RU2360655C1 - Method of aniridia elimination - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and aims at aniridia elimination. At the beginning, cohesive viscoelastic is introduced through cornea paracentesis in a posterior chamber to level of the plane passing through anterior surface of ciliary apparatus processes. The anterior chamber is filled with air. Autoblood is introduced through the same paracentesis on anterior surface of viscoelastic in amount sufficient to form iris of required shape and dimensions. In 5-10 minutes, air is replaced with viscoelastic.

EFFECT: method allows obtaining in the aniridia eye within topographic location of the iris of regular-rounded autoblood clot fixed to internal structures of an eyeball and having a functional and cosmetic part of the iris.

1 ex, 5 dwg

Description

The present invention relates to medicine, namely to ophthalmology, and is intended to eliminate aniridia and the formation of an artificial iris from autologous blood.

State of the art

For the correction of aniridia and aphakia, the widespread use of iridocrystalline diaphragms (IHD) of the eyes of various models (for example, RU 2219881, 2003.12.27), which are made round from an elastic material and include a colored peripheral and transparent optical central part, is known. On the peripheral part there are support elements for fixing in the form of hooks, the number and shape of which varies depending on the ICD model. IHD is fixed in the eye by introducing it into the eye through a corneal incision, and stitching the supporting elements with synthetic or metal microsurgical threads to the sclera through the flat part of the ciliary body. However, the disadvantage of all models of artificial iridocrystalline diaphragms is their instability associated with damage to the internal structures of the eye by hook-clamps, the risk of large intraoperative bleeding, the risk of cutting and resorption of sutures, and displacement of ICD.

A known method of correcting aniridia using IHD, characterized by the method of fixation (RU 2290132, 2006.12.27). The implantation method includes intrascleral implantation of polymer elastic magnets in the form of a ring with the induction of a constant magnetic field according to preliminary marking on the sclera. The ICD is held in the correct position due to the magnetic field when comparing magnets implanted in the sclera with magnets in the supporting elements of the ICD. The disadvantage of this method is the instability of the model associated with damage to the internal structures of the eye by the fixing elements, the danger of displacement of both the ICD itself and the fixing intrascleral polymer magnets, as well as the delayed nature of the operation after the injury and major surgical trauma.

The closest analogue of the invention is a method of the same purpose, including the implantation of artificial IHD from synthetic material (RU 2275174, 2006.04.27). The disadvantages are major surgical trauma during implantation, the risk of intraoperative bleeding, prolonged recurrent inflammation in the early and late postoperative period, associated with constant mechanical irritation of the internal structures of the eye by ICD elements, the risk of cutting and resorption of sutures and displacement of ICD.

Disclosure of invention

The objective of the invention is to develop a new approach to eliminate aniridia.

The technical result of the invention is the absence of damage to the structures of the anterior segment with the exception of mechanical fixation of the autobiological iris and the absence of inflammatory reactions of eye tissues in the long term.

The technical result is achieved through the use as an iris of autologous blood, introduced according to the developed technology.

The method is illustrated by the following drawings (figures 1-5), where 1 is the cornea, 2 is the crystalline lens, 3 is the vitreous, 4 is paracentesis, 5 is viscoelastic, 6 is the plane passing through the front surface of the processes of the ciliary body, 7 is air, 8 - autoblood.

A prerequisite for the development of the method was the following observation. A patient with a diagnosis of admission to the specialized ophthalmology department was admitted: the right eye — consequences of a contusion of the eyeball of the third degree, total aniridia, destruction of the vitreous body. Visual acuity OD // OS = 0.02 n / a // 0.8; IOP OD // OS = 24 // 20 mmHg From the anamnesis: I received a blunt injury to my right eye three years ago when I was hit by a wheel from a car at the time of changing tires. During the first three months, the vision of OD was normalized to 0.6, and an IOP of 22 mmHg was noted. Two years after the injury, the visual acuity of OD decreased to 0.2 and the IOP values corresponded to 24 mmHg.

After the examination, the patient was offered an operation - cataract extraction with iridoplasty and artificial iris implantation in the block with IOL, since the visual acuity of the left eye was 0.8 and the spectacle correction is considered inadequate in this case.

In the operating room under local anesthesia, a corneal incision was performed according to the classical approach in this operation. When hemming the side of the iris - IOL, hemorrhage occurred in the anterior chamber, which served as an aggravating factor in this operation, and the block was removed. However, the presence of blood in the anterior chamber during aniridia made it possible to exclude the prominence of the vitreous into the anterior chamber. The blood clot occupied up to 120 degrees of circumference along the limbus.

In the postoperative period, changes in the position of the vitreous body and blood state were not observed.

8 months after the operation, the patient had a lysis of the edges of a clot of organized blood, which led to his displacement into the anterior chamber. With contact correction, the patient showed visual acuity of up to 0.5.

The patient underwent an operation of implantation of the posterior chamber IOL +23.0 Dptr. with the subsequent formation of the iris autologous blood.

