RU2742736C1 - Method for deposition iol-capsular bag dislocated complex - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For reposition of the dislocated IOL-capsular bag complex, limbal paracentesis and scleral puncture are formed. First, a polypropylene filament is made in an injection needle combined with a hollow handle, forming a loop from the pricked end; the needle is bent at an angle with the needle cut upwards. At 2.5 mm from the limb in the projection of the haptic element, a through puncture of the sclera and the ciliary body by the injection needle is performed, and after alignment of the IOL-capsular bag complex, located under it, the capsular bag is perforated in the projection of the pupil, at the point of optic-haptic transition from one side of the haptic element. First loop is removed into a paracentesis; after that, the needle is brought under the haptic element from the other side, and after perforation of the capsular bag in the projection of the pupil, the second loop is removed from the anterior chamber into the same paracentesis. After the needle is removed from the eye, the first and second loops are dissected. Duplicate portion of the suture is removed, and the remaining ends of the suture are interconnected by nodes to form a third loop, which is immersed into the anterior chamber, and then through the pupil into the posterior chamber, and fixed on the surface of the IOL-capsular bag complex. Further, the same actions are performed with the second haptic element of the IOL using the same paracentesis. Thereafter, the IOL-capsular bag complex is fixed to the sclera to allow immersing the formed nodal suture into a space between the episcler and tenon membrane.

EFFECT: method reduces invasiveness of reposition of the dislocated complex IOL-capsular bag, increases reposition efficiency, reduces the risk of eye tissue injuries.

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Description

The invention relates to the field of medicine, namely to ophthalmology, and is intended for reposition of the dislocated complex "IOL-capsule bag" in patients with previously conducted phacoemulsification and intracapsular IOL implantation.

The known method of reposition of the dislocated complex "IOL-capsule bag", described in patent RU 2691925, 3.27.09.2018, op. 06/18/2019, chosen as the closest analogue, including the formation of 2.5 mm from the limbus in opposition to one of the oblique meridians of two through punctures of the sclera and ciliary body in the projection of the haptic elements with a 25 or 23 G needle, respectively. Above the puncture sites, one limbal paracentesis of the cornea is formed and in the perpendicular oblique meridian - two more diametrically located limbal paracentesis of the cornea. Through one of the scleral punctures (the first puncture), a needle with a thread in the form of a loop is passed with the back of the IOL forward without touching it, then the back of the needle is pulled out through the corneal paracentesis, located 90 angular degrees from the first puncture. After that, a guide needle 25 or 23 G is inserted into the first puncture under the IOL-capsule bag complex, in the area of the proximal haptic element, and the IOL is centered, the cutting part of the needle with a thread is passed through the guide needle and brought out through the first puncture. Then, a noose loop is formed from the outside, which is tightened on the IOL haptic element. A needle with a thread is inserted into the first puncture and passed intrascleral and intracorneally through both lips of the paracentesis closest to this puncture, the needle with the thread with the back side is taken out of the paracentesis, an "anchor" knot is formed, the remainder of the thread with the needle is cut off, and the knot is immersed in paracentesis. The same surgical actions are performed from the opposition side through the second scleral puncture.

The disadvantage of this method is a large invasion associated with the formation of four paracenteses, using the needles of the conductors 23 and 25G. In addition, a large number of manipulations in the anterior chamber (holding the needle with the back side and then reverse its stroke) increases the risk of trauma to the eye tissues and increases the risk of hemorrhagic complications.

The problem of the claimed invention is the development of an effective and low-traumatic method of reposition and fixation of the dislocated complex "IOL-Capsule bag".

The technical result is to reduce invasiveness in the process of implementing the method of reposition of the dislocated complex "IOL-capsule bag", to increase the efficiency of reposition of the dislocated complex "IOL-capsule bag", to reduce the risk of injury to eye tissues.

To achieve the claimed technical result in the method of reposition of the dislocated complex "IOL-capsule bag", including the formation of limbal paracentesis and scleral puncture, according to the invention, a polypropylene thread is preliminarily passed into an injection needle 30G, combined with a hollow handle, forming a loop from the pricking end, the needle is bent at an angle of 120-140 ° with the cut of the needle up, then in the upper sector a limbal paracentesis is formed, through which a viscoelastic is introduced into the anterior chamber, after which a through puncture of the sclera and ciliary body is made with an injection needle at 2.5 mm about the limbus in the projection of the haptic element, and after centering the "IOL-capsule bag" complex by means of an injection needle located under it, the capsule bag is perforated in the projection of the pupil, at the place of the optical-haptic transition on one side of the haptic element, as shown in FIG. 1, and using a hook, the formed first loop is brought out into the paracentesis, after which the needle is brought under the haptic element from its other side, and after perforation of the capsule bag in the projection of the pupil, the second loop is brought out of the anterior chamber by means of the hook into the same paracentesis, as shown in Fig. ... 2, and after removing the needle from the eye, the first and second stitches are cut as shown in FIG. 3, the duplicate part is removed, and the remaining ends of the thread are knotted together to form a third loop, as shown in FIG. 4, which by pulling the free ends of the thread emerging from the sclerotome is immersed in the anterior chamber, and then through the pupil into the posterior chamber, and fixed on the surface of the "IOL-capsule sac" complex, then the same actions are performed from the opposite side, with the second haptic element IOL, using the same paracentesis, after which the complex "IOL-capsule bag" is fixed to the sclera by forming at least two nodes at the free ends of the threads emerging from each sclerotome, and after cutting off the ends of the threads that are melted by an electrocoagulator, tighten with scleral forceps the conjunctiva in the area of the formed nodal suture, ensuring its immersion in the space between the episclera and the tenon membrane.

The invention is illustrated by drawings.

FIG. 1 schematically depicts a method of repositioning a dislocated complex "IOL-capsule bag", perforation of the capsule bag.

FIG. 2 - the same, removing the first and second loops through paracentesis.

FIG. 3 - the same, two loops formed around one haptic element.

FIG. 4 - the same, the threads of the first and second loops, after removing the duplicate part, connected to each other to form the third loop.

The method is carried out as follows.

Preliminarily, a thread 2 of polypropylene 9-0 10 cm long is passed into the injection needle 30G (1), combined with a hollow handle, forming the first loop 3 5 cm long from the piercing end, the other end of the thread 2 remains free. In the upper sector, a limbal paracentesis 4 is formed, through which a viscoelastic is introduced into the anterior chamber. With a needle holder, the needle 1 is bent at an angle of 120-140 ° with the needle cut up. At 2.5 mm from the limbus in the projection of the haptic element, the injection needle 1 is used to puncture the sclera and ciliary body. Using the needle 1, located under the complex "IOL-capsule bag" 5, the dislocated complex 5 is centered, while determining the localization of the haptic elements 6.7 of the IOL. Then the capsule bag is perforated at point 8, in the projection of the pupil, at the place of the optic-haptic transition on one side of the haptic element 6, and with the help of a hook the formed first loop 3 is taken out of the anterior chamber into paracentesis 4. After that, the needle 1 is not removed from the formed sclerotoma , and is brought under the haptic element 6 from its other side, and after perforation of the capsule bag at point 9 in the projection of the pupil, the second loop 10 is removed from the anterior chamber into the paracentesis 4. After that, the injection needle 1 is removed from the eye. Thus, thread 2 occupies the following position: two free ends 11,12 of thread 2 exit from one sclerotome formed by needle 1, in paracentesis 4 there are two loops 3 and 10, removed from the eye cavity, covering haptic element 6 on both sides. Both loops 3 and 10 are cut at points 14, 15, the duplicate part 13 is removed, and the free ends 16, 17 of the thread 1 are connected with nodes 18 to form a third loop 19 (these actions are carried out outside the eye cavity), which is pulled by the free ends 11, 12 threads 2 emerging from the sclerotome are immersed in the anterior chamber, and then through the pupil into the posterior chamber and fixed on the surface of the "IOL-capsule bag" complex. Then the same actions are performed from the opposite side with the second haptic element 7 of the IOL, and the same paracentesis is used to remove the thread loops 4. After that, the complex "IOL-capsule bag" 5 is fixed to the sclera, for this the free ends of the thread coming out of each sclerotomes are tied with at least two knots, thus forming stops at the ends of the threads. The ends of the threads are cut off, and additionally melted using an electrocoagulator. Then, using scleral forceps, the conjunctiva is pulled in the area of the formed nodal suture, ensuring its immersion in the space between the episclera and tenon's sheath.

The claimed invention makes it possible to reduce the invasiveness of the method of reposition of the dislocated complex "IOL-capsule bag", to increase the efficiency of reduction, to reduce the risk of injury to the eye tissues.

Clinical examples

1. Patient Sh. Was admitted with complaints of decreased vision in the left eye for 6 months. From the anamnesis, in 2008 she underwent uncomplicated phacoemulsification with the implantation of a monolithic hydrophilic lens on the left eye.

