RU2376962C1 - Method of cataract phacoemulsification in case of cristalline lens subluxation resulting from weakness of zinn's ligaments or their disruption - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be used in carrying out cataract phacoemulsification in patients with crystalline lens subluxation, resulting from expressed weakness of Zinn's ligaments or their local defect, complications induced by increased mobility of capsule sac, reduction of probability of developing inflammatory reactions and bleeding, as well as reduction of degree of eye tissue trauma. Main cornea cut and two cornea paracenteses are made. Scleral-conjunctival flaps are formed. Visco-elastic is introduced into anterior chamber. After performing crystalline lens hydrodissection and its separation from capsule sac through main cornea cut intracapsule implant in form of open ring with openings on ends is introduced into capsule sac. Implant is placed in such way that its open part is projected on the middle of zone of Zinn's ligaments defect. Openings on the ends of implant are displaced into area of capsulorexis. Through one of cornea paracenteses (first paracentesis) into eye cavity introduced is first curved needle with thread (first needle) to other end of which second curved needle (second needle) is fixed. First needle is passed sequentially from bottom to top through openings on implant ends. Then first needle is brought out through second cornea paracentesis (second paracentesis). After that first needle is introduced through second paracentesis, and second needle - through first paracentesis. Needles are passed from inside outside through ciliary furrow above capsule sac and brought out under preliminarily formed scleral valve onto external surface of sclera in zone corresponding to the middle of zone of Zinn's ligaments defect. After preliminary tightening and centration of capsula sac thread are fixed to sclera. After that removal of cataract with implantation of intraocular lens is performed.

EFFECT: reduction of risk of post-operation complications induced with increased capsule sac mobility, as well as reduction of probability of developing inflammatory reactions and bleeding, as well as reduction of degree of eye tissue trauma.

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Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used for phacoemulsification of cataracts in patients who have a subluxation of the lens due to severe weakness of the zinc ligaments or their local defect.

A known method of conducting phacoemulsification of cataracts in patients with weakness of the zinc ligaments, including performing a corneoscleral incision, corneal paracentesis, introducing viscoelastic into the anterior chamber, performing phacoemulsification of cataract, introducing into the capsular bag along its equator an elastic ring made in the form of a torus with an annular groove in the ring diameter implantation of an artificial lens with the placement of haptic elements in a groove on the inner surface of the ring (RF patent No. 2173126).

However, with pronounced weakness of the zinc ligaments, subluxation of the lens, and also with extensive local ruptures of the zinc ligaments, which in most cases are found only during surgery, it is very difficult to eliminate the excessive mobility of the capsular bag at the stage of phacoemulsification, which increases the likelihood of aspiration, rupture of the edge of capsulorexis , damage to the posterior capsule, further weakening of the zinc ligaments with subsequent exit to the anterior chamber of the vitreous body, as well as a high probability of damage to ka at the time of irrigation and aspiration of lens mass and implantation of an intraocular lens (IOL), and administering intracapsular implant without suturing may not be enough to secure the capsular bag and its correct central location.

The objective of the invention is to provide an effective method for the prevention of intraoperative damage to the capsular bag and the zinc cords of the lens during phacoemulsification. The technical result is to reduce the risk of intraoperative complications associated with increased mobility of the capsular bag, reducing the likelihood of inflammatory reactions and bleeding, as well as reducing the degree of trauma to eye tissue.

The technical result is achieved by the fact that in the method of phacoemulsification of cataract with subluxation of the lens due to weakness of the zinc ligaments or their rupture, including the main corneal incision and two corneal paracentesis, the formation of sclero-conjunctival flaps, the introduction of a viscoelastic implantation in the anterior chamber, and the implementation of phacoemulsification with an intraocular lens according to the invention after hydrodissection of the lens and its separation from the capsular m the intracapsular implant is introduced into the capsule bag through the main corneal incision in the form of an open ring with holes at the ends, positioning it so that the open part is projected onto the middle of the zone of the defect of the zinc ligaments, then through one of the corneal paracentesis (the first paracentesis) is introduced into the eye cavity a curved needle with a thread (first needle), to the other end of which a second curved needle (second needle) is fixed, the first needle is inserted into the eye cavity and is carried out sequentially from the bottom up through the holes I am at the ends of the implant, which are previously displaced into the capsulorexis region, then the first needle through the second corneal paracentesis (second paracentesis) is brought out, then both needles are inserted sequentially through paracentesis into the anterior chamber of the eye, while the first needle is inserted through the second paracentesis, and the second needle - through the first paracentesis, they are carried out from the inside out through the ciliary groove, on top of the capsular bag, and brought under the preformed scleral valve to the outer surface of the sclera in the area corresponding to in the middle of the zone of defect of the zinc ligaments, the fixation of the threads after their preliminary tension and centering of the capsular bag is carried out to the sclera, after which cataract phacoemulsification with implantation of an intraocular lens is carried out.

