RU2421187C1 - Intracapsular stabilisation-optic complex - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine. Complex is made from elastic transparent material from copolymers of acryl and vinyl series, contains optic part in form of lenses and flat haptic, lying in main plane of lenses, with diameter from 10 to 15 mm. Haptic part in the centre has hole with diameter 2-5 mm, in which removable optic part is located. On periphery haptic part has 2-4 holes with diameter 1.5-3 mm. On the edge of haptic part not fewer than two cuts are made in form of part of rectangular, triangular, ellipse, trapezium or not fewer than two radial cuts, and optic part additionally contains two pairs or flat projections. One pair of projections adjoins anterior surface of haptic part (anterior projections), and the second pair adjoins posterior surface of haptic part (posterior projections). In each pair projections are located diametrically opposite to each other, with longitudinal axes of anterior and posterior projections being parallel to each other. Anterior projections are shorter than posterior ones, surfaces of all four projections, adjoining haptic part, are made rough or ribbed. Periphery of optic part has, at least, one rotational hole.

EFFECT: application of complex will make it possible to achieve maximally possible visual functions due to possibility to stabilise capsule sac and presence of replaceable lenses, including possibility of its delayed implantation and/or replacement.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in all cases of instability of the ligamentous apparatus of the lens, for example, when combining cataracts with the treatment of severe forms of retinal detachments, as well as in the surgical treatment of cataracts in children.

With the combination of surgical treatment of recurrent retinal detachments and cataracts, during which silicone is injected into the cavity of the eyeball, silicone often moves into the anterior chamber and has prolonged contact with the cornea, which causes the development of epithelial-endothelial dystrophy, secondary glaucoma, uveitis.

In the surgical treatment of cataracts in young children, the degree of change in eye refraction during its growth cannot be envisaged, especially in cases of development or progression of myopia; this problem is currently being solved with the help of corneal excimer laser surgery, however, excimer laser operations have limitations in the frequency of application, as well as in the type and degree of ametropia.

Surgical treatment of cataracts in conditions of instability of the ligamentous apparatus of the lens increases the risk of complications: tearing off the capsule bag, prolapse of the vitreous body into the anterior chamber of the eye, displacement of the lens masses into the vitreous cavity.

The closest analogue is the barrier-optical membrane described in the patent of the Russian Federation for invention No. 2371148, made of an elastic transparent material from copolymers of acrylic or vinyl series and containing the optical part in the form of a lens with a diameter of 5 to 8 mm and a flat haptic part lying in the main plane of the lens, with a diameter of 10 to 15 mm, while the membrane contains on the front surface of the haptic part two furrows made tangentially to the optical part and parallel to each other, from one to the other edge of the haptic part.

The disadvantages of this membrane are:

1) for the implantation of a barrier-optical membrane, a complete or partial absence of a capsular bag is necessary;

2) the barrier-optical membrane is not intended for implantation in the capsular bag and does not allow it to stabilize in the presence of defects in the ligamentous apparatus;

3) as part of the barrier-optical membrane, the optical part is not replaceable.

The technical result according to the invention is to achieve the maximum possible visual functions due to the possibility of stabilizing the capsule bag and the presence of interchangeable optics, including the possibility of delayed implantation and / or replacement.

The technical result according to the invention is achieved by the fact that the intracapsular stabilization-optical complex, made of an elastic transparent material from copolymers of acrylic or vinyl series, contains an optical part in the form of a lens and a flat haptic part lying in the main plane of the lens, with a diameter of 10 to 15 mm, characterized in that the haptic part in the center has a hole with a diameter of 2-5 mm, in which a replaceable optical part is placed, on the periphery of the haptic part has 2-4 holes with a diameter of 1.5-3 mm, in cr at least two cuts in the shape of a rectangle, triangle, ellipse, trapezoid, or at least two radial cuts are made in the haptic part, and the optical part additionally contains two pairs of flat protrusions, one pair adjacent to the front surface of the haptic part (front protrusions), and the second the pair is adjacent to the rear surface of the haptic part (rear protrusions), in each pair the protrusions are diametrically opposite to each other, the longitudinal axes of the front and rear protrusions are parallel to each other, while the front the stupas are shorter than the rear ones, and the surfaces of all four protrusions adjacent to the haptic part are roughened or ribbed, the periphery of the optical part may have at least one rotational hole.

There is also an option in which an annular groove or annular protrusion is made at the end of the haptic part, having in cross section passing through the optical axis the shape of a part of a rectangle, triangle, ellipse or trapezoid.

Each element of the complex performs certain functions.