For this, in the operating room under local anesthesia, the formed blood clot in the anterior chamber was removed. A posterior chamber IOL +23.0 Dptr was implanted through a corneal tunnel incision.

A cohesive sterile pyrogen-free viscoelastic was introduced into the posterior chamber of the eyeball to the level of a plane passing through the front surface of the processes of the ciliary body.

The front chamber was filled with sterile air.

Autologous blood in a volume of 0.05 ml was introduced onto the front surface of viscoelastic.

After 7 minutes, the air in the anterior chamber was replaced with viscoelastic.

2 days after surgery, the OD is calm, the cornea is calm, the anterior chamber is moderately deep, its moisture is transparent, the IOL is in the correct position. The position of the pupil is without dynamics; there is no negative dynamics in the area of the blood clot. Visual acuity OD = 0.2-0.3; IOP OD = 22 mm Hg

7 days after the operation, at the time of discharge from the hospital, OD is calm, there is no negative dynamics.

3 months after surgery, the OD is calm, there are no deviations in the position of the pupil, adhesions have formed in the zone of local lesion of the pupil border, which additionally fix the position of the pupil. The IOL stands flat and also fixed. Visual acuity OD = 0.6 n / k; IOP OD = 22 mm Hg

The method allows to achieve the formation in the eye with aniridia at the place of the topographic location of the iris of the autologous clot of regular round shape, fixed to the internal structures of the eyeball (coronary ciliary body and the structure of the anterior chamber angle) and playing the functional and cosmetic role of the iris.

The method is carried out in the following way.

Intraoperatively, under the visual control of an ophthalmic surgical microscope in the cornea (1), self-sealing paracentesis is performed (4), through which all further manipulations are performed.

Through paracentesis (4), a cohesive sterile pyrogen-free viscoelastic (5) is introduced into the posterior chamber of the eyeball to the level of a plane passing through the front surface of the processes of the ciliary body (6).

The front chamber is filled with sterile air (7).

Autologous blood (8) is injected through paracentesis (4) onto the front surface of viscoelastic in a volume sufficient to form the iris of the required shape and size.

After 5-10 minutes, the air in the anterior chamber is replaced by viscoelastic (5).

The proposed method allows the formation in the eye with aniridia at the place of the topographic location of the iris of the autologous clot of regular round shape, fixed to the internal structures of the eyeball (coronary ciliary body and the structure of the anterior chamber angle) and playing the functional and cosmetic role of the iris.

Example

Patient Cherin, 38 years old, was admitted to a specialized ophthalmology department with a diagnosis of the right eye - consequences of a contusion of the eyeball of the III degree, total aniridia, aphakia, post-traumatic maculopathy. Visual acuity of OD // OS = 0.025 n / a // 0.9; IOP OD // OS = 24 // 20 mmHg From the anamnesis: I received a dull injury to the right eye a year ago when a hammer hit the eye. At the place of residence, extracapsular extraction of swelling cataracts was performed a month after the injury.

After the examination, the patient was offered an operation - implantation of the posterior chamber IOL with the formation of the iris autologous blood.

For this, in the operating room under local anesthesia, a posterior chamber IOL +21.5 Dptr was implanted through a corneal tunnel incision.

A cohesive sterile pyrogen-free viscoelastic was introduced into the posterior chamber of the eyeball to the level of a plane passing through the front surface of the processes of the ciliary body.

The front chamber was filled with sterile air.

Autologous blood in a volume of 0.05 ml was injected onto the front surface of viscoelastic, which was sufficient to form an iris of the required shape and size.

After 6 minutes, the air in the anterior chamber was replaced with viscoelastic.

2 days after surgery, the OD is calm, the cornea is calm, the anterior chamber is moderately deep, its moisture is transparent, the IOL is in the correct position.

The position of the pupil is without dynamics; there is no negative dynamics in the area of the blood clot. Visual acuity OD = 0.2-0.3; IOP OD = 22 mm Hg

7 days after the operation, at the time of discharge, OD is calm, there is no negative dynamics. 3 months after surgery, the OD is calm, there are no deviations in the position of the pupil, adhesions have formed in the zone of local lesion of the pupil border, which additionally fix the position of the pupil. The IOL stands flat and also fixed. Visual acuity OD = 0.5 n / a; IOP OD = 22 mm Hg

The method allows to achieve the formation in the eye with aniridia at the place of the topographic location of the iris of the autologous clot of regular round shape, fixed to the internal structures of the eyeball (coronary ciliary body and the structure of the anterior chamber angle) and playing the functional and cosmetic role of the iris.

Claims (1)

A method for eliminating aniridia, including the formation of an artificial iris, characterized in that through paracentesis, cohesive viscoelastic is first introduced into the posterior chamber of the eye to the level of the plane passing through the front surface of the processes of the ciliary body, then the anterior chamber is filled with air, and autologous blood is introduced through the same paracentesis the front surface of viscoelastic in a volume sufficient for the formation of the iris of the necessary shape and size, and after 5-10 minutes replace the air with viscoelastic.

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