RU2662426C1 - Method of mini-invasive reposition of the intraocular lens dislocated into the vitreal cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmosurgery. For surgical repositioning of the intraocular lens (IOL) having C-shaped haptic elements dislocated in the vitreal cavity, perform vitrectomy using the 25 G technology without the administration of PFOC. When manipulating the left eye: establish a port for infusion in the meridian at 4 hours, ports for lighting and for vitreotoma at 10 and 2 hours respectively. After vitrectomy and removal of the port at 10 hours, insert a tweezer of a 25G caliber forceps into the vitreal cavity through the sclerostome, capture by forceps the IOL arch, remove the arch through the sclerostome outward, tie it with 10/0 nylon thread with a needle curved on 3/8 on the other end of the thread and tighten the thread with a surgical knot; then the arch of the IOL is inserted into the posterior chamber of the eye. Then delete the port in the meridian at 4 hours and perform a similar manipulation with the opposite arch of the IOL. Then alternately curved needles with a thread are introduced through the sclerostomy at 10 and 4 hours respectively, followed by their puncture of 1.5–2.0 mm from the limb in the same meridians, pull the threads outward, alternately pulling both threads, center the IOL relative to the pupil, fix each thread with an intrascleral Z-shaped suture and cut the ends of the threads.

EFFECT: method makes it possible to increase the reliability of the repositioning of the IOL placed in the vitreal cavity and fixing it and stable position in the posterior chamber of the eye, and also allows to reduce the amount of surgical manipulations, to reduce the time of surgery with minimization of surgical trauma of the eye.

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Description

The invention relates to ophthalmology, namely to ophthalmosurgery, and is intended for surgical reposition of an intraocular lens (IOL) deployed in the vitreous cavity, having C-shaped haptic elements (arches) of the C-loop type.

The dislocation of the posterior chamber IOL model, which developed at various times after cataract phacoemulsification, needs to be repositioned or replaced by IOL. It occurs in 0.2-2.8% of cases [Tereshchenko Yu.A., Krivko SV., Sorokin E.L., Egorov V.V. Spontaneous dislocation of posterior chamber intraocular lenses (IOL) in the late postoperative period: frequency, causes, complications // breast cancer. Clinical Ophthalmology. 2010. No3. S. 100]. Often it is due to the presence of preoperative initial weakness of the zinc ligaments, which are not able to hold the capsular bag with IOL.

Given that the initial weakness of zinc support at the preoperative examination is not detected in 48% of patients with cataracts, the frequency of this complication may increase [Egorov VV, Sorokin EL, Tonkonogy SV The study of the frequency and patterns of the formation of capsule support weakness in patients with age-related cataract // Far Eastern Medical Journal. 2016. No4. S. 80-83].

There are methods for surgical reposition of IOLs located in the vitreous cavity:

1. RF patent No. 2427353: Shkvorchenko D.O., Kakunina S.A. “A method for reposition of an intraocular lens deployed in the vitreous cavity”;

2. RF patent No. 2393826: Shkvorchenko D.O., Sharafetdinov I.Kh., Kislitsyna N.M., Norman K.S., Belikova S.V. "A method for reposition of a deployed intraocular lens into a ciliary sulcus (options)";

3. RF patent No. 2271180: Malyugin B.E., Verzin A.A., Mohammad F.R. "A method of reposition of a deployed intraocular lens";

4. RF patent No. 2527912: Ivanov D.I., Kleimenov A.Yu. “A method for reposition of a monoblock intraocular lens deployed together with a capsular bag”;

5. RF patent No. 2444339: Ivanov D.I., Kremeshkov M.V. "A method for reposition of an intraocular lens deployed with a capsular bag."

The closest analogue prototype is the "Method of reposition of an intraocular lens deployed in the vitreal cavity" Shkvorchenko DO, Kakunina SA (RF patent No. 2427353).

The essence of the method is to perform a surgical vitrectomy followed by a tamponade of the vitreous cavity with a perfluororganic compound (PFOS). IOL rises from the surface of the retina on the surface of PFOS, as the vitreous cavity of PFOS is filled, right up to the posterior chamber, where it then centers relative to the pupil, beyond the plane of the iris.

