RU2444339C1 - Method for repositioning intraocular lens dislocated together with capsular bag - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely ophthalmology, and can be used for centring and fixation of an intraocular lens (IOL) found in a capsular bag when the capsular bag has lost its zonular support. It is followed by sutural fixation to an iris from a posterior chamber. For this purpose, an injection needle 30 G bent at an blunt angle of 120° at the distance of 2/3 needle length from a working end is inserted through a flat portion of a ciliary body, while a distal end of the needle is delivered under the IOL-capsular bag block to centre the block thereby. Then the needle presses the block upwards to visualise the contours of the support elements Thereafter with the block to be pressed upwards, a single-step transcorneal suture is applied on one support element, and then on the other support element at 2.5-3.5 mm from a pupil border. It is an atraumatic bent needle that is used for the stick-in and stick-out at 0.5 mm from the support element. Thereafter the outside in-between suture is dissected. In a projection of the suture zone, paracenteses whereto suture ends are delivered and fastened are made at the first and second support elements.

EFFECT: method provides the stable central position of the IOL-capsular bag block, promotes recovered visual acuity, preserved an irising function, reduced length of surgery.

4 cl, 1 ex

Description

The invention relates to medicine, and more particularly to ophthalmology, and can be used to center and fix an intraocular lens (IOL) located in a capsular bag in a situation where the capsular bag has lost its zonal support. Such a picture is characteristic of pseudoexfoliation syndrome, eye injury with rupture of fibers of the zinc ligament, etc.

In a situation where the IOL is deployed or decentered along with a capsular bag (whole bag), the reposition technology of such a lens proposed by Dr. B.E. Malyugin, Moscow (2008). The technology consists in the fact that the IOL-capsule bag block is centered and fixed by suture fixation of the intracapsular implant, brought to the equator of the bag between the capsule and the lens body, in the form of an open ring with holes at the ends. One of the ends is helically bent inward, namely it is fixed with a suture in the ciliary groove, where the place of the middle of the defect of the ligamentous apparatus is projected (RF patent No. 2375996 - prototype).

The disadvantages of the prototype are that

- before the implantation of the intracapsular implant, it is necessary to separate the capsule bag from the front surface of the IOL and to separate the front and back sheets of the capsule - this is not always atraumatic, especially with a significant length of ligamentous fiber separation or complete separation,

- the arsenal requires, in addition to standard instruments, an intracapsular implant in the form of an open ring with one spiral-curved end (not all operating rooms have it).

The objective of the invention is to develop a reliable method of reposition of IOLs with diametrically located supporting elements, deployed together with the capsule bag, with a significant length of tearing of the fibers of the zinc bundle or complete separation, by suture fixation of the IOL-capsule bag block to the iris.

EFFECT: IOL occupies a stable central position, as a result, visual acuity is restored, while the iris diaphragm function is preserved, and due to rational actions, the time of the operation is reduced.

The specified technical result can be obtained if, in the method of reposition of an intraocular lens (IOL), deployed together with the capsule bag, by suture fixation of the IOL-capsule bag block, according to the invention, suture fixation is carried out to the iris from the back of the camera, for this through the flat part of the ciliary the bodies carry out an injection needle, bent at an obtuse angle, the distal end of which is placed under the IOL-capsule bag block and with the help of the center the block is centered, then pressing the block up with the needle, visualize the contours of the elements, and while continuing to press the block up, impose a transcornal suture in one approach on one and then on the other support elements at a distance of 2.5-3.5 mm from the edge of the pupil, performing an injection and puncture with an atraumatic curved needle at a distance of 0.5 mm from the support element, after which the thread passing from the outside between the seams is dissected, and in the projection of the suture zone at one and the second support elements, paracentesis is performed, into which the ends of the threads are brought out and knots are tied. As private embodiments of the method, it is proposed to use an injection needle of caliber 30G, and it is also proposed to bend such a needle at an angle of 120 ° at a distance of 2/3 of the length of the needle from the working end.

Among the essential features characterizing the method, the distinctive is that:

- suture fixation of the block IOL-capsule bag is carried out to the iris from the back of the camera,

- for this, an injection needle is passed through the flat part of the ciliary body,

- the distal end of the injection needle is placed under the IOL-capsule bag block and with its help the block is centered,

- then, with a needle, pressing the block up, visualize the contours of the supporting elements and, continuing to press the block up, impose a transcornal suture on one and then on the other supporting elements in one approach,

- sutures are applied at a distance of 2.5-3.5 mm from the edge of the pupil, performing an injection and puncture with an atraumatic curved needle at a distance of 0.5 mm from the supporting element,

- then the thread passing from the outside between the seams is cut,

- in the projection of the suture zone at one and the second supporting elements, paracentesis is performed,

- the ends of the threads are brought out into paracentesis and knots are tied.

Between the totality of the essential features and the claimed technical result, there is a causal relationship.

A thin injection needle (for example, 30G caliber) is easily injured through the flat part of the ciliary body and, being bent at an obtuse angle, its distal end easily finds itself under the IOL, which is in the bag, which has lost its fixation for a considerable length or completely. The surgeon first centers the block of the IOL capsule bag using the distal end of the needle, then presses the block up, as a result, the lens support elements are clearly visualized through the iris. Continuing to press the IOL-capsule bag block up with one hand, he puts the other, in one approach (this reduces the time of the operation), the transcornal suture on one and then on the other supporting elements, i.e. Hemming of support elements is performed by one thread. Sutures can be applied atraumatically, because at the moment of flashing the tissues with a curved atraumatic needle, a counteracting force is created, which arises as a result of pressing the IOL-capsule bag block up with the injection needle. Both seams are superimposed on diametrically located support elements at a distance of 2.5-3.5 mm from the edge of the pupil, performing an injection and puncture with a curved needle at a distance of 0.5 mm from the support element. Having performed the seam at a distance of 2.5-3.5 mm from the edge of the pupil, such a seam will not distort the shape of the pupil and impede the iris as a diaphragm in the future. To place the seam farther from the edge of the pupil than 3.5 mm is undesirable, because the position of the lens will be less stable in the frontal plane. The stitch width (injection and puncture is made with a curved needle at a distance of 0.5 mm from the supporting element) allows for slight movement of the arch, and this is necessary after suturing in order to achieve the correct central position of the IOL.

After the thread passing from the outside between the seams is dissected, and paracentesis is performed in the projection of the suture zone at one and the second supporting elements, the ends of the threads of the corresponding seams are easily brought out and knots are tied. The IOL-capsule bag block is fixed to the iris from the back of the camera with two interrupted sutures, while the lens occupies a stable central position. Thus, between the set of essential features and the claimed technical result, there is a causal relationship.

The method is as follows.

The operation begins with anesthesia by a standard technique. Then a modified 30G injection needle is taken (the needle is bent at an angle of 120 ° C at a distance of 2/3 of the length of the needle from the working end) and an eyeball is perforated in the flat part of the ciliary body in the meridian for 1-2 hours. The needle is held under the IOL-capsule bag block, and using the needle, the block is brought into a central position relative to the optical axis of the eye. Then, with a needle, the block is pushed up, as a result, the supporting elements are contoured on the iris, and the block is fixed. The surgeon, continuing to press the block upwards with the injection needle, takes a curved atraumatic needle with a diameter of 11 mm in his other hand and imposes a transcornal suture on one and then on the other supporting elements at a distance of 2.5-3.5 mm from the edge of the pupil, performing injection and puncture with a curved needle at a distance of 0.5 mm from the support element. After that, the injection needle is brought out. The thread passing from the outside between the seams is dissected, and in the projection of the suture zone at one and the second supporting elements, paracentesis is performed, in which the ends of the threads are brought out and knots are tied. The IOL-capsule bag block is reliably fixed to the iris from the back of the camera with two interrupted sutures, while the lens occupies the correct central position.

EXAMPLE. Patient M., 66 years old, was admitted to the hospital with a diagnosis of Artifakia, dislocation of the IOL block - capsule bag as a result of complete separation of the fibers of the zinc ligament - OD. The front hyaloid membrane is not damaged.

Initial cataract - OS.

Pseudoexfoliation syndrome - OU.

Upon enrolment

Vis OD = 0.05 sph + 12.0 = 0.6 cyl n / a

Vis OS = 0.3

IOP OD = 22 mmHg

IOP OS = 22 mmHg

It was decided on the right eye to perform the reposition operation of the IOL-capsule bag block according to the invention.

After the operation on the right eye, visual acuity and pressure on the 3rd day amounted to:

Vis OD = 0.5 sph -2.0 = 0.6 cyl n / a

IOP OD = 22 mmHg

The IOL-capsule bag block occupies the correct central position, the pupil has a round shape, the reaction to light is 1-2 degrees.

When viewed after 3 months: the lens is in the correct central position, the pupil is round in shape, the iris has retained its diaphragmatic function.

The inventive method in the Yekaterinburg center performed 45 operations that were successful without complications. In all patients in the postoperative period, the IOL-capsule bag block occupied the correct central position relative to the optical axis of the eye, the pupil had a round shape, the iris diaphragm function was preserved. The developed technology for the reposition of the IOL, deployed with the capsule bag, is easily mastered by experienced surgeons, it takes less time to perform the operation compared to analogous operations, and no additional intracapsular device is required.

Claims (4)

1. The method of reposition of an intraocular lens (IOL), deployed together with the capsule bag, by suture fixation of the IOL-capsule bag block, characterized in that the suture fixation is carried out to the iris from the back of the camera, for this, an injection needle is passed through the flat part of the ciliary body, bent at an obtuse angle, the distal end of which is led under the IOL-capsule bag block, and with the help of the center the block is centered, then with the needle, pressing the block up, visualize the contours of the supporting elements and, continuing to press the block up, for one approach, the transcornal suture is applied to one and then to the other support elements at a distance of 2.5-3.5 mm from the edge of the pupil, performing an injection and puncture with an atraumatic curved needle at a distance of 0.5 mm from the supporting element, after which the thread, passing outside between the seams, dissect, and in the projection of the suture zone at one and the second supporting elements perform paracentesis, in which the ends of the threads are brought out and knots are tied. 2. The method according to claim 1, characterized in that they use an injection needle of caliber 30G. 3. The method according to claim 1, characterized in that the injection needle is bent at a distance of 2/3 of the length of the needle from the working end. 4. The method according to claim 1, characterized in that the obtuse bend angle of the injection needle is 120 °.