RU2338494C1 - Method of fixation of postchamber intraocular lens - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: offered way can be used for fixation of the intraocular lense (IOL) in the absence of a posterior capsule of the lens for maintenance of qualitative sight at patients. Do standard limbal cut and conjunctiva cuts on VI and XII hours. Fix a double thread on basic elements of IOL out of an eye loop formation. Needles with double threads deduce through standard limbal cut and a pupil on a sclera in a projection of corresponding conjunctival cuts on VI and XII hours. Carry out implantation of IOL in the posterior chamber of an eye through the standard limbal cut. Align the lens by pulling up threads and then file the extremities of threads to the sclera. Put in stitches on conjunctiva.

EFFECT: increase of efficiency of operation of fixation of postchamber intraocular lense and depression of risk of a traumatising of tissues of an eyeball.

2 ex, 1 dwg

Description

The proposed method relates to medicine, namely to ophthalmology, and can be used to fix an intraocular lens in the absence of a posterior lens capsule to ensure high-quality vision in patients.

Implantation of an artificial lens is used in the absence of a lens - aphakia, or in diseases associated with changes in the transparency or localization of the patient’s own lens, and, in practice, has no contraindications.

There are various methods of fixing the posterior chamber IOL.

A known method of fixing the posterior intraocular lens / Patent of the Russian Federation No. 2135136, A61F 9/007, 08/27/1999 /, which consists in the section and separation of the conjunctiva, cutting in the projection area of the ciliary groove of the sclera rag flaps with the base to the limb, in which in the area of the scoliosis two pairwise filaments parallel to the horizontal axis of the eye and symmetrical about it. To do this, use a needle that is injected into the corners of the base of one cut surface flap, equal to or greater than the optical part of the implanted lens. And output to the appropriate angles of the oppositely located surface flap. The implantable lens is fixed between the paired threads. The method allows the fixation of an intraocular lens of any model.

This method is not effective enough in that it does not allow to obtain the exact centering of the lens horizontally, and the method is time-consuming and time-consuming. In addition, the need for cutting flaps increases the invasiveness of the eyeball tissue during surgery.

The closest set of essential features to the proposed method is a method for transscleral fixation of the posterior intraocular lens into the ciliary sulcus / RF Patent No. 2180544, A61F 9/007, 03.20.2002 /.

The essence of this method is that they preliminary localize the projection of the ciliary sulcus on the sclera and make through scleral sections at the 6th-12th hours, 1 mm long, 1 mm lower and higher than the limb. A microneedle with an eye near the tip is inserted through the through scleral incision at VI hours. The end of the needle is carried out under the iris and removed through a standard limbal incision outside the eye. A thread is inserted into the eye of the needle, fixed on one of the supporting elements of the lens, and out through the scleral incision at VI hours to the outside. A curved microneedle with an eye near the tip is inserted through a scleral incision at the 12th hour. The end of the needle under the iris is brought out through the standard limbal incision outside the eye. A thread is inserted into the eye of the needle, mounted on another lens support member, and the needle and thread are brought out. The threads at VI and XII hours tighten and implant the lens into the back chamber. The ends of the threads are sutured to the sclera. The method provides good alignment of the implantable lens.

This method is not effective enough in that due to the rigid suture fixation of the lens there is a risk of injury to the eyeball tissue due to the possible eruption of the sclera at the location of the suture.

The problem to be solved and the expected technical result of the proposed method are to increase the efficiency of the fixation of the posterior intraocular lens by reducing the risk of injury to the eyeball tissue by reducing the stiffness of the system consisting of the lens, loops on its supporting elements and fixing sutures, and protecting the main fixing suture on the sclera .

The problem is solved by the proposed method for fixing the posterior intraocular lens, including the production of a standard limbal incision, incisions at the VI-XII hours, fixing the threads on the lens support elements outside the eye, implanting the lens into the posterior chamber of the eye through a standard limbal incision, pulling the threads, followed by suturing the ends of the threads to the sclera at the VI-XII hours, characterized in that the cuts at the VI-XII hours are made on the conjunctiva, a double thread is fixed on each supporting element of the lens outside the eye, and replication of the double thread is carried out by looping, the needle with the double thread is brought out through the standard limbal incision and the pupil onto the sclera in the projection of the corresponding conjunctival incision at VI and XII hours, and after suturing the ends of the threads to the sclera, stitches are placed on the conjunctiva.

The proposed method is carried out by the following sequence of operations.

1. Previously, at VI and XII hours, 1 mm from the limb, incisions are made on the conjunctiva 2 mm long. This cut length is optimal for fixing the ends of the thread to the sclera. A standard limbal incision of 5.6-5.7 mm is made to remove the altered lens (if necessary) and implant an intraocular lens through it into the posterior chamber of the eye. As an intraocular lens, for example, the T-26 model, an intraocular lens widely used in Russia, is used. The intraocular lens of the T-26 model structurally has an optical part and diametrically opposite symmetrical closed support (haptic) elements in the form of curved figures (AS No. 1697788, A61F 2/16, 12/15/1991).