After this, they additionally create artificial support for the IOL in the achieved correct anatomical position. It is performed by the following manipulations. First, in one meridian, an injection is carried out through the scleral capsule outside the limb, passing the needle through the posterior chamber with its subsequent puncture in the opposite segment, also behind the limb; that is, forming an X-shaped wiring thread. Then, in the perpendicular meridian, a similar manipulation is carried out with the 2nd needle with thread, forming a U-shaped thread path through the back chamber. Thus, artificial support for the IOL is created in the form of 2 mutually intersecting paired threads. On this support, as in a hammock, and IOL is located. Then PFOS is removed and the operation is completed.

The disadvantages of the prototype:

- unreliability of the stability of the anatomical position of the IOL, since it simply lies on the threads, without any additional fixation - a high risk of decentralization or dislocation of the IOL in the postoperative period;

- the impossibility of postoperative correction of the anatomical position of the deployed IOL;

- the need to use PFOS to fill the vitreous cavity, which increases the cost of the operation;

- a large amount of surgical intervention due to the need to use PFOS, coupled with a high degree of surgical injury to the eye;

- long duration of the operation;

- the technical complexity of the manipulations in the formation of 4 injections and 4 needle punctures with its passage inside the eye through the entire front diameter of the eyeball;

- the need for 4-fold intraoperative traumatic compression with a needle on the scleral capsule of the eye when it is injected and punctured when the needle is passed through the entire diameter of the eyeball through the ciliary body - deformation of the region of the flat part of the ciliary body - increased risk of excessive traction in the retina and ciliary body;

- the risk of mechanical damage to the pigment sheet of the iris with the front surface of the IOL due to the constant oscillatory movements of the IOL, since the IOL is not fixed.

Object of the invention: the creation of a reliable, low-invasive minimally invasive (25G) reposition of IOLs deployed in the vitreous cavity.

EFFECT: increased reliability of reposition and fixation of an IOL deployed in the vitreous cavity, reduction in the volume of surgical intervention with minimization of surgical eye injury.

The invention is illustrated by drawings:

FIG. 1. - gripping the IOL temples with tweezers.

FIG. 2. - Extraction of the IOL arch.

FIG. 3. - Putting the IOL arm into the back of the eye.

FIG. 4. - Gouging the needle.

1 - sclerostomy at 10 hours,

2 - tweezers,

3 - the handle of the IOL,

4 - thread

5 - surgical unit

6 - a curved needle,

7 - sclerostomy at 4 hours.

The technical result is achieved as follows: perform surgical vitrectomy using 25G technology. Three standard trans-scleral ports are installed: one for infusion, one for lighting, and one for the vitreotome. The location of the ports for infusion on the left eye is 4 hours in the meridian, and 8 hours for the right eye. Accordingly, the ports for lighting and for the vitreotome are installed in the meridians of 10 and 2 hours. Perform vitrectomy with filling the vitreous cavity with a balanced saline solution.

Further, all manipulations are described for the left eye.

After the port is removed at 10 o’clock, jaw forceps 2 of 25G caliber are inserted into this sclerosome 1, and with its help they capture the IOL arch 3 located in the vitreous cavity (Fig. 1). Then the IOL 3 arch is brought out through sclerosis 1 (Fig. 2), where it is tied with a 10/0 nylon 4 thread 2–3 times and the thread is tightened with a surgical unit 5. A 10/0 nylon thread is used, at the other end of which is bent 3 / 8 needle 6. After that, the tied arch 3 of the IOL is pushed with tweezers through the sclerosome 1 to the back chamber of the eye, while the other end of the thread with the curved needle 6 remains outside (Fig. 3).

Then, the infusion cannula is removed from the port at 4 hours and inserted into the port at 2 hours for delivery of saline solution into the vitreous cavity in order to maintain ophthalmotonus. Then the port is removed at 4 o’clock and, accordingly, the same manipulation is performed with another IOL handle through the sclerotomy port at 4 o’clock 7.

Then, the bent needle 6 is passed through sclerosome 1 in the meridian at 10 hours to a depth sufficient to puncture the needle 1.5-2.0 mm from the limb in the same meridian, puncture the needle and pull the thread 4 outward (Fig. 4).

In the same way, a curved needle is passed through the sclerosome at 4 hours 7, it is punctured 1.5-2.0 mm from the limbus in the same meridian and the thread is pulled out.

Then alternately pulling both threads, they gradually achieve a centering of the anatomical position of the IOL in the posterior chamber relative to the pupil. After that, both ends of the threads are hemmed intrasclerally using the technique of Z-shaped flashing of the scleral capsule without tying a knot and the ends of the threads are cut.