Diagnosis upon admission: dislocation of the "IOL-Capsule bag" complex of the left eye. Artifakia, age-related macular degeneration "dry form" of both eyes. Objective data on admission: VOS = 0.05 Sph + 10.0 = 0.5; P = 11.0

On examination: the left eye is calm, the cornea is smooth, shiny, transparent. The anterior chamber is deep, there are signs of iris subatrophy, pseudoescfoliation along the pupillary margin.

In the pupil, when the patient is sitting behind the slit lamp, the edge of the optical part is visible in the optical center of the pupil, the complex "IOL-capsule bag" is displaced downward. When the patient is lying on the couch, the "IOL-capsule bag" complex is located on the anterior hyaloid membrane.

The fundus of the eye: optic nerve disc b / pink, clear contours, the course and caliber of vessels are normal (A / B = 2/3), in m.o. the presence of "dry" drusen.

Intraoperatively, according to the claimed method, the "IOL-capsule bag" complex was repositioned with transscleral fixation for 11 hours and 5 hours.

On the next day OS, a moderate injection of the conjunctiva in the fixation area at 11 h and 5 h, the position of the IOL-capsule bag complex is correct in the frontal, horizontal and vertical planes. Lack of pseudophacodenesis.

The patient was discharged on the 3rd day after the operation, standard anti-inflammatory and antibacterial treatment was prescribed

On discharge:

VOS = 0.4 Sph-1.0 = 0.6; P = 10.

2. Patient Ch. Was admitted with complaints of visual impairment in the left eye with different body positions, for 6-8 months. In 2015, he underwent phacoemulsification on the left eye with implantation of a monolithic hydrophobic IOL. Of the features, the weakness of the ligamentous apparatus in one of the sectors was noted, an intracapsular ring was implanted.

Diagnosis on admission: dislocation of the IOL-capsule bag complex, pseudophakia of the left eye. Initial cataract, East hyperopia, amblyopia of the 1st stage of the right eye. Axial anisometropia.

Objective data on admission: VOS = 0.55 Sph-1.0 = 0.65; P = 15.

On examination: the left eye is calm, the cornea is smooth, shiny, transparent. The anterior chamber is deep. In the pupil, when the patient is sitting behind the slit lamp, the edge of the optical part of the IOL is visible along the upper edge of the pupil, the complex "IOL-capsule bag" is displaced downward, to the right, when the eye moves to the sides, it changes its position relative to the pupil. When the patient is lying on the couch, the "IOL-capsule bag" complex is located centrally in the pupil.

Intraoperatively, according to the claimed method, the "IOL-capsule bag" complex was repositioned. Transscleral fixation was performed at 11 h and 5 h.

The patient was discharged on the 3rd day after the operation; standard anti-inflammatory and antibacterial treatment was prescribed

On discharge: VOS = 0.85; P = 11.

In both cases, no intraoperative hemorrhagic reactions were observed, and no inflammatory reactions and corneal complications were observed in the postoperative period.

Claims (1)

The method of reposition of the dislocated complex "IOL-capsule bag", including the formation of limbal paracentesis and scleral puncture, characterized in that a polypropylene thread is preliminarily passed into the 30G injection needle, combined with a hollow handle, forming a loop from the pricking end, the needle is bent at an angle of 120- 140 ° cut the needle up, then in the upper sector form a limbal paracentesis, through which a viscoelastic is introduced into the anterior chamber, after which a through puncture of the sclera and ciliary body is made with an injection needle 2.5 mm from the limbus in the projection of the haptic element, and after centering the complex IOL-capsule bag "by means of an injection needle located under it, the capsule bag is perforated in the projection of the pupil, at the place of the optical-haptic transition on one side of the haptic element, as shown in FIG. 1, and using a hook, the formed first loop is brought out into the paracentesis, after which the needle is brought under the haptic element from its other side, and after perforation of the capsule bag in the projection of the pupil, the second loop is brought out of the anterior chamber by means of the hook into the same paracentesis, as shown in Fig. ... 2, and after removing the needle from the eye, the first and second stitches are cut as shown in FIG. 3, the duplicate part is removed, and the remaining ends of the thread are knotted together to form a third loop, as shown in FIG. 4, which by pulling the free ends of the thread emerging from the sclerotome is immersed in the anterior chamber, and then through the pupil into the posterior chamber, and fixed on the surface of the "IOL-capsule sac" complex, then the same actions are performed from the opposite side, with the second haptic element IOL, using the same paracentesis, after which the complex "IOL-capsule bag" is fixed to the sclera by forming at least two nodes at the free ends of the threads emerging from each sclerotome, and after cutting off the ends of the threads that are melted by an electrocoagulator, tighten with scleral forceps the conjunctiva in the area of the formed nodal suture, ensuring its immersion in the space between the episclera and the tenon membrane.

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