RU2591641C1 - Method for surgical treatment of immature cataract - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology, and can be used in surgical management of immature cataract. Two 1.2 mm paracentesis are made in the anterior chamber, high-molecular viscoelastic is introduced into the chamber. After that, the injection needle with a syringe brought to the centre of the anterior capsule is aspirated at the opening part of lenticular mass of anterior lenticular bag, then two-step capsulorhexis is carried out.

EFFECT: method enables to maintain a good visualising of the anterior chamber, to reach a recess of the anterior chamber before small capsulorhexis without abrupt pressure drop in the anterior chamber and preventing uncontrolled break of the anterior capsule of lens.

1 cl, 2 ex

Description

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

Swelling cataracts are characterized by the presence of liquid lens masses in the anterior and posterior parts of the lens bag, a dense nucleus and increased pressure in the lens in relation to other parts of the eye, and in this type of cataracts, the ligamentous apparatus is stretched. In this regard, phacoemulsification of swelling cataracts causes certain difficulties even for experienced surgeons. One of the most critical moments of the operation is the opening of the anterior capsule of the lens and the formation of the anterior capsulorhexis, when under the pressure of the lens masses an uncontrolled rupture of the anterior capsule may occur with the possibility of its transition to the posterior capsule, prolapse of the vitreous body and displacement of the nucleus in the posterior part of the eye. It is important to prevent a significant pressure difference in the lens bag and in the anterior chamber in order to prevent the rupture of the anterior capsule during its perforation.

There is a method of opening the front capsule in front of the eyes with a swelling overripe cataract (Patent RU 2480187 dated 03/14/2012), according to which a hole in the front capsule is formed in the central region of the capsule using ultrasound with a vacuum in the tip of the phacoemulsifier, after which the lens masses are removed. However, the use of ultrasound implies the constant use of an irrigation-aspiration system, thereby maintaining the maintenance of hypertension in the anterior chamber. This prevents the surgeon from monitoring the pressure level at the time of puncture of the anterior capsule. Also, when entering the anterior chamber and aspirating part of the lens masses, the tip of the phacoemulsifier can “pull” the core onto itself and thus create conditions for rupture of the anterior capsule.

These factors cause unpredictable reactions from the lens masses and can provoke an uncontrolled rupture of the anterior capsule.

The closest in technical essence and the achieved result is a method of performing a small “controlled” capsulorhexis (application for invention No. 2007138386/14 dated 01.11.2007), according to which, after the introduction of high molecular weight viscoelastic into the anterior chamber, a small capsulorhexis with a diameter of 1.0-2 is formed , 0 mm in the central zone of the anterior capsule, through which, in order to reduce the volume and tension of the lens capsule, “liquid” cortical lens masses are aspirated from the capsule bag, after which the capsules are expanded orexis to the required size and carry out phacoemulsification of the lens nucleus and implantation of the IOL (prototype).

However, this method does not provide sufficient control over the state of liquid lens masses in the capsule bag during the rupture of the anterior capsule and the formation of small capsulorhexis, which can provoke the appearance of an uncontrolled rupture of the thin anterior lens capsule. The disadvantages of this method can also include the deterioration of visualization during the puncture of the anterior capsule due to the release of cloudy lens masses in the anterior chamber.

An effective and gentle method for opening the anterior lens capsule with swelling cataract is proposed.

The present invention allows perforation of the anterior capsule without additional trauma to the stretched thin lens capsule, to reduce the pressure in the capsule bag until small capsulorhexis is formed and, accordingly, prevent uncontrolled rupture of the anterior capsule, and also maintain good visual control over the manipulation.

The essence of the invention is after the formation of two paracentesis 1.2 mm, staining the front capsule with dye and introducing high molecular weight viscoelastic into it, opening the front capsule is performed with an injection needle with a syringe after placing it in the center of the front capsule with simultaneous aspiration of turbid lens masses from the anterior section of the lens bag, after then proceed to perform small capsulorhexis with a diameter of 1.5-2 mm, then remove the lens mass from the anterior and posterior parts of the lens, then expand the capsule lorexis to the required diameter of 5.5-6 mm, a continuous circular anterior capsulorexis is performed, after which a tunnel corneal incision of 2.2 mm is performed.

