RU2684526C1 - Intraocular lens - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to ophthalmology, and aims at surgical management of cataract. Intraocular lens (IOL) comprises an optic and a haptic portion. IOL is delineated by a virtual outer cylinder 11–12 mm in diameter. Haptic part represents two pairs of support closed elements located diametrically opposite to optical part. Each support element consists of two arc-shaped parts – large and small, coming from the optical part, bent towards the outer cylinder and containing bulges in the central part. Large arc-shaped part with outer bent part touches outer cylinder. Each support element comprises three zones with reduced width, made at connection points of arc-shaped parts with optical part and in points of their connection to each other. Width of zones with reduced width increases in the following order: at the point of connection of the small arc-shaped part with the optical part, at the point of connection of arc-shaped parts to each other, at the point of connection of the large arc-shaped part with the optical part.EFFECT: use of the given invention enables to control compression in the plane of the lens and adaptation of the IOL to the size and shape of the capsular sac.1 cl, 1 dwg, 2 ex

Description

The invention relates to the field of medicine, namely to ophthalmology, and is intended for the surgical treatment of cataracts.

In the process of cataract extraction, a complication often arises in the form of rupture of the posterior lens capsule, prolapse of the vitreous body, which in some cases complicates the ability to implant an S-shaped posterior chamber model of the intraocular lens (IOL), causes the development of serious postoperative complications, for example, MIOL-2 NN ”, Nizhny Novgorod, Russia). In such cases, it is preferable to implant a lens with four closed support elements, due to which the IOL has more points of contact with the capsular bag and allows it to stretch more evenly. In addition, such an IOL model, if necessary, can be hemmed for the supporting elements.

Known IOL patent RU 2377964, IPC A61F2 / 16, publ. 01/10/2010, containing the optical and haptic parts. It can be seen from the graphic part of the patent description that the haptic part is made in the form of four closed support elements. Each support element represents a ring spaced from the “leg” from the optical part. As is known, the diameter of the capsule bag can vary from 10 to 12 mm and depends on the anatomical features of the patient. In the case where the total diameter of the IOL exceeds the diameter of the capsule bag, the supporting elements must ensure the adaptation of the IOL to the size of the capsule bag and be compressed in the plane of the lens. The supporting element is made in such a way that the width of its ring is uniform everywhere. For this reason, compression zones are not clearly defined. In this regard, the compression occurs uncontrollably, the load is distributed unevenly, a high probability of the lens bending out of the plane. In this case, the lens may bend and cling to the back wall of the lens capsule, which will lead to an incorrect calculation of the refractive parameters of the IOL, or the lens may bend with a deviation from the optical axis and the formation of the Z effect, which will lead to complete image distortion.

The technical result consists in the creation of an IOL with four closed support elements, providing controlled compression in the plane of the lens and the adaptation of the IOL to the size and shape of the capsule bag.

The technical result is achieved by the fact that the proposed IOL containing optical and haptic parts, while the IOL is outlined by a virtual external cylinder with a diameter of 11-12 mm, the haptic part consists of two pairs of supporting closed elements located diametrically opposite to the optical part, with each supporting element consists of two arcuate parts - large and small, emanating from the optical part, curved towards the outer cylinder and containing bulges in the central part, a large arcuate I part of the outer curved part relates to the outer cylinder, each supporting element contains three zones with a reduced width, made at the junction of the arcuate parts with the optical part and at the junction between them, while the width of the zones with reduced width increases in the following order: in place the connection of the small arcuate part with the optical part, at the junction of the arcuate parts with each other, at the junction of the large arcuate part with the optical part.

The proposed device is illustrated in graphic material.

In FIG. 1 shows a general view of the IOL.

The IOL contains the optical part 1 with a diameter of 6 mm and the haptic part 2. The IOL is outlined by a virtual external cylinder 3 with a diameter of 11-12 mm. The haptic part 2 is two pairs of support closed elements located diametrically opposite to the optical part 1. Each support element 4 consists of two arcuate parts - large 5 and small 6, coming from the optical part 1, curved towards the outer cylinder 3 and forming so called the "ear." The large arcuate part 5 with the outer curved part touches the outer cylinder 3. Each support element 4 contains three zones with a reduced width (zones A, B, C). The width of the zones with reduced width increases in the following order: at the junction of the small arched part with the optical part (zone A), at the junction of the arched parts with each other (zone B), at the junction of the large arched part with the optical part (zone C).

The work of the proposed invention is as follows.

The support element 4 is attached to the optical part 1 by two points - this is zone A and zone C, which eliminates the bending of the lens with a deviation from the optical axis and the formation of the Z-effect. During implantation, the large arcuate part 5 rests on the arch of the capsular bag and its curvature in a compressed position maximally repeats the shape of the capsular bag. The small arcuate part 6 is curved towards the outer cylinder 3, which provides compression of the support element 4 bending the “ear” in the plane of the IOL to the side of the optical part 1. Each support element 4 contains three zones with a reduced width (zones A, B, C), whose width increases in a certain order. The gradation of the width of these zones depends on the compression angle in this zone when the supporting element 4 is bent in the plane of the IOL — the larger the compression angle, the smaller the width of the zone. The smallest width is laid at the junction of the small arcuate part with the optical part (zone A), since it requires maximum compression when folding the supporting element 4. Further, the width of the zones increases in the following order: at the junction of the arcuate parts between themselves (zone B), in place connections of a large arcuate part with an optical part (zone C). In the central part of the large 5 and small 6 arcuate parts there are thickenings (zone D and E), which are laid in order to exclude deflection in these places. The curvature of the arcuate parts was chosen based on the results of modeling lens compression. The curvature of the large arcuate part 5 was determined so that it with the maximum compression of the support element 4 repeated the shape of the capsule bag.

