RU2695951C1 - Scissors for femtolasik surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to ophthalmology and can be used in Femtolasik surgery at the stage of corneal flap formation, when undercutting of the cut out flap is performed, which is eliminated with the help of the proposed scissors. Scissors for Femtolasik surgery contain branches crosswise pivotally connected to each other, equipped with bent working ends on one side, interacting with each other to perform cutting process, and on the other side each branch is provided with a handle spring-loaded with another handle. Working ends of the branches are bent simultaneously along the radius of the averaged circumference of the cut out flap, the branch placed from below during cutting is shortened relative to the other branch and its end is rounded.

EFFECT: use of the invention allows higher effectiveness of the performed elimination of a corneal flap with a pedicle when performing Femtolasik surgery using the proposed scissors.

1 cl, 2 dwg

Description

The invention relates to medicine, namely, to ophthalmology and can be used during the FEMTOLASIK operation at the stage of formation of the corneal flap, when there is undercutting of the cut out flap, which is eliminated using the proposed scissors.

When performing the FEMTOLASIC operation at the stage of formation of the corneal flap, microbubbles are formed, which subsequently connect and form the plane of delamination. However, with insufficient applanation of the vacuum ring, excessive mobility of the patient’s eye with his restless behavior, incomplete loss of vacuum may occur, as a rule, from the nasal or temporal side of the cornea. In this case, a vertical cut may be formed defectively in a circle, as a result of which it is possible to obtain a defectively formed corneal flap with a leg. Such a flap cannot be taken aside, and, as a result, the area of the surgical field for excimer laser exposure will be limited, which makes further surgery impossible and requires its cancellation.

A known instrument in the form of scissors used in the FEMTOLASIK operation to eliminate undercutting of a cut out corneal flap (see Model M 119 Microsurgical Instrument LLC Medin-Ural Ekaterinburg, 2012), containing jaws cross-hinged to one another, equipped on one side with curved workers the ends interacting with each other to carry out the cutting process, and on the other hand, each jaw is equipped with a handle, spring-loaded connected to the other handle.

A disadvantage of the known scissors that are used to eliminate undercutting of the corneal flap with the leg during the FEMTOLASIK operation, which can occur during the formation of this flap, is that it is very difficult to eliminate the resulting undercut due to the sharp long working ends of the jaw that can injure the cornea . The constructive shape of the working ends of the jaw of known scissors leads to increased morbidity of the corneal tissue, due to the fact that the sharp ends of the working part, when inserted under an undercut area, injure the corneal tissue. When the cut is formed around the circumference, the working ends of the branches form an uneven “fringed” edge of the corneal flap cut out during the FEMTOLASIK operation. Given the existing curvature of the working part of the tool, it is difficult to observe the cutting path when removing undercut sections of the corneal flap to be cut. In addition, difficulties arise in the exact formation of a semicircular cut, which should coincide with the initially cut out circular shape of the corneal flap. Non-observance of this can subsequently affect the course and duration of the surgical process and cause various complications.

The present invention solves the problem of developing a new tool in the form of scissors used in the FEMTOLASIK operation to eliminate undercutting of the corneal flap being cut. Obtained when using the proposed scissors, the technical result consists in increasing the efficiency of the elimination of undercutting of the corneal flap with the leg when performing the FEMTOLASIC operation using the proposed scissors. The working ends of the branches bent at the same time along the radius of the averaged circumference of the flap to be cut allow eliminating undercutting by completing the formation of the flap around the circumference, which will allow the flap to be folded to the side of the leg during the following stages of the operation and to carry out further stages of the operation. Due to the execution of the tool in two versions with bending of the working ends of the jaw towards each other, it will be possible to undercut both on the right and left sides relative to the leg of the flap. This will eliminate the underestimation and continue the operation.

The specified technical result is achieved by the fact that in the FEMTOLAZIK scissors containing jaws cross-hingedly connected to each other, equipped on one side with curved working ends interacting with each other to carry out the cutting process, and on the other hand, each jaw is equipped with a handle, spring-loaded with with the other handle, the working ends of the branches are simultaneously bent along the radius of the averaged circumference of the flop to be cut, the branch located below during cutting is shortened by the ratio to the other jaw and the end thereof is rounded.

The invention is illustrated by drawings, where

in FIG. 1 schematically shows the proposed scissors;

in FIG. 2 top view.

The scissors for the FEMTOLASIK operation contain jaws 1 cross-hingedly connected to each other. The jaws 1 are equipped on one side with curved working ends 2, interacting with each other to implement the cutting process. Each branch 1 on the opposite side from the working ends 2 is provided with a handle 3, spring-loaded connected with another handle. The working ends 2 of branch 1 are simultaneously bent along the radius of the averaged circumference of the flop to be cut out. The branch 1, placed below during the cutting process, is shortened relative to the other branch 1 and its end is rounded.

Scissors for operation FEMTOLASIC use as follows.

