RU2731819C1 - Method of iridoplasty in post-traumatic ectopia of pupil - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For iridoplasty to form and center the pupil, 2 corneocentesis is performed. Anterior chamber is filled with an adhesive-and-cohesive highly elastic preparation. Microscissors 23g perform dosed iridotomy in posttraumatic coloboma meridian. Ends of dissected iris to limb are fixed by two iris retractors. Corneal incision of 2.2 mm is formed by calibrated disposable keratome. Phacoemulsification is carried out using a conventional method. Elastic IOL model is implanted into the capsular sac. Iris retractors are removed. Nodal sutures are sequentially applied on area of posttraumatic coloboma by closed iridoplasty method, thus forming lower pupillary edge. Upper pupillary edge is formed by applying interrupted sutures on the edges of a dissected iris. Dosed resection of the lateral and medial edges of the newly formed pupil is performed by vitrectomy cutter 25 g. Hemostasis in the areas of resection if necessary is performed by co-axial endocoagulant 25 g connected to the control panel of a phaco machine. Then coagulates are applied along formed pupillary edge in segments, which must be tightened to give pupil final round shape. Number and localization of coagulates depend on initial condition of iris.

EFFECT: method enables to achieve high functional result and satisfactory cosmetic effect.

1 cl, 1 ex, 2 dwg

Description

The proposed invention relates to medicine, namely to ophthalmology, and can be used for iridoplasty in order to form and center the pupil. The method allows to achieve a high functional result and a satisfactory cosmetic effect.

Traumatic injuries of the iris and lens are the most frequent and severe outcome of eyeball injuries and occupy a leading place in the structure of visual disability in persons of predominantly young working age. The incidence of iris lesions varies from 33.3 to 84.8% (Fedorov S.N., Egorova E.V., 1985; Venger G.E., 1984; Venger G.E., Rykov S.A., Venger L.V., 2006; Gundorova R.A., Stepanov A.V., Kurbanova N.F., 2007). Damage to the iris is more common with penetrating wounds of the eye (71.6%), less often with contusion of the eyeball (49.8%) (Gundorova R.A., 1986). One of the severe consequences of penetrating eye injuries is partial or complete closure of the pupil, as well as its displacement due to retraction into the corneal or corneal-scleral scar. All this negatively affects the visual acuity of the injured eye even with the preserved transparency of the optical media of the eyeball and can significantly reduce the possible functional result of the operation when removing a traumatic cataract. Post-traumatic iris defects are also a serious cosmetic defect that has a depressing psychological effect on patients.

Reconstructive surgery of the iris (reconstructive surgery on the iris) for the formation and centering of the pupil is one of the leading stages in the complex surgical treatment of post-traumatic pathology of the anterior part of the eyeball and is the most difficult and at the same time promising direction in ophthalmosurgery.

There is a known method of forming the pupil in cases of its absence with full pulling up of the iris to the post-traumatic scar or preserving a small pupil, at the scar, which consists in the following: the anterior chamber is opened with a wide incision along the limbus, after which the iris in the center is grasped with tweezers and excised with scissors Vannas, forming the pupil (Gundorova R.A. Eye trauma. - M: 1986 p. 54).

The disadvantages of this method are the need to perform a large incision for iridoplasty, which increases the likelihood of intra- and postoperative complications. Uncontrolled irectomy of the central parts of the iris does not always allow obtaining a pupil of a given diameter and correct shape.

There is a known method of iridoplasty in the formation of the pupil, including the conduct of radio frequency coagulation of the iris in the area opposite to the displacement of the pupil using the device MIRA - 4000 (USA). (RF patent No. 2125858. Method of iridoplasty).

The disadvantages of this method are the implementation of only the adjustment of the location and shape of the pupil, as well as the need to use a special device for coagulation of the iris.

No 34625, Венгер Е.В.).The closest prototype analogue of the proposed method is a method in which 1-3 knotty sutures are applied transcorneally to the peripheral part of the displaced pupil, which are tied by the method of closed iridoplasty, and then through 2 punctures in the peripheral part of the cornea using collet forceps and scissors, partial iridectomy is performed bimanually in the optical zone until the pupil reaches its normal size (2.5-3 mm) and its central location. (

No 34625, Wenger E.V.).

The disadvantages of the prototype method are: the complexity of dosing the amount of excised iris tissue when manipulating two instruments in the anterior chamber of the eye. In this regard, the difficulty in achieving the correct rounded shape of the pupil. There are also no clear recommendations for hemostasis during iridectomy. The described method does not take into account the need to perform phacoemulsification of traumatic cataract with ectopia of the pupil and, accordingly, the possibility of achieving the necessary mydriasis for this.

The object of the invention is to provide a method for correcting the shape and position of the pupil.

The technical result consists in obtaining high functional results and a satisfactory cosmetic effect.

