RU2340317C1 - Method of treatment of high degree myopia - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: spend a forward keratotomy. Then perform implantation of an intraocular lens through the self-sealing corneal tunnel executed in a strong meridian. In 30 days after operation perform diploptic treatment using a binarimeter in the conditions of free haploscopy within 10 days.

EFFECT: restoration of binocular function of visual system at patients with a high myopia, reduction of terms of treatment.

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Description

The present invention relates to the field of medicine, namely to ophthalmology.

High degree myopia is the most common cause of decreased visual acuity. The progression of the myopic process, especially against the background of high visual stress, causes the appearance of high myopia at a young age, and 70% of these patients are people aged 20-40 years. In this regard, the rational correction of ametropia in modern conditions is gaining great social importance, since a pronounced decrease in the functions of the visual system can cause early disability.

Existing methods for the correction of high myopia do not always provide a complete clinical and social rehabilitation of patients. Traditional methods of correction, such as glasses and contact lenses, often do not allow to achieve the desired result, since the tolerated correction does not give maximum visual acuity, and the full one is accompanied by asthenopic complaints.

Surgical correction methods combine operations that are different in technique and mechanism of action, aimed at improving the overall refraction of the eye due to the effect on the cornea or lens.

Known methods of treatment by performing anterior keratotomy. A sharp knife makes a certain number of radial incisions from the pupil zone to the limbal sclera. With high myopia, scleroplastic surgery is performed, which consists in applying a kind of bandage, mainly on the posterior surface of the eye, to prevent further stretching of the sclera in this section (Avetisov E.S. 201).

A known method of treatment for high myopia, according to which meridial scleroplasty is first performed, then after at least two weeks have passed, an actual negative intraocular lens is implanted to eliminate residual myopia. Implantation is carried out through a scleral tunnel (RF Patent No. 2134563, 1999, M. cl. A61F 9/013).

The closest is a method for correcting high myopia by sequentially combining a non-partial method of surgical correction - anterior dosed keratotomy and a cavity - implantation of a negative phakic intraocular lens. The time interval between two surgical interventions on the same eye is at least 6 months (RF Patent No. 2144808, 2000, A61F 9/007).

However, known methods of correcting high myopia by implanting phakic IOLs cannot completely eliminate binocular vision impairment in patients with high myopia, therefore, for the full rehabilitation of myopic patients after surgery, an additional course of treatment is necessary to form a new functional system.

The technical result of the proposed method is the restoration of the binocular function of the visual system in patients with high myopia, as well as reducing treatment time.

New in achieving the technical result is that keratotomy is performed simultaneously with implantation of a phakic intraocular lens.

Also new is the fact that implantation is carried out through a self-sealing corneal tunnel made in a strong meridian.

Also new is the fact that 30 days after the operation, diploptic treatment is carried out on a binarimeter under free haploscopy for 10 days.

A corneal self-sealing incision in a strong meridian is performed with a length of 3.5 mm and does not impose stitches, which reduces the patient's rehabilitation time.

Implantation of a phakic intraocular lens at the same time as performing keratotomy provides a reduction in treatment time.

Conducting diploptic treatment on a binarimeter under conditions of free haploscopy allows a directed effect on the sensory, motor and proprioceptive mechanisms of binocular vision, while also positively affecting vergence, accommodation, fusion ability, depth perception and stereo vision. As a result of treatment, a normal perception of the absolute and relative remoteness of objects, their size and three-dimensionality is formed, visual acuity and stereo perception are improved, thus normal functioning of the functional visual system is restored.

Comparative analysis with the prototype shows that the proposed method differs from the known one in that keratotomy is performed simultaneously with implantation of a phakic intraocular lens, and implantation is performed through a self-sealing corneal tunnel made in a strong meridian, and diploptic treatment is carried out on the binarimeter 30 days after the operation under conditions free haploscopy for 10 days, which meets the criterion of "novelty."

A new set of features provides the restoration of binocular function of the visual system in patients after implantation of an intraocular lens, reducing treatment time and postoperative complications, which meets the criterion of "industrial applicability".

The method is as follows.

Before surgery, two laser iridectomies are performed in mutually perpendicular meridians. Patients undergo anesthesia with retrobulbar injection. Then, 2% novocaine is akinesia, 1% dicaine is instilled twice in the conjunctival sac and blepharostat is applied. Using a keratotomy knife, an incision of the cornea is made with a depth depending on the thickness of the cornea, according to the marking previously applied on the cornea. Two paracentesis and one corneal self-sealing incision are formed in a strong meridian. Viscoelastic Provisk is introduced into the anterior chamber. Next, implantation of a phakic IOL is performed through a corneal tunnel, the optical power of which is calculated in advance, individually for each patient. The lens is introduced first into the anterior chamber, then its lower haptic part is successively implanted into the posterior chamber of the eye between the iris and the lens. After that, with the help of spatulas, the upper haptic part of the lens is brought into the rear chamber, and viscoelastic is removed from the front chamber. Sutures on the corneal incision do not impose. Under the conjunctiva, dexazone and gentamicin are administered. Blepharostat is removed and an aseptic dressing is applied.