Work with the proposed device is carried out according to the standard method of IOL implantation using an injector, which is illustrated by clinical examples.

Example 1

 Patient N., 65 years old, was admitted for complicated cataract of the left eye

Visual acuity: 0.05 with spherical correction (-) 5.0D = 0.2

IOP = 20 mm RT. Art.

Keratometry: 45.5 D ax 100 deg., 46.0 D ax 10 deg.

Eye length 23.22 mm; no additional echo signals are detected.

Biomicroscopically, the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, multiple pseudoexfoliation elements are located on the anterior capsule of the lens, the pupil is round, 3.5 mm in diameter, the lens is cloudy, 3 degrees of density.

During the operation revealed an increased extensibility of the ligamentous apparatus of the lens, which determined the performance of microinvasive phacoemulsification (RF patent No. 2571529). The proposed elastic intraocular lens was implanted through a 2.0 mm tunnel incision using a disposable injector in such a way that the front pair of support elements of the haptic part 2 is inserted directly into the capsule bag, and the remaining support elements freely start due to the elasticity and the possibility of folding in zones A and C beyond the edge of capsulorexis by lightly pressing the optical part 1 with a micro-tool. In this case, the support elements of the haptic part 2 are self-expanding in accordance with the times erami and shape of the capsular bag and avtotsentratsiya optical part 1, which was confirmed by visual intraoperative control: the supporting elements 4 are in a slightly compressed state, and their large arcuate portion 5 abuts against the body of the capsular bag evenly pulling his posterior capsule and following the shape of the capsular bag.

At discharge:

visual acuity = 1.0

IOP = 21 mm Hg. Art.

Keratometry: 45.5 D ah 95 degrees, 45.75 D ah 5 degrees

The eye is calm biomicroscopically, the cornea is transparent, the anterior chamber is of medium depth, the moisture is clear, the intraocular lens is centered in the capsule bag, in the right position, the back capsule of the bag is smooth, has no wrinkles and tension ribs, the optic disc is pale pink on the fundus with clear contours, angiosclerosis, on the periphery - without gross focal changes.

Example 2

Patient M., 70 years old, was admitted for complicated subluxated cataracts, open-angle developed glaucoma with normal intraocular pressure of the left eye.

Visual acuity: 0.02 does not correct.

In the drug regime IOP = 19 mm Hg. Art.

Keratometry: 42.5D ah 105 degrees, 42.9D ah 15 degrees

Eye length 23.0 mm; no additional echo signals are detected.

Biomicroscopically, the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, multiple pseudoexfoliation elements are located on the anterior capsule of the lens, pupil is round, 3.0 mm in diameter, phacodenesis, lens is cloudy, 4 degrees of density.

In order to minimize the impact on the ligamentous apparatus of the lens during its subluxation, the technology of bioenergetic cataract extraction was selected (RF patent No. 2544458). During the operation, the insolvency of the zinc ligament on 1/5 of the circle was confirmed. The proposed elastic intraocular lens was implanted through a 2.2 mm tunnel incision using a disposable injector in such a way that the front pair of support elements of the haptic part 2 is inserted directly into the capsular bag, and the remaining support elements due to the elasticity and the possibility of folding in zones A and C for minimal the effects on the zinc ligament are introduced beyond the edge of the capsulorexis alternately by simultaneously diverting the edges of the capsulorexis and the supporting element 4 with micro hooks with its slight bending in zones A and C. After this, the support elements 4 are independently expanded in accordance with the size and shape of the capsule bag and the autocentering of the optical part 1 is confirmed by visual intraoperative control: the supporting elements 4 are in a slightly compressed state, and their large arcuate part 5 rests against the capsule arch bag, evenly pulling its back capsule and repeating the shape of the capsular bag. Moreover, the support element located in the zone of insolvency of the zinc ligament is pressed in the plane of the IOL towards the optical part 1 to a greater extent than other support elements, which, due to the independent bending of this support element from all others, determines the absence of influence on the position of the optical part 1, keeping its centering.

At discharge:

visual acuity = 1.0

IOP = 19 mm Hg. Art.

Keratometry: 42.5D ah 110 deg., 42.75D ah 20 deg.

The eye is calm biomicroscopically, the cornea is transparent, the anterior chamber is of medium depth, the moisture is clear, the intraocular lens is centered in the capsule bag, in the correct position, the posterior capsule is smooth, has no wrinkles and tension ribs, the optic disk has clear contours on the fundus, e \ d = 0.7, angiosclerosis, on the periphery - without gross focal changes.

The design of the proposed IOL with four closed support elements provides controlled compression in the plane of the lens and allows it to adapt to the size and shape of the capsule bag.

Claims (1)

An intraocular lens containing optical and haptic parts, characterized in that the intraocular lens is outlined by a virtual external cylinder with a diameter of 11-12 mm, the haptic part consists of two pairs of support closed elements located diametrically opposite to the optical part, each support element consists of two arched parts - large and small, emanating from the optical part, curved towards the outer cylinder and containing thickenings in the central part, a large arched part the outer curved part touches the outer cylinder, each support element contains three zones made at the junction of the arcuate parts with the optical part and at the junction of them with each other, while the width of the zones increases in the following order: at the junction of the small arcuate part with the optical part, at the junction of the arched parts with each other, at the junction of the large arched part with the optical part.

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