RU2393826C1 - Method of intraocular lens reposition in ciliary furrow (versions) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and more specifically to ophthalmology. After delivering an IOL into the anterior chamber, two diametrical corneal paracenteses follow. A threaded long curved needle is stuck in the cornea through the first paracentesis and stuck out through sclera within a projection of the ciliary furrows oppositely from paracentesis. The thread ends are left outside. A hook is introduced through the second paracentesis, and the threaded needle is introduced from the first paracentesis into the second paracentesis. The second threaded long curved needle is used to perform described procedures through the second paracentesis. One of haptic elements is delivered outside through one of paracenteses and fixed with the thread delivered through the same paracentesis. Similarly, the other diametrical haptic element is handled. The IOL is implanted into the posterior chamber with aligning the thread ends delivered within a projection of the ciliary furrow, and fixing the thread ends to sclera. According to another version, after delivering the IOL into the chamber, performing two diametrical corneal paracenteses, one haptic element is delivered outside through the first paracentesis, then the threaded long curved needle is used with fixing the thread end to the delivered haptic element, further, the haptic element is reset in the anterior chamber with the thread fixed thereto; the needle is stuck in the cornea through the first paracentesis and stuck out through sclera within a projection of the ciliary furrows oppositely from paracentesis, thus the thread end with the needle delivered within a projection of the ciliary furrow is left outside; further, the second haptic element is delivered outside through the second paracentesis, thereafter the second threaded long curved needle is used to perform the same procedures through the second paracentesis, then the IOL is rotated around in the anterior chamber, and the IOL is implanted into the posterior chamber with aligning the thread ends delivered within a projection of the ciliary furrows, and fixing the thread ends to sclera. The assigned task is realised by two developed versions for treating the dislocated IOL to ensure the same technical effect.

EFFECT: reduced number of postoperative complications, such as astigmatism and IOL decentration.

2 cl, 2 dwg, 2 ex

Description

The invention relates to medicine, and more particularly to ophthalmology.

A known method of fixing a deployed intraocular lens (IOL) in the ciliary sulcus (Zakharov VD Vitreoretinal surgery. - M., 2003. - 138-140.). The method consists in removing the IOL into the anterior chamber, suturing the filaments to the haptic elements and centering the IOL in the posterior chamber, followed by stitching the filaments to the sclera in the area of the projection of the ciliary groove.

However, this method has the disadvantages of a high invasiveness of the operation associated with many manipulations in the anterior chamber.

The objective of the invention is to develop an atraumatic method of repositioning IOL.

To solve this problem, two options for the reposition of the deployed IOL have been developed, providing the same technical result.

The technical result achieved by using both options is to reduce the number of postoperative complications, such as astigmatism, decentralization of IOL.

The technical result according to the first embodiment is achieved by the fact that in the method of reposition of a deployed intraocular lens into a ciliary sulcus, including the removal of IOLs with two diametrically located haptic elements into the anterior chamber, threading through corneal paracentesis, suturing of the filaments to the haptic elements, implantation of an IOL into the posterior chamber centering, stitching the threads to the sclera, according to the invention, after removing the IOL into the anterior chamber, two diametrically located corneal paracentesis are performed, then a thread with a long curved needle and inject the cornea through the first paracentesis and puncture through the sclera in the projection area of the ciliary sulcus in a place diametrically opposite from this paracethesis, while the ends of the threads are left outside, then a hook is inserted through the second paracentesis and the thread is removed from the first paracentesis into the second paracentesis, after which they take the second thread with a long curved needle and carry out the same actions through the second paracentesis, then one of the haptic elements is brought out through one of the paracenteses and fixed yvedennoy through the same thread paracentesis likewise fed to another diametrically disposed haptics thereafter implanted IOL into the posterior chamber, centered over the ends of the strands withdrawn in the projection of the ciliary sulcus, and fixed ends of the filaments to the sclera.

