RU2717709C1 - Method for phacoemulsification of cataract on eyes with small anterior chamber - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For phacoemulsification of mature cataract on the eyes with a small anterior chamber, a viscoelastic is introduced into the anterior chamber through the paracentesis. Inadequate cavity of anterior chamber and presence of intraocular hypertension are stated. Thereafter, through the paracentesis in the flat part of the ciliary body, the vitrectomy cutter tip is brought into the vitreal cavity through port with 23G calibre and 6 mm height, and before the introduction on the tip a limiter is placed in the form of a polymer tube with calibre 22G, wherein the tube is put on against the stop, leaving the distal end of the vitreous cutter tip free for 10 mm. Tip is inserted into the vitreal cavity perpendicular to the sclera, and during the vitrectomy it is held in this position. Performing a partial anterior vitrectomy and phacoemulsification with front access.

EFFECT: method eliminates operational and postoperative complications accompanying phacoemulsification of cataract due to non-traumatic deepening of a small anterior chamber, and also increases visual functions of the eye.

1 cl, 1 ex

Description

The invention relates to medicine, in particular to ophthalmology, and is intended to perform phacoemulsification of cataracts in the eyes with a shallow anterior chamber.

There is a method of deepening the shallow anterior chamber during surgical interventions on the anterior segment of the eye in situations with increased pressure in the posterior segment of the eye, with nanophthalmos, large swelling lens size, traumatic damage to the anterior segment (RF patent No. 2237455). The essence of the method of deepening the anterior chamber is that after the introduction of the viscous preparation through paracentesis in the cornea into the anterior chamber, paracentesis is performed in the flat part of the ciliary body to a depth of 2-3 mm, then a new portion of the viscose preparation is added to the anterior chamber and then the incision is opened in the flat part of the ciliary body and, while continuing to feed the viscometer into the anterior chamber, a portion of the vitreous is released to the outside, repeat this technique until the optimal depth of the anterior chamber is obtained.

The disadvantage of this method is that the release of a portion of the vitreous to the outside with this technique is poorly controlled and, due to traction, can cause retinal detachment.

There is a way to deepen the anterior chamber in front of the eyes with nanophthalmos with a narrow pupil or dense cataract. The essence of the method is that through the flat part of the vitreous humor, a partial vitrectomy is performed using a vitreotome. At the same time, a marker is applied to the tip of the vitreotome to prevent excessive immersion of the tip into the vitreous body and damage to the retina (Rosa Braga-Mele, MD, FRCSC, Nastasia Nianiaris, El-Karim Rhemtulla, MD, FRCSC, Pars Plana in Nanophthalmos-a-small gauger procedure with a sutureless, self-sealing incision facilitates phacoemulsification and the implantation of a foldable IOL in abnormally smoll eyes // FRCSC-Cataract and Refractive surgery today. - February. - 2008 - P. 42-47 - prototype).

The disadvantage of the described method is the inability to constantly monitor the immersion depth of the vitreotome tip in opaque environments (for example, an opaque lens). The applied mark may not be visible or erased during manipulations with the tip, especially if it is necessary to simultaneously conduct vitrectomy and evaluate ophthalmotonus by pressing the eyeball with a spatula. As a result, a deeply inserted tip can damage the retina. Also, the article does not say how far from the distal end of the vitreotome the label is located.

The objective of the invention is to develop a reliable, non-invasive and non-costly way to perform phacoemulsification of cataracts in the eyes with a shallow anterior chamber.

The technical result obtained as a result of solving this problem consists in an atraumatic deepening of the shallow anterior chamber, eliminating surgical and postoperative complications when performing cataract phacoemulsification, and increasing the visual functions of the eye.

The specified technical result can be obtained if in the method of phacoemulsification of mature cataract in the eyes with a shallow anterior chamber, including the introduction of viscoelastic into the anterior chamber through paracentesis, ascertaining an insufficient deepening of the anterior chamber and the presence of intraocular hypertension, after which an institution through paracentesis in the flat part of the ciliary body of the tip vitreotoma, performing partial anterior vitrectomy and then performing anterior access phacoemulsification, according to the invention a threotome is inserted into the vitreous cavity through a port with a caliber of 23G and a height of 6 mm, and before insertion, a stopper in the form of a tube made of polymer with a caliber of 22G is put on the tip, and they are put on the tube until it stops, leaving the distal end of the vitreotome tip free for 10 mm, while the tip is inserted into the vital cavity perpendicular to the sclera and during vitrectomy hold it in this position.

Among the essential features characterizing the method, the distinguishing ones are:

- the tip of the vitreotome is inserted into the vitreous cavity through a port with a caliber of 23G and a height of 6 mm,

- before the institution on the tip put on the stopper in the form of a tube of polymer caliber 22G,

- moreover, they put on the tube until it stops, leaving the distal end of the vitreotome tip free for 10 mm,

- at the same time, the tip is inserted into the vital cavity perpendicular to the sclera and during vitrectomy it is held in this position.

Between the totality of the essential features and the claimed technical result, there is a causal relationship.

The presence of a shallow anterior chamber of the eye does not allow traditional phacoemulsification to be performed atraumatically (it threatens to damage the corneal endothelium).

It is required to deepen the front camera. Reception of a shallow anterior chamber by partial anterior vitrectomy using a vitreotome is known.