The optical part allows for the correction of aphakia. The optical part is interchangeable, which gives significant advantages compared to the prototype: it allows for the implantation of the haptic and optical parts, spaced apart in time. If necessary, the central and peripheral openings of the haptic part can be used to wash out cortical lens masses. The peripheral holes, in addition, serve to wash out viscoelastic at the final stage of the operation. Cutouts along the edge of the haptic part allow it to adapt to the size of the capsular bag and do not prevent its uniform stretching, which is necessary to stabilize the position of the capsular bag in cases of a defect in the ligamentous apparatus of the natural lens. In addition, the cutouts facilitate folding of the haptic part before implantation and allow implantation through a minimum incision, and also facilitate lens implantation if necessary. The diametrically located protrusions of the optical part are intended for fixing the optical part in the central hole of the haptic part. The surface of the protrusions adjacent to the haptic part is roughened or ribbed for reliable fixation of the optical part. The front protrusions are shorter than the rear for better visualization of the location of the protrusions during implantation of the optical part. Rotational holes on the periphery of the optical part are used for manipulations during the implantation or explantation of the optical part.

There is an option in which a closed annular groove or annular protrusion having the shape of a part of a rectangle, triangle, ellipse or trapezoid is made at the end of the haptic part. This form provides a tight fit of the capsule to the edge of the haptic part and prevents the development of fibrosis of the lens capsule.

Thus, the complex allows preventing silicone from entering the front chamber, performing the operation of replacing the optical part and stabilizing the capsule bag in case of defects in its ligamentous apparatus.

The invention is illustrated by drawings, where in figures 1-7 shows an intracapsular stabilization-optical complex. The figure 1 shows a removable optical part of the complex, front view. The figure 2 shows the optical part in a perpendicular section passing through its center. The figure 3 shows the haptic part, front or rear view. In figures 4 and 5 shows the haptic part with options for the number of peripheral holes. The figure 6 shows the haptic part with options for the shape of the cutouts. The figure 7 shows the haptic part 2 and its view in cross section passing through the optical axis of the complex.

The complex contains an optical part 1 in the form of a lens and a flat haptic part 2. In the center of the haptic part 2 there is a hole 3 in which the interchangeable optical part 1 is located, on the periphery of the haptic part 2 it has from two to four holes 4. Along the edge of the haptic part 2 is made at least two cutouts in the form of a part of a triangle 5, a rectangle 5a, an ellipse 5b, a trapezoid 5b, 5g or at least two radial cuts 5d, and the optical part 1 additionally contains two pairs of flat protrusions: front protrusions 6 and rear protrusions 7. Surfaces 8 of all h The four protrusions adjacent to the haptic part 2 are made rough or ribbed. The periphery of the optical part 1 may have at least one rotational hole 9.

There is also an option in which an annular groove 10 or an annular protrusion 10 is made at the end of the haptic part 2, having in cross section passing through the optical axis the shape of a part of a triangle 10a, 10b, an ellipse 10b, 10g or a trapezoid 10d, 10e.

The stabilization-optical complex can be made of copolymers of acrylic (from 10% to 90%) or vinyl series (from 10% to 90%). A stabilization-optical complex is implanted for a long period of time, which allows for repeatedly operated patients to achieve persistent medical, social and professional rehabilitation.

Implantation of an intracapsular stabilization-optical complex is one of the stages of the operation in cases of a defect in the ligamentous apparatus of the lens and combined with cataract vitreoretinal pathology, as well as in pediatric cataract surgery.

In cases of a defect in the ligamentous apparatus of the lens, implantation of the complex is as follows:

At 12 hours, a tunnel incision of the cornea is made with a width of 1.8-3.0 mm using a knife-spades. Perform capsulorexis and proceed to cataract phacoemulsification. At the stage of detecting the integrity defect of the zinc ligaments, viscoelastic is introduced into the anterior chamber, the haptic part 2 is implanted through the pupil into the capsular bag. Then, the removal of the lens masses through the central 3 and peripheral holes 4 of the haptic part 2 is continued. After the removal of the lens masses, viscoelastic is introduced and the optical part 1 of the complex is implanted in the central hole 3 of the haptic part 2 so that the front protrusions 6 lie on the front surface of the haptic part 2 and the rear protrusions 7 to the rear surface of the haptic part 2. Viscoelastic is washed out of the front chamber, the tunnel section is sealed.

With a combination of cataracts with vitreoretinal pathology, implantation of the complex is as follows:

At 12 o’clock, a corneal tunnel incision is made with a width of 2.0-3.0 mm using a peak knife. During phacoemulsification of a cataract, a viscoelastic is introduced into the anterior chamber, and the haptic part of the stabilization-optical complex is implanted through the pupil into the capsular bag. Viscoelastic is washed out of the anterior chamber. One provisional nodal suture with a thread of 10.0 can be applied to the corneal incision. Further, according to the indications, tamponade of the vitreous cavity is carried out with silicone. Then the provisional suture is removed, the optical part of the complex is implanted similarly to the previous case, the viscoelastic is washed out, and the tunnel incision is sealed. In case of danger of a relapse of retinal detachment, the implantation of the optical part of the complex can be delayed and performed as a secondary operation.