The technical result according to the second embodiment is achieved by the fact that in the method of reposition of a deployed intraocular lens into a ciliary sulcus, including removing the IOL with two diametrically located haptic elements into the anterior chamber, suturing the filaments to the haptic elements, passing the filaments through corneal paracentesis, implanting the IOL into the posterior chamber centering the IOL, suturing the threads to the sclera, characterized in that after removing the IOL into the anterior chamber, two diametrically located corneal paracentesis is performed, one of the haptic elements is brought out through the first paracentesis, then a thread with a long curved needle is taken and the end of this thread is fixed to the extracted haptic element, then the haptic element is inserted into the anterior chamber with a thread fixed to it and this needle is injected into the cornea through the first paracentesis and puncture through the sclera in the projection area of the ciliary sulcus in a place diametrically opposite to this paracethesis, while the end of the thread with the needle brought out in the projection area of the ciliary sulcus is left outside, then you they put the second haptic element out through the second paracentesis, then take the second thread with a long curved needle and perform the same actions through the second paracentesis, then the IOLs rotate 180 degrees in the anterior chamber, after which the IOLs are implanted in the posterior chamber, centered at the ends of the threads, bred in the projection area of the ciliary sulcus, and fix the ends of these threads to the sclera.

Each of the variants of the method differs from the closest analogue in that it ensures reliable fixation of the IOL in the posterior chamber, avoids unnecessary rotation of the IOL in the anterior chamber, and thus avoids postoperative complications, such as astigmatism and decentralization of the IOL.

The method is illustrated in figure 1-2.

Figure 1 schematically depicts an eyeball. Position 1 indicates the first paracentesis of the cornea. Position 2 indicates the second paracentesis of the cornea. Position 3 denotes one end of the first thread output through paracentesis 1. Position 4 denotes one end of the second thread output through paracentesis 2. Position 5 indicates the projection area of the ciliary sulcus in 1 place diametrically opposite from paracentesis. 6 indicates the area of the projection of the ciliary sulcus in the diametrically opposite place from paracentesis 2. Position 7 marks the other end of the first thread, displayed in the area of the projection of the ciliary sulcus. Position 8 marks the other end of the second thread, displayed in the area of the projection of the ciliary groove.

Figure 2 schematically shows an eyeball with an IOL in the anterior chamber. Number 9 is the IOL. Position 10 denotes the first haptic element derived through paracentesis 1. Position 11 denotes the second haptic element derived through paracentesis 2.

The method according to the first embodiment is as follows. Spend two paracentesis 1 and 2 (0.9 mm) at 3 and 9 hours. Then they take a polypropylene thread with a long curved needle of 15 mm. This needle with a thread makes an injection of the cornea at 3 o’clock and a puncture at 9 o’clock in the area of projection 5 of the ciliary sulcus. Then a hook is introduced into paracentesis 2, a thread is captured and it is removed from paracentesis 1 through paracentesis 2 at 9 o’clock. Thus, it is obtained that the thread enters through the paracentesis of 2 corneas at 9 o’clock and leaves in the projection area of 5 ciliary grooves at 9 o’clock, respectively. Another needle with a thread makes an injection of the cornea at 9 o’clock and a puncture at 3 o’clock in the area of the projection of 6 ciliary grooves. Then a hook is introduced into paracentesis 1, a thread is captured and it is removed from paracentesis 2 through paracentesis 1 for 3 hours. Thus, it is obtained that the thread enters through paracentesis of 1 cornea at 3 o’clock and exits in the projection area of 6 ciliary grooves at 3 o’clock, respectively. Then IOL is displayed in the anterior chamber to the iris. Next, one of the haptic elements 10 is brought out through paracentesis 1 for 3 hours. The thread 3 is fixed by a nodal suture to the haptic element 10 and is set into the front chamber. The same manipulations are performed at 9 o’clock. IOLs are inserted into the back chamber, centered, threads 7 and 8 are fixed to the sclera.

The method according to the second embodiment is as follows. Spend two paracentesis 1 and 2 (0.9 mm) at 3 and 9 hours. Then IOL is displayed in the anterior chamber to the iris. Next, one of the haptic elements 10 is brought out through paracentesis 1 for 3 hours. Then they take a polypropylene thread with a long curved needle of 15 mm. The thread 3 is fixed by a nodal suture to the haptic element 10 and is set into the front chamber. This needle with a thread makes an injection of the cornea at 3 o’clock and a puncture at 9 o’clock in the area of projection 5 of the ciliary sulcus. Next, the second haptic element 11 is brought out through paracentesis 2. The same manipulations are performed at 9 o’clock. Then the IOL is rotated 180 degrees. IOLs are inserted into the back chamber, centered, threads 7 and 8 are fixed to the sclera.

