached to them are alternately held under the iris to the previously designated places on the limb, when the tip-conductor enters the iridociliary sulcus, the needle is advanced further by piercing the tip-conductor through, and then to the sclera, where back pressure is created from the outside tweezers. At the same time, during the passage of the needle through the tip-conductor, a compression is created, which helps to squeeze the vessels at the puncture site, which reduces the risk of bleeding. Further, from the outside, the end of the needle is captured by the needle holder, straight needles with fixed threads are brought out parallel to the sclera surface by turning the eye in the opposite direction, then a rounded needle is used to pass the upper thread, the direction of which corresponds to the projection of the corneal tunnel incision, after which a folded FIOL is inserted into the back chamber or toric IOL, then with the help of previously introduced FIOL threads, they are centered, and the ends of the threads are sutured to the sclera and at the last stage the viscoelastic is washed out, after which self-sealing incision and tunneled subconjunctivally administered antibiotic deksazonom.

A conductor tip representing a ball made of an inert, elastic material, such as silicone, is intended to be put on the cutting part of the fixing needles in order to:

a) visualization of the latter in areas inaccessible to the ophthalmologist under the iris and in the iridociliary sulcus;

b) the creation of mechanical pressure on the tissue of the choroid and sclera, which contributes to the decline of the lumen of the vessels in the puncture sites and, accordingly, to reduce hemorrhage in the tissue and the anterior segment of the eye during and after surgery;

c) reduce the risk of trauma during the intervention of nearby tissues and structures of the eye, which reduces the possibility of postoperative complications.

The proposed method was tested in an experiment on 10 pig cadaveric eyes, as well as 5 rabbits of the Chinchilla breed weighing 1.5-2 kg.

Histomorphological studies of enucleated eyes in rabbits after 1 week, 1 month, 3 months and 6 months showed the IOL position are reactivity and minimal tissue changes in the puncture sites and around the conductors. His lens remained transparent.

Using the proposed fixation method, it was proved that it is possible to fix the IOL in the eyes with an unremoved lens, which expands the scope of the method for correcting refractive errors (i.e., myopia, hyperopia and astigmatism), while eliminating damage to the posterior surface of the cornea, anterior lens capsule , cinnamon ligaments and iris, the risk of hemorrhage is reduced, and the method also makes it possible to: - reduce the area of the haptic elements of the IOL, which will lessen the hindrance the dynamics of the eye and reduces the rate of formation of complicated cataracts; - hemming of the artificial iris with partial or complete aniridia.

In contrast to the procedure for removing a clear crystalline lens, patients who will be provided with a phakic lens due to the proposed method will retain the preoperative accommodation possibilities. Therefore, this procedure can be recommended for young patients with large accommodation reserves. Indications for this type of correction are as follows:

1. Myopia from -6.00 to -22.00 diopters for today, in the future it can be from -4.00 to -25.00 diopters.

2. Hypermetropia from +3.00 to +16.00 diopters, this is the maximum, the correction of which has been described.

3. Astigmatism with intolerance to spectacle and contact correction.

4. High-sided myopia with amblyopia in children. In case of progressive myopia, preliminary scleroplasty is recommended. In this case, given the instability of refraction in childhood and eye growth, the reversibility of surgery has a very large advantage.

Clinical example.

Patient Sh. 86 years old. The medical history No. 883/ 331 from 02.19.2006

Diagnosis: Overripe cataract.

February 20, 2006 cataract phacoemulsification surgery. During the operation, an extensive rupture of the posterior capsule. Removal of the remains of the lens masses, anterior vitrectomy.

Given the lack of capsular support of the IOL, suture fixation of the upper and lower haptic elements of the IOL into the ciliary sulcus according to the proposed method was performed. The suture from the conjunctival flap was removed 5 days after surgery.

6 months after surgery, the IOL occupies a stable central position.

Clinical example.

Patient Oh. 59 years old. The medical history No. 2459/842 from 05.23.2006

Diagnosis: Mature cataract.

May 24, 2006 cataract phacoemulsification operation. During the operation, a local rupture of the posterior capsule. Anterior vitrectomy was performed with the removal of residual lens masses.

The lower haptic part of the IOL is hemmed into the ciliary sulcus, the upper haptic is implanted in the preserved upper remainder of the capsular bag according to the proposed method.

Claims (3)

1. A method for fixing a posterior intraocular lens (IOL), including through-cuts near the limb, introducing filaments into them, securing the filaments on the lens support elements outside the eye, pulling the filaments and implanting the lens into the posterior chamber of the eye, followed by stitching the filaments to the sclera, characterized in that during implantation of the posterior chamber IOL, a corneal tunnel incision is made at XII hours, and during implantation of a toric IOL along a strong meridian, then the front and rear chambers are filled with viscoelastic, the lens support elements are closed repeating, stitching with threads, one of which is connected to a rounded, and the rest with direct atraumatic needles, on the cutting part of which there are devices for fixing posterior chamber IOLs according to claim 2, then the threads with needles are held alternately under the iris to the previously designated meridians on the limb, when the device enters the iridociliary sulcus, the needle is further advanced, the device and the underlying tissues are punctured, creating pressure from the outside until the end of the needle appears on the outer surface of the sclera, after which I grab the end of the needle t and further, by turning the eye in the opposite direction, the needle is brought out parallel to the sclera surface, the direction of the rounded needle corresponds to the projection of the corneal tunnel incision, after which an IOL is installed in the posterior chamber. 2. A device for fixing posterior intraocular lenses containing a tip-conductor made of an elastic biologically inert material, with the possibility of sticking a needle with thread into it, characterized in that the tip-conductor has a spherical shape. 3. The device according to claim 2, characterized in that the diameter of the tip-conductor is 0.3-1.0 mm