We proposed to perform partial anterior vitrectomy using a 23G caliber port, the port height is 6 mm, through which the tip of the vitreotome is inserted. To prevent deep uncontrolled immersion of the vitreotome tip in the vitreous body with possible damage to the intraocular structures, a tube is placed on the vitreotome tip - a stopper that prevents the tip from immersing to a dangerous depth. A sterile intravenous catheter of caliber 22G (0.9 × 25 mm) made of polymer is taken as a stopper tube, it is cut to the desired length. After calculations, we determined the optimal length of the tube, it was 20 mm, while it is put on the tip until it stops, leaving the distal end free.

The entire length of the tip of the 23G Vitreotome is 30 mm. Therefore, the distal end, on which the tube is not mounted, will be 10 mm (30 mm - 20 mm = 10 mm). From our practice, we have found that it is possible to perform partial anterior vitrectomy atraumatically if the distal end of the vitreotome tip extends beyond the distal part of the port by 4 mm (for any eye length). Moreover, one more condition must be observed: the tip should be inserted into the vital cavity perpendicular to the sclera and during vitrectomy it is necessary to keep it in the same position (meaning directivity), otherwise the lens can be damaged. Thus, we showed that, using a port with a height of 6 mm for vitrectomy, through which the tip of the vitreotome was brought, and this value is 10 mm, since the worn restrictor tube will not allow the tip to be inserted into the port, the distal part of the port will stand the tip of the vitreotome 4 mm long (10 mm - 6 mm). What was required in order to conduct partial anterior vitrectomy atraumatically, as a result, deepen the anterior chamber to normal and perform atraumatic phacoemulsification of cataracts by anterior access.

The method is as follows. The beginning of surgery in the anterior segment of the eye is traditional. Corneal paracentesis is performed, mydriatic is introduced, the anterior chamber is filled with viscoelastic, and if the surgeon sees that the chamber does not deepen to the optimal size, intraocular hypertension is observed, then the developed method is applied. That is, a 22G sterile intravenous cannula (0.9 * 25 mm) is taken and cut to a length of 20 mm. The cannula is put on the tip of the vitreotome 23 G (its length is 30 mm) and brought to

stop, while the distal end of the tip remains free (not covered by the tube), its length is 10 mm Then port 4G is installed 4 mm from the limbus and the tip of the vitreotome is inserted through the port into the vitreous body perpendicular to the sclera. The limiter does not allow the vitreotome needle to enter the port more than 10 mm, while the vitreotome needle will extend 4 mm beyond the distal end of the port (port height - 6 mm). Partial anterior vitrectomy is performed until normal ophthalmotonus is achieved, which is determined by pressing the eyeball with a spatula. An additional portion of viscoelastic is introduced into the anterior chamber, and upon obtaining the optimal size of the anterior chamber, they proceed to phacoemulsification with front access.

Example. Patient N., 66 years old, was admitted with a diagnosis

OD: stage III angle-closure glaucoma, pressure-compensated using antihypertensive drops, complicated swelling cataract

OS: stage III angle-closure glaucoma, with compensated pressure using antihypertensive drops, complicated swelling cataract

On admission:

VOD = 0.01 n / k

VOS = pr.certae

IOP Pi OD = 12 mmHg; Pi OS = 14 mmHg

On OST, the depth of the anterior chamber is OD 680 microns.

PZO OD - 20.0 mm

PZO OS - 19.93 mm

Surgery was performed on the right eye.

Operation progress:

According to the claimed invention, an intraoperative deepening of the anterior chamber to an optimal value (3.0 mm) was carried out, which made it possible to perform atraumatic cataract phacoemulsification with implantation of a posterior chamber IOL without damaging the corneal endothelium.

On the first day after surgery:

VOD = 0.7

IOP Pi OD = 7 mmHg

The depth of the anterior chamber is 3.4 mm.

The eye is calm, the cornea is transparent, the moisture in the anterior chamber is transparent, the IOL in the capsule bag is centered.

When appearing after 1 month:

VOD = 0.6 sph + 0.5D = 0.8

IOP Pi 0D = 12 mmHg

The eye is calm, the cornea and optical media are transparent, the IOL is centered. Changes in the vitreous body are not observed. Thus, the used method of introoperative deepening of the anterior chamber made it possible to atraumatically perform a partial anterior vitrectomy, deepen the anterior chamber to an optimal value and perform phacoemulsification of complicated cataract by anterior approach.

Using the described method, 12 patients were operated on at the Yekaterinburg center of the IRTC "Eye Microsurgery". In all cases, the proposed method allowed us to deepen the anterior chamber to optimal sizes and perform the planned surgical interventions successfully, without damaging the posterior lens capsule and retina.

Claims (1)

A method for phacoemulsification of a mature cataract in the eyes with a shallow anterior chamber, including the introduction of viscoelastic into the anterior chamber through paracentesis, ascertaining an insufficient deepening of the anterior chamber and the presence of intraocular hypertension, then introducing a vitreotome tip through a paracentesis in the flat part of the ciliary body, performing a partial anterior vitrectomy and then performing front access phacoemulsification, characterized in that the tip of the vitreotome is introduced into the vitreous cavity through a port of caliber 2 3G and a height of 6 mm, and before starting the tip, they put on a stopper in the form of a tube made of polymer with a caliber of 22G, and put on the tube until it stops, leaving the distal end of the vitreotome tip free for 10 mm, while inserting the tip into the vitreous cavity perpendicular to the sclera and during vitrectomy holds him in that position.