RU2339350C1 - Method for intracapsular implantation of intraocular lens in localised rapture of the posterior capsule - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: when rupture is detected on the stage of removal of the first or second quadrants of nucleus, the remaining quadrants of nucleus are removed through 5-7 mm long corneal incision. If rapture of the capsule is detected during removal of the third of fourth quadrants phacoemulsification is discontinued and remaining quadrants of the nucleus are moved to the anterior chamber with the help of viscoelastic. Elastic IOL is implanted into the capsule sac, covering with the optic part of the lens defect of posterior capsule. Phacoemulsification of remaining quadrants of nucleus in anterior chamber is finished under cover of viscoelastic.

EFFECT: anatomic essence of capsule is preserved, prolapse of vitreous humor is prevented, and it ensures getting prognostic optical effect of the surgery and possibility of intracapsular implantation of IOL.

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Description

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

During phacoemulsification of cataract nuclei, local ruptures of the posterior lens capsule can form for the following reasons: the presence of solid nuclei in overripe or traumatic and uveal cataracts, fusion of the posterior lens capsule with the vitreous body, as well as the presence of degenerative changes in the capsule.

If a local rupture of the posterior capsule is detected, the surgeon is forced to stop phacoemulsification, because under the influence of vacuum and irrigation, an inevitable increase in the gap, loss of stability of the capsule and prolapse of the vitreous body in the anterior chamber.

According to H.P. Takhchidi and colleagues, the most serious consequence of rupture of the posterior lens capsule is the loss of integrity of the capsular bag and the inability to use the intracapsular posterior chamber lenses (H.P. Takhchidi, E.V. Egorova, A.I. Tolchinskaya. Intraocular correction in surgery of complicated cataracts. M., 2004, p.133).

In these situations, the use of anterior chamber IOL with fixation to the iris and in the ciliary groove is recommended. However, the extracapsular fixation of the IOL is a necessary measure, as it is less effective, and therefore, methods for the intracapsular fixation of the IOL are also proposed for local ruptures of the posterior capsule.

There is a method of implantation of a posterior chamber IOL in aphakic eyes, in which, during ultrasound phacoemulsification, a rupture of the posterior capsule occurs with prolapse of the vitreous. The method includes performing a circular capsulorexis, anterior vitrectomy and implantation of a posterior chamber IOL on the surface of the anterior lens capsule (I.V. Malov. Broshevsky readings. Proceedings of the All-Russian Conference "Gerantological Aspects of Ophthalmology", Samara, 2002, p. 195).

The disadvantages of the method include:

- irritation of the ciliary body in the area of the ciliary groove, which leads to the possibility of increasing IOP;

- destruction of the pigment leaf of the iris is possible.

There is also a method of implanting an IOL in case of violation of the integrity of the capsule bag, which, after removing the lens nucleus and evacuating the lens masses, filling the capsule bag with viscoelastic, introducing an elastic ring with an outer diameter corresponding to the diameter of the capsule bag, and implanting the posterior chamber IOL. The ring is made in the form of a torus with an annular groove, which serves as a support for the haptic of the IOL (RF Patent No. 2173126, MKP ₇ A61F 9/007, з 06.08.1998, op.10.09.2001, application No. 98115321/14, prototype).

The disadvantage of this method is the threat of dislocation of the capsule ring into the vitreous at large breaks.

The objective of the invention was to develop an effective, gentle method for intracapsular implantation of IOLs with a central local rupture of the posterior capsule that occurs during ultrasonic phacoemulsification of the lens nucleus.

The essence of the invention is that when a local rupture of the posterior capsule is detected at the stage of removal of the 3rd or 4th quadrant of the lens nucleus, the tip of the phacoemulsifier is removed from the eye, an anterior vitrectomy is performed, the capsule bag is filled with viscoelastic, the remaining quadrants of the lens nucleus are moved to the anterior chamber, after which an elastic IOL is implanted in the capsule bag, covering the defect of the posterior capsule with the optical part of the lens, and then the phacoemulsification of the remaining quadrants is completed in the anterior chamber and leaching of the lens masses.

