RU2790786C1 - Method for local vitreous herniation in complicated cataract surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology. The presence of straits of vitreous body fibres to the area of surgical accesses is checked by touching the distal part of the swab directly to the incision. Then a microsurgical spatula is inserted into the anterior chamber, without exerting pressure on the surgical accesses, with a circular motion of the spatula the remaining vitreous body fibres are separated from the incisions from the inside, directing them to the site of the primary prolapse. A methylcellulose based viscoelastic is introduced, a Simcoe Irrigation Aspiration Cannula is inserted into the anterior chamber, a vacuum is created, the remaining vitreous fibres are pulled into the infusion opening of the cannula. Then, collet scissors are used to cut off the residual vitreous body fibres partially inserted with the spatula. The cut off vitreous fibres are removed from the anterior chamber using collet tweezers. Then, a methylcellulose based viscoelastic is added to the anterior chamber so that the place of previously dropped vitreous fibres is pushed back. In case of presence of straits of vitreous body fibres to the area of surgical accesses, those are glued to the distal part of the swab, the adhered fibres are cut off with microsurgical scissors and inserted in with a microsurgical spatula into the anterior chamber. In particular case, if necessary, the described procedure is performed again. EFFECT: method allows to reduce the risks of intra- and postoperative complications, reduce the risk of traction effect on the structures of the posterior segment (retina), and reduce the risk of retinal detachment.

2 cl, 2 dwg

Description

The invention relates to the field of medicine, namely to ophthalmology, and is intended for the elimination of vitreous hernias as part of the surgical treatment of complicated cataracts.

During the surgical treatment of cataracts, prolapse of the vitreous body (VST) into the anterior chamber of the eye and / or beyond it, for example, into the area of operative accesses (into the surgical wound), which is called a hernia of the vitreous body (VST), is possible.

This phenomenon can be triggered by the peculiarities of the anatomical structure of the anterior segment of the eyeball (defect of the zonium ligament of age-related or traumatic origin, anatomical changes in the posterior capsule of the lens bag, etc.) or a violation (features) of the surgical technique.

In turn, VST necessarily requires the surgeon to perform a number of surgical procedures that allow to complete the surgical intervention with a minimum risk of intra- and postoperative complications. Intraoperative complications include: progressive SST into the surgical wound, which violates the tightness of surgical approaches, the inability to implant and position the intraocular lens (IOL), violation of the anatomical and topographic relationships of the structures of the anterior and posterior segments of the eye (vitreoretinal traction, intraoperative retinal detachment). Postoperative complications of VST include: dislocation and decentration of the IOL, infectious complications associated with the lack of tightness of surgical approaches due to the insertion of vitreous body fibers into them, traction-rhegmatogenous retinal detachment, destruction of the corneal endothelium, provoked by the contact of the vitreous body with corneal endothelium. Depending on the volume of the TSA, it is divided into local and extensive GTS.

To prevent the development of intra- and postoperative complications of all types of HST (local and volumetric), the standard technology for removing the prolapsed vitreous body is traditionally used by using a vitreotome (a mechanical knife for removing the vitreous body with the function of taking the contents inside itself). Vitreotome is inserted into the surgical wound on the one hand, on the other hand, various systems are introduced to supply fluid to the anterior chamber of the eye. Through the operation of the vitreotome knife and the supply of liquid, mechanical watering and removal of the vitreous body in the area of its prolapse is performed.

The disadvantage of this technology is the fact that by watering the vitreous body, it is additionally ejected into the anterior chamber, requiring more active work of the vitreotomy and a more complete volume of the removed vitreous body. Due to these phenomena, the volume of surgical intervention and the volume of the removed vitreous body increases many times. Moreover, the mechanically removed vitreous body exerts additional traction on the vitreoretinal structures and provokes a multiple risk of developing retinal detachment in the early and late postoperative periods. Thus, this method of removing the vitreous body realizes the potential risk of developing intra- and postoperative complications. This method is justified only in cases of extensive HTS, when alternative manipulations are not possible.

The problem to which the invention is directed is the creation of a minimally invasive effective method for eliminating local vitreous hernias that form during cataract surgery.

The technical result of the claimed invention is to reduce the risk of intra- and postoperative complications, reduce the risk of traction effects on the structures of the posterior segment (retina), reduce the risk of retinal detachment, which can be triggered by a large volume of the vitreous to be removed.

The technical result is achieved due to the fact that in the method of eliminating a local hernia of the vitreous body in complicated cataract surgery, which includes checking for the presence of vitreous fibers in the area of surgical accesses, by touching the distal part of the tupfer directly to the incision, if there are fibers, they are glued to the distal parts of the tupfer, adhered fibers are cut off with microsurgical scissors, then a microsurgical spatula is inserted into the anterior chamber, without exerting pressure on the surgical accesses, the remaining fibers of the vitreous body are separated from the incisions from the inside by a circular motion of the spatula, directing them to the site of primary loss, viscoelastic based on methylcellulose is injected to maintain the volume of the anterior chamber, an irrigation-aspiration cannula is inserted according to "Simco" into the anterior chamber, a vacuum is created, the remaining vitreous fibers are pulled into the infusion hole of the cannula, then with the help of collet intracameral scissors c cut off the residual, partially filled with a spatula, vitreous fibers, then remove the cut vitreous fibers from the anterior chamber using collet tweezers, add methylcellulose-based viscoelastic to the anterior chamber, in such a way as to squeeze out the place of the previously dropped out vitreous fibers, if necessary, the described manipulations are carried out again.

The method is carried out as follows.

With local HTS, depending on their localization, the surgeon checks for the presence of vitreous body fibers in the area of surgical accesses by touching the distal part of the tupfer directly to the incision. If there are fibers, they are glued to the distal part of the tupfer. Then she cuts off the adhered fibers with microsurgical scissors, thereby shortening the volume of the fallen fibers into the surgical access as much as possible (the effect of contraction of the vitreous body fibers). Next, the surgeon inserts a microsurgical spatula into the anterior chamber without exerting pressure on the operating approaches to minimize the risk of emptying the anterior chamber. The entrance is carried out through access with the smallest diameter, for example through paracentesis. With a circular motion of the spatula, the surgeon separates the remaining fibers of the vitreous body from the incisions from the inside, directing them to the site of the primary prolapse. To maintain the volume of the anterior chamber, viscoelastic based on methylcellulose is introduced. Then the surgeon inserts the Simco irrigation and aspiration cannula into the anterior chamber and, creating a vacuum (on his own or with the help of an assistant), pulls up the remaining vitreous fibers and the infusion hole of the cannula, after which, using collet intracameral scissors, cuts off the residual vitreous fibers pulled into the cannula. body (the second effect of contraction of the vitreous body fibers). Using collet tweezers, cut vitreous fibers are removed from the anterior chamber. After that, a methylcellulose-based viscoelastic is added to the anterior chamber in such a way as to squeeze out the place of the previously dropped vitreous fibers (pressing effect). If necessary, these manipulations can be repeated.

The proposed method for eliminating local HTS can be used at any stage of cataract treatment.

The claimed method is illustrated by the following clinical cases.

Example #1. Patient K. was operated on for a complicated cataract in the right eye. Intraoperatively, there was a rupture of the posterior lens capsule, which was complicated by prolapse of the CT into the anterior chamber. By touching the eyepiece directly to the incision, the CT fibers were cut with microsurgical scissors, then tucked into the anterior chamber with a microsurgical spatula, then methylcellulose-based viscoelastic was introduced to maintain the volume of the anterior chamber, and the remaining the vitreous body fibers were pulled into the infusion hole of the cannula and cut using collet intracameral scissors. This was followed by IOL implantation. The operation ended without complications. The postoperative period was unreactive with a high functional and anatomical result.

Example No. 2. Patient S. Was operated on for an immature cataract in the left eye. Intraoperative rupture of the posterior capsule occurred after IOL implantation. Using a tupfer, the CT fibers were cut with microsurgical scissors and filled with a microsurgical spatula into the anterior chamber (the site of the primary prolapse). The volume of the anterior chamber was filled with methylcellulose. Using the Simco irrigation-aspiration cannula, the remnants of the CT fibers were pulled into the infusion hole of the cannula in a standard way and cut off. Surgery ended with washing the anterior chamber. A high functional and anatomical result was obtained in the early postoperative period.

The advantages of this method lie in the fact that only that part of the vitreous body fibers that has entered the anterior chamber and/or the area of surgical accesses is removed. The remainder of the fibers are shortened, sheared and/or tucked into their original anatomical position. Thus, the risk of traction impact on the structures of the posterior segment (retina) is minimized to the maximum, all anatomical formations (vitreous body) remain intact, and the risk of retinal detachment in the postoperative period, which can be triggered by a large volume of the removed vitreous body, is minimized.

Claims (3)

1. A method for eliminating a local hernia of the vitreous body in complicated cataract surgery, including checking for the presence of vitreous body fibers in the area of surgical accesses, by touching the distal part of the tupfer directly to the incision, then inserting a microsurgical spatula into the anterior chamber, without exerting pressure on the surgical accesses, in a circular fashion by moving the spatula, the remaining fibers of the vitreous body are separated from the incisions from the inside, directing them to the site of primary prolapse, viscoelastic based on methylcellulose is introduced, the irrigation-aspiration cannula is inserted according to "Simco" into the anterior chamber, a vacuum is created, the remaining fibers of the vitreous body are pulled into the infusion hole cannula, then with the help of collet intracameral scissors, the residual vitreous fibers partially filled with a spatula are cut off, the cut fibers of the vitreous body are removed from the anterior chamber with the help of collet tweezers, then methylcellulus-based viscoelastic is added oses into the anterior chamber in such a way as to squeeze out the place of the previously dropped out fibers of the vitreous body. 2. The method according to claim 1, characterized in that if there is an exit of the vitreous body fibers into the area of surgical accesses, they are glued to the distal part of the tupfer, the adhered fibers are cut off with microsurgical scissors and filled with a microsurgical spatula into the anterior chamber. 3. The method according to claim 1, characterized in that, if necessary, the described manipulations are carried out again.