The technical result achieved from the implementation of the proposed method is as follows:

- increases the security of the operation stage, because simultaneous puncture of the anterior capsule and aspiration of a part of the cloudy lens masses until small capsulorhexis is performed can reduce the pressure in the capsule bag, while avoiding a sharp pressure drop, thereby deepening the anterior chamber and preventing the uncontrolled rupture of the lens capsule

- provides stable visual control over the course of the operation by reducing the exit of the lens masses into the anterior chamber.

The proposed method is as follows.

An anterior chamber is opened (two 1.2 mm paracentesis). Then, the anterior chamber is stained under the protection of an air bubble, washed with saline and the introduction of high molecular weight viscoelastic. After that, an injection needle with a syringe brought to the center of the front capsule performs its perforation with simultaneous aspiration of part of the crystalline masses, then capsulorhexis with a diameter of 1.5-2.0 mm is formed with collet tweezers. After completion of its implementation, an irrigation-aspiration system is introduced into the anterior chamber. The vacuum is 500 mmHg, the suction flow is 50 ml / min. After the removal of the remains of the lens masses from the anterior part of the lens by changing the position of the nucleus, for example, its inclination or rotation, the nucleus moves away from the equator of the capsular bag and the lens masses exit the posterior part of the capsular bag to the front and remove them. Next, the anterior capsule is incised using collet scissors and capsulorexis of a standard diameter of 5.5-6 mm is formed. Hydrodissection is not carried out, since the core is already free. A 2.2 mm tunnel corneal incision is performed. Then produce the separation of the nucleus into fragments and its phacoemulsification. Lens aspiration is carried out according to conventional technology. Then IOL is implanted, viscoelastic is washed out and the incisions are closed by corneal hydration.

The invention is illustrated by the following examples.

Example 1

A patient Ch., Born in 1941, was admitted to the Tambov branch of MNTK Eye Microsurgery with a diagnosis of OD - swelling mature cataract, OS - initial cataract, PES OI.

VIS OD - pr. 1. certa, VIS OS - 0.03, does not correct.

The patient underwent surgery OD: FEK with IOL implantation using the proposed method on the right eye. After preparation of the surgical field and m / a, two paracentesis were performed at 10 and 14 hours. After staining the front capsule with trypan blue solution and filling the front chamber with a cohesive viscoelastic (diskisk) with an insulin syringe with a needle, the front capsule was opened in its center, while part of the liquid lens masses were aspirated from the capsule bag. Next, small capsulorhexis 2 mm was made with collet forceps and the remains of the lens masses were washed out of the anterior and posterior parts of the lens. Then capsulorhexis of standard diameter 5.5 mm was formed and a tunnel corneal incision was made 2.2 mm. After that, the lens nucleus was divided into fragments and its phacoemulsification, aspiration of the lens masses and implantation of an IOL. The operation was completed by leaching of viscoelastic and sealing sections. During the operation and the postoperative period, no complications were noted.

Example 2

Patient Shch., Born in 1946, was admitted to the Tambov branch of the MNTK Eye Microsurgery with a diagnosis of OD - mature swelling cataract, lens subluxation of the 1st stage, initial complicated cataract OS, PES OI.

The patient underwent surgery OD using the proposed method.

When discharging V OD 0.3-1.75 cyl - 1.0 Ah 155 ° = 0.8.

IOP 14.6 mmHg

Claims (1)

A method of swelling cataract extraction and IOL implantation, including opening the anterior chamber, introducing high molecular weight viscoelastic, forming small capsulorexis with a diameter of 1.5-2 mm, aspiration of cortical lens masses, expanding capsulorexis to the desired size, phacoemulsification of the lens nucleus, leaching of lens masses, implantation, implant leaching of viscoelastic and sealing of the incision, characterized in that before performing small capsulorhexis with a needle with a syringe brought to the center of the front capsule, stvlyayut its perforation with simultaneous aspiration of lens parts by weight, avoiding abrupt pressure drop in the anterior chamber, after which is formed a small capsulorhexis 1.5-2 mm in diameter.