One month after the operation, diploptic treatment is carried out on a binarimeter under free haploscopy for 10 days. Classes are as follows. A test carriage is installed (double images with marking parts corresponding separately to the right and left eye) at a distance of 5-20 cm from the patient’s eyes, the test distance corresponds to the interpupillary distance. The patient fixes his gaze behind the test plane. In this case, the phenomenon of physiological doubling occurs (the patient sees four test objects). By varying the distance between test objects, a relatively stable perception of the binocular visual image is achieved. Then smoothly reduce the test distance. With a tendency to bifurcate the binocular visual image, the test distance is again increased until a stable binocular visual image is obtained. Slowly and gradually reducing the test distance to the minimum possible, they seek to achieve a stable vision of the binocular visual image. After that, the distance from the tests to the patient’s eyes is slowly reduced. Upon obtaining a stable perception of the binocular visual image with a minimum distance between tests and the distance from the eyes to the tests of 20-10 cm, they begin training in deep vision. By changing the intertest distance, the distance of the binocular visual image in space is changed. If the patient feels a change in the distance of the binocular visual image from the eyes, proceed with the assessment of spatial visual perception. To do this, install a carriage with tests at a distance of 15 cm from the eyes. A ring with a diameter of 10 cm installed at a distance of 50 cm from the eyes is used as a bifixation object. The patient must combine the binocular visual image with the plane of the ring, changing the distance between the tests. The study is sequentially repeated at a distance from the eyes to the object of bifixation equal to 60, 70, 80, 90, 100 cm, after which they begin training in accommodation ability. For this, tests with the same patterns are used with a constant distance between tests of 30-40 mm. After a stable binocular visual image appeared in patients, the carriage was gradually brought closer to the patient's eyes until the perception of the binocular visual image was lost, and then it was removed from the patient’s eyes until the binocular visual image was lost. Another option for training accommodative ability is the use of positive and negative optics of increasing strength with an interval of 0.5 diopters. At the same time, the distance from the tests to the patient’s eyes is not changed, and the power of corrective lenses is also increased until the perception of the binocular visual image is lost. If the clarity of the image is not restored, begin to relatively quickly increase the distance between the tests until then, until you get a sense of clarity of the entire binocular visual image.

58 eyes were operated on in 29 patients with high myopia. Among them, 21 are women and 8 are men. The age of patients ranged from 18 to 37 years. Preoperative refraction: spherical component from -6.0 D to -21.0 D, cylindrical component from -0.5 D to -5.5 D. In all patients, the structural and functional state of the visual system before surgery was examined, after one week and one month after surgery, as well as after a course of treatment on a binarimeter.

For a comprehensive assessment of the structural and functional state of the visual system in patients with high myopia and mechanisms of structural and functional changes after implantation of a phakic lens and subsequent binarimetry, the following studies were used: refractometry and keratometry, visometry (with and without correction), electrophysiological studies, tonometry , perimetry, biometry, optical coherence tomography, visocontrastometry. Studies of fusional reserves, dark adaptation, gaze fields, Lang stereotest, the nature of vision, volume and reserve of accommodation were carried out, the presence or absence of stereokinetic deep vision was determined. The research results are presented in table 3.

After 6 months and a year after treatment, the state of binocular function of the visual system in patients remained stable.

The proposed method for the treatment of high myopia is illustrated by the following clinical examples.

Example 1. The treatment of high myopia without additional treatment on a binarimeter.

Patient: Lysenko L.G. Date of birth: 10/18/1984

Operations: left eye - 09/19/05, implantation of a negative IOL - (-) 16.0 D and tangential keratotomy.

Right eye - 09/20/05, implantation of a negative IOL - (-) 12.0 D and tangential keratotomy.