After performing anesthesia by double instillation in the conjunctival cavity of a 0.5% Sol solution. Proxymetacaini and the disposable sterile vacuum ring installation of the cornea are planned with a sterile disposable cone. When exposed to the FS200 femtosecond laser, a corneal flap is formed with the specified parameters. When performing a photo-fracture, an exact stratification of the corneal tissue occurs at a certain predetermined depth. Laser pulses of short pulses into the outer layers of the cornea form microbubbles, which, when they appear next to each other, gradually merge and form a plane of separation. In the case of hypermobility of the eyeball at the time of applanation, which arose due to the patient’s increased emotional stress during surgery, a shift in the vacuum ring is possible, i.e. uneven applanation and / or partial loss of vacuum is possible. As a result of this, an incorrectly formed vertical cut of the corneal flap in a circle occurs. To eliminate this use the proposed scissors for the operation FEMTOLASIC. Scissors are chosen to eliminate undercutting on one side relative to the flap leg to continue cutting around the circumference so that the shortened jaw is placed from the bottom during cutting. A shortened jaw is introduced under the flap and, making cutting movements, repeat the contour of the planned corneal flap to the required width of the corneal flap leg. Similarly, the undercut of the flap is eliminated on the other hand relative to its leg, using another version of the tool. After receiving the finally formed flap, it turns it on the leg for further excimer laser ablation on the surface of the stromal bed of the cornea using the SCHWIND-AMARIS-750 Hz system. Upon completion of ablation, the stromal bed and corneal flap are washed with a sterile balanced BSS saline solution, and the epithelial-stromal corneal flap is smoothed and dried on the stromal bed with sterile microtupers. At the final stage of the FEMTOLASIC operation, an antibiotic solution of 0.5% Sol is instilled into the conjunctival cavity. Levofloxacini.

A clinical example of the implementation of the proposed tool.

Patient T., 25 years old. Complaints of low visual acuity from adolescence, stable vision over the past 10 years. The experience of wearing soft contact lenses of planned replacement is 8 years. He is planning an excimer laser surgery - FEMTOLASIC surgery on both eyes. Patient T. underwent a complete ophthalmological examination, including visometry, refractometry under normal and cycloplegia conditions, biometry, pachymetry, pupillometry, measurement of the diameter of the cornea, keratotopography, biomicroscopy, examination of the fundus with a Goldman lens.

Survey Results:

Manifest Visometry: VOD = 0.05 with sph-4.0Dptr = 1.0,

ROD = sph-4.0 Dptr cyl-0.25 ax 10. VOS = 0.05 with sph -4.0 Dptr 1.0,

ROD = sph-4.0 Dptr cyl-0.25 ax 0.

Visometry in cycloplegia: VOD = 0.05 with sph-3.5Dptr = 1.0,

ROD = sph-3.5Dptr cyl-0.25 ax 10.VOS = 0.05 with sph -3.5 Dptr = 1.0,

ROD = sph-3.5Dptr cyl-0.0 ax 0.

Pachymetry in the central optical zone of both eyes is 520 μm, the diameter of the right pupil under mesopic conditions is 6.0 mm, the left is 6.0 mm, the diameter of the cornea of both eyes is 11.0 mm. According to the keratotopograph, no changes in the anterior and posterior surface of the cornea were detected. The clinical diagnosis is “OU - Moderate Myopia.”

Patient T. underwent surgery FEMTOLASIC using the proposed tool.

At the stage of formation of a corneal flap on the right eye, the patient behaved uneasily, as a result of which there was a partial loss of vacuum from the temporal side of the cornea. As a result, a flap of about 4-5 mm was visualized. It was decided to continue the operation. To eliminate the flap undercut, the proposed scissors for the FEMTOLASIK operation were used. We chose scissors to eliminate undercut on one side relative to the flap leg. To continue cutting around the circumference, a shortened branch in the cutting process was placed below. They brought a shortened jaw under the flap and, making cutting movements, repeated the contour of the corneal flap to the required width of its leg. The formed edge of the corneal flap showed a clear and even contour. After receiving the finally formed flap, they turned it on the leg at 12 o'clock for further excimer laser ablation on the surface of the stromal bed of the cornea using the SCHWIND-AMARIS-750 Hz device. At the end of ablation, the stromal bed and corneal flap were washed with sterile balanced BSS, and the corneal epithelial-stromal flap was smoothed and dried on the stromal bed with sterile microtupers. At the final stage of the FEMTOLASIC operation, a solution of the antibiotic 0.5% Sol was installed in the conjunctival cavity. Levofloxacini. On the double eye, the use of the tool was not required. On the first day after surgery, a flat edge of the corneal flap was visualized with biomicroscopy, without an epithelial defect. Further healing was unremarkable. There were no complaints of lacrimation and photophobia, a feeling of a foreign body. The patient showed visual acuity in both eyes - 1.0.

Claims (1)

FEMTOLAZIK operation scissors containing jaws cross-hingedly connected to each other, provided with curved working ends on one side that interact with each other to carry out the cutting process, and on the other hand, each jaw is equipped with a handle, spring-loaded connected to the other handle, characterized in that the workers the ends of the branches are simultaneously bent along the radius of the averaged circumference of the flap to be cut, the branch located below during cutting is shortened relative to the other branch and the end of its rounds linen.

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