RU2547788C2 - Method for femtosecond laser assisted phacoemulsification - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmic surgery and can be used for femtosecond laser-assisted phacoemulsification. A pupil centre is placed under a slit lamp on the cornea if the pupil is narrow. The pupil is dilated. A vacuum ring is placed onto the cornea, and a femtosecond laser approaches the eye through the above ring. The laser is adjusted. A central mark of planned capsulorhexis gets matched with the pencil mark on the cornea in the pupil centre. That is followed by femtosecond laser-assisted capsulorhexis following the marks, nucleus of lens fragmentation and corneal incisions, which are then opened by means of microspatulas. A phacoemulsifier is used to remove the laser-fragmented nucleus of lens and crystalline mass. A multifocal IOL is implanted into a capsular sac; the IOL is advanced 0.2-1.0 mm so that an optical part of the IOL is found in front of an elastic border of the capsulorhexis; the optical part of the IOL is clamped in the caplorhexis aperture with the haptic elements of the IOL left behind the capsulorhexis aperture in the capsular sac. An anterior chamber volume is refilled, and the incisions are sealed by hydrating with balanced physiological solution. A glucocorticoid preparation and an antibiotic solutions are administered subconjunctivally.

EFFECT: method enables reducing the number of injuries and providing the precise centring of the IOL.

Description

The invention relates to medicine, namely to ophthalmology, and is intended for the surgical treatment of eye diseases using a laser.

A known method of laser correction of aberrations after phacoemulsification, including the formation using a microkeratome of a superficial flap of the cornea with a thickness of 130-160 μm on the leg, turning it toward the legs, draining the corneal bed, exposing the corneal stroma to a laser beam to eliminate residual tunnel-induced aberrations and aberrations incision and implantation of an intraocular lens, the reposition of the flap, characterized in that first they carry out laser ablation of only spherical and cylindrical of aberrations, and after 3 months, aberrometry is performed and, based on its data, after repeated folding of the corneal flap, laser ablation of induced and residual aberrations, including higher order, is performed (see, for example, RF patent No. 2331400 with priority dated 07.03.2007 IPC A61F 9/01).

The application of the known method is associated with the risk of injury to the eyeball due to the need for a large number of corneal incisions when performing it.

The closest analogue prototype is a method of phacoemulsification of cataracts (FEC) with femtolaser support (see, for example, S.Yu. Anisimova, S.I. Anisimov, V.N. Trubilin, I.V. Novak "Cataract and refractive surgery" , 2012, v. 12, No. 3, pp. 7-10), consisting of a femtosecond laser using a VVTUS femtosecond laser from TPV (Germany) and the surgical stages of working with the patient, the femtolaser stage being carried out in the laser operating room, and then the patient goes on the operating table in the surgical room. At the femtolaser stage perform:

- installation of a vacuum retaining ring;

- installation of an optical interface;

- X-U-centering;

- approaching the laser to the patient’s eye and fastening the vacuum ring with an optical interface;

- setting the working IOP in the Z coordinate;

- marking of the pupil, anterior and posterior surfaces of the lens;

- clarification of the position of the anterior lens capsule relative to the working plane of the femtolaser.

At the surgical stage, procedures are carried out directly for implantation: capsulorexis, fragmentation of the nucleus, tunnels for introducing microsurgical instruments into the eye to perform the steps of removing fragments of the nucleus, lens masses and IOL implantation and directly implanting an intraocular lens.

The criteria for the effectiveness of the operation when using the known method were:

- the accuracy of capsulorexis according to the results of measuring diameter, circularity (deviation of the shape of the anterior capsule flap from the ideal circle), centering of capsulorexis (deviation of the center of the flap from the visual axis);

- time to remove fragments of the kernel;

- energy level of ultrasound;

- the number of intraoperative complications;

- the number of failures in conducting femtolaser support.

This method provides a solution to the problem of treating cataracts and correcting aphakia using IOLs, however, its use is associated with the risk of decentralization of IOLs due to uneven fibrosis of the capsular sac and inaccurate centering of the circular capsulorexis relative to the pupil.

The objective of the invention is to develop a method of femtolaser phacoemulsification with IOL implantation, providing minimal trauma to the surrounding tissues and accurate centering of the IOL.

The proposed method is recommended for the treatment of patients with cataracts in cases when multifocal IOL is implanted, for which the exact center of the IOL relative to the pupil is especially important.

Indications for implantation of multifocal intraocular lenses are:

- unilateral or bilateral initial or immature cataract,

- presbyopia (age-related hyperopia),

- high predicted retinal visual acuity.

The essence of the invention lies in the fact that the proposed method of femtolaser phacoemulsification, including preoperative regional and local topical anesthesia, is characterized by the fact that after standard processing of the surgical field, first, with the narrow pupil under the slit lamp, the center of the pupil is marked on the cornea, then the pupil is dilated, a vacuum is placed on the cornea ring and carry out the approach of the femtolaser to the eye through this ring, after which the laser is adjusted, the central marking marking is planned capsulorhexis with a pre-set pencil mark on the cornea in the center of the pupil, and the diameter of capsulorhexis is marked 0.5-1.0 mm less than the diameter of the optical part of the implanted IOL, and then femtolaser sequentially performed: capsulorexis corresponding to preliminary marking, lens core fragmentation and corneal incisions which are then opened using micro spatulas, after which the lens core and lens masses fragmented by a laser are removed with a phacoemulsifier, and then into capsules a multifocal IOL is implanted in the bag and the IOL is shifted forward by 0.2-1.0 mm so that the optical part of the IOL is in front of the elastic edge of the capsulorexis hole, the optical part of the IOL is clamped in the capsulorexis hole, and the haptic elements of the IOL are left behind the capsulorexis hole in the capsule bag, after which the volume of the anterior chamber is replenished and the sections are sealed by hydration with a balanced saline solution and the glucocorticoid preparation is administered subconjunctively and an antibiotic solution.

In this case, the center of the pupil is marked with a pencil like Codman Surgical Marker.

The technical result of using the invention is to ensure accurate centering of the optical part of the IOL relative to the pupil, which is especially important for multifocal IOLs, and, as a rule, eliminating the need for subsequent surgical treatment.

The method of femtolaser phacoemulsification during implantation of the IOL is as follows:

After preoperative regional and local topical anesthesia and standard treatment of the operative field during the operation, first, with the narrow pupil under the SL 115 Classic slit lamp manufactured by Carl Zeiss, the center of the pupil is marked on the cornea, then the pupil is dilated, a vacuum ring is placed on the cornea and the Intralase femtolaser is applied to eye through this ring, after which laser tuning is performed, the central marking of the planned capsulorexis marking is combined with the pre-set mark on the cornea in the center of the pupil with a pencil of the Codman Surgical Marker type, with the capsulorexis diameter marked 0.5-1.0 mm smaller than the diameter of the optical part of the implanted IOL, and then femtolaser sequentially performed: capsulorexis corresponding to preliminary marking, lens core fragmentation and corneal incisions that reveal using micro spatulas, then using a phacoemulsifier, the laser core of the lens and lens masses fragmented by a laser are removed, and a multifocal Acrysof IQ Restor IOL is implanted into the capsular bag, while m IOL is shifted forward by 0.2-1.0 so that the optical part of the IOL is in front of the elastic edge of the capsulrexis hole, the optical part of the IOL is clamped in the capsulorexis hole, and the haptic elements of the IOL are left behind the capsulorexis hole in the capsule bag, after which the front chamber volume is replenished and the sections are sealed by hydration with a balanced saline solution and a glucocorticoid preparation, for example, Dexamethasone (0.3 ml), and an antibiotic solution, for example, are administered subconjunctively Imer Gentamicin (0.1 ml).

The inventive method of treatment was tested in LLC “Ophthalmological Center Konovalov” on 9 patients (9 eyes) aged 50 to 78 years (of which 4 men, 5 women).

In all cases, after treatment, a different degree of improvement in visual acuity from the initial one was observed.

The invention is confirmed by examples.

Example No. 1

Patient S., 64 years old.

On admission: Complaints about a gradual decrease in left eye vision over the past 3 years. Immature cataract of the left eye.

On examination:

Visual acuity of the left eye is 0.3 n / a (30%).

Fields of view are the norm.

Intraocular pressure 17 mmHg

When ophthalmoscopy revealed clouding of the lens in the nucleus of medium intensity. The cornea is transparent. The fundus without pathology.

The operation was performed on the left eye in accordance with the claimed method with the capsulorexis diameter, marked and made 0.7 mm smaller than the diameter of the optical part of the implanted and 0.5 mm forward multifocal AcrySof IQ ReSTOR IOL (Alcon, USA).

The day after surgery, the vision of the left eye improved to 0.8 n / a (80%). When viewed, the optical media are transparent. IOL exactly in the center of the pupil. The anterior chamber of the eye is of medium depth. The fundus without pathology.

After 1 month, the vision of the left eye is 0.9 n / a (90%).

Example No. 2

Patient A., 69 years old.

On admission: Complaints about decreased vision of the left eye over the past 5 years. Immature cataract of the left eye.

On examination:

Visual acuity of the left eye is 0.1 n / a (10%).

Fields of vision are normal.

Intraocular pressure 15 mmHg

When ophthalmoscopy revealed intense clouding of the lens of the left eye and the initial pseudoexfoliation syndrome. The cornea is transparent. The fundus without pathology.

The operation was performed on the left eye in accordance with the claimed method according to the above method with a capsulorexis diameter marked and performed 1.0 mm smaller than the diameter of the optical part of the implanted and 0.2 mm forward shifted Acrysof IQ Restor multifocal IOL (Alcon, United States).

The day after surgery, the patient's vision improved to 0.9 (90%). On examination, the cornea is transparent, the IOL is precisely centered on the pupil. Front camera of medium depth.

After 1 month, visual acuity was 1.0 (100%).

Example No. 3

Patient M., 65 years old.

Upon receipt of the diagnosis: Complaints about a gradual decrease in vision of the right eye within 1 year. Immature cataract of the right eye.

On examination:

Visual acuity of the right eye is 0.5 n / a (50%).

Fields of vision are normal.

Intraocular pressure 17 mmHg

On examination, uneven turbidity in the lens nucleus and under the posterior capsule was revealed. The cornea is transparent. The fundus without pathology.

The operation was performed in accordance with the claimed method according to the above method with a capsulorexis diameter marked and made 0.5 mm smaller than the diameter of the optical part of the Acrysof IQ Restor multifocal IOL implanted and shifted forward 1.0 mm.

The day after surgery, the visual acuity of the patient’s right eye improved to 1.0 (100%).

On examination, the cornea is transparent, the IOL is precisely centered on the pupil, the anterior chamber is of medium depth.

After 1 month, visual acuity was 1.0 n / a (100%).

Claims (1)

A method of femtolaser phacoemulsification, including preoperative regional and local topical anesthesia, characterized in that after standard processing of the surgical field, first, with the narrow pupil under the slit lamp, the center of the pupil is marked on the cornea, then the pupil is dilated, a vacuum ring is placed on the cornea and the femtolaser is approached through this ring, after which laser tuning is performed, the central marking of the planned capsulorexis marking is combined with the pre-set a Codman Surgical Marker pencil with a mark on the cornea in the center of the pupil, and the capsulorexis diameter is marked 0.5-1.0 mm smaller than the diameter of the optical part of the implanted IOL, and then femtolaser sequentially performed: capsulorexis corresponding to preliminary marking, lens core fragmentation and corneal incisions, which are then opened using micro spatulas, after which the lens core and lens masses fragmented by a laser are removed with a phacoemulsifier, and then a multifocus is implanted into the capsular bag the entire IOL and the IOL is shifted forward by 0.2-1.0 mm so that the optical part of the IOL is in front of the elastic edge of the capsulorexis hole, the optical part of the IOL is clamped in the capsulorexis hole, and the haptic elements of the IOL are left behind the capsulorexis hole in the capsule bag then fill up the volume of the anterior chamber and seal the incisions by hydrating them with a balanced saline solution, and the glucocorticoid preparation and antibiotic solution are administered subconjunctively.