RU2806507C1 - Method of cataract extraction through hole of optical cylinder of keratoprosthesis (options) - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: according to the first option, coagulation of newly formed vessels is performed in the projection area of the opening of the optical cylinder of the keratoprosthesis (OPC). Then, the tissue is dissected above the OOC to a plug located between the upper and lower parts of the vascular cataract. After finding the plug, it is unscrewed using a key made in the form of a metal cylinder with a diameter of 3.5 mm, a length of 5 cm, on each end of which there are two metal pins, each 0.2 cm long, congruent with the blind holes in the keratoprosthesis plug and in the optical cylinder. After unscrewing the keratoprosthesis plug, the lower part of the vascular cataract is visualized, dissected with a scalpel and scissors, after which the native lens is visualized; the lens capsule is stained with dye, viscoelastic is injected and a circular capsulorhexis the diameter of which corresponds to the diameter of the OOC — 3.5 mm is performed. Next, hydrodissection and hydrodelineation are performed, the lens masses are washed out, and the residual cortical masses are removed using a Simcoe cannula. Then, using a key, the aphakic optical cylinder is screwed in and interrupted sutures are placed around it. According to the second option, the phakic optical cylinder is unscrewed using a key, and the lens capsule is stained with dye. Viscoelastic is injected and a circular capsulorhexis, the diameter of which corresponds to the diameter of the OOC — 3.5 mm is performed. Next, hydrodissection and hydrodelineation are performed, the lens masses are washed out, and the residual cortical masses are removed using a Simcoe cannula. Then, using a key, the aphakic optical cylinder is screwed in and interrupted sutures are placed around it.

EFFECT: group of inventions makes it possible to reduce the risk of intraoperative complications, as well as reduce the time of cataract extraction.

3 cl, 2 dwg

Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used for cataract extraction (EC) in patients during the second stage of keratoprosthesis or in the delayed period after the second stage of keratoprosthesis.

Keratoprosthetics is the only possible way to restore visual functions in patients with vascular cataracts of category 4-5 (according to the classification of V.P. Filatov - D.G. Bushmich, 1947). One of the common concomitant pathologies in patients with vascular leukomas is cataract, which is diagnosed both during keratoprosthesis and after keratoprosthesis in the long-term period. EC in eyes with vascular thorn has its own characteristics and is often an extremely complex manipulation.

There is a known method of EC in a patient after keratoprosthesis, which is the closest analogue of the claimed method (Harissi-Dagher M., Colby K.A. Cataract extraction after implantation of a type I Boston keratoprosthesis // Cornea. - 2008. - Vol.27, No. 2. - P 220-222).

The method involves cutting the sutures after penetrating keratoprosthesis and completely removing the keratoprosthetic complex, consisting of a graft and a keratoprosthesis with an optical cylinder implanted into it. The removed keratoprosthetic complex is placed in a medium for preserving the cornea and then proceeds to EC, which is carried out in an extracapsular way: a circular capsulorhexis with a diameter of 4.5 mm is performed, hydrodissection, hydrodelineation and washing out of the lens masses. Next, a cohesive viscoelastic is injected into the capsular bag and an intraocular lens is implanted. The operation is completed by removing the keratoprosthetic complex from the cornea preservation medium and fixing it with interrupted sutures to the recipient's cornea.

Disadvantages of the method: the absence of an anterior chamber when performing EC, the impossibility of rapid sealing in case of incipient ophthalmic hypertension, the inability to replace the optical cylinder taking into account aphakia, which leads to the need for implantation of an intraocular lens and lengthens the operation time, the risk of trauma to the posterior capsule of the lens and the anterior hyaloid membrane, as well as the risk development of expulsive hemorrhage. In the delayed period, a retroprosthetic membrane may develop, which will require repeated surgical intervention.

The objective of the invention is to create two variants of EC through the opening of the optical cylinder of the keratoprosthesis during the second stage of keratoprosthesis or in a delayed period after the second stage of keratoprosthesis.

To solve this problem, two variants of the method have been developed.

The technical result of both options is to reduce the risk of intraoperative complications by maintaining a relatively sealed anterior chamber in patients during the second stage of keratoprosthesis or in the delayed period after the second stage of keratoprosthesis, as well as reducing the time of cataract extraction.

The method according to the first option, in which EC is performed during the second stage of keratoprosthesis, is carried out as follows.

Coagulation of newly formed vessels is performed in the projection area of the opening of the optical cylinder (OC). Then, with the help of a scalpel, the tissue tissues are dissected above the OOC to the keratoprosthesis plug located between the upper and lower parts of the vascular cataract. After finding the keratoprosthesis plug, it is unscrewed using a key made in the form of a metal cylinder with a diameter of 3.5 mm, a length of 5 cm, on each end side of which there are 2 metal pins (rods) each 0.2 cm long, congruent with the blind holes in the plug keratoprosthesis and in the optical cylinder, the plug is removed, and the lower part of the vascular cataract is visualized.

Next, using a scalpel and scissors, the lower part of the vascular cataract is dissected so that the OOC and its thread are not damaged and are completely cleared of tissue. The lens is visualized through the OOC and its capsule is stained using MembraneBlue dye. The dye is then washed out and viscoelastic is injected. Using collet tweezers, a circular capsulorhexis is performed, the diameter of which corresponds to the diameter of the OOC - 3.5 mm. Next, hydrodissection and hydrodelineation are performed, the lens masses are washed out, and the residual cortical masses are removed using a Simcoe cannula. At the end of the operation, using the key described above, the aphakic optical cylinder is screwed in and interrupted sutures are placed around it.

The method according to the second option, in which EC is performed in a delayed period after the second stage of keratoprosthesis, is carried out as follows.

Unscrew the phakic optical cylinder using the key described above and remove it. The lens is visualized through the OOC and its capsule is stained using MembraneBlue dye. The dye is then washed out and viscoelastic is injected. Using collet tweezers, a circular capsulorhexis is performed, the diameter of which corresponds to the diameter of the OOC - 3.5 mm. Next, hydrodissection and hydrodelineation are performed, the lens masses are washed out, and the residual cortical masses are removed using a Simcoe cannula. To complete the operation, the aphakic optical cylinder is screwed in using the key described above.

Significant differences of this method:

the method allows you to maintain a relatively stable anterior chamber due to the diameter of the optical cylinder of 3.5 mm, which makes it possible to quickly seal the anterior chamber in case of intraoperative complications;

The method makes it possible to speed up the operation, given that there is no need to implant an intraocular lens to achieve optimal visual results, since it is possible to replace the optical cylinder taking into account aphakia.

The method is illustrated by the following examples:

Example 1

Patient B, 63 years old. Diagnosis: OU Vascular cataract of the cornea. The outcome of a chemical burn. OD Subatrophy of the eyeball. OS Condition after the first stage of keratoprosthesis.

From the anamnesis it is known that 3 years ago at home there was a burn with acetic acid; 6 months ago, the first stage of keratoprosthesis on the left eye was performed at MNTK MG.

Biomicroscopy visualizes a vascularized corneal cataract in both eyes. Deep-lying environments are not ophthalmoscopically.

Visual acuity: OD - Visus=l/∞ proectia lucis incerta; OS - l/∞ projectia lucis certa. Intraocular pressure (IOP) was normal by palpation in both eyes.

Optical coherence tomography (OCT) of the anterior segment of the left eye showed that the keratoprosthesis was in the correct central position.

According to the electrophysiological study (EPS), the presence of gross changes in the right eye and minor changes in the left eye were revealed.

According to B-scan data: the membranes of the left eye are adjacent, destruction of the vitreous body; of the right eye, total retinal detachment, destruction of the vitreous body.

Taking into account the greater potential of visual functions, as well as the correct central position of the keratoprosthesis according to OCT data, it was decided to carry out the second stage of keratoprosthesis with simultaneous EC and screwing in the aphakic optical cylinder according to the first version of the proposed method.

The early postoperative period occurred without complications. In the first days, moderate swelling and hyperemia were noted, and the sutures were intact. Visual acuity of the left eye was 0.2 without correction. IOP palpation is normal.

Upon discharge from the hospital on the 7th day: the eye is calm, the sutures are intact. Visual acuity: 0.2 with correction sph -2.0 D=0.6. IOP palpation is normal.

When examining the patient after 3 months, the eye is calm, the sutures are intact. Visual acuity: 0.3 with correction sph -1.0=0.7. IOP palpation is normal.

After 6 months, when examined, the eye is calm. According to OCT data, the keratoprosthesis is in the correct central position. Visual acuity: 0.3 with correction sph -1.0 D=0.7. IOP palpation is normal.

The proposed version of the method was used in 12 clinical cases. In each of them, it was possible to achieve restoration of visual functions.

Example 2

Patient A, 31 years old. Diagnosis: OS Vascular cataract of the cornea. The outcome of a chemical burn. Condition after the second stage of keratoprosthesis. Complicated cataract OD Anophthalmos

From the anamnesis it is known that 4 years ago he received an industrial lime burn on both eyes. At the place of residence, the right eye was enucleated immediately after the burn. 2 years ago, the second stage of keratoprosthesis on the left eye was performed at MNTK MG. Visual acuity at discharge 0.4 with correction sph -3.0=0.8

Biomicroscopy of the left eye reveals a vascularized corneal cataract, a centrally located optical cylinder, and complete opacification of the lens in the nucleus and cortical layers. Deep-lying environments are not ophthalmoscopically.

Visual acuity: OS - l/∞ proectia lucis certa. IOP palpation is normal.

OCT of the anterior segment of the left eye shows the keratoprosthesis in the correct central position.

According to EFI data, minor changes in the left eye were revealed.

According to B-scan data: the membranes of the left eye are adjacent, destruction of the vitreous body.

Taking into account the potential of visual functions, as well as the correct central position of the keratoprosthesis according to OCT data and the presence of complicated cataracts, it was decided to perform an EC with replacing the optical cylinder with an aphakic one according to the second version of the proposed method.

The early postoperative period occurred without complications. In the first days, moderate swelling and hyperemia were noted. Visual acuity of the left eye was 0.1 without correction. IOP palpation is normal.

Upon discharge from the hospital on the 7th day: the eye is calm, the sutures are intact. Visual acuity: 0.3 with correction sph -2.0 D cyl -1.75 D akh 80=0.7. IOP palpation is normal.

When examining the patient after 3 months, the eye is calm. Visual acuity: 0.3 with correction sph -2.0 D cyl -1.5 D akh 75=0.8. IOP palpation is normal.

After 6 months, when examined, the eye is calm. According to OCT data, the keratoprosthesis is in the correct central position. Visual acuity: 0.3 with correction sph -2.0 D cyl -1.5 D akh 75=0.8. IOP palpation is normal.

The proposed version of the method was used in 9 clinical cases. In each of them, it was possible to achieve restoration of visual functions.

Claims (2)

1. A method of cataract extraction through the opening of the optical cylinder of a keratoprosthesis (KP), including the introduction of viscoelastic, performing a circular capsulorhexis, hydrodissection, hydrodelineation, washing out of the lens masses and removal of the remaining cortical masses using a cannula, characterized in that coagulation of newly formed vessels in the projection area of the KP is performed , then the tissue is dissected over the OOC to a plug located between the upper and lower parts of the vascular cataract; after finding the plug, it is unscrewed using a key made in the form of a metal cylinder with a diameter of 3.5 mm, a length of 5 cm, on each end side of which there are two metal pins, each 0.2 cm long, congruent with the blind holes in the keratoprosthesis plug and in the optical cylinder; after unscrewing the keratoprosthesis plug, the lower part of the vascular cataract is visualized, which is dissected with a scalpel and scissors, after which the native lens is visualized; the lens capsule is stained with dye, viscoelastic is injected and a circular capsulorhexis is performed, the diameter of which corresponds to the diameter of the OOC - 3.5 mm, then hydrodissection and hydrodelineation are performed, the lens masses are washed out, and the residual cortical masses are removed using a Simcoe cannula, after which the aphakic lens is screwed in using a key the optical cylinder and interrupted sutures are placed around it. 2. A method of cataract extraction through the OOC of a keratoprosthesis, including the introduction of viscoelastic, performing a circular capsulorhexis, hydrodissection, hydrodelineation, washing out the lens masses and removing the remaining cortical masses using a cannula, characterized in that the phakic optical cylinder is unscrewed using a key made in the form of a metal cylinder with a diameter of 3.5 mm, a length of 5 cm, on each end side of which there are two metal pins, each 0.2 cm long, congruent with the blind holes in the keratoprosthesis plug and in the optical cylinder; the lens capsule is stained with dye, viscoelastic is injected and a circular capsulorhexis is performed, the diameter of which corresponds to the diameter of the OOC - 3.5 mm, then hydrodissection and hydrodelineation are performed, the lens masses are washed out, and the residual cortical masses are removed using a Simcoe cannula, after which the aphakic lens is screwed in using a key the optical cylinder and interrupted sutures are placed around it.