The specified technical result is achieved due to the fact that the implementation of dosed iridotomy minimizes the traction effects on the iris during the application of iris retractors to achieve mydriasis, which is necessary to perform phacoemulsification of traumatic cataract with pupil ectopia. The imposition of interrupted sutures on the edges of the dissected iris and the edges of the decentralized pupil forms a new upper and lower pupillary edge. Dosed iris resection with a 25 g vitreotome allows the formation of a pupil of a given size. The use of a 25 g coaxial endocoagulator provides hemostasis and the possibility of final correction of the shape and position of the pupil by applying coagulates along the pupillary edge.

Among the essential features that characterize the proposed method distinctive are the following:

- performing a metered iridotomy and fixing the edges of the dissected iris with iris retractors to the limbus to achieve mydriasis, which is necessary for high-quality phacoemulsification;

- performing dosed resection of the iris tissue with a 25g vitreo tome to form the pupil;

- application of coagulates along the formed pupillary edge of the iris with a 25g endocoagulator for final centering of the pupil. For coagulation, a disposable coaxial endocoagulator is used, which is connected through a cable to the standard coagulation port located on the front console of the phacoemulsifier. Due to the electric current, the tip of the endocoagulator heats up and, upon contact with the iris tissue, causes coagulation (denaturation of proteins), which leads to contraction of the iris tissue and pulling the iris to the affected area. The caliber of the coagulator provides targeted point coagulation, minimizing the risk of unnecessary tissue injury. A sparing effect allows you to get the maximum tightening effect and avoid the development of destructive changes and the formation of gross atrophic changes in the iris in the future.

The proposed method is carried out as follows. The operation is performed under local anesthesia. 2 corneocentesis is performed. The anterior chamber is filled with an adhesive-cohesive highly elastic preparation. Microscissors 23g perform dosed iridotomy in the meridian of posttraumatic coloboma. Two iris retractors fix the edges of the dissected iris to the limbus (Fig. 1). A corneal incision of 2.2 mm is formed with a calibrated disposable keratoma. Phacoemulsification is performed in the traditional way. An elastic IOL model is implanted into the capsular bag. The iris retractors are removed. On the area of post-traumatic coloboma, interrupted sutures are sequentially applied by the method of closed iridoplasty, thereby forming the lower pupillary margin. The upper pupillary margin is formed by applying interrupted sutures to the edges of the dissected iris. With a 25 g vitreotome, dosed resection of the lateral and medial edges of the newly formed pupil is performed. Coaxial endocoagulator 25 g connected to the control panel of the facomachine, if necessary, perform hemostasis in the resection areas. Then coagulates are applied along the formed pupillary edge in segments that need to be tightened in order to give the pupil the final rounded shape. The number and localization of coagulates depend on the initial state of the iris (Fig. 2). The operation ends traditionally.

The method is illustrated by the following clinical example:

Patient Z., 64 years old, was admitted to the Irkutsk branch of the National Medical Research Center MNTK Eye Microsurgery with complaints of low vision, cosmetic defect in the left eye. On examination: the cornea is transparent, corneoscleral scar from 3 to 5 hours. The irregular pupil 2.5 mm by 3.0 mm is pulled up to the limbus for 4 hours. VIS OS - 0.08 n.c., IOP - 19 mm Hg. Diagnosis: traumatic cataract, corneoscleral scar, post-traumatic iris coloboma, pupil decentration.

On July 11, 2018, phacoemulsification of traumatic cataract with IOL implantation, iris plasty was performed. Dosed iridotomy at 11 o'clock was performed under local anesthesia with microscissors. The edges of the dissected iris are fixed to the limbus by 2 iris retractors. Phacoemulsification was performed through a 2.2 mm incision in a standard manner. An elastic IOL model is implanted into the capsular bag. Irisretractors removed. On the area of post-traumatic coloboma, 3 interrupted sutures were successively applied by the method of closed iridoplasty, thus forming the lower pupillary margin. The edges of the dissected iris were sutured with 2 interrupted sutures using the closed iridoplasty method, thus forming the upper pupillary edge. For the final formation of the pupil with a 23g vitreo-tom, dosed resection of the iris in the lateral and medial segments was performed. A 25 g microcoagulator performed hemostasis in the resection segments, and the final centering of the pupil was performed by applying coagulates along the formed pupillary margin. After VIS OS surgery - 0.6 n.c., IOP - 18 mm Hg. The patient is satisfied with the functional and cosmetic result. On re-examination after 3 months. the condition is stable.

Claims (1)

The method of iridoplasty for post-traumatic ectopia of the pupil, which consists in performing a dosed iridotomy and fixing the edges of the dissected iris to the limbus with 2 iris retractors to achieve mydriasis, which is necessary for phacoemulsification followed by suturing post-traumatic coloboma and iridotomy, dosed resection of the iris tissue 25g along the newly formed pupillary edge with a 25 g endocoagulator for final centering of the pupil.

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