RU2589633C1 - Method of performing keratoplasty (versions) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, more specifically to ophthalmology, and can be used for keratoplasty in patients with Keratoconus. According to first version, for formation of bed graft in recipient with help of a femtosecond laser through circular incision of the cornea is made concentrically to limb at depth of ¾ thickness, selecting diameter from 6 mm to 9 mm, with pitch of 0.25 mm. Then, to form a transplant donor cornea is fixed in holder by means of a femtosecond laser intra-stromal circular tunnel is formed concentrically to limb, at depth of ¾ thickness, selecting inner diameter from 3 mm to 9 mm, with pitch of 0.25 mm, and one incision above a tunnel for inlet to it. Then femtosecond laser through incision of the donor cornea is performed concentrically to limb, selecting diameter from 6 mm to 9 mm, with pitch of 0.25 mm to form, forming so the transplant. From graft endothelium is removed and posterior limiting membrane and placed in recipient's bed and fixed with sutures. In circular tunnel opened ring is implanted, selecting its internal diameter from 3 mm to 9 mm, with pitch of 0.25 mm, and thickness from 100 mqm to 400 mqm, with pitch of 0.25 mqm. According to second version of method for formation of bed graft in recipient with help of femtosecond laser blind circular incision of cornea is performed concentrically to limb at depth of ¾ thickness, selecting diameter from 6 mm to 9 mm, with pitch of 0.25 mm. Using sterile air stroma is detached from posterior limiting membrane, dissected layers are cut. Donor cornea is fixed in holder, cornea is splitted by means of femtosecond laser concentrically to limb, from external diameter from 6 mm to 9 mm, with pitch of 0.25 mm, to internal diameter from 3 mm to 6 mm, with pitch of 0.25 mm at depth of ¾ of thickness, in form of ring. Through circular incision of donor cornea is performed by femtosecond laser concentrically to limb, selecting diameter from 6 mm to 9 mm, with pitch of 0.25 mm to form transplant. closed intra-stromal circular tunnel is implanted into formed graft between layers, selecting its internal diameter from 3 mm to 6 mm, with pitch of 0.25 mm, and thickness from 100 mqm to 400 mqm, with pitch of 0.25 mm. Endothelium and posterior limiting membrane are removed from graft, laid in recipient's bed and sutured.

EFFECT: group of inventions provides reducing corneal astigmatism after keratoplasty.

2 cl, 2 ex

Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used when performing keratoplasty.

The closest analogue is a keratoplasty method using intraoperative astigmatism prophylaxis, including the creation of a graft from a donor cornea using a trepan, the formation of a bed in a recipient using a trepan, implantation of an 8 mm intrastromal ring from a cobalt-titanium-molybdenum alloy into the space between the graft and the bed, and suturing , restoration of the anterior chamber with a balanced solution, subsequent removal of the ring after 3-9 months. Perforating Keratoplasty with an Intracorneal Ring, Cornea journal 1999 May; 18 (3): 277-81, http://joumals.lww.com/corneajrnl/Abstract/1999/05000/Perforating_Keratoplasty_with_an_Intracorneal.6.aspx.

However, further studies of long-term results showed that the values of astigmatism in patients undergoing end-to-end keratoplasty with implantation of intrastromal rings and patients undergoing through keratoplasty without implantation of intrastromal rings are similar. This shows the failure of the proposed method. The Intrastromal Corneal Ring in Penetrating Keratoplasty-Long-term Results of a Prospective Randomized Study. Journal of Cataract and Refractive Surgery 2006 Jun; 32 (6): 993-8. http://www.jcrsjournal.org/article/S0886-3350(06)00166-0/abstract.

The objective of the invention is to provide an effective method of keratoplasty using intraoperative prophylaxis of corneal astigmatism after keratoplasty.

To achieve this objective, two variants of the keratoplasty method have been developed.

The technical result of our proposed two variants of the method is a low corneal astigmatism after keratoplasty.

The technical result according to the first variant of the method is achieved by the fact that in order to form a transplant bed for the recipient using a femtosecond laser, a through circular incision of the cornea is performed concentrically to the limb with a diameter of 6 mm to 9 mm, in increments of 0.25 mm. To form a transplant, the donor cornea is fixed in the holder, using an femtosecond laser, an intrastromal ring tunnel is formed concentrically to the limb with a diameter of 3 mm to 9 mm, in increments of 0.25 mm, at a depth of% of the thickness of the donor cornea and one incision above the tunnel to enter it, then, a femtosecond laser makes a through circular incision of the donor cornea concentrically to the limb with a diameter of 6 mm to 9 mm, in increments of 0.25 mm, thereby forming a graft; they put it in the recipient’s bed and fix it with sutures, then an open ring with an inner diameter of 3 mm to 9 mm, with a pitch of 0.25 mm and a thickness of 100 μm to 400 μm, with a pitch of 25 μm is implanted into the annular tunnel.

