RU2436555C1 - Method of performing anterior capsulorexis - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to ophthalmology and can be applied in surgery of cataract with implantation of multifocal intraocular lenses. Centering of anterior capsulorexis with respect to pupil edge is performed by focusing light ray in form of circumference with concentric circle onto anterior eye lens capsule, matching circle borders with initial borders of pupil. Circumference diameter is set in accordance with optic part of multifocal intraocular lens. Instillation of mydriatics is carried out. By means of cystome anterior capsule is opened, with orientation on preliminarily specified circumference diameter. Cloudy lens is ablated. Multifocal intraocular lens is implanted with its further centering by matching "refraction elements" of optics with projected circumference with concentric circle. ^ EFFECT: method ensures increase of visual acuity, reduction of aberration induction, subjective complaints on lits when looking at bright source of light, preservation of space-contrast sensitivity values, and it also makes it possible to preserve stable, centric position of intraocular lens in capsule sac. ^ 3 cl, 3 dwg, 3 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of cataracts with implantation of multifocal intraocular lenses.

The quality and dosage of the anterior capsulorexis during cataract phacoemulsification determines the anatomical and functional outcome of the operation. The main requirements for the anterior capsulorexis are the planned diameter, round shape, centering in relation to the pupil. Violation of centering when performing anterior capsulorhexis can lead to a decrease in eye functions, such as visual acuity, and its qualities, expressed in the induction of spherical aberrations, the appearance of unwanted light phenomena (halo glare), and a violation of spatial contrast sensitivity.

The USSR invention is known by copyright certificate No. 1148613, which implements a method for performing anterior capsulorhexis, which consists in centered performing anterior capsulorhexis due to the risks present on the device at a distance from the edge corresponding to the distance from the limbus to the center of the eye.

The disadvantage of the invention is the low accuracy of centering of the anterior capsulorhexis, which leads to a decrease in eye functions, such as visual acuity and its quality, expressed in the induction of spherical aberrations, the appearance of undesirable light phenomena (halo glare), violation of spatial contrast sensitivity, and the invasiveness of the method .

A known method of performing anterior capsulorhexis (Ocular Surgery News. - 2006. - Vol.24. - No. 18. - P.59), based on the use of a special tool for marking capsulorhexis opening 2 diameters depending on the radius of the cornea.

The disadvantage of this method is the low accuracy of centering of the anterior capsulorhexis, which leads to a decrease in eye functions, such as visual acuity and its quality, expressed in the induction of spherical aberrations, the appearance of unwanted light phenomena (halo glare), a violation of spatial contrast sensitivity, and the invasiveness of the method .

Known patent GB No. 2437252, selected as a prototype, which implements a method of performing anterior capsulorhexis, which consists in centering by marking the scale on the branches of the cystotome or capsular scissors, which are visible to the surgeon through a microscope during the formation of the anterior capsulorexis.

The disadvantage of the invention is the low accuracy of centering of the anterior capsulorhexis, which leads to a decrease in eye functions, such as visual acuity and its quality, expressed in the induction of spherical aberrations, the appearance of undesirable light phenomena (halo glare), violation of spatial contrast sensitivity, and the invasiveness of the method .

The technical result of the invention is to improve the centering accuracy of the anterior capsulorexis, which allows to increase eye function and reduce the invasiveness of the method.

The technical result is achieved by the fact that in the method for performing anterior capsulorhexis, including centering the anterior capsulorhexis, opening the anterior capsule, removing a cloudy lens and implanting a multifocal intraocular lens, with its subsequent centering, centering the anterior capsulorhexis relative to the pupil edge is performed by focusing the light beam in the form of concentric circle on the anterior capsule of the lens of the eye, combining the boundaries of the circle with the original boundaries of the pupil, and the diameter of the surrounding the noses are set in accordance with the size of the optical part of the intraocular lens; moreover, drug mydriasis is performed after combining the concentric circle with the original borders of the pupil, and then after the expansion of the pupil, capsulorexis proper is performed around the circumference of the beam.

Figure 1 shows the frontal plane of the eye prior to the installation of mydriatics, where the sclera 1, iris 2 and pupil 3.

Figure 2 presents the image of the iris 2 of the eye and the projection of the focused beam of light in the form of a circle 4 with a concentric circle 5.

Figure 3 presents the image of the projection of a focused light beam on the front capsule of the lens of the eye 6 in the form of a circle 4 of a given diameter with a concentric circle 5 after installation of mydriatics.

The method of performing anterior capsulorexis is implemented as follows: prior to performing local anesthesia and installing mydriatics, a focused light beam is projected in the form of a circle 4 with a concentric circle 5 onto an anterior capsule of the eye lens using a light source integrated into an operating microscope.

