RU2809441C1 - Method of implantation and suture fixation of soft intraocular lens to iris in absence of capsular support - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used for implantation and suture fixation of a soft intraocular lens (IOL) to the iris in the absence of capsular support. First outside the eye, before implanting an intraocular lens (IOL) into the anterior chamber, a thread is tied to the base of the upper haptic element at 12 o'clock position, both ends of which 10–15 mm long remain free. The IOL is inserted into the cartridge in such a way that the haptic element with the thread enters the eye last. A tunnel incision is formed. Viscoelastic is injected into the anterior chamber of the eye. The IOL is implanted into the anterior chamber, with two free ends of the threads remaining in the main incision, haptic elements in the meridian from 6 and 12 o'clock position. Through corneal paracenteses, two colobomas with a diameter of 0.2 mm are formed at 11:30 position and 12:30 position at the root of the iris using a vitreotome, “right” — 11:30 position, “left” — 12:30 position. In the anterior chamber, a spatula with a forked end is used near the node on the upper haptic to grab one end of the thread and bring it to the left side of the pupil zone. Then the other end of the thread is grabbed and brought to the right side of the pupil zone. Using a microhook, the right coloboma is entered through paracentesis at 11:30 position. The movement is performed under the iris, the right thread in the pupil area is grabbed and brought back through the coloboma to the paracentesis. Then, using a microhook, paracentesis is entered through into the left coloboma at 12:30 position, similar to the first. The left thread is grabbed in the area of the pupil and brought out through the coloboma into a paracentesis. Then the upper haptic element is inserted behind the iris at 12 o’clock position and both ends of the upper thread are pulled up. After this, the IOL body is moved beyond the plane of the pupil, leaving the lower haptic element in the anterior chamber. The ends of the threads brought into the paracenteses are pulled upward by the upper haptic element of the IOL until the base of the lower haptic element appears in the pupil area. At 6 o'clock position, paracentesis is performed and, using a vitreotome, one coloboma with a diameter of 0.2 mm is formed in the root of the iris. The needle and thread are passed transcorneal at 5:30 position. The root of the iris is pierced 2–3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil zone, covering the lower haptic element under the inner surface. The needle is pulled out through the pupil zone into the anterior chamber. The needle is passed over the iris towards the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 position. The passed thread is cut off above the eyeball. The lower haptic element is tucked behind the iris. Then, at 6 o’clock position, a microhook is used to go under the iris into the posterior chamber through paracentesis and coloboma. The pupil area is entered and the thread is grabbed above the outer surface of the lower haptic element. They thread is taken back to the coloboma and paracentesis at 6 o'clock position outwards. Then, using a microhook, the anterior chamber is entered through paracentesis into the area of the iris root at 5:30 position. The second end of the thread is grabbed at the injection site and brought out in the same way. Then a microhook is used to enter the paracentesis at 12:30 position. The second end of the thread removed through coloboma and paracentesis is grabbed at 11:30 position and withdrawn through paracentesis at 12:30 position. The IOL is pulled up and centered by the ends of the free threads located in the paracenteses at 12:30 position and 6 o'clock position. They are sequentially tied and tightened. The viscoelastic is washed out of the anterior chamber. The incisions are sealed using the hydration method.

EFFECT: invention makes it possible to safely and reliably perform microsurgical manipulations during surgery without the risk of damage to intraocular structures and the risk of luxation of the IOL into the vitreous body, with complete visualization of the stages of suturing the haptic elements of the IOL to the iris, while in the postoperative period the diaphragmatic function of the iris, the cosmetic shape of the pupil, as well as strong fixation and stable central position of the IOL relative to the optical axis of the eye remain stable.

1 cl, 2 ex

Description

Field of technology

The invention relates to medicine, namely to ophthalmology, and can be used for implantation and suture fixation of a soft intraocular lens (IOL) to the iris in the absence of capsular support.

State of the art

The most common reasons for the lack of capsular support are eye injuries, intraoperative complications during cataract surgery, severe subluxation of the lens, and aphakia after previous cataract extraction. Thus, severe contusion of the eyeball and penetrating injury to the eye can lead to complete destruction of the ligamentous apparatus of the lens. Blunt trauma, according to a number of authors, is one of the main causes of lens subluxation and ranges from 23% to 46.9% of cases, and with complete luxation of the lens into the vitreous, trauma is most often the main cause (Jacob, S. Efficacy of a capsular tension ring for phacoemulsification eyes with zonylar dialysis. J Cataract Surg., 2003).

Currently, various microsurgical techniques for fixing IOLs in the absence of capsular support are known: fixation of the IOL in the corner of the anterior chamber, suture and seamless fixation of the IOL to the iris, transscleral suture fixation of the IOL, irido-vitreal fixation of the IOL. However, the issue of choosing a fixation method remains relevant, since each of the proposed methods has its own advantages and disadvantages. Suture fixation to the iris is the method of choice when suturing all S-shaped IOL models; it has the lowest risk of complications in the postoperative period and the risk of repeated dislocations, and also ensures a predominantly stable and central position of the IOL in relation to the optical axis of the eye.

The closest analogue is a method of implantation and suture fixation of an S-shaped intraocular lens to the iris. The method is that for implantation and fixation of an IOL to the iris without capsular support, it is necessary to first constrict the pupil and implant the IOL through a small tunnel incision into the anterior chamber, first sequentially insert one haptic element behind the iris and perform suture fixation of the IOL in the area of the inserted haptic element, then the second haptic element and perform suture fixation of the IOL in the area of the second haptic element. Suture fixation of the IOL is performed as follows.

