RU2601920C1 - Method of primary posterior capsulorrhexis before implantation of intraocular lens in eyes with cystic changed back capsule - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be used in complicated cataract surgery in presence of partial fibrosis of posterior capsule. Method comprises primary posterior capsulorrhexis diameter 3.0-4.5 mm on eyes with cystic changed back capsule using collet shears within greatest fibrosis capsular sac. On transparent section of posterior capsule, fracturing is performed with forceps, then on packed fibrous part of capsule collet shears are used to transparent section, wherein capsulorrhexis is given required direction with scissors, and then again with forceps to next fibrous changed section of posterior capsule, which is also modeled with collet scissors, and so on, until completion of primary posterior capsulorrhexis.

EFFECT: method enables to prevent uncontrolled ruptures of posterior capsule, and also enables to obtain capsulorrhexis of specified diameter with high strength and stability along its entire circumference, which ensures reliable retention of IOL in capsular SAC.

1 cl, 1 ex

Description

The invention relates to ophthalmology and can be used in surgery of complicated cataracts in the presence of partial fibrosis of the posterior lens capsule.

Primary posterior capsulorhexis with opacification of the posterior lens capsule and as a prevention of its opacification has been used since 1990 (Gimbel M., Neuhann T. Development, advantages and methods of continuous circular capsulorhexis technique // J Cataract Refract Surg. - 1990. - Vol. 16 . - P. 31-37). Further indications for posterior capsulorhexis were expanded, in particular, in case of fibrous opacification of the posterior capsule, this technique was considered as an alternative to repeated surgery (L. Buratto Cataract Surgery, Fabiano Editore, 1999, pp. 264-267).

The essence of the technique is the formation of a “window” in the posterior lens capsule with a diameter 0.5-0.75 mm smaller than the diameter of the anterior circular capsulorhexis (usually the anterior circular capsulorhexis with a diameter of 5.5-5, before or after implantation of the intraocular lens (IOL)) 75 mm).

Known methods for performing primary posterior posterior caculorexis with a transparent posterior capsule before or after IOL implantation (in particular, Balashevich LI, Takhtaev Yu.V., Radchenko A.G. Rear capsulorexis during phacoemulsification with a transparent posterior lens capsule // Ophthalmosurgery . - 2008. - No. 1. - p. 36-41).

However, in the case of a fibrotic modified posterior capsule, the problem of controllability of its rupture arises. In the transparent portion of the posterior capsule, where its thickness is the same, the gap is controllable and occurs in the right direction. With severe fibrosis of the posterior capsule and an increase in its strength in this place, it is not possible to completely control the direction of separation of the capsule flap. In this case, the posterior capsule has an uneven thickness and density, denser and stronger in the area of fibrosis, which requires great efforts to break it, which does not occur as a continuation of the circular rupture, but in the place of the lowest density of the capsule. This leads to the appearance of chaotic gaps with their departure for the equator and a sharp decrease in the strength of the back capsule. During IOL implantation, in this case, its dislocation into the vitreous body can occur, and there is also a risk of common serious complications during primary posterior capsulorexis, such as vitreous prolapse into the anterior segment of the eyeball and damage to the anterior hyaloid membrane. These complications require anterior vitrectomy and increase the time of surgery.

The closest in technical essence and the achieved result is a method of performing primary posterior capsulorhexis with a diameter of 3.0-4.5 mm in cases of primary fibrosis of the posterior capsule when there is a tendency to “run away” capsulorexis to the equator during traction of the capsule with forceps when resorting to capsular scissors and then continue the forceps traction of the newly formed flap from the place of its beginning with traction of the capsule in the opposite direction to the original direction (Bikbov M.M., Bikbulatova A.A. at the optimal technique of primary posterior capsulorhexis // IX scientific-practical conference with international participation "Modern technologies in Cataract and Refractive Surgery -. 2008", with 21-26), the prototype..

However, this method does not provide capsulorhexis with a strong and even edge of the planned diameter, and the use of scissors is provided for the chaotic rupture of the posterior capsule that has already arisen.

A method is proposed for performing primary posterior capsulorhexis prior to IOL implantation on the posterior capsule fibrically changed in the optical zone (degree fibrosis of degree III-IV according to the classification of Wilhelmus K. et al. (1980)) using collet scissors in the region of the highest fibrosis of the capsular bag. The method provides capsulorexis of the planned diameter, having high strength and stability around the entire circumference, and also prevents the formation of radial tears. Since the manipulations are performed in a stable position of the posterior capsule using high molecular weight viscoelastic, the risk of damage to the anterior hyaloid membrane is reduced.

The technical result from the implementation of this method:

- tears of the back capsule are prevented;

- it is possible to obtain capsulorexis of a given diameter with high strength and stability around its circumference, which allows you to reliably hold the IOL in the capsule bag.

