RU2714161C1 - Method for combined removal of viscoelastic from capsule of crystalline lens during phacoemulsification - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology. After removal of viscoelastic by irrigation-aspiration method 25G scissors perform 4–6 radial incisions of anterior capsule of crystalline lens. Incision is made from an edge of capsulorhexis to its equator with an output beyond the edge of the optical part of the implanted intraocular lens by 1–2 mm, through which the viscoelastic is independently evacuated from the capsule of the lens.

EFFECT: method enables maximally complete removal of the viscoelastic from the capsule of the lens following phacoemulsification, excluding the development of postoperative complications caused by presence of viscoelastic remains in the capsule of the lens.

1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of cataracts.

The main purpose of using viscoelastic in cataract surgery is the intraoperative maintenance of the depth of the anterior chamber of the eye and the protection of the corneal endothelium by the distance from possible intraoperative injuries. At the same time, the presence of residues of dispersed or cohesive viscoelastics in the lens capsule (KC) is one of the factors for the development of various complications after phacoemulsification (PE), such as hypertension, secondary cataract, uveitis, as a result of which the necessary technological condition for PE is the complete removal of viscoelastic from eyes (Aznabaev M.T. Optimization of IOL implantation for the prevention of capsule block / M.T. Aznabaev, G.F. Yakupova, G.A. Azamatova // EACO Collection. - 2008. - P. 269-275.). The above complications arise due to the structural features of the biochemical structure of viscoelastics, consisting of solutions of hydroxypropyl methylcellulose or sodium hyaluronate, capable of acting as sensitizing immunocompetent agents or their properties as a medium containing infectious agents (Lillian C. Becker. Final Report of the Safety Assessment of Hyaluronic Acid Potassium Hyaluronate, and Sodium Hyaluronate // International Journal of Toxicology. - 2009. - Vol. 28. - No. 4S July / August. - P. 5-67).

The main problem of removing viscoelastic from the eye is its localization at the final stage of PV. Viscoelastic, introduced initially to make a technological hole (capsulorexis) in the anterior KX leaflet through which the native lens will subsequently be removed, is located in the anterior chamber of the eye and is able to passively evacuate with a balanced solution current through a phacoemulsifier needle and an irrigation-aspiration system when the nucleus is removed lens and its cortical masses. However, viscoelastic administered repeatedly before implantation of an intraocular lens (IOL) is able to freely enter the lens capsule (KX) and remain there at the final stage of the operation. Depending on the location of viscoelastic, its effect on the nature of the course of the postoperative period may be different. So, the remnants of viscoelastic in the anterior chamber of the eye can independently be removed from the eye through its drainage system (Malyugin B.E., Shpak A.A., Morozova T.A. Cataract surgery: clinical and pharmacological approaches. - Moscow, 2015. - 82 from.). More dangerous is the presence of viscoelastic residues in the capsule bag. Due to the fact that any viscoelastics are able to hydrate with an increase in their volume, they exert pressure on the intraocular lens (IOL), shifting it anteriorly. Since the opening of capsulorexis, preferably for the prevention of secondary cataract, is smaller than the diameter of the optical part of the IOL, the displacement of the IOL in front leads to its close contact with the anterior KX and the development of the capsule block. The presence of the capsule block eliminates the possibility of spontaneous removal of viscoelastic from the CH and, depending on its amount, leads to the development of secondary glaucoma, reactive inflammation and secondary cataract (Sugiura T., Miyauchi S., Eguchi S. et al. Analysis of liquid accumulated in the distended capsular bag in early postoperative capsular bloc syndrome // J. Cataract Refract. Surg. - 2000. - Vol. 26. - P. 420-425.).

The most famous and widely used prototype method for removing viscoelastic from the anterior chamber of the eye and from the CH is an irrigation-aspiration method using special cannulas used to evacuate cortical lens masses and maintain the depth of the anterior chamber of the eye.

The disadvantages of the prototype method are:

1. The lack of objective and subjective methods for controlling the complete evacuation of viscoelastic due to its transparency;

2. The evacuation of viscoelastic occurs only in the area located directly near the opening of the suction cannula;

3. The sectoral zone of action of the suction cannula is limited to the standard incision and paracentesis of the cornea and may have zones inaccessible to its action and removal of viscoelastic;

4. The equatorial sections of the CH are practically inaccessible for access of the aspiration system, especially with a small diameter of capsulorexis due to the rigid pupil, because due to the high risk of damage (rupture) of the anterior and posterior CH with loss of the vitreous body, it is impossible to freely manipulate the aspiration system and cannula.

5. The impossibility of complete removal of viscoelastic in the presence of weakness of the zonal support of CH (subluxation of the lens), because due to the high probability of iatrogenic destruction of the fibers of the zinc ligament and intra- or postoperative displacement of the SC with the IOL relative to the central optical axis, the introduction of an aspiration cannula into the SC and the movement of the cannula in the capsule is very difficult.

The objective is to propose a method of technically simple and effective combined removal of viscoelastic from KH.

The technical result is the most complete combined removal of viscoelastic from CH after PE, the exclusion of the development of postoperative complications due to the presence of residues of viscoelastic in CH.

The technical result is achieved by the fact that during the PE after implantation of the IOL and removal of the viscoelastic by the phacoemulsifier irrigation-aspiration system from the anterior chamber of the eye and the CH, 25G scissors inserted through the main or additional corneal incisions perform 4-6 radial incisions of the anterior CH from the edge of the capsulorexis to its equator with an exit beyond the edge of the optical part of the IOL by 1-2 mm. After the operation, through the incisions made, viscoelastic can freely leave the CH in the anterior chamber of the eye, from which it is independently evacuated through the drainage system of the eye during the first days after the operation.

The advantages of the proposed method:

1. Technical simplicity;

2. The absence of the need to control the presence of residues of viscoelastic in CH after completion of PV;

3. The possibility of applying the method for any diameter of capsulorexis and pupil;

4. The absence of intra- and postoperative complications with weakness of the zinc cords, in the presence of a rigid pupil;

5. Guaranteed no risk of secondary glaucoma.

Example 1. Patient B., 62 years old, was operated on for age-related cataracts by the PE method with IOL implantation. A complicating factor in the operation was the presence of a rigid pupil (5 mm in conditions of drug mydriasis). During the operation, after removing the viscoelastic from the anterior chamber of the eye and the CH with the phacoemulsifier irrigation and aspiration system, 25G scissors performed 4 radial incisions of the anterior CH from the edge of the capsulorexis to its equator through the main and additional sections of the cornea, leaving 1-2 mm On the 1st day after the operation, a bimicroscopic examination of the IOL-KX interface revealed the presence of a small amount of viscoelastic in it. On the 2nd day after surgery, viscoelasticity in the CH was not found.

Example 2. Patient P., 78 years old, underwent PV of an immature immature cataract with IOL implantation. The factors complicating the operation were the presence of a rigid pupil (4.5 mm in conditions of drug mydriasis) in combination with a pronounced weakness of the zinc ligaments. During the operation, after the viscoelastic was removed from the anterior chamber of the eye and the CH by the phacoemulsifier irrigation and aspiration system, 25G scissors, through the main and additional corneal incisions, 6 radial incisions of the anterior CH were performed from the edge of the capsulorhexis to its equator with 1- beyond the edge of the optical part of the IOL 2 mm. On the 1st day after the operation, the presence of residues of viscoelastic for IOL was revealed, on the 2nd day after the operation, viscoelastic was not determined in the CC.

Claims (1)

A method for the combined removal of viscoelastic from the lens capsule during phacoemulsification, including the use of an irrigation-aspiration system of the phacoemulsifier, characterized in that after removing the viscoelastic by the irrigation-aspiration method, 25G scissors perform 4-6 radial incisions of the anterior lens capsule from the edge of the capsulorhexis to the edge of the capsulorexis to exit the optical part of the implanted intraocular lens is 1-2 mm through which the viscoelastic is independently evacuated from the lens capsule.