RU2527912C1 - Method for repositioning one-piece intraocular lens dislocated together with capsular bag - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for reposition an intraocular lens (IOL) dislocated together with the capsular bag. That is ensured by bringing an injection needle through a flat portion of the ciliary body under the block of the IOL and the capsular bag. The above block is aligned with this needle. Then, the block is pressed upwards, and support elements are located. The injection needle is directed under the support element more distant from the puncture point towards the iris at 2.5-3.5 mm from the pupil edge. The injection needle is advanced farther from this area towards an equator. The block is pressed farther with the needle upwards. A transcorneal suture is applied on the remote support element. The suture covers the needle itself under the block. The suture needle is punctured out. The injection needle is brought out from the suture and directed to a point of an expected fixation of the second support element. The suture is applied again at 2.5-3.5 mm from the pupil edge. The injection needle is grasped by the suture. The suture needle with the filament envelopes the injection needle to be punctured out. The injection needle is brought out. Thereafter the outside in-between suture is dissected. Suture ends are brought out into paracenteses performed in a projection of the sutures. The sutures are tied up.

EFFECT: method provides reliable, non-traumatic fixation of the dislocated IOL, stable visual acuity, reduced postoperative complications with maintained diaphragm function of the iris.

3 cl, 1 ex

Description

The invention relates to medicine, and more particularly to ophthalmology, and can be used to reposition an intraocular lens (IOL) located in a capsular bag in a situation where the capsular bag has completely or partially lost its zonal support due to zonulolysis as a result of pseudoexfoliation syndrome.

It is known that the incidence of cataract with pseudoexfoliation syndrome is about 80%. It should be noted that the removal of the contents of the capsular bag and the implantation of IOLs do not interrupt the process of progression of dystrophy in the anterior segment of the eye, resulting in several years either to the development of glaucoma or to further destruction of the ligamentous apparatus of the lens (zinc ligament), which leads to the displacement of the artificial lens together with capsule bag. In this case, the capsular bag is most often fibrosed.

Known technologies for the reposition of an intraocular lens deployed together with a capsular bag, for example, lens reposition technology 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 wound to the bag equator 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, it is it that 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). The disadvantages of the described method:

- 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 tearing of the ligamentous fibers or complete separation,

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

Later, in our center, an effective technology was developed for the reposition of IOLs deployed together with a capsule bag (RF patent No. 2444339 - prototype). This technology is intended for three-part IOLs, the supporting elements of which are made of polymethylmethacrylate (PMMA), i.e. are rigid and are at a slight angle to the body of the lens. The technology is the following. Suture fixation is carried out to the iris from the back of the camera. To do this, an injection needle is drawn through the flat part of the ciliary body, bent at an obtuse angle, the distal end of which is inserted under the "IOL-capsule bag" block and the block is centered with it, then the needle, pressing the block up, visualize the contours of the supporting elements and, continuing to press block, impose in one approach a transcornal suture on one and then on the supporting 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. Then the thread passing from the outside between the seams is dissected, and the ends of the threads are brought into paracentesis made in the projection of the suturing, and knots are tied, fixing the block to the iris.

The disadvantage of this technology is that it is difficult to use it for the dislocation of monoblock hydrophilic IOLs due to certain features - the lens is soft, the support elements are not elastic enough, and the structurally support elements (haptic) are made wide enough near the optics, which makes it difficult to apply a fixing seam.

The objective of the invention is to develop a reliable, atraumatic technology for the reposition of a monoblock intraocular lens, deployed together with a fibrosed capsular bag, in the absence of fibrosis in the optical zone.

EFFECT: operational and postoperative complications are reduced, operation time is reduced, stable visual acuity is provided.

The indicated 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 to the iris, for this, an injection needle is inserted through the ciliary body under the block, with with the help of which the block is first centered, and then, pressing the block up, sequentially, in one approach, the transkornal fixation sutures are applied to one and then to the other supporting elements at a distance of 2.5-3.5 mm from the edge of the pupil, last whereby the thread extending from the outside between the seams is dissected, and the ends of the threads are brought into paracentesis made in the projection of the suturing, and knots are tied, according to the invention, after centering the block and locating the support elements, the injection needle is guided under the more distant support element to the place of its future fixation to the iris, the injection needle is advanced further than this zone towards the equator and, continuing to press the block upward with the needle, a suture is applied, and the injection needle itself is captured into the seam, and after the injection of the suture needle, the injection needle is withdrawn from the seam and sent to the place of future fixation of the second support element, where, again, by applying the suture, the injection needle is gripped into the seam, and after the injection of the suture needle, the injection needle is brought out. Developing and clarifying signs:

- an injection needle of caliber 30G is used as an injection needle;

- the injection needle is bent at an obtuse angle at a distance of 2/3 of the length of the needle from the working end.

Among the essential features characterizing the method, the distinguishing ones are:

- after centering the block, squeezing it up and finding the location of the supporting elements, direct the supporting injection needle under the more remote supporting element to the place of its future fixation to the iris,

- advance the needle beyond this zone towards the equator,

- while continuing to press the block upward with the needle, suturing is performed,

- moreover, the injection needle itself is captured in the seam,

- and after the injection of the suture needle, the injection needle is removed from the seam and sent to the place of future fixation of the second supporting element,

- when applying the second seam, the injection needle is again captured in the seam,

- after the injection of the suture needle, the injection needle is brought out.

