RU2472473C1 - Sutureless method of fixing elastic intraocular lens with 'o-shaped" haptic element - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular ophthalmology and can be used for surgical treatment of aphakia. 2 paracenteses, located on one axis on 6 and 12 o'clock are made above triangles on cornea, needle with double thread is introduced into "o-shaped" haptic element of implanted lens, arch of support element is enveloped with double thread and needle is passed between threads with formation of loop around arch of support element. Second thread is fixed to second support element in the similar way. Tunnel cut on 9 o'clock is formed, one of needles is passed through tunnel in paracentesis on 6 o'clock, needle is brought out of needle, needle is turned and introduced into the same paracentesis, passed through pupil and brought out on sclera under scleral flap strictly on 12 o'clock 2 mm from limb, thread is pulled, second needle is introduced through tunnel cut into anterior chamber, brought through paracentesis on 12 o'clock out of eye, turned and introduced through the same paracentesis into anterior chamber; needle is passed under iris and brought out on sclera under scleral flap strictly on 6 o'clock; thread is pulled, intraocular flexible IOL is bent and introduced into posterior eye chamber; IOL is centred and fixed by means of threads.

EFFECT: method makes it possible to create conditions for absence of necessity of applying suture on cornea cut; IPL physiological position, absence of post-operative corneal astigmatism.

1 ex

Description

The invention relates to medicine, in particular ophthalmology, and can be used for surgical treatment of aphakia by implantation and scleral fixation of an elastic intraocular lens with an “o” shaped element without applying a corneal suture.

A known method of transscleral fixation of the posterior intraocular lens into the ciliary sulcus [RF Patent No. 2180544, A61F 9/007, 03.20.2002]. At two opposite points (at 6 and 12 hours), 1 mm from the limb, they pass with a needle and an eye in the tip area through prepared through scleral sections. The end of the needle is carried out under the iris and removed through a standard limbal incision outside the eye. A thread is inserted into the eye of the needle, fixed on one of the supporting elements of the intraocular lens (IOL), and brought out through the scleral incision at 6 o’clock. A curved microneedle with an eye near the tip is inserted through a scleral incision at 12 hours. The end of the needle under the iris is brought out through the standard limbal incision outside the eye. A thread is inserted into the eye of the needle, mounted on another lens support member, and the needle and thread are brought out. At 6 and 12 hours, the threads tighten and implant the lens into the back chamber. The ends of the threads are sutured to the sclera.

The disadvantages of this method are the need for a standard limbal incision for IOL implantation (incision up to 6 mm). This method requires the use of a specific tool - a needle with an eye at the end for holding the thread. Despite the good centering of the IOL, the method involves conducting through scleral incisions, which adds complexity to sealing the eyes at the end of the operation.

The closest set of essential features to the proposed method is a method for fixing the posterior chamber lens from the side of the internal environments of the eyeball [RF Patent No. 2338494, A61F 9/007, 11/20/2008] without the use of additional tools. The proposed method is as follows. A standard limbal incision of 5.6-5.7 mm is made to remove the altered lens. Outside the eye, a non-absorbable thread 10: 0 is inserted into the needle and both free ends of the thread are closed. A needle with a closed ring thread, i.e. with a double thread, is introduced into the lower supporting (haptic) element of the implantable lens. A needle with a double thread is removed through the limbal incision and the pupil onto the sclera in the projection of the prepared conjunctival incision at 6 hours. Then, a similarly prepared needle with a closed ring is threaded into the upper support element of the implantable lens and the needle is brought out through the limbal incision and the pupil onto the sclera in the projection of the prepared conjunctival incision at 12 o’clock. A lens is implanted through a standard limbal incision.

The disadvantage of this method is the need to use a large incision, since a rigid posterior chamber IOL is implanted. The use of a standard 10/0 thread implies the use of a standard needle up to 4 mm long, which complicates this method.

The objective of the invention was the development of a universal method for fixing a flexible posterior chamber IOL using a tunnel incision.

The technical result when using the invention is to obtain a significantly better and stable position of the posterior chamber IOL with aphakia, the absence of suturing.

The proposed method is as follows:

At 12 and 6 hours, the conjunctiva is cut, to visualize the sclera. Cut out 2 triangular scleral flaps up to 3 mm high, located on one axis. Over triangles on the cornea, 2 paracentesis are performed, located on the same axis for 6 and 12 hours. Intracameric anesthesia (lidocaine 2% -0.1) is performed, mydriatics (mesatone 1%), viscoelastics (discovisk) are used. As an intraocular lens, any elastic IOL with an “o-shaped” haptic element, for example ACRYFOLD, is used. To fix the IOL, use 2 holes located diagonally. The distance from the extreme points of the haptic corresponds to the distance W toW. A 10/0 double-thread needle is inserted into the “o-shaped” haptic element of the implantable lens, the arc of the support element is covered with a double thread and the needle is drawn between the threads, forming a loop around the arc of the support element. Thus, the double thread is attached to the support element using a "spring" loop. Similarly, the second thread is attached to the support element located diagonally. A tunnel incision is formed for 9 hours for IOL implantation. One of the needles is passed through the tunnel into paracentesis for 6 hours and the needle is removed from the eye. Having deployed the needle, it is introduced into the same paracentesis, passed through the pupil and brought to the sclera under the scleral flap strictly for 12 hours, 2 mm from the limbus. The thread is pulled. The second needle is inserted through the tunnel incision into the anterior chamber, removed through paracentesis for 12 hours from the eye, and, deployed, inserted through the same paracentesis into the anterior chamber. The needle is carried out under the iris and displayed on the sclera under the scleral flap strictly for 6 hours. The thread is pulled. The flexible intraocular IOL is bent in half using anatomical micro forceps and inserted into the posterior chamber of the eye. Using the threads, the IOLs are centered and fixed to the sclera under the scleral flaps. Paracentesis hydrate. The conjunctiva is sutured.