The proposed method is characterized by the following clinical examples.

Example 1

Patient W., 73 years old. Diagnosis: the right eye is artifact, the dislocation of the IOL into the vitreous body, the left eye is the initial cataract.

An extracapsular cataract extraction with implantation of the T-26 model IOL was performed on the patient’s right eye.

Right eye:

Visual acuity - 0.1 n / a

Ophthalmometry - 45.40-14

45.00-104

Tonometry - 18 mmHg

In order to eliminate the decentralization of IOL on the right eye, the operation according to the invention according to the first embodiment was performed.

The operation and the postoperative period proceeded without complications. On the 2nd day, visual acuity - 0.5 cyl 1.0 ax 15 = 0.7

Tonometry - 15 mmHg

After 3 months, visual acuity - 0.8 n / a

Tonometry - 16 mmHg

IOL is central.

Example 2

Patient T., 65 years old. Diagnosis: the right eye is artifact, the dislocation of the IOL into the vitreous body, the left eye is healthy.

The patient had cataract phacoemulsification 2 days ago with implantation of an IDEA model IOL.

Right eye:

Visual acuity - 0.03 sph-7.5 = 0.5 n / k

Ophthalmometry -

44.00-0

44.50-90

Tonometry - 18 mmHg

In order to eliminate the decentralization of the IOL, the operation according to the invention according to the second embodiment was performed.

The operation and the postoperative period proceeded without complications. One month after the operation, visual acuity is 0.6-0.7 sph-0.5 cyl-0.78 ax 175 = 1.0

Ophthalmometry -

43.50-180

44.75-90

Tonometry - 18 mmHg

IOL is central.

Thus, the use of the proposed invention allows atraumatic, without performing large incisions to eliminate the decentralization of IOL.

Claims (2)

1. A method for reposition of a deployed intraocular lens (IOL) into the ciliary sulcus, including the removal of the IOL with two diametrically located haptic elements into the anterior chamber, passing the threads through the corneal paracentesis, suturing the threads to the haptic elements, implanting the IOL into the posterior chamber, centering, suturing the threads sclera, characterized in that after removing the IOL into the anterior chamber, two diametrically located corneal paracentesis are performed, then a thread with a long curved needle is taken and this needle is injected into the cornea through the first paracentesis and puncture through the sclera in the projection area of the ciliary sulcus in a place diametrically opposite to this paracethesis, while the ends of the threads are left outside, then a hook is inserted through the second paracentesis and the thread is removed from the first paracentesis to the second paracentesis, after which the second thread is taken with with a long curved needle and carry out the same actions through the second paracentesis, then one of the haptic elements is brought out through one of the paracentesis and fix the thread removed through the same paracentesis, analog In another way, they enter another diametrically located haptic element, after which IOL is implanted in the posterior chamber, centered at the ends of the threads brought out in the projection area of the ciliary groove, and the ends of these threads are fixed to the sclera. 2. A method for reposition of a deployed IOL into a ciliary sulcus, including the removal of IOL with two diametrically located haptic elements into the anterior chamber, suturing of the filaments to the haptic elements, passing the filaments through corneal paracentesis, implanting the IOL into the posterior chamber, centering the IOL, suturing the filaments to the sclera, the fact that after removing the IOL into the anterior chamber, two diametrically located corneal paracentesis are performed, then one of the haptic elements is brought out through the first paracentesis, then I take a thread with a long curved needle and fix the end of this thread to the extracted haptic element, then put the haptic element into the anterior chamber with a thread fixed to it and make this needle inject the cornea through the first paracentesis and puncture through the sclera in the projection area of the ciliary sulcus in the diametrically opposite from this paracethesis in place, while the end of the thread with the needle removed in the projection area of the ciliary sulcus is left outside, then the second haptic element is brought out through the second paracentesis, then take thread with a long curved needle and carry out the same actions through a second paracentesis, then the IOL is rotated 180 ° in the anterior chamber, then the IOL is implanted in the posterior chamber, centered at the ends of the threads brought out in the projection area of the ciliary groove, and the ends of these threads are fixed to the sclera.

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