Table 1 Visual function Before surgery After IOL implantation After surgery after 1 month Visus without correction (conventional units) 0,03 0.65 0.65 Visus with correction (conventional units) 0.5 0.7 0.7 Spherical Refraction (Dpt) -16.0 -0.75 -0.5 Cylindrical Refraction (Dpt) -3.5 -0.5 -0.5 The nature of binocular vision (m) 2.0 4.0 4.0 Simultaneous vision (m) 3.0 1,0 1,0 Fusion reserves (degrees) fifteen fifteen fifteen Stereotest Lang (sec) 0 2600 2600 Deep vision absent absent absent The positive part of relative accommodation (Dpt) 4.0 2,5 2,5 The negative part of the relative accommodation (Dpt) 4.0 4.0 4.0 The volume of absolute accommodation (Dpt) 2.2 5.5 6.1 Visocontrastometry (conventional units) four fifteen fourteen

It was not possible to obtain stable high results of postoperative refraction and improve the functions of the visual system

Example 2

Patient: Pikhlaeva V.V.

Date of birth 04/27/1979

Operations: right eye - 10/03/2005, implantation of a negative IOL (-) 12.0 D + tangential keratotomy.

Left eye - 10/05/2005, implantation of a negative IOL (-) 12.0 D + tangential keratotomy.

table 2 Visual function Before surgery After IOL implantation After surgery and subsequent binarimetry Visus without correction (conventional units) 0,03 0.65 0.8 Visus with correction (conventional units) 0.6 0.65 0.95 Spherical Refraction (Dpt) -11.5 -0.75 -0.75 Cylindrical Refraction (Dpt) -2.5 -0.75 -0.75 The nature of binocular vision (m) 3.0 4.0 5,0 Simultaneous vision (m) 2.0 1,0 0 Fusion reserves (degrees) fifteen 22 25 Stereotest Lang (sec) 0 2350 3550 Deep vision absent absent is present Positive part 2.0 1,0 4.0 relative accommodation (dpt) The negative part of the relative accommodation (Dpt) 4.0 3.0 3,5 The volume of absolute accommodation (Dpt) 3.2 5.7 8.5 Visocontrastometry (conventional units) 16 19 26

As a result of treatment, the patient obtained high results of postoperative refraction and the binocular function of the visual system was restored. When observing the patient for a year, the results of treatment remained stable.

Thus, the proposed method for the treatment of high myopia is effective, as it allows not only to obtain stably high results of postoperative refraction, but also to improve the functions of the visual system.

Table 3 Dynamics of visual functions in patients with high myopia after implantation of phakic IOLs and subsequent binarimetry (M ± m) Visual function Before surgery After IOL implantation After surgery and subsequent binarimetry Visus without correction (conventional units) 0.04 ± 0.03 0.63 ± 0.03 0.77 ± 0.06 P1-2 <0.001 P2-3 <0.05 Visus with correction (conventional units) 0.6 ± 0.03 0.77 ± 0.03 0.85 ± 0.03 P1-2 <0.001 Spherical Refraction (Dpt) -14.8 ± 0.56 -0.3 ± 0.1 -0.12 ± 0.05 P1-2 <0.001 Cylindrical Refraction (Dpt) -1.3 ± 0.19 -0.9 ± 0.15 -0.6 ± 0.15 The nature of binocular vision (m) 2.7 ± 0.3 3.9 ± 0.28 4.7 ± 0.23 P1-2 <0.01 Simultaneous vision (m) 1.5 ± 0.3 1.1 ± 0.28 0.3 ± 0.23 Fusion reserves (degrees) 22.5 ± 1.48 24.8 ± 1.5 30.5 ± 2.33 P2-3 <0.05 Stereotest Lang (sec) 560 ± 239.9 1478 ± 229.7 2915 ± 341.8 P1-2 <0.01 P2-3 <0.001 Depth Vision (conventional units) 1.88 ± 0.07 1.6 ± 0.1 1.2 ± 0.1 P1-2 <0.05 P2-3 <0.01 The positive part of relative accommodation (Dpt) 2.5 ± 0.36 1.9 ± 0.32 4.0 ± 0.48 P2-3 <0.001 The negative part of the relative accommodation (Dpt) 3.04 ± 0.21 3.6 ± 0.24 3.96 ± 0.41 The volume of absolute accommodation (Dpt) 4.7 ± 0.35 7.9 ± 0.31 9.4 ± 0.42 P1-2 <0.001 P2-3 <0.01 Visocontrastometry (conventional units) 5.8 ± 0.83 11.4 ± 0.15 14.7 ± 1.23 P1-2 <0.001 P2-3 <0.05

Claims (1)

A method of treating high degree myopia, including performing anterior keratotomy with implantation of a negative phakic intraocular lens, characterized in that keratotomy is performed simultaneously with implantation of a phakic intraocular lens, and implantation is carried out through a self-sealing corneal tunnel performed in a strong meridian, and 30 days after the operation diploptic treatment with a binarimeter in free haploscopy for 10 days.