A focused light beam in the form of a concentric circle 5 is combined with the original borders of the pupil 3, thereby centering the anterior capsulorexis. Then set the diameter of the circle 4, in accordance with the size of the optical part of the multifocal intraocular lens. Mydriatics are installed, and then using the cystotome they open the front capsule 6, focusing on the previously set diameter of the circle 4. This allows us to make the hole on the front capsule 6 as round as possible. Then, a cloudy lens is removed by a standard technique. After implantation of a multifocal intraocular lens, it is centered by combining the "refractive elements" of the optics with the projected circle 4 with a concentric circle 5.

The proposed method is illustrated by the following examples.

Example 1

Patient L., 68 years old, diagnosis: OS Immature age-related cataract. OD Presbyopia

Visual acuity OD = 0.03 n / a.

Surgical intervention was performed on the right eye: ultrasonic cataract phacoemulsification with the method according to the invention and implantation with a multifocal intraocular lens. The postoperative period without complications. During biomicroscopy, the cornea is transparent, the moisture of the anterior chamber is transparent, the posterior chamber intraocular lens occupies the correct position centered in relation to the pupil, the vitreous body is transparent. On the fundus without features. Visual acuity at discharge far 1.0, near 0.8. After 6 months: visual acuity of the right eye at a distance of 1.0, near 0.8. Lens position centered on the pupil. Abberometry and spatial contrast sensitivity data are within normal limits. Subjective complaints of side effects of light does not show.

Example 2

Patient K., 46 years old, diagnosis: OD Immature age-related cataract. OS Medium Hypermetropia

Visual acuity OD = 0.09 n / a.

Surgical intervention was performed on the right eye: ultrasonic phacoemulsification of cataracts by the method according to the invention and implantation with a multifocal intraocular lens. The postoperative period without complications. During biomicroscopy, the cornea is transparent, the moisture of the anterior chamber is transparent, the posterior chamber intraocular lens occupies the correct position centered in relation to the pupil, the vitreous body is transparent. On the fundus without features. Visual acuity at discharge far 0.8, near 0.5. After 6 months: visual acuity of the right eye at a distance of 0.8, near 0.5. Lens position centered on the pupil. Abberometry and spatial contrast sensitivity data are within normal limits. Subjective complaints of side effects of light does not show.

Example 3

Patient R., 60 years old, diagnosis: OU Immature age-related cataract.

Visual acuity OD = 0.01 n \ k. OS OD n \ k.

Surgical intervention was performed on the right eye: ultrasound phacoemulsification of cataract with implantation of a multifocal intraocular lens in a standard way. The postoperative period without complications. During biomicroscopy, the cornea is transparent, the moisture of the anterior chamber is transparent, the posterior chamber intraocular lens occupies the correct position centered in relation to the pupil, the vitreous body is transparent. On the fundus without features. Visual acuity at discharge far 1.0, about 0.5. After 6 months: visual acuity of the right eye in the distance 0.5 s corrections +1.75 D = 0.8, about 0.2 with a correction of 1.5 D = 0.4. The lens is decentered in relation to the pupil. According to abberometry - the induction of spherical aberrations and a decrease in spatial contrast sensitivity. Subjective complaints of flare when looking at a bright light source.

This method of performing anterior capsulorhexis by increasing the centering accuracy of the anterior capsulorexis allows increasing eye function, visual acuity in the distance and near, reducing aberration induction, subjective complaints of light when looking at a bright light source, preserving the values of spatial contrast sensitivity, and also allows preserving stable, centered position of the intraocular lens in the capsular bag.

A decrease in the invasiveness of the method for performing anterior capsulorexis is caused by the absence of a mechanical effect on the corneal endothelium, since it excludes the introduction of the instrument into the anterior chamber.

Claims (3)

1. A method of performing anterior capsulorhexis, including centering the anterior capsulorhexis, opening the anterior capsule, removing a cloudy lens and implanting an intraocular lens with its subsequent centering, characterized in that the centering of the anterior capsulorhexis relative to the pupil edge is performed by focusing the light beam in the form of a circle with a concentric circle anterior capsule of the lens of the eye, combining the boundaries of the circle with the original borders of the pupil. 2. The method of performing anterior capsulorexis according to claim 1, characterized in that the circle diameter is set in accordance with the size of the optical part of the multifocal intraocular lens. 3. The method of performing anterior capsulorexis according to claim 1, characterized in that drug mydriasis is performed after combining the concentric circle with the original pupil borders, and then after the pupil has expanded, capsulorhexis proper is performed around the beam circumference.

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