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

The developed technology provides for suture fixation of the block to the iris. In order for the iris to function normally, ophthalmosurgeons determined the most optimal place for suture fixation of the IOL to the iris - this is 2.5-3.5 mm from the edge of the pupil. A monoblock hydrophilic (soft) lens, located in the capsule bag, is centered using an injection needle 30G atraumatically inserted through the micro-access (does not require suturing), made in the flat part of the ciliary body. In the developed technology, the needle is used not only to center the block and squeeze it up, but the needle has a new function. Since the capsule bag is fibrosed, and the lens belongs to soft planar lenses (the supporting elements are not elastic and are in the same plane as the lens body), atraumatic and effective suturing (puncture of the fibrous capsule bag is to be pierced) is achieved by the correct use of an injection needle. After centering the block, the injection needle is guided under the more distant support element to the place of its future fixation to the iris (2.5-3.5 mm from the pupil edge), the needle is advanced slightly further than this zone in the same direction, towards the equator and, while continuing to squeeze block up, suturing is carried out, while the injection needle is also captured by the atraumatic curved suture needle. That is, in the absence of elastic support elements, the suture needle is counteracted with the help of an injection needle, which the surgeon places under the block in the suture area (2.5-3.5 mm from the edge of the pupil). The injection needle provides not only counteraction during the injection with the suture needle, but also, due to the bending of the injection needle by the suture needle, it becomes possible to make the stitch wider. This is exactly what is required in a place located 2.5-3.5 mm from the edge of the pupil, because the supporting element of the monoblock lens, and one, and the second, in this zone have a structural expansion. After suturing the distal support element, the injection needle is withdrawn from the seam and directed to the place of future fixation of the second support element, further moved towards the equator and again, by suturing the 2nd support element, the injection needle located under the block is captured into the seam , and after the injection of the suture needle, the injection needle is brought out. As a result, the IOL-capsule bag block appears to be atraumatic and reliably fixed with sutures to the iris, while it is centered relative to the optical axis.

Thus, between the set of essential features and the achieved technical result, there is a causal relationship.

The method is as follows.

The operation begins with anesthesia by a standard technique.

Then, through the flat part of the ciliary body in the meridian for 1-2 hours, a modified 30G injection needle is inserted under the "IOL-capsule bag" block. The needle is bent at an angle of 120 ° at a distance of 2/3 of the length of the needle from the working end. Using a needle, the block with a monoblock lens is installed in a horizontal position and centered. Then, using a needle, the block is pushed up, as a result of this action, the supporting elements are contoured on the iris. The injection needle is directed under the support element farther from the injection needle injection site, to the place of its future fixation to the iris (2.5-3.5 mm from the pupil edge), the injection needle is moved slightly further from this zone towards the equator and in the same direction . Continuing to press the block upward with the needle, a transcornal suture is applied to the remote supporting element (2.5-3.5 mm from the edge of the pupil), and the injection needle itself is located in the seam, which is located under the block. After the suture needle is punctured, the injection needle is removed from the suture and sent to the place of future fixation of the second support element, where again, by suturing at a distance of 2.5-3.5 mm from the edge of the pupil, the injection needle is gripped into the suture (i.e., the suture the needle with the thread, after piercing the fibrous capsule bag, bends around the injection needle and is punctured), and after the needle is punctured, the injection needle is brought out. The thread passing from the outside between the seams is dissected, and the ends of the threads are brought into the paracentesis performed in the projection of the suturing, and knots are tied. The IOL-capsule bag block is securely, atraumatic and quickly fixed to the iris.

EXAMPLE. Patient K., 63 years old, was admitted to our Center with a diagnosis of artifact, dislocation of the IOL-capsule bag block as a result of tearing of the fibers of the zinc ligament over 290 ° - OS. The front hyaloid membrane is damaged by -OS.

Cataract - OD.

Pseudoexfoliation syndrome - OU.

Upon enrolment:

Vis OD = 0.3

Vis OS = 0.05sph + 9.0 = 0.6

IOP OD = 21 mmHg

IOP OS = 22 mm

On the left eye, the operation according to the invention was performed - reposition of the IOL-capsule bag block by suturing the block to the iris, a single-block hydrophilic lens was located in the bag.

After the operation on the left eye, visual acuity and pressure for 3 days amounted to:

Vis OS = 0.55 n / a

IOP OS = 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 left eye: the lens occupies the correct central position, the pupil is round in shape, the iris retained the diaphragmatic function.

The inventive method in the Yekaterinburg center performed 8 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 technology is successfully mastered by doctors, takes less time compared to peers.

Claims (3)

1. A method for reposition of an intraocular lens (IOL), deployed together with the capsule bag, by suturing the IOL-capsule bag block to the iris, for this purpose, an injection needle is inserted through the flat part of the ciliary body, using which the block is first centered, and then, pushing the block up, the location of the supporting elements is detected and with the help of an atraumatic curved suture needle, sequentially, in one approach, the transcorneal fixing sutures are applied to one and then to the other supporting elements a distance of 2.5-3.5 mm from the edge of the pupil, after which the thread passing from the outside between the sutures is dissected, and the ends of the threads are brought into paracentesis made in the projection of suturing, and knots are tied, characterized in that after the block is centered and detected the locations of the support elements, the injection needle is directed under the more distant support element to the place of its future fixation to the iris, the injection needle is moved further than this zone towards the equator and, while continuing to press the block with it upwards, the suture is applied, and I grab the seam t is the injection needle itself, and after the injection of the suture needle, the injection needle is removed from the seam and sent to the place of future fixation of the second supporting element, where, again, when the suture is applied, the injection needle is gripped into the seam, and after the needle is sutured, it is brought out. 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 an obtuse angle at a distance of 2/3 of the length of the needle from the working end.