2. Out of the eye, a non-absorbable thread 10: 0 is inserted into the needle and both free ends of the thread are closed, for example, tied with a bundle that is pulled to the needle’s eye. A needle with a closed ring thread, i.e. with a double thread, is introduced into the lower support (haptic) element of the implantable lens, a double thread is covered by the arc of the support element and a needle is drawn between the threads, forming a loop around the arc of the support element. Thus, the double thread is attached to the support element using a "spring" loop, which is illustrated by the attached drawing, where there are the following positions: 1 - support (haptic) element of the implanted lens; 2 - a thread closed by a ring, i.e. double thread; 3 - needle.

3. A needle with a double thread is removed through the limbal incision and the pupil onto the sclera in the projection of the conjunctival incision prepared in advance (according to claim 1) at VI hours.

4. Then a similarly prepared needle with a closed ring thread, ie with a double thread, they are threaded into the upper support (haptic) element of the implantable lens, form a loop, and the needle is brought out through the limbal incision and the pupil onto the sclera in the projection of the previously prepared conjunctival incision at XII hours.

The use of a double thread allows you to quickly, easily and reliably fix it on the supporting elements of the lens using a loop.

5. A lens is implanted through a standard limbal incision.

6. The lens is pulled by the threads at VI and XII hours, centered, fixed and hemmed with a knotted suture to the layers of the sclera. Due to the presence of a “spring” loop on the lens support elements, the rigidity of the system consisting of an implantable lens, thread loops on its support elements and fixing seams is reduced. This reduces the invasiveness of the operation, reduces the risk of rupture of the sclera at the location of the suture.

7. Knotty sutures are superimposed on the conjunctiva, thus the sclera sutures are covered by the conjunctiva. In this case, the main fixing suture on the sclera is protected, which increases the strength of the fixing sutures and also reduces the risk of scleral tearing at the location of the suture.

The lens implantation operation indicated in clause 5 in some cases may not be carried out after the operations described in clauses 3-4, but between them.

The positive aspects of this fixation are also the physiological position of the artificial lens, the safety of the pupil reaction under different lighting conditions, since the iris muscles are not injured.

The method proposed by the authors for fixing a posterior intraocular lens does not require additional technical equipment and can be performed in any eye department where intraocular lens implantation operations are performed; moreover, this technique does not differ in duration and trauma from standard implantation of a T-26 model’s intraocular lens, which carry out the implantation of the lens in the area of the capsular bag and fix the lens so that the equatorial capsule sheet is sandwiched between the arcs E pivot support member of the type "paper clip" / Patent RF №2132667, A61F 9/007, 10.07.1999 /.

The method of fixing the posterior chamber intraocular lens of the T-26 model in the absence of a capsule bag, proposed by the authors, was introduced in the Orenburg branch of the Federal State Institution IRTC Eye Microsurgery named after Acad. S.N. Fedorova Roszdrav "of the Russian Federation.

36 eyes were operated on using this technique. The postoperative period was uneventful, treatment according to generally accepted schemes. The results are positive. Vision ranged from 0.3 to 1.0 depending on the condition of the fundus of the patient.

Examples of specific performance of the proposed method.

Example 1. Patient P., 34 years old, was admitted in February 2006 for traumatic cataract of the right eye. When removing cataracts, a violation of the integrity of the posterior capsule was found, which required additional fixation of the implanted lens.

The patient was operated on according to the method proposed by the authors: removal of the lens through a limbal incision, implantation of a T-26 lens and its fixation. In the postoperative period, treatment was carried out according to the scheme. There were no complications. Visual acuity of the right eye after surgery 0.9.

Example 2. Patient M., 73 years old, was admitted for an overripe cataract of the left eye in May 2006. When a cataract was removed, a lysed posterior capsule was revealed, i.e. the back capsule was defective.

The patient was operated on according to the method proposed by the authors. There were no complications in the postoperative period. Visual acuity of the left eye after surgery 0.7 (due to concomitant dystrophic changes in the fundus).

Claims (1)

A method for fixing a posterior intraocular lens, including the production of a standard limbal incision, incisions at VI-XII hours, fixing the threads on the lens support elements outside the eye, implanting the lens into the posterior chamber of the eye through a standard limbal incision, pulling the threads, followed by suturing the ends of the threads to the sclera on VI -XII hours, characterized in that the cuts at VI-XII hours are made on the conjunctiva, a double thread is fixed on each lens support element outside the eye, and the double thread is fixed using a loop, a double-thread needle is removed through a standard limbal incision and the pupil onto the sclera in the projection of the corresponding conjunctival incision at VI and XII hours, and after the ends of the threads are sutured to the sclera, sutures are placed on the conjunctiva.