RU2642263C1 - Method for surgical treatment of cataract using femtosecond laser energy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for the surgical treatment of cataract using femtosecond laser (FSL) energy, a femto stage is performed, opening of major incisions, hydrodissection, fragmentation and phacoemulsification of the lens mass and intraocular lens implantation. After the femto stage and major incisions opening, the core is destroyed by efforts in a horizontal plane along a notch line left after the core fragmentation using the FSL energy and passing through the lens center, then each half of the lens core is alternately hydrodissected after the release of bubbles of intra-and retrolens gases, and then the operation is continued traditionally.

EFFECT: creation of optimal conditions for safe performance of hydrodissection and prevention of the risk of uncontrolled ruptures of the posterior capsule of the lens.

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Description

The invention relates to medicine, in particular to ophthalmology, and can be used for the surgical treatment of cataracts using the energy of a femtosecond laser (FSL).

In recent years, the use of FSL as a stage of cataract surgery has become widespread. FSL energy is used for corneal incisions, capsulotomy and partial fragmentation of the lens nucleus and allows these stages of the operation to be carried out extremely accurately and in eye-safe mode (Mayer W., Klaproth O., Hengerer F., Kohnen T. Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery. Am J Ophthalmol., 2014, Vol. 157, p. 426-432).

However, during the formation of notches under the lens nucleus and inside it from the influence of the FSL energy, bubbles of intra- and retro-crystalline gas form, which create tension in the capsular bag and put additional pressure on the back capsule. This makes it unsafe to perform hydrodissection (separation of the lens substance from the capsule using irrigation fluid), since it can lead to spontaneous rupture of the capsule bag.

Closest to the proposed invention is a method of phacoemulsification of cataracts with femto tracking (Anisimova S.Yu. et al. Clinical analysis of complicated phacoemulsification with femtolaser follow-up and features of phacoemulsification after femto-stage. Ophthalmosurgery, 2014, 4, p. 14-20), including bag from intra- and retro-crystalline gas bubbles to hydrodissection by releasing these bubbles after opening the main incisions to reduce intracapsular pressure and reduce the risk of rupture of the posterior lens capsule, prototype.

However, the opening of the main sections after the femto-stage does not provide unhindered exit of the bubbles of gas accumulated after the femto-stage from the intra- and retro-crystalline spaces and does not exclude the risk of capsular block syndrome. The surgeon is forced to either refuse the stage of hydrodissection, which inevitably complicates the surgical intervention, or try to perform various manipulations with the core without breaking it to try to release gas bubbles, or conduct gentle hydrodissection, which does not always give the optimal result. All these actions significantly increase the risks of rupture of the posterior capsule and dislocation of the nucleus into the vitreous body.

The present invention is aimed at improving the process of phacoemulsification of cataracts using FSL energy.

The technical result from the use of the invention is to create optimal conditions for the safe performance of hydrodissection and to prevent the risk of uncontrolled ruptures of the posterior lens capsule.

The technical result is achieved by the fact that after performing the femto phase of cataract surgery, the main sections are opened and the nucleus is fractured using a phacoemulsifier and chopper, applying force along the notch lines formed after fragmentation by the FSL energy and passing through the center of the lens nucleus. Fracture of the core is carried out “on weight”, in a strictly horizontal plane, which minimizes the load on the zinc cords and eliminates additional pressure on the back capsule. As a result of this, intra- and retro-crystalline gas bubbles are released. Then, in turn, hydrodissection of each half of the lens nucleus is performed, without fear of excessive pressure of irrigation fluid on the posterior capsule.

This method is applicable to all types of cataracts that have indications for the use of FSL.

The invention is as follows. After processing the surgical field and installing a surface anesthetic, using the FSL energy, anterior circular capsulotomy is performed, the main incision and paracentesis are formed, as well as incisions are formed for the subsequent division of the nucleus into fragments. Then, at the stage of phacoemulsification, the main incision and paracentesis are opened. Using a phacoemulsifier and chopper, the lens nucleus is split and divided into two parts, applying force along the line of a notch made with the help of FSL energy, passing through the center of the lens nucleus. After exit into the anterior chamber of gas bubbles accumulated in the intra- and retro-lens space, hydrodissection of both halves of the lens is performed alternately. Then the core is rotated, it is split into two or more parts and their fragmentation. Perform phacoemulsification of fragments, irrigation-aspiration of residual lens masses. Next, the implantation of an intraocular lens (IOL) is performed and the operation is completed according to the usual method.

The method is illustrated by the following clinical examples.

Example 1. Patient G., born in 1949, was admitted with a diagnosis of complicated mature OS cataract, mature OD cataract.

The patient underwent a femtolaser stage of cataract surgery on the OS with the formation of 5.5 mm capsulorexis, incisions for subsequent crushing of the lens nucleus into four fragments, and the formation of the main incision and paracentesis. At the stage of phacoemulsification, the main incision and paracentesis were revealed. Using the phacochop chopper method, the core was split and separated along the line of a notch made using the FSL energy passing through the center of the lens nucleus. Intra- and retro-crystalline gas bubbles are released into the anterior chamber. After that, hydrodissection of both halves of the lens was performed alternately, then the nucleus was turned and split into two or more parts and their fragmentation was performed. Next, the remaining fragments of the nucleus were removed, irrigation-aspiration of the residual crystalline masses was performed, and the Acrysof Single Piece 20.5 IOL was implanted. The IOL is centered in the capsule bag.

On the first day after surgery, the anterior segment of the eye with no signs of inflammation. The cornea is transparent, the IOL is in the right position in the capsule bag. The optic nerve disc is pale pink, the borders are clear. The macular region is not changed. Visual acuity of 0.8.

1 month after surgery. The cornea is transparent, the anterior chamber is deep. The iris is calm. The pupil is round, it reacts to light. The IOL is fixed in the capsule bag in the correct position. Anterior capsulotomy of regular round shape. Visual acuity of 0.8.

Example 2. Patient M., born in 1951, was admitted with a diagnosis of complicated immature cataract OD.

During biomicroscopy, pronounced opacities were noted in the cortex and above the posterior lens capsule. The patient would undergo a femtolaser stage of cataract surgery with the formation of capsulorexis with a diameter of 5.5 mm, crushing the nucleus into 4 fragments and the formation of the main incision and paracentesis. At the stage of phacoemulsification, the main incision and paracentesis were revealed. Using the focochop chopper method, the nucleus was split and divided along the line of a notch made using the FSL passing through the center of the lens nucleus. Intra- and retro-crystalline gas bubbles came into the anterior chamber. After this, hydrodissection of both halves of the lens, a turn of each half of the nucleus, and separation of each half into two or more parts were performed. Then, phacoemulsification of the fragments, irrigation-aspiration of residual lens masses were performed. A bifocal IOL Okulentis comfort with an addition of +1.5 is implanted in the capsule bag. The IOL is in the correct position, the reflex is pink. On the first day after surgery, the cornea is transparent, the anterior chamber is deep. The iris is calm, the pupil is round, reacts to light. The IOL is fixed in the capsule bag in the correct position. Visual acuity of 1.0, vision at a distance of 70 cm = 0.5.

Claims (1)

A method for the surgical treatment of cataracts using the energy of a femtosecond laser (FSL), including performing a femto stage, opening the main sections, performing hydrodissection, fragmentation and phacoemulsification of the lens masses and implanting an intraocular lens, characterized in that after performing the femto stage and opening the core sections, the incisions are performed by efforts in the horizontal plane along the notch line formed after fragmentation of the nucleus with the help of FSL energy and passing through the center of the nucleus of the lens Further after intra- and retrohrustalikovogo gas bubbles hydrodissection operate alternately each half of the lens nucleus, after which the operation continues conventionally.