The essence of the invention is as follows. In the presence of partial fibrosis of the posterior capsule after phacoemulsification and filling of the anterior chamber and capsule bag with high molecular weight viscoelastic to maintain normal anterior chamber depth, microperforation is performed in the center of the posterior capsule with a cystotome and the formation of primary posterior posterior capsulorhexis with a diameter of 3.0-4.5 mm (i.e., less than the diameter of the optical part of the IOL and the anterior capsulorekisis). On a transparent (unchanged) section of the posterior capsule to the densified fibrous part, its rupture is performed with collet forceps according to the standard method. Further, the densified fibrous part of the capsule is modeled with collet scissors to the transparent portion of the posterior capsule. The capsulorexis is given the desired direction with the scissors, and then it is again performed with tweezers until the next fibrously changed portion of the posterior capsule, which is also modeled with collet scissors, and so on, until the completion of the primary posterior capsulorexis.

For a more convenient and safe implementation of the primary posterior posterior capsulorhexis, a special oblique paracentesis is formed at an angle to the iris. This is necessary so that the collet tweezers do not bend the cornea and do not reduce the visualization. For more stable control of the capsule in terms of obtaining the posterior capsulorhexis of the planned size and reducing the stretching of the anterior hyaloid membrane, it is necessary that the capsule bag is straightened and the front and rear chambers are maximally deepened. Stabilization of the depth of the anterior chamber and the volume of the capsule bag increase the strength characteristics of the hyaloid membrane, therefore, to reduce the loss of viscoelastic, it is necessary to perform posterior capsulorexis on viscoelastic with a high molecular weight (for example, Diskovisk).

The invention is carried out as follows.

After phacoemulsification by the method of vertical chop (Quick chope) and complete leaching of the lens masses, the anterior chamber and capsule bag are filled with high molecular weight viscoelastic. Then, microperforation is performed in the center of the posterior capsule by a cystotome. After that, on the basis of microperforation, they begin to perform primary posterior capsulorhexis with a diameter of 3.0-4.5 mm. On a transparent (unchanged) section of the posterior capsule to the densified fibrous part, its rupture is performed with collet forceps according to the standard method. Further, the densified fibrous part of the capsule is modeled with collet scissors to the transparent portion of the posterior capsule. The capsulorexis is given the desired direction with the scissors, and then it is again performed with tweezers until the next fibrously changed portion of the posterior capsule, which is also modeled with collet scissors, and so on, until the completion of the primary posterior capsulorexis. Next, implantation of the IOL, leaching of viscoelastic and hydration of the corneal stroma is performed.

The invention is illustrated by a clinical example.

Patient N., b. 1944 Received June 18, 2015 with a diagnosis of complicated overripe OD cataract, initial complicated OS cataract, OES PES.

Upon enrolment:

VOD - pr. l.certa VOS - 0.6 sph - 0.5 = 0.8

IOP - pneumonometry:

OD - P ₀ = 13.3 mm Hg; OS - P ₀ = 14.1 mm Hg Echobiometry: OD - Axl - 23.11 ASD - 3.03. Lens - 3.16 OS - Axl - 23.06 ASD-2.59. Lens - 4.50

The density of endothelial cells - SD OD - 1446 cells / mm ²

On examination: OD - the cornea is transparent, the anterior chamber is of medium depth, atrophy of the pigment border of the iris of the I degree, the pupil is round, pseudoexfoliation along the edge of the pupil. The lens is cloudy, overripe, pseudoexfoliation along the anterior capsule. The fundus is not ophthalmoscopic.

06/19/2015 an operation was performed - phacoemulsification of a cataract with implantation of an Acrysof IQ 23.0 IOL with the formation of posterior capsulorexis with a diameter of 3.5 mm according to the proposed method.

At discharge: VOD = 0.5 sph - 0.5 = 0.8

VOS = 0.6 sph - 0.5 = 0.8

IOP OD P ₀ = 14.6 mm Hg

The density of the endothelial cells of diabetes OD - 1422 cells / mm ²

Objectively: OD - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the position of the IOL is correct, in the posterior capsule there is a rounded opening of the posterior capsulorhexis with a diameter of 3.5 mm. Optic nerve disc pale pink, clear boundaries, in the macular region, the retina is not changed. According to OST - the retina in the macula is not changed.

Claims (1)

A method for performing primary posterior capsulorhexis in the eyes with a fibrotic rear capsule prior to implantation of an intraocular lens, comprising introducing high molecular weight viscoelastic after phacoemulsification and leaching of the lens masses in the anterior chamber and capsular bag, puncture in the center of the posterior capsule and forming on its basis a posterior continuous circular diameter of 3 capsules , 0-4.5 mm with tweezers and collet scissors, characterized in that on the transparent portion of the posterior capsule its gap is performed by a collet ovym forceps for densified fibrous part of the capsule continue capsulorhexis collet scissors to a transparent portion of the capsule, giving capsulorhexis desired direction, and so on, until completion of the primary rear capsulorhexis.