RU2421198C2 - Method of intraoperative deepening of anterior chamber - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology, and aims at for intraoperative deepening of an anterior chamber in surgical management of immature cataract. Substance of an offered method consists in removal of an intraocular fluid from anterior and posterior chambers with hypotension and normal tension alternated in the anterior chamber, replacement of the intraocular fluid from the posterior chamber into the anterior chamber, and replacement of the intraocular fluid in the anterior chamber with a viscoelastic. The method is implemented by using a cannula with the viscoelastic and a spatula introduced into the anterior chamber through two opposite paracenteses.

EFFECT: method enables avoiding a conventional vitrectomy, preserving a crystalline lens support by a vitreous body, creating conditions for effective capsulorhexis and the following conventional manipulations of the cataract surgery.

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Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in the surgical treatment of swelling cataracts.

In the presence of a swollen cataract nucleus, as a rule, a small anterior chamber (PC) of the eye is formed and increased intraocular pressure (IOP) is created, which complicates the formation of capsulorexis and further surgical procedures - phacoemulsification of the nucleus and IOL implantation. In addition, there is a risk of damage to the corneal endothelium and the possibility of postoperative complications, such as corneal edema and its clouding.

There is a method of increasing the depth of the anterior chamber for swelling cataracts by performing a dosed anterior vitrectomy or non-penetrating deep sclerectomy (O.V. Goncharenko, O.G. Gamzatov, L.I. Rud. In the Collection of scientific articles on the materials of the VI International Scientific and Practical Conference “Modern technologies of cataract and refractive surgery - 2005”, p. 80, Moscow). The disadvantage of this method is the morbidity and complexity of the manipulation. There is also known a method of intraoperative regulation of the anterior chamber depth in the surgical treatment of overripe cataracts with a swollen lens (RF Patent No. 2271787, A61F 9/007, filed February 16, 2004, published March 20, 2006, BI No. 8). This method involves the partial removal of the vitreous using a vitreotome with the simultaneous supply of physiological saline to the PC (prototype).

The main disadvantage of the prototype is the invasiveness and complexity of the procedure: the procedure is performed blindly and bleeding and hemorrhage may occur, as well as the collapse of the posterior chamber (ZK). In addition, in this case, adhesions between the corneal endothelium and the iris are preserved.

The objective of the invention is to develop a safe, effective intraoperative method for increasing the depth of PC in the surgical treatment of swelling cataracts.

The essence of the invention consists in the removal of intraocular fluid (IHL) from the anterior and posterior chambers of the eye and the iridocrystalline diaphragm downward while alternately creating hypotension and normotonia in the anterior chamber by successively pressing cannulas with viscoelastic on the edge of paracentesis, the iris and lens, and the subsequent introduction of viscose plastic until its full recovery.

The technical result from the implementation of the invention:

- IOP is reduced due to the removal of IOP without vitrectomy;

- intraocular fluid from ZK in the PC moves due to the creation of hypotension in it;

- formed paracentesis is used for further manipulations:

- performing capsulorexis, bimanual aspiration of the lens masses and FEC;

- the possibility of supporting the lens on the vitreous body;

- The ciliary and vitreous bodies are not injured.

The proposed method is as follows: at 10 and 14 hours, paracentesis is performed. A spatula is introduced into one of them and pressed against the edge of paracentesis and the limbal region. In this case, the HPW follows from the PC (Fig. 1), hypotension is created, the camera becomes smaller (Fig. 2). The freed space is immediately filled with viscoelastic using a cannula inserted through the opposite paracentesis, up to normotonia (Fig. 3). Repeatedly apply pressure with a spatula until hypotension, while the IHL from the posterior chamber is moved to the anterior chamber and removed by the introduction of viscoelastic to normotonia. A cannula with viscoelastic is advanced from the periphery to the pupillary edge, gently pushing it on the iridocrystalline diaphragm, which facilitates the movement of the HPW from the posterior chamber to the anterior and the anterior chamber. The alternation of intraocular pressure to hypotension, the movement of intraocular pressure from the posterior chamber to the anterior one, the introduction of viscoelastic to normotonia, create a deep PC.

The proposed method is illustrated by a clinical example:

Patient K., born in 1937, a / c No. 212615.

The patient complained of severe pain in the OD. The eye does not see for about 6 months. On admission: IOP -42 mmHg, swollen cornea, PC depth: 1-2 mm, Vis OD - pr.l.certa. The lens is swollen, milky gray, the reflex from the fundus is not determined. The patient underwent antihypertensive therapy and the procedure for deepening the PC according to the proposed method, then phacoemulsification of the lens and implantation of the IOL. At discharge on the sixth day after surgery: Vis OD = 0.08-2.0 = 0.25. The eye is calm, the cornea is transparent around the periphery, slight edema has remained in the center, PK depth: 2-3 mm, the eye is calm, the borders are clear.

Claims (1)

A method for intraoperative restoration of the depth of the anterior chamber with swelling cataract, which involves reducing intraocular pressure, characterized in that it alternates the displacement of intraocular fluid from the anterior chamber to hypotension, the transfer of intraocular fluid from the posterior chamber to the anterior chamber and the introduction of viscoelastic into the anterior chamber to normotonia, and the procedure is performed using a cannula with viscoelastic and a spatula inserted into the anterior chamber through two oppositely located paracentesis formed in mbalny zone.

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