Thus, the proposed method for phacoemulsification of cataracts in patients with a lens subluxation due to the pronounced weakness of the zinc ligaments or their local rupture with the help of an intracapsular implant is the most reliable, since the implant fixed to the sclera in the projection zone of the rupture of the zinc ligaments allows the thread to be dosed by dosing tension center the capsule bag, make its position more stable, reduce its mobility during phacoemulsification and prevent developed e associated intraoperative complications; in addition, conducting only corneal paracentesis has a minimum of traumatic effect on the eye tissue, reduces the likelihood of bleeding and inflammatory complications in the postoperative period.

The method is as follows.

The surgical field is treated with 0.5% chlorhexidine solution and akinesia by introducing 5 ml of 1% lidocaine. With insufficient mydriasis, 0.3 ml of 1% mesatone solution is injected into the anterior chamber.

An incision is made and the conjunctiva is separated 2 mm from the limbus at a place corresponding to the middle of the defect of the zinc ligament, a scleral valve 2 by 2 mm in size is formed here. The main corneal incision is 2.75 mm wide, as well as two paracentesis 1 mm wide. A viscoelastic solution is introduced into the anterior chamber, a continuous circular capsulorexis with a diameter of 5 mm is performed using tweezers inserted through the main incision, hydrodissection of the lens and its separation from the capsule bag are performed, after which an intracapsular implant is inserted into the capsule bag as an open ring with holes at the ends (for example, the model for the production of electronic drives "MG", with parameters 13/11); positioning it so that the open part is projected onto the middle of the zone of the defect of the zinc ligaments, then through one of the corneal paracentesis (first paracentesis), a curved needle with a thread (first needle) is inserted into the cavity of the eye with the needle holder, the second curved needle is fixed to the other end of it (second needle), the first needle is inserted into the cavity of the eye and it is carried out sequentially from the bottom up through the holes at the ends of the implant, which are preliminarily displaced into the capsulorexis region using a microhook inserted through h the main corneal incision, then the first needle through the second corneal paracentesis (second paracentesis) is brought out, then both needles are inserted sequentially through paracentesis into the anterior chamber of the eye, while the first needle is inserted through the second paracentesis, and the second needle through the first paracentesis, from the inside out through the ciliary groove, on top of the capsular bag, and out under a pre-formed scleral valve on the outer surface of the sclera in the area corresponding to the middle of the zone of defect of the zinc ligaments, then, pull wound around the threads, the capsular bag is centered, after which both threads are tied with three knots, the ends of the threads are cut off with scissors at the base of the node, then the superficial scleral flap is placed in place, and a nodular suture is placed on the conjunctiva, then cataract phacoemulsification is carried out followed by implantation of the intracapsular model lenses; Viscoelastic is washed out of the anterior chamber and the zones of paracentesis are infiltrated with physiological saline; the operation is completed by administering 1 ml of a dexazone solution and an antibiotic under the conjunctiva.

Example.

Patient V., 60 years old, was hospitalized in the department with a diagnosis of: OD: mature traumatic cataract, traumatic rupture of the zinc ligaments over 120 degrees (from 3 to 7 hours), lens subluxation of 2 tbsp.

Upon receipt, visual acuity is the count of fingers in the face.

Biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the iris is subatrophic, diffuse opacification of the lens, pronounced phacodesone, the capsular bag is displaced by 11 hours due to the pronounced stretching and local rupture of the zinc ligaments by 3-7 hours, deep-lying media are not ophthalmoscopic.

Intraoperatively verified the length of the rupture of the zinc ligaments.

The implantation and hemming of the intracapsular implant was carried out according to the proposed method, followed by phacoemulsification of cataracts.

When viewed on the 1st day after surgery, visual acuity is 0.7, IOP is normal, IOL is located in the capsule bag and occupies the correct position.

After 2 months after operation Visus = 0.9, IOP is normal, IOL in the correct position.

Claims (1)

A method for cataract phacoemulsification in case of lens subluxation due to weakness of the zinc cords or rupture of the lens, including the main corneal incision and two corneal paracentesis, the formation of sclero-conjunctival flaps, the introduction of viscoelastic into the anterior chamber, the cataract phacoemulsification followed by the implantation of the implant, the implant implantation and the implant implantation that after hydrodissection of the lens and its separation from the capsular bag through the main corneal rupture in the capsular bag of intracapsular implant is administered in the form of an open ring with holes at the ends, positioning it so that the open-loop portion projected on the middle area of the defect Zinn ligaments; then, through the hearth from the corneal paracentesis (first paracentesis), the first curved needle with a thread (first needle) is inserted into the cavity of the eye, the second curved needle (second needle) is fixed to the other end of it, the first needle is passed sequentially from the bottom up through the holes at the ends of the implant, which previously displaced into the capsulorexis, then the first needle through the second corneal paracentesis (second paracentesis) is brought out; then both needles are inserted sequentially through paracentesis into the anterior chamber of the eye, while the first needle is inserted through the second paracentesis, and the second needle through the first paracentesis, the needles are passed from the inside out through the ciliary groove over the capsular bag and brought under the pre-formed scleral valve to the outer surface of the sclera in the zone corresponding to the middle of the zone of defect of the zinc ligaments; after preliminary tension and centering of the capsular bag, the threads are fixed to the sclera, and then cataract is removed with the implantation of an intraocular lens.