The technical result according to the second variant of the method is achieved by the fact that for the formation of the transplant bed in the recipient using a femtosecond laser, a continuous circular incision of the cornea is performed concentrically to the limb at a depth of ¾ thickness with a diameter of 6 mm to 9 mm, in increments of 0.25 mm, using sterile air , descemetic membrane and endothelium are exfoliated from the stroma, the separated layers are removed. To form a transplant, the donor cornea is fixed in the holder, using a femtosecond laser, the cornea is stratified in the form of a ring, concentric to the limb, from an outer diameter of 6–9 mm, in increments of 0.25 mm, to an inner diameter of 3–6 mm, in increments of 0.25 mm, at a depth of ¾ thickness, then a femtosecond laser makes a through circular incision of the donor cornea concentrically to the limb with a diameter of 6–9 mm, in increments of 0.25 mm, thereby forming a graft; A closed intrastromal ring with an internal diameter of 3 mm to 9 mm, with a pitch of 0.25 mm and a thickness of 100 μm to 400 μm, with a step of 25 μm is implanted between the separated layers into the formed graft, the endothelium and descemet shell are removed from the graft, and it is laid in the recipient’s box and fixed with sutures.

Intrastromal rings are made of polymethylmethacrylate (PMMA).

An advantage of the proposed variants of the keratoplasty method is the use of intraoperative prophylaxis of corneal astigmatism. A decrease in astigmatism is achieved due to implantation of the intrastromal ring during keratoplasty. Intrastromal rings, which have rigidity and a constant shape, help maintain the cornea in the correct shape, prevent it from being pulled by the sutures, thereby reducing postoperative corneal astigmatism.

The method is carried out by one of the following options.

According to the first option:

The recipient's surgical field is treated with 0.5% chlorhexidine solution, local anesthesia with 2% lidocaine solution (into the subtenon space).

To form the transplant bed in the recipient using a femtosecond laser, a through circular incision of the cornea is performed concentrically to the limb with a diameter of 6 mm to 9 mm, in increments of 0.25 mm. To form a transplant, the donor cornea is fixed in the holder, using an femtosecond laser, an intrastromal ring tunnel is formed concentrically to the limb with a diameter of 3 mm to 9 mm, with a step of 0.25 mm at a depth ¾ of the thickness of the donor cornea and one incision above the tunnel to enter it. A femtosecond laser makes a through circular incision of the donor cornea concentrically to a limb with a diameter of 6 mm to 9 mm, in increments of 0.25 mm, thus forming a graft.

The graft is placed in the recipient’s bed so that the entrance to the intrastromal annular tunnel is at 12 o’clock to cover it with the upper eyelid in the postoperative period. Impose 8 interrupted sutures, a curvy seam. An intrastromal open ring with an inner diameter of 3 mm to 9 mm, with a pitch of 0.25 mm, a thickness of 100 μm to 400 μm, and a pitch of 25 μm is implanted into the annular tunnel.

The operation is completed by the introduction of a conjunctiva of a solution of dexazone and an antibiotic in a volume of 1.0 ml.

According to the second option:

The recipient's surgical field is treated with 0.5% chlorhexidine solution, local anesthesia with 2% lidocaine solution (into the subtenon space).

To form the transplant bed in the recipient using a femtosecond laser, a through circular incision of the cornea is performed concentrically to the limb at a depth of ¾ thickness with a diameter of 6 mm to 9 mm, in increments of 0.25 mm. Do one paracentesis. Using sterile air, the Descemetic membrane and endothelium are exfoliated from the stroma. Using scissors, peeled layers are removed. To form a transplant, the donor cornea is fixed in the holder, using a femtosecond laser, the cornea is stratified from an external diameter of 6–9 mm, in increments of 0.25 mm, to an internal diameter of 3 mm to 6 mm, in increments of 0.25 mm, at a depth of ¾ thickness in the form of a ring, concentric to the limb. Next, a through circular incision of the donor cornea concentrically limb with a diameter of 6 mm to 9 mm, with a pitch of 0.25 mm, is made through a femtosecond laser, thereby forming a graft.

An intrastromal closed ring is implanted between the layers of the formed graft with an inner diameter of 3 mm to 9 mm, in increments of 0.25 mm, and a thickness of 100 μm to 400 μm, in increments of 25 μm, by gradually setting the ring into the layers of the cornea. Endothelium and descemetic membrane are removed from the graft.

The graft is placed in the bed of the recipient. Impose 8 interrupted sutures, a curvy seam.

The operation is completed by the introduction of a conjunctiva of a solution of dexazone and an antibiotic in a volume of 1.0 ml.

Example 1

Patient M., 60 years old, was hospitalized with a diagnosis of OD Epithelial-endothelial dystrophy of the cornea.

Upon receipt, visual acuity - 0.05 does not correct.

Through keratoplasty with intraoperative femtosecond prophylaxis of corneal astigmatism was performed according to the first option.