Using tweezers inserted through the paracentesis into the anterior chamber, grasp the edge of the IOL optic next to the haptic element, insert this haptic element through the pupil behind the iris and, continuing to hold the lens with tweezers, pass the needle with suture material through the paracentesis in the cornea, in the sector of the haptic element inserted behind the iris . A needle is used to make an injection in the iris 1.5-2.0 mm from the pupillary edge, after which, going around the haptic element, the needle pierces the lens at a point located in the middle of the base of the haptic element, or moving from this point along the axis of the lens, which passes through the middle of the base of one and the other haptic element, by up to 0.5 mm in one direction or the other. Next, the needle is brought into the anterior chamber, piercing the iris at a distance of 1.5-2.0 mm from the pupillary edge and at a distance of 1.5-2.0 mm from the initial insertion of the needle into the iris. Then the needle is withdrawn, piercing the cornea, and the thread is cut off. After this, the second haptic element is placed behind the iris, the lens is centered and, by analogy with the technology described above, it is fixed to the iris from the diametrically opposite side relative to the axis of the lens, which passes through the middle of the base of one and the other haptic element. After this, opposite each haptic element, the ends of the thread are brought out into the corresponding paracenteses and the first and second loose sutures are sequentially tightened. (RF patent for invention No. 2017133687 dated August 28, 2018).

The disadvantages of this method are:

- application of two sutures in the most mobile area of the iris (0.2 mm from the edge of the pupil in opposite meridians): practically turns off the diaphragmatic function of the iris (constriction and dilation of the pupil), as well as the friendly reaction of the pupils to light, creates cosmetic defects associated with shape, size and synchronicity of the pupils. The area of the iris tissue where the sutures are placed is under constant tension of the antagonist muscles (sphincter and dilator pupil), which may cause failure of interrupted sutures in the long-term postoperative period;

- the microsurgeon is forced to “rigidly” hold the IOL with tweezers throughout the entire operation inside the eye in a limited microspace, which is associated with a high risk of causing serious injury to the internal structures of the eye with the IOL fixed with tweezers in the slightest non-standard situations (involuntary movement of the operated eye or head, inappropriate behavior of the patient during operating table, peculiarities of anesthesiological support, etc.) or the alternative possibility of losing the IOL into the vitreous;

- stitching an IOL with a needle and subsequent passage of a thread creates “cracks” in its material, which can subsequently lead to destruction of the IOL material and disrupt the strength of the suture fixation in the area of constantly experiencing active tension in the antagonist muscles (sphincter and dilator pupil). The IOL material is not intended by the manufacturer to be mechanically damaged by the needle and thread during stitching and thread insertion;

- lack of full visual control and increased risk of injury to the eye in conditions of extremely limited maneuverability of the microsurgeon. An 18 mm long needle is used to suture the IOL to the iris. The needle is passed through the paracentesis of the cornea, then the iris is pierced 1.5-2.0 mm from the pupillary edge (injection through the anterior surface of the iris, puncture on the posterior surface), after which the needle, bending around the haptic element, is punctured through the lens at a point located at in the middle of the base of the haptic element (in order to puncture through the IOL material and subsequently advance a needle 18 mm long, it is necessary to “rigidly” hold the IOL with tweezers). Next, this entire complex strung on a needle (cornea-iris-IOL) is inserted under the iris, (where there is no visual control and “in the blind”) the needle is punctured into the anterior chamber through the iris at a distance of 1.5-2.0 mm from the edge of the pupil and at a distance of 1.5-2.0 mm from the initial injection of the needle into the iris. Then the needle is pushed out through the cornea. Thus, the author has a needle threaded with a cornea on a pin (paracentesis - fixed fixation), an iris on a pin (movable fixation), an IOL (haptics - limited mobility together with an IOL fixed by the surgeon), an iris on a pin (movable fixation), a cornea on a pin (fixed fixation). This entire “design” at various stages of needle advancement is limited in maneuverability, in visual control, in accuracy, and also has an increased risk of causing injury to the eye as the 18 mm long needle passes through all the structures strung on it, in conditions where the surgeon needs to constantly “rigidly” hold the IOL with tweezers;

- the absence of preventive colobomas can cause severe complications in the postoperative period: posterior vitreal block, bombardment of the iris and, as a consequence, the development of ocular hypertension and the inflammatory process.

The objective of this invention is the need to develop a method for implantation and suture fixation of a soft IOL to the iris in the absence of capsular support, allowing during surgery to safely and reliably perform microsurgical manipulations, maintain strong fixation and a stable central position of the IOL in relation to the optical axis of the eye in the postoperative period, diaphragmatic function of the iris and cosmetic shape of the pupil.

To solve this problem, we propose a method of implantation and suture fixation of a soft intraocular lens to the iris in the absence of capsular support, which consists of first outside the eye, before implanting the intraocular lens (IOL) into the anterior chamber, to the base of the superior haptic element at 12 o'clock tie a thread, both ends of which 10-15 mm long remain free, insert the IOL into the cartridge so that the haptic element with the thread enters the eye last, form a tunnel incision, introduce viscoelastic into the anterior chamber of the eye, implant the IOL into the anterior chamber, with two the free ends of the threads remain in the main section, haptic elements in the meridian from 6 and 12 o'clock, through paracenteses of the cornea with a vitreotome, two colobomas are formed at 11:30 and 12:30 in the root of the iris with a diameter of 0.2 mm ( “right” - 11:30 and “left” - 12:30), in the anterior chamber, with a spatula with a forked end near the node on the upper haptic, grab one end of the thread and bring it to the left side of the pupil zone, then grab the other end of the thread and bring it to the right side of the pupil zone, with the help of a microhook they enter through the paracentesis into the right coloboma at 11:30 o’clock, pass under the iris, