RU2458658C1 - Method of microinvasive intracapsular extraction of cataract in case of crystalline lens subluxation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used in surgical treatment of cataract. Complete ablation of cloudy lens together with capsule sac is performed. Operation and implantation of IOL Rsp-3 with sewing to iris is performed through supersmall tunnel cut 2,2 mm, which is self-sealing, that is without application of corneal sutures. Viscoelastic based on hyaluronic acid is introduced.

EFFECT: method contributes to increase of cataract treatment efficiency in case of crystalline lens subluxation by prevention of development of induced hyaloids membrane and without fallout of vitreous body and development of following negative tractions of vitreous body on eye retina, with obtaining high vision acuity.

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Description

The invention relates to medicine, to ophthalmology and, in particular, to the surgical treatment of cataracts.

One of the methods for surgical removal of a cloudy lens during its subluxation is intracapsular cataract extraction. Intracapsular cataract extraction is the removal of a cloudy lens with a capsule through a corneal incision of more than 5 mm.

The closest analogue to the prototype of the proposed method is intracapsular cataract extraction, in which through a corneal incision of more than 5.0 mm, a cloudy lens is removed in a capsular bag, followed by implantation of the pupillary intraocular lens (IOL), hemming it to the iris and applying a corneal suture according to Pierce 10-00.

The disadvantages of the treatment of the prototype are:

- induced postoperative corneal astigmatism;

- frequent damage to the anterior hyaloid membrane;

- prolapse of the vitreous body after removal of the lens or at the time of implantation of the pupillary intraocular lens;

- subsequent negative effects of vitreous traction on the retina;

- postoperative hypertension;

- reduced visual acuity in the postoperative period;

- the presence of corneal sutures.

Objective: to propose a method for microinvasive intracapsular cataract extraction with lens subluxation.

Technical result: increasing the effectiveness of surgical treatment of cataracts with subluxation of the lens by preventing the development of postoperative hypertension induced by corneal astigmatism, without damaging the anterior hyaloid membrane and without prolapse of the vitreous body and the development of subsequent negative effects of vitreous traction on the retina, with high visual acuity and lack of corneal sutures.

The technical result is achieved as follows: after standard double treatment of the surgical field, under local anesthesia, a corneal tunnel incision of 2.2 mm is made at 9 hours. At 12 o'clock, paracentesis is performed with a 1.0 mm diamond or disposable knife for paracentesis. The same additional paracentesis in 1.0 mm with a diamond or disposable knife for paracentesis is performed at 7 hours for the right eye and 5 hours for the left eye. Through a tunnel incision, viscoelastic is introduced into the anterior chamber until it is completely filled with the volume of the anterior chamber. Then, anterior continuous capsulorexis is performed with capsulorexis forceps. Through paracentesis, iris retractors are installed so that the bent ends fix the lens capsule beyond the edges of the anterior capsulorexis. After that, hydrodisection and hydrodelineation is performed by supplying physiological solution between the capsule and the lens through an irrigation cannula attached to a 5.0 ml syringe until the lens core is completely separated from the capsule. Through the tunnel incision, the needle of the handle of the apparatus for ultrasonic phacoemulsification is introduced and the lens nucleus is removed. The lens masses are removed by an irrigation-aspiration system. Then the iris retractors are removed and through the tunnel incision with capsulorexis forceps they capture the front edge of the capsule in the area of the defect of the zinc ligaments and pull it to the center. A hyaluronic acid-based viscoelastic is introduced into the space between the capsular bag and the anterior hyaloid of the vitreous body, which allows the anterior hyaloid membrane of the vitreous body to be moved away and intact and the prolapse of the vitreous body to be prevented, as well as subsequent negative effects on the vitreous trajectories. This viscoelastic resolves in the eye cavity within 1-3 days and does not cause hypertension, unlike methyl cellulose-based viscoelastics, which, when attracting water to themselves, can be a source of prolonged postoperative hypertension. Then, the capsule bag is pulled by capsulorexis forceps over the front edge to the center in the remaining quadrants, so that the capsule bag is in the pupil area. After that, through the 2.2 mm tunnel incision, the capsule bag is removed with capsulorexis forceps or spatulas. The next step is the introduction of viscoelastic into the cartridge for the implantation of posterior chamber elastic IOLs and the Rsp-3 IOL is installed so that the edges of the haptic elements are tucked under the edges of the semicircle and when the cartridge is folded, the entire IOL is inside the cylindrical cavity. Through a 2.2 mm tunnel incision under the control of a spatula inserted through paracentesis, implantation of an Rsp-3 IOL is performed at 12 hours. For faster capture of the implanted lens, 6% pilocrpin is instilled with the pupil. After that, a basal coloboma is made through a 2.2 mm tunnel incision with iris forceps and Vanass scissors. Then, using suture material, nylon 10-00 is hemmed with an Isp Rsp-3 to the iris. After that, the viscoelastic is removed from the anterior chamber by an irrigation-aspiration system, followed by hydration of the paracentesis and the tunnel incision with a physiological solution of the irrigation cannula on the syringe. Subconjunctival injection of 1 mg dexon and 10 mg gentamicin.

The advantages of the proposed method:

- the operation is performed through an ultra-small incision of 2.2 mm;

- achievement of high visual functions on the first day after surgery;

- the absence of intraoperative complications in the form of prolapse of the vitreous body and subsequent complications;

- maintaining the integrity of the anterior hyaloid membrane of the vitreous body and eliminating the danger of the development of negative effects of vitreous traction on the retina;

- lack of postoperative astigmatism;

- the absence of corneal sutures, since an ultra-small incision of 2.2 mm does not require suturing and is self-sealing;

- the absence of postoperative hypertension due to the use of viscoelastic based on hyaluronic acid.

Example: 1. Patient I., 78 years old. Clinical diagnosis: age-related immature cataract, lens subluxation of the 1st degree of the right eye. Visual acuity of 0.1 does not correct. According to ultrasound biomicroscopy, a defect in the zinc cords in the lower and outer quadrants. The patient underwent microinvasive intracapsular cataract extraction with implantation of Rsp-3 IOL through a 2.2 mm tunnel incision. The operation took place without complications, without prolapse of the vitreous. Visual acuity increased to 0.5 on the first day after surgery and to 1.0 on the second day after surgery. Corneal astigmatism according to refractometry of 0.5 diopters of the direct type, which corresponds to physiological parameters.

Example: 2. Patient V., 73 years old. Clinical diagnosis: age-related immature cataract, lens subluxation of the 1st degree of the left eye. Visual acuity of 0.2 does not correct. According to ultrasound biomicroscopy, there are multiple local defects in all quadrants and stretching of the zinc ligaments in the upper and outer quadrants. The patient underwent microinvasive intracapsular cataract extraction with implantation of Rsp-3 IOL through a 2.2 mm tunnel incision. The operation took place without complications, without prolapse of the vitreous. Visual acuity increased to 0.8 with a spherical correction of -0.5 diopters 1.0 in the first day after surgery. Corneal astigmatism according to refractometry of 0.75 diopters of the direct type, which corresponds to physiological parameters. The position of the IOL on examination after 11 months is stably central.

Claims (1)

A method of microinvasive intracapsular cataract extraction with lens subluxation, consisting in the complete removal of a cloudy lens together with a capsular bag, characterized in that the operation and implantation of the Rsp-3 IOL with hemming to the iris is performed through an ultra-small 2.2 mm tunnel incision, which is self-sealing. e. without corneal sutures, with the introduction of viscoelastic based on hyaluronic acid.