In a patient undergoing surgery, an through circular incision of the cornea with a diameter of 7 mm was performed using a femtosecond laser, forming a graft bed.

The donor cornea was fixed in the holder. Using a femtosecond laser, an intrastromal ring tunnel was formed concentrically to a limb with a diameter of 4 mm at a depth ¾ of the thickness of the donor cornea and one incision above the tunnel to enter it. Next, a graft was formed by a femtosecond laser by performing a through circular incision of a donor cornea with a diameter of 7 mm. The graft was placed in the bed of the recipient. After suturing, an open ring with an inner diameter of 4 mm and a thickness of 250 μm was implanted in the intrastromal tunnel.

On the first day after the operation, visual acuity is 0.25-0.28 cyl +1.5 ax 160 = 0.4-0.5.

One month after the operation, visual acuity is 0.5-0.6 cyl -0.5 ah 90 = 0.8.

Pachymetry OD: The thickness of the cornea in a thin place is -536 microns.

Using this method allowed to obtain postoperative astigmatism within 1 diopter.

Example 2

Patient S., 43 years old, hospitalized in a hospital with a diagnosis of OD keratoconus IV degree.

Upon receipt, visual acuity - 0.04 does not correct.

Pachymetry OD: the thickness of the cornea in a thin place is 360 microns.

An anterior deep layer-by-layer keratoplasty with intraoperative femtosecond prophylaxis of corneal astigmatism was performed according to the second option.

Using a femtosecond laser, a non-through circular incision of the cornea at a depth руем of thickness with a diameter of 8 mm was performed on the patient’s eye using a femtosecond laser. Using sterile air, the Descemetic membrane and endothelium were exfoliated from the stroma. Using scissors, peeled layers were removed to form a graft bed.

The donor cornea was fixed in the holder. Using a femtosecond laser, the donor cornea in the form of a ring was stratified from an external diameter of 8 mm to an internal diameter of 5 mm, at a depth of ¾ thickness, then a through circular incision of the donor cornea with a diameter of 8 mm was performed by a femtosecond laser, thus forming a graft. A closed intrastromal ring with an internal diameter of 5 mm and a thickness of 300 μm was implanted between the separated layers in the formed graft. The graft was placed in the bed of the recipient. Imposed 8 nodal and 1 twisting seam.

On the first day after surgery, visual acuity is 0.2-0.3 cyl + 1.0 ax 170 = 0.4.

One month after the operation, visual acuity is 0.5 cyl -0.75 ah 94 = 0.8.

Pachymetry OD: the thickness of the cornea in a thin place is 550 microns.

Using this method allowed to obtain postoperative astigmatism within 0.5 diopters.

Claims (2)

1. A method of keratoplasty, including implantation of an intrastromal ring, characterized in that a circular circular incision of the cornea concentrically to the limb at a depth is performed to form a transplant bed in the recipient using a femtosecond laser

thickness, choosing a diameter from 6 mm to 9 mm, in increments of 0.25 mm, then for the formation of a graft the donor cornea is fixed in the holder, using an femtosecond laser an intrastromal ring tunnel is formed concentrically to the limb, at a depth

thickness, choosing an inner diameter from 3 mm to 9 mm, in increments of 0.25 mm, and one incision above the tunnel to enter it, then a through-section of the donor cornea concentrically limb is made by a femtosecond laser, choosing a diameter from 6 mm to 9 mm, s 0.25 mm increments, thus forming a graft, the endothelium and descemet shell are removed from the graft, placed in the recipient’s bed and fixed with sutures, then an open ring is implanted into the annular tunnel, choosing an internal diameter from 3 mm to 9 mm, s 0.25 mm pitch, and a thickness of 100 μm to 400 μm, in increments of 0.25 mm. 2. A method of keratoplasty, including implantation of an intrastromal ring, characterized in that for the formation of a transplant bed in a recipient using a femtosecond laser, an endless circular incision of the cornea is performed concentrically to the limb at a depth

thickness, choosing a diameter from 6 mm to 9 mm, in 0.25 mm increments, using sterile air, the stroma is peeled off from the descemet sheath, the exfoliated layers are cut off, then the donor cornea is fixed in the holder to form a graft, using a femtosecond laser, the cornea is stratified concentrically with the limbus , choosing an outer diameter from 6 mm to 9 mm, in increments of 0.25 mm, and an inner diameter from 3 mm to 6 mm, in increments of 0.25 mm, at a depth

thickness, in the form of a ring, then a femtosecond laser makes a through circular incision of the donor cornea concentrically to the limb, choosing a diameter from 6 mm to 9 mm, in increments of 0.25 mm, thus forming a graft, a closed intrastromal implant is inserted into the formed graft between the separated layers ring, choosing an inner diameter of 3 to 6 mm, in increments of 0.25 mm, and a thickness of 100 microns to 400 microns, in increments of 0.25 mm, remove the endothelium and descemet shell from the graft, lay it in the recipient’s bed and fix it with sutures .