The method proposed by the authors for fixing the posterior intraocular lens does not require additional technical equipment and can be performed in any eye department where intraocular lens implantation operations are performed. The method is easy to use, involves the use of a tunnel incision, which eliminates the need for suturing the cornea and the development of postoperative corneal astigmatism. A similar method can fix any flexible intraocular IOL.

The developed method was tested in 19 patients operated on for the secondary implantation of IOLs against the background of postoperative astigmatism. All the patients underwent implantation of the IOL into the posterior chamber without applying a corneal suture.

The proposed method is illustrated by the following clinical example.

Patient Alifanova N.R., born in 1939

Visual acuity of the right eye: 0.05 H11.0 = 0.6

Visual acuity of the left eye: 0.5 n / a

Objectively right eye: the cornea is transparent, the anterior chamber is deep.

The pupil is round, mobile. Aphakia.

Diagnosis: Postoperative aphakia of the right eye.

Operation: Secondary implantation of the posterior chamber IOL (ACRYFOLD 21, OD).

Under local anesthesia, a conjunctival incision was made at 12 and 6 hours. 2 triangular scleral flaps 3 mm high were cut out. Over triangles on the cornea, 2 paracentesis are performed, located on the same axis for 6 and 12 hours. Intra-chamber anesthesia (lidocaine 2% -0.1) was performed, mydriatic (mesatone 1%), viscoelastic (diskovisk) were used. A 10/0 double-thread needle was passed through an “o-shaped” haptic element of an implantable lens (ACRYFOLD 21, OD), covering the arc of the support member with double thread and passing the needle between the threads, forming a loop around the support member arc. Similarly, the second thread was attached to the support element located diagonally. A 9-hour tunnel incision was formed for implantation of an IOL with a 2.75 mm diamond knife. One of the needles was passed through the tunnel into paracentesis for 6 hours and the needle was removed from the eye. Having deployed the needle, it was introduced into the same paracentesis, passing through the pupil and leading to the sclera under the scleral flap strictly for 12 hours, 2 mm from the limbus. The thread was pulled up. The second needle was inserted through the tunnel incision into the anterior chamber, removing through the paracentesis for 12 hours from the eye, and, unfolding, was introduced through the same paracentesis into the anterior chamber. The needle is carried out under the iris and displayed on the sclera under the scleral flap strictly for 6 hours 2 mm from the limbus. The thread was pulled up. The flexible intraocular IOL was bent in half using anatomical micro forceps and inserted into the posterior chamber of the eye. Using IOL threads, they were centered and fixed to the sclera under scleral flaps. Paracentesis hydrated. The conjunctiva was sutured.

After surgery for 3 days.

Visual acuity of the right eye: 0.7 n / a Visual acuity of the left eye: 0.5 n / a

Objectively right eye: the cornea is transparent, the anterior chamber is deeper than the middle. The pupil is round, mobile. Post-chamber IOL, correct position. The conjunctiva sutures are clean.

Claims (1)

A method of fixing an elastic intraocular lens (IOL) with an “o-shaped” haptic element, including the formation of scleral flaps of a triangular shape for 6 and 12 hours, attaching a double thread to the lens support element, scleral fixation of the IOL, characterized in that they make over the triangles on the cornea 2 paracentesis, located on the same axis for 6 and 12 hours, the double-thread needle is inserted into the “o-shaped” haptic element of the implantable lens, the arc of the supporting element is covered with a double thread and a needle is drawn between the threads, forming a loop around the arc about porn element; similarly fasten the second thread to the second support element; form a 9-hour tunnel incision for IOL implantation; one of the needles is passed through the tunnel into the paracentesis for 6 hours and the needle is taken out of the eye by expanding the needle, it is inserted into the same paracentesis, it is passed through the pupil and brought out to the sclera under the scleral flap strictly for 12 hours 2 mm from the limb, the thread is pulled; the second needle is inserted through the tunnel incision into the anterior chamber, removed through paracentesis for 12 hours from the eye, and, deployed, inserted through the same paracentesis into the anterior chamber; the needle is held under the iris and displayed on the sclera under the scleral flap strictly for 6 hours; the thread is pulled; the flexible intraocular IOL is bent in half using anatomical micro forceps and inserted into the posterior chamber of the eye; with the help of threads, the IOLs are centered and fixed to the sclera under scleral flaps.