In the surgical treatment of cataracts in children, implantation of the complex is as follows:

At 12 o’clock, a corneal tunnel incision is made with a width of 2.0-3.0 mm using a peak knife. Perform capsulorexis and proceed to cataract phacoemulsification. After phacoemulsification, a viscoelastic is introduced into the anterior chamber, and the haptic part 2 is implanted through the pupil into the capsular bag. Then the optical part of the complex is implanted similarly to the previous case. Viscoelastic is washed out of the anterior chamber, the tunnel incision is sealed. In the distant postoperative period, in case of a change in eye refraction due to its growth in length, the optical part of the complex is replaced. To do this, at 10 o’clock, a tunnel incision of the cornea is carried out with a width of 2.0-3.0 mm, viscoelastic is introduced into the anterior chamber, and the optical part of the complex is mobilized with a spatula. Then the optical part is removed through the tunnel section with collet tweezers. After that, the optical part of the required diopter is implanted in the central hole of the haptic part, viscoelastic is washed out, and the tunnel incision is sealed.

Clinical examples:

Example 1

Patient S., 21 years old. Diagnosis of OS - corneal scar, iridodialysis 3-6 hours, traumatic cataract, iridofacodonez. Condition after PHO of a corneal wound.

On admission: visual acuity OS - 0.05 n / a, IOP - 11.0 mm Hg, eye length 23.18 mm, traumatic mydriasis, suspension of shaped elements in the moisture of the anterior chamber, the vitreous body is transparent, the retina is adjacent. During surgery, after iridoplasty and partial removal of the lens masses, a defect in the zinc ligaments was detected. The haptic part of the stabilization-optical complex was implanted to stabilize the capsule bag under conditions of inferiority of the ligamentous apparatus of the lens. Then, the remaining crystalline masses, including cortical ones, were washed through the central and peripheral openings of the haptic part. The next stage was the implantation of the optical part of the complex.

After the operation, the visual acuity of 0.6 is not corrected, the spheroequivalent is 0.25 D, the IOP is 14 mm, the position of the intracapsular stabilization-optical complex is correct. After 6 months: visual acuity with a correction of 0.9, IOP 15 mm, the stabilization-optical complex is centered in the posterior chamber.

Example 2

Patient M., 55 years old. Diagnosis: OD - regmatogenous retinal detachment, immature mixed cataract, moderate myopia.

On admission: visual acuity OD - light perception with the correct projection, IOP - 12.0 mm Hg, eye length - 24.8 mm. The patient decided to undergo surgical treatment according to the above method. During phacoemulsification of the cataract, the haptic part of the stabilization-optical complex was implanted. Excision of epiretinal membranes, retinal mobilization, tamponade with an organofluorine compound (PFOS) were performed. Next, retinal endolasercoagulation was performed, and PFOS was replaced by silicone. After surgery: visual acuity - 0.1 with correction; IOP - 16 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. 1 month after the operation, the silicone block was completed, visual acuity increased to 0.3 with correction; IOP - 18 mmHg, the retina is adjacent. After 1 month, the patient was implanted with the optical part of the stabilization-optical complex. After surgery, visual acuity of 0.4 without correction, IOP 17 mm Hg

Thus, the intracapsular stabilization-optical complex is effective in the surgical treatment of cataracts in combination with severe forms of retinal detachments, as well as in the surgical treatment of cataracts in case of a defect in the ligamentous apparatus of the lens: in case of traumatic cataract, aniridia, subluxation of the lens (after injuries, congenital pathology - Marfan syndrome, due to rupture of the zinc ligaments during cataract extraction). The use of a stabilization-optical complex in children's practice is promising, since replacing the optical part of the complex helps to delay the refractive surgery of the cornea until the eye grows in length.

Claims (2)

1. The intracapsular stabilization-optical complex, made of an elastic transparent material from copolymers of acrylic or vinyl series, contains an optical part in the form of a lens and a flat haptic part lying in the main plane of the lens, with a diameter of 10 to 15 mm, characterized in that the haptic part in the center there is a hole with a diameter of 2-5 mm in which the interchangeable optical part is located, on the periphery the haptic part has 2-4 holes with a diameter of 1.5-3 mm, at least two cuts in the form of h are made along the edge of the haptic part a rectangle, triangle, ellipse, trapezoid, or at least two radial cuts, and the optical part additionally contains two pairs of flat protrusions, one pair adjacent to the front surface of the haptic part (front protrusions), and the second pair adjacent to the rear surface of the haptic part (rear protrusions ), in each pair, the protrusions are located diametrically opposite to each other, the longitudinal axes of the front and rear protrusions are parallel to each other, while the front protrusions are shorter than the rear, and the surfaces of all four protrusions are hedging to the haptic part, made rough or ribbed, the periphery of the optical part has at least one rotational hole. 2. The intracapsular stabilization-optical complex according to claim 1, characterized in that an annular groove or annular protrusion is made at the end of the haptic part, having in cross section passing through the optical axis the shape of a part of a rectangle, triangle, ellipse or trapezoid.

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