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

- provides the possibility of intracapsular implantation of the IOL with local posterior rupture of the capsular bag;

- the anatomical purpose of the capsule is preserved;

- eliminates the possibility of prolapse of the vitreous body;

- provides a predicted optical effect of the operation;

- excludes the possibility of secondary cataracts.

The proposed method is as follows: perform phacoemulsification of the lens in the traditional way (Lucio Buratto. Cataract surgery. Transition from extracapsular cataract extraction to phacoemulsification. Fabiano Editore, 1999, p. 333), break the lens core into 4 quadrants and remove the obtained quadrants from the quadrant capsule bag. During the procedure, for objective reasons, the formation of a local rupture of the posterior capsule is possible, upon detection of which the surgeon stops phacoemulsification and removes the tip of the phacoemulsifier from the eye. If a gap is detected at the stage of extraction of the first or second quadrant, the quadrants of the lens nucleus are removed in the traditional way - through a corneal incision 5-7 mm long.

If a defect is detected at the extraction stage of the 3rd or 4th quadrant, the remaining quadrants of the nucleus are transferred to the anterior chamber using viscoelastic, in the presence of prolapse of the vitreous body, anterior vitrectomy is performed and an elastic lens is implanted in the capsular bag, closing the local gap in the optical part of the lens, after which completes the phacoemulsification of the remaining quadrants of the lens in the anterior chamber.

The method of intracapsular implantation of IOLs with local rupture of the posterior capsule is illustrated by the following clinical examples.

Example No. 1 A.K. No. 188395.

Patient N., born in 1938.

Diagnosis: mature cataract OS, Vis OS - upon admission - pr.l.certa.

On March 7, 2003, the patient underwent surgery for cataract removal and IOL implantation. During surgery, when removing the 3rd quadrant, a defect in the posterior capsule was detected in the optical zone.

In accordance with the proposed method, phacoemulsification was stopped by removing the tip of the phacoemulsifier from the eye. The remaining quadrants of the core with viscoelastic were transferred to the anterior chamber, after which the elastic Acrysof MA 60 BM 21 OD IOL was implanted, closing the capsule gap with the optical part of the lens. Then, phacoemulsification of the remaining quadrants of the nucleus in the anterior chamber was completed.

On the 4th day after surgery, the patient was discharged with the result of Vis OS-0.8.

Example No. 2 A.K. No. 171196.

Patient K., born in 1940.

Diagnosis: artifactia OD, brown overripe cataract OS. Vis OS - pr.l.certa. A patient underwent OS phacoemulsification on February 15, 07. When the fourth (last) quadrant was removed, a local rupture of the posterior capsule was found in the paraoptic zone, in the lower segment.

In accordance with the proposed method, phacoemulsification was stopped and, using viscoelastic, the remaining quadrant of the lens was moved to the anterior chamber. A RYNER IOL 620 N ± 23 OD was implanted into the capsule bag.

At discharge, Vis OS = 0.4-1.0 D = 0.6.

According to the proposed method, more than 20 operations are performed with obtaining high functional results.

Claims (1)

A method for intracapsular implantation of an intraocular lens with local rupture of the posterior capsule, which involves phacoemulsification of the lens nucleus, characterized in that if a gap is detected at the stage of removal of the first or second quadrant of the lens nucleus, the remaining quadrants are removed through a corneal incision 5-7 mm long, and if a gap is detected, at the stage of removal of the third or fourth quadrant, phacoemulsification is stopped and the remaining quadrants of the nucleus are transferred to the anterior chamber, implanted into an elastomeric capsule bag complete IOL, covering the defect of the posterior capsule with the optical part of the lens, and complete phacoemulsification of the remaining quadrants of the nucleus in the anterior chamber.