RU2613418C1 - Method for artificial iridolenticular orifice implantation in case of aniridia and aphakia complicated by lack of lens capsule - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: after 5 mm long conjunctival incision, sclera is cut to 1/3-1/2 of its thickness concentrically with the scleral sulcus, at three meridians at an equal distance from each other, in 3 mm from the scleral sulcus with base direced thereto to form the entrance to three scleral pockets. The sclera is exfoliated to produce pockets. A tunnel corneal 2.2 mm wide incision is performed. ILO consisting of a circular optical portion of a positive lens and the colored haptic portion formed as a ring is implanted concentrically with the optical portion. The haptic part is further provided with three elastic supporting members, arranged at the same distance from each other, each of them has the form of spear. Thus, ILO implantation is performed through the cartridge and injector into the anterior chamber. Using 25G vitreous tweezers, each of the spear-form supporting members are placed in the appropriate scleral pocket.

EFFECT: method provides stable central position and secure ILO fit, allowing to reduce the risk of intraoperative bleeding and postoperative complications due to hypertension, eliminate the cosmetic defect of aniridia, improve intraocular fluid circulation while increasing the strength of the artificial iris.

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Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used for implantation of an artificial iris lens in case of aniridia and aphakia complicated by the absence of a posterior lens capsule.

A known method of surgical treatment of aniridia (RF patent for the invention No. 2129851).

The method includes conducting through corneal incisions through half its thickness, delaminating along this thickness along the ring to the central optical zone, then an open intracorneal diaphragm is implanted into the corneal pocket. The method allows to reduce the invasiveness of surgical intervention.

The closest analogue is the method of surgical correction of total aniridia combined with aphakia in the single-chamber eye (RF patent for the invention No. 22427,546).

The method consists in implanting an artificial implant inside the eye, previously on the sclera after incisions and separation of the conjunctiva in the meridians 2-30, 6-30 and 10-30 form scleral flaps. Under the flaps in the middle of their bases, sections of the remaining layers of the sclera and the flat part of the ciliary body are cut. Then, through the corneal incision, an artificial eye implant (iridocrystalline diaphragm) is introduced into the cavity of the eye, consisting of two components. The first component is a positive lens, in the body of which 3 flexible support elements are fixed. The second component is an artificial iris. Loops are located at the ends of the support elements, each of which is successively brought out through previously formed incisions in the sclera and is sutured to the edges of the incisions under scleral rags.

The disadvantage of this method is that the required suture fixation of the iridocrystalline diaphragm (IHD) cannot be considered completely reliable due to the possibility of biodegradation of the sutures, as well as due to the rather frequent intraoperative bleeding from the vessels of the ciliary body when it is stitched to fix the ICD. Considering the variety of available modifications of iridocrystalline diaphragms, most of which have openings in the haptic for suture fixation, a more universal way of fixing them is required.

The objective of the invention is to develop a more reliable and universal method of implantation without suture fixation of the iris lens in case of aniridia, aphakia complicated by the absence of the posterior lens capsule.

The technical result of the invention is a stable, central position and reliable fixation of ICD, which can reduce the risk of intraoperative hemorrhagic and postoperative hypertensive complications, eliminate the cosmetic defect of aniridia and contribute to a more complete social and professional rehabilitation of patients.

The method also allows to improve the circulation of intraocular fluid while increasing the strength of the artificial iris, as well as expand the range of production of artificial irises.

The technical result is achieved by the fact that in the method of implanting ICD in aniridia and aphakia complicated by the absence of a lens capsule, including the introduction of ICD, consisting of two elements, through a corneal incision, fixing it to the sclera, according to the invention, after a conjunctiva incision 5 mm long, concentric to the limb, in three meridians at an equal distance from each other, cut the sclera to 1 / 3-1 / 2 of its thickness 3 mm from the limb with the base to it to form the entrance to the three scleral pockets, then stratify the sclera towards the limb, for the floor Pocket pockets perform a corneal tunnel incision 2.2 mm wide, then an ICD is implanted through it, consisting of a round optical part in the form of a positive lens and a colored haptic part made in the form of a ring, a concentric optical part, while the haptic part is additionally equipped with three elastic support elements located at the same distance from each other, each of which is made in the form of a spear, while the implantation of ICD is carried out through a cartridge and an injector into the anterior chamber of the eye, then Using 25G vitreous tweezers, each of the supporting elements in the form of a spear is placed in the corresponding scleral pocket, then twist stitches are placed on the conjunctiva, the operation is completed by introducing a dexazone and antibiotic solution under the conjunctiva.

The technical result is achieved due to the fact that:

1. The optical central part of the IHD performs the function of aphakia correction.

2. The peripheral round colored part of the IHD performs a diaphragmatic function.

3. The presence of supporting elements located at an equal distance from each other, allows for a stable position and reliable fixation of ICD inside the eye.

4. The implementation of the three supporting elements in one with the peripheral part at the same distance from each other provides a stable position of the IHD and eliminates its displacement.

5. Fixing the ICD into the formed scleral pockets due to the design of the supporting elements in the form of a spear eliminates the need for damage to the inner membranes of the eye, as, for example, when stitching the ICD to the sclera or fixing it to the hooks-clamps.

6. Elastic haptic elements made in the form of a spear contribute to reliable fixation of ICD with a minimum compression area on the inner membranes of the eye, excluding the displacement of ICD into the eye.

The implantation method according to the invention is as follows.

The treatment of the surgical field is carried out with 0.5% chlorhexidine solution twice. Alcain and vitabact are instilled into the conjunctival cavity. The operation is performed under local anesthesia and intravenous anesthesia. After the conjunctiva is cut, concentric limb in three meridians with a length of 5 mm cut three blanks 3 mm from the limb to enter three scleral pockets, for which the sclera is cut into 1 / 3-1 / 2 of its thickness, with the base to the limb in the meridians, respectively, the projection of the three supporting elements of the haptic part of the IHD. Next, the sclera is stratified towards the limb to make pockets. Directly 1.5 mm from the limbus, in the projection of the ciliary sulcus, the outer lip is lifted, sclera is punctured at an angle of 45 degrees. IHD implantation is carried out through a special injector. Performs a corneal tunnel incision 2.2 mm wide. The artificial iris is first folded with tweezers and placed in the lumen of the cartridge. The iris is placed in a viscoelastic medium of 0.5 ml. In the injector, an elastic plunger advances the IHD along the cartridge. This allows the implantation of ICD in the form of a visco-injection (ICD is pushed by viscolastic rather than a plunger). After placement in the eye cavity, with the help of vitreous forceps 25 G, each of the supporting elements in the form of a spear is placed in the corresponding scleral pocket. Then, upholstery stitches are applied to the conjunctiva (Vicryl 8.0). 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.

The proposed invention is illustrated in the drawing, which shows a General view of the IHD. Position 1 denotes a round optical part, 2 - colored haptic part in the form of a ring, 3 - supporting elements in the form of a spear.

The supporting elements are located at an equal distance from each other at an angle of 120 °, which ensures a stable position of the IHD.

The diameter of the optical part is 3.2 mm.

The diameter of the haptic part is 10.5 mm.

The length of the support element is 2 mm.

The width of the support element is 0.75 mm.

The invention is illustrated by the following examples.

Example 1. Patient S., 54 years old. History: On July 14, 2014, he received a contusion injury of the left eye, which resulted in rupture of the sclera with prolapse of the vitreous body and membranes of the eye, post-traumatic hypertension, total hyphema, total hemophthalmus. Primary surgical treatment (PCP) of scleral injury on the day of injury. 07/31/2014 Ahmed drainage implantation, subtotal vitrectomy, gas tamponade were performed. Upon receipt of the diagnosis: OS - condition after contusion of the eyeball with rupture of the sclera, traumatic aniridia, traumatic aphakia, postoperative avitria, operated secondary glaucoma. The visual acuity of the right eye is 1.0, the left eye is 0.06 Sph + 8.0 cyl + 3.75 ax 180 = 0.7. IOP of both eyes - 16 mm Hg

An implantation of an iridocrystalline diaphragm according to the invention was performed on the left eye. The operation and the postoperative period proceeded without complications. Visual acuity in the distance after surgery: 0.3 sph + 3.75 cyl + 3.75 ax 165 ° = 0.6.

When viewed a month after the operation: the eye is calm, ICD is in a stable position. Visual acuity OS: 0.5 cyl + 1.0 ah 105 = 0.9

Example 2. Patient M., 23, In a history of childhood, a dull injury to the right eye with loss of the iris, PHO at the place of residence. Upon receipt of the diagnosis: OD - Condition after injury, aniridia, aphakia, corneal scar, divergent strabismus. Visual acuity of the left eye is 1.0, right eye count fingers. IOP OD 14 mmHg, OS 15 mmHg On the right eye, an implantation of the iris-lens diaphragm according to the invention was performed. The operation and the postoperative period without complications. Visual acuity after surgery: 0.05 sph + 3.0 cyl-6.0 ah 5 ° = 0.2.

On examination after 6 months: the position of the IHD is stable, the visual acuity of OD is 0.4, it is not corrected, the patient is satisfied with the cosmetic and functional effect.

Thus, the use of the proposed method for the implantation of an iridocrystalline diaphragm in the eyes with aniridia, aphakia and the absence of a lens capsule ensures reliable fixation and stable position of the ICD in the eye, despite the lack of adequate support for its supporting elements, to restore the anatomy of the eye, to improve the circulation of intraocular fluid while increase the strength of the artificial iris, reduce the risk of intraoperative hemorrhagic and postoperative hypertensive complications, lips injure a cosmetic defect in aniridia and contribute to a more complete social and professional rehabilitation of patients.

Claims (1)

A method for implanting an artificial iridocrystalline diaphragm (ICD) in case of aniridia and aphakia complicated by the absence of a lens capsule, including the introduction of ICD, consisting of two elements, through a corneal incision, fixing it to the sclera, characterized in that after the conjunctiva incision 5 mm long, concentric to the limb, in three meridians at an equal distance from each other, cut the sclera 1 / 3-1 / 2 of its thickness 3 mm from the limb with the base to it to form the entrance to the three scleral pockets, then lay the sclera in the direction to the limb for the floor pockets, in the sclera at a distance of 1.5 mm from the limb in the projection of the ciliary sulcus, they make punctures at an angle of 45 degrees, make a tunnel corneal incision 2.2 mm wide, then IHD implanted through it, consisting of a round optical part in the form of a positive lens and a colored haptic part made in the form of a ring, a concentric optical part, while the haptic part is additionally equipped with three elastic support elements located at the same distance from each other, each of which is made in in the form of a spear, while the implantation of ICD is carried out through a cartridge and an injector into the anterior chamber of the eye, then each of the supporting elements in the form of a spear is placed into a corresponding scleral pocket using a 25 G vitreal tweezers, then the twisted stitches are placed on the conjunctiva, the operation is completed by introducing a solution under the conjunctiva dexazone and antibiotic.

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