RU2454209C2 - Method of intracapsular extraction of subluxated lens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmosurgery, by methods of intracapsular removal of a lens along with its capsule if observing a lens subluxation. The method consists in applying a relaxation incision of an anterior capsule of lens for the purpose of debulking the lens, and bringing the lens either in one piece, or a nucleus, a lens mass, a lens sac. The method is implemented as follows: making a corneoscleral or corneal incision is followed by exposing the anterior capsule of lens; then the subluxated lens in the capsule or the nucleus are brought out both in extracapsular cataract extraction; the remained lens mass are aspirated, while the capsular sac is drawn up with preserving the hyaloid membrane integrity.

EFFECT: method allows preserving the hyaloid membrane with its drop to be avoided; it enables reducing operative injures, decreasing a probability of intra - and postoperative complications, ensuring higher surgical effectiveness.

2 ex

Description

The invention relates to medicine, in particular to ophthalmology, and for cataract surgery.

The presence of subluxation of the lens and difficulty in removing it by the extracapsular method dictates the need to remove it entirely together with the capsule.

A known method of cryoextraction of cataracts, in which a cryoextractor is frozen to the front surface of the lens and the lens thus fixed through the pupil is removed from the eye [1].

There is also known a method of removing the subluxated lens with a loop by lifting the lens dislocated into the vitreous body with a tool, the working part of which is made in the form of a loop, and removing its eyes [2].

The disadvantages of these methods is that one of the conditions for the operation is a sufficiently large corneoscleral or corneal incision - up to 14-16 mm, the invasiveness of the operation due to the use of coarse additional instruments - cryoextractor or loop, mechanical impact on the posterior corneal epithelium, iris, the need for significant expansion operating wounds, which creates the risk of prolapse of the vitreous body and hemorrhagic complications.

The aim of the invention is to reduce the invasiveness of the operation and the risk of surgical complications during intracapsular cataract extraction with lens subluxation.

This goal is achieved by opening the front lens capsule after a corneoscleral or corneal incision, the subluxed lens in the capsule or the nucleus is removed as during extracapsular cataract extraction, the remains of the lens masses are aspirated and extended into the capsular bag, preserving the integrity of the vitreous membrane.

Comparison of the proposed method with others known in the field of ophthalmology, showed its compliance with the criteria of the invention.

The method is implemented as follows.

After a corneoscleral or corneal incision, the anterior lens capsule is opened for a short distance by a horizontal incision. In this case, the volume of the lens is reduced due to the release of a certain amount of cortical masses. The scleral lip of the incision is slightly squeezed downward by the closed branches of the tweezers, allowing the upper edge of the luxated lens to fit into the surgical wound. At the same time, a micro spatula is pressed against the diametrically located part of the limb from below, pushing the lens towards the surgical incision. As soon as a significant part of the lens is shown, it is picked up with tweezers and removed from the eye in a capsule. In the case of the exit of the lens nucleus through a preliminary incision in the capsule, the operation is continued, aspirating the lens masses, and complete by pulling the capsule bag.

The method allows you to save the vitreous membrane and prevent it from falling into the anterior chamber of the eye and into the surgical wound. Prevention of this operational complication prevents the most formidable of them - expulsive bleeding and postoperative complications, such as iridocyclitis, secondary glaucoma, corneal dystrophy, epithelial ingrowth, Irwin-Gass syndrome, retinal detachment.

Example 1. Patient B-in, 68 years old, medical history No. 1022. Diagnosis: Incomplete complicated cataract in the left glaucoma eye operated with normal intraocular pressure. Subluxation of the lens. Open-angle developed with normal intraocular pressure glaucoma, partial complicated cataract of the right eye. To remove the subluxated lens, the proposed method of intracapsular extraction was applied. A corneal incision was made in the upper part of the limb, a puncture of the anterior lens capsule in the upper part of the dilated pupil was made, a viscoelastic was inserted into the anterior chamber, while pressing the forceps with jaws on the upper lip of the corneal wound and using the micro spatula on the lower part of the limb, the lens in the capsule was removed through the pupil to the anterior the camera and further into the lumen of the corneal wound, where it is picked up by tweezers and removed from the eye. An anterior chamber artificial lens was implanted. The wound is sealed with a continuous suture. The vitreous membrane remained intact, which prevented intraoperative and postoperative complications. The patient was discharged from the hospital with good visual functions (Visual acuity of the operated eye 0.6).

Example 2. Patient So, 70 years old, medical history No. 2617. Diagnosis: Incomplete complicated cataract in the left glaucoma eye operated with normal intraocular pressure. Subluxation of the lens. Open-angle initial with normal intraocular pressure glaucoma, partial complicated cataract of the right eye. To remove the subluxated lens, the proposed method of intracapsular extraction was applied. A corneal incision was made in the upper part of the limb, an incision-puncture of the anterior lens capsule in the region of the upper part of the dilated pupil, and viscoelastic was inserted into the anterior chamber. While pressing the jaws of forceps on the upper lip of the corneal wound and the micro spatula on the lower part of the limb, the lens core was inserted into the incision in the capsule and was removed by tweezers from the eye. The remaining lens masses are aspirated, the lens capsule is easily pulled out of the eye. An anterior chamber artificial lens was implanted. The wound is sealed with a continuous suture. The vitreous membrane remained intact, and its prolapse did not occur. No postoperative complications were observed. The patient was discharged from the hospital with visual acuity of the operated eye 0.6.

Thus, the use of the method allows to reduce the invasiveness and laboriousness of the operation, to prevent the prolapse of the vitreous body, to reduce the likelihood of intra- and postoperative complications, to increase the efficiency of the operation.

Using the proposed method is advisable in the ophthalmic departments of medical institutions in complicated cases of cataract extraction associated with subluxation of the lens.

Information sources

1. Guide to eye diseases / Ed. V.N.Arkhangelsky), M .: Medicine, 1964.V.5.

2. Eye diseases / Ed. A.P. Nesterova, V.M. Malova, M .: Medicine, 2008. P.316.

Claims (1)

The method of intracapsular extraction of the subluxated lens by removing the lens and capsule, characterized in that after the corneoscleral or corneal incision, the front lens capsule is opened horizontally, respectively, the upper edge of the dilated pupil, while the volume of the lens and the voltage of its capsule are reduced, since part of the cortical masses are independently and by irrigation and aspiration is removed through an incision in the capsule; further, the scleral lip of the incision is slightly squeezed downward by closed branches of tweezers, allowing the upper edge of the luxated lens or its nucleus, depending on the degree of luxation of the lens, to be inserted into the surgical wound; at the same time, with a micro spatula, press on the diametrically opposite part of the limb, pushing the lens to the surgical incision; as soon as a significant part of the lens or its nucleus is shown, it is picked up and taken out of the eye; in case of exit of the lens nucleus through an incision in the capsule, the remains of the lens masses are aspirated and the capsule bag is pulled, while maintaining the integrity of the vitreous membrane.