The advantages of the proposed method:

- reliability and stability of the anatomical position of the IOL due to its strong mechanical fixation with 2 Z-shaped seams;

- the possibility of postoperative correction of the anatomical position of the IOL, in cases of slight displacement, by pulling the corresponding filament of a Z-shaped suture (its ability to maintain the achieved degree of tension);

- the absence of the need to use PFOS to fill the vitreous cavity and subsequent removal - reducing the volume of surgical intervention with minimizing surgical injury to the eye; reduction in transaction costs;

- reduction in the duration of the operation;

- technical simplicity of the methodology;

- reduction of trauma to the ciliary body and mechanical deformation of the eyeball when passing through the needle (instead of 4 injections, punctures, only 2 should be performed);

- minimizing the risk of damage to the pigment leaf of the iris with the front surface of the IOL in connection with suture fixation of the supporting elements of the IOL.

Example 1. Patient G., 40 years old. On admission: complaints of a sharp decrease in vision of the left eye. Anamnesis: phacoemulsification of cataract with implantation of AcrySof Natural IOL. He received a dull eye injury, as a result of which the IOL was deployed in the vitreous.

Objectively: Visual acuity of 0.04 with a correction of 11.0 D 0.8. The eye is calm. Postoperative corneal scars. Front camera 3.5 mm, moisture is clean. The pupil is irregular in shape, 4 mm in diameter, the reaction to light is weakened, tears of the pupil edge of the iris, depigmentation of the pupil border. In the lumen of the pupil, the vitreous body with granules of pigment promotes. The vitreous is liquefied. With reverse ophthalmoscopy in the lower sections, a dislocated mobile IOL in a capsular bag is visualized.

The patient was performed 25G endovitreal intervention, reposition of IOL according to the proposed method.

After surgery: Visual acuity of 0.7. Eye moderately irritated. Small swelling and conjunctival hyperemia. The cornea is transparent. The position of the IOL in the pupil lumen is correct. Avitria. The retina is in all quadrants. IOP 16 mmHg

Inspection after 2 weeks: the position of the lens is stable, visual acuity of 0.9.

Example 2. Patient N., 77 years old. On admission: complaints of a sharp decrease in visual acuity of the right eye. Anamnesis: phacoemulsification of cataract with implantation of IOL “Miol 2” on the right eye. As a result of a fall from a height of his own growth, the vision of his right eye sharply worsened. Diagnosed with dislocation of the IOL in the vitreous. Objectively: visual acuity of the right eye: 0.05 with correction of the sphere + 11.0 D is 0.4. The anterior chamber is deep, iridodonezum, a pupil of a rounded shape, tears of the pupil edge, in the lumen of the pupils are vitreous fibrils, which are streaming into the anterior chamber. In the vitreous body - mixed destruction and lumps of pigment; in the lower sections, a dislocated mobile IOL in a capsular bag is visible.

Performed 25G vitrectomy, reposition of the IOL according to the proposed method.

After surgery: visual acuity 1.0. Eye moderately irritated. Slight swelling and conjunctival hyperemia. The cornea is transparent. The position of the IOL in the pupil lumen is correct. Avitria. The retina is in all quadrants. IOP 18 mmHg

Examination after 2 weeks: the eye is almost calm. The position of the lens is stable. Visual acuity 1.0.

Claims (1)

A method for minimally invasive reposition of an intraocular lens deployed in the vitreous cavity, including vitrectomy, centering the IOL in the posterior chamber, characterized in that they perform vitrectomy according to 25 G technology without PFOS and during manipulations on the left eye: establish a port for infusion into the meridian for 4 hours, ports for lighting and for vitreotome at 10 and 2 hours, respectively; After a vitrectomy and removal of the port at 10 o’clock, a 25G forceps jaw branches are inserted through the sclerosome into the vitreous cavity, they grasp the IOL handle, pull the handle through the sclerosis outward, tie it with a 10/0 nylon thread with a 3/8 needle bent at the other end of the thread and tighten thread by a surgical unit; after that, the IOL arch is set into the posterior chamber of the eye; then remove the port in the meridian for 4 hours and perform the same manipulation with the opposite handle of the IOL; then alternately bent needles with a thread are inserted through sclerostomes at 10 and 4 hours, respectively, followed by their puncture of 1.5-2.0 mm from the limbus in the same meridians, pull the threads outward, alternately pulling both threads, center the IOL relative to the pupil, fix each thread is an intrascleral Z-shaped suture and the ends of the threads are cut.

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