RU2626693C1 - Method for subluxated lens treatment in patients of young age - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: metered incisions of the anterior capsule are performed, 0.1-0.2 mm less than the diameter of the irrigation and aspiration cannulae. The sections are performed bimanally simultaneously from both sides, after which irrigation-aspiration is carried out inside the capsule bag, introducing the irrigation-aspiration tips through the incisions in the anterior capsule.

EFFECT: method helps to prevent detachment of subluxated lens ligaments and endothelial cells injury, allows to maintain a stable volume of the capsular sac during irrigation-aspiration, absence of migration of lens masses to the anterior chamber and vitreous body.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used for surgical removal of the lens in case of subluxation in young patients.

There is a method of intracapsular aspiration of the lens through its puncture in the anterior capsule (A. Khvatova, “Actual Issues of Ophthalmology.” Thesis of the 7th Republic Conference of the Lithuanian SSR, Kaunas, 1980, pp. 109-110), which allows to remove the movable lens with minor trauma through one surgical incision (1.5 mm). The disadvantages of the method include the probability of displacement of the unfixed lens in the vitreous at the time of puncture of the anterior capsule and the impossibility of its further removal, as well as the inability to completely remove the crystalline masses without supplying irrigation fluid to the cavity of the capsular bag.

A known method of removing subluxated crystalline lens in children using YAG laser to excise the front capsule portion to form a channel for introducing one suction cannula with subsequent removal of the crystalline lens by aspiration-irrigation technique (patent RU No. 2197927, dated July 31, 2000). The advantage of the method is the excision of the planned portion of the anterior capsule without mechanical impact on the unfixed dislocated lens. However, when using this method, there is a likelihood of trauma to endothelial cells when using irrigation flows in the anterior chamber, the inability to completely remove the lens masses due to the risk of "collapse" and tearing of the capsule bag at the end of aspiration, and the likelihood of the lens masses entering the vitreous body. In addition, the effect of the YAG laser on the structures of the anterior eye can provoke the development of reactive ophthalmic hypertension in the early stages after surgery.

Closest to the technical nature of the present invention is the intralenticular bimanual aspiration of the subluxated lens in Marfan syndrome (R. Sinha, N. Sharma, RV Vajpayee. Intralenticular bimanual irrigation: aspiration for subluxated lens in Marfan's syndrome // J. Cataract Refract Surg. 2005. - Vol. 31. - P. 1283-1286), in which two openings with a diameter of 1.5-2 mm are formed in the capsule and then the lens masses are bimanally aspirated. The disadvantages of the method are: a change in the volume of the capsular bag during irrigation-aspiration due to the lack of tightness due to the sufficiently large size of the holes in the capsule, the likelihood of uncontrolled exit of the lens masses through the holes in the capsule and their ingress into the vitreous body, as well as the risk of dislocation of the lens in vitreous at the time of capsulorexis formation.

An effective method for removing the subluxated lens in young patients with a soft lens substance and the absence of a dense nucleus is proposed.

The invention consists in the following.

Bimanually, with metal disposable knives, metered cuts of the anterior capsule are performed with dimensions 0.1–0.2 mm smaller than the diameters of the irrigation and aspiration cannulas. Given the elasticity of the tissue of the capsular bag, especially in young patients, the indicated sizes of the cuts allow tight fitting of the cannula to achieve further manipulations in a sealed mode. For the purpose of additional fixation of the movable crystalline lens, the capsule bag sections are made simultaneously with two knives on both sides, then the irrigation-aspiration is carried out inside the capsule bag by introducing the irrigation-aspiration tips through the incisions in the front capsule.

The technical result from the implementation of the proposed method:

- prevention of the risk of tearing of the ligaments of the subluxated lens due to the simultaneous bimanual dosage formation of incisions in the anterior capsule;

- the absence of the need to perform capsulorhexis provides a reduction in the time of the operation and its lesser trauma, i.e. the efficiency of the operation phase is increased;

- linear sections tightly fit the suction and irrigation cannulas, which ensures the tightness of the capsule bag, allows it to maintain a stable volume during the irrigation-aspiration process and does not allow it to “collapse”, as well as the absence of migration of lens masses into the anterior chamber and vitreous body;

- prevention of trauma to endothelial cells due to the absence of hydrodynamic flows in the anterior chamber.

The invention is carried out as follows.

After anesthesia and instillation of antibacterial drugs with a disposable knife, corneal paracentesis is formed in the meridians 0 ° and 180 °, the anterior chamber is filled with viscoelastic. Then, simultaneously, from two sides, with two disposable knives, metered incisions of the anterior capsule are formed, 0.1-0.2 mm in size smaller than the diameters of the irrigation and aspiration cannulas in the middle periphery of the anterior lens capsule, also in the meridians 0 ° and 180 °, after which the irrigation and suction tips are inserted directly into the capsule bag. Then, the lens masses are aspirated when the irrigation fluid is supplied directly to the capsule bag; after the lens mass is aspirated, the capsule bag is removed from the anterior chamber with tweezers. Next, anterior vitrectomy and iridectomy are performed, after which an injection implantation of an elastic intraocular lens (IOL) with pupil fixation is performed through a tunnel incision, viscoelastic is washed out and corneal incisions are sealed and the anterior chamber is restored with physiological saline.

The proposed method is illustrated by the following clinical example.

Patient A. Age 5 years. Diagnosis: OU - microspherophakia, lens ectopy, moderate myopia, complex myopic astigmatism, amblyopia, Marfan syndrome. Eye status: VOU = 0.1 s corr. 0.3;

OU - eyeballs of normal sizes, the corneas are transparent, the anterior chambers are of medium depth, pupils with a diameter of 3.0 mm, microspherophakia, crystalline lenses are transparent, are displaced in the upper-outer direction, the lens equator is located in the center of the pupil, the fundus is without pathology.

Surgical intervention in the right eye was performed:

disposable knife 1.2 mm formed paracentesis in the meridians 0 ° and 180 °;

simultaneously from two sides, with two disposable knives 1.2 mm for 2/3 of the length of its cutting part, cuts 0.7-0.8 mm long were formed in the middle periphery of the anterior lens capsule, also in meridians 0 ° and 180 °; irrigation and aspiration tips are inserted directly into the capsule bag; lens aspiration was performed when irrigation fluid was supplied directly to the capsule bag; after aspiration of the lens masses, the capsule bag is removed from the anterior chamber with tweezers; anterior vitrectomy and iridectomy were performed; through a 2.2 mm tunnel section, injection implantation of an elastic IOL with pupillary fixation was performed; sealing of corneal incisions and restoration of the anterior chamber of the eye was performed with saline.

Ocular status on the 5th day after surgery: VOD = 0.5 not corr .;

OD - the eyeball is calm, the cornea is transparent, the anterior chamber is of medium depth, the pupil is 3.0 mm in diameter, the IOL is fixed in the pupil in the correct position, the fundus is without pathology.

Claims (1)

A method of treating a subluxated lens in young patients, including the formation of two holes in the anterior capsule and bimanual irrigation-aspiration of the lens masses, characterized in that after the formation of two paracentesis, the capsule bag is cut 0.1 to 0.2 mm smaller than the irrigation and aspiration cannula, moreover, the incisions are performed bimanally simultaneously, after which intracapsular aspiration of the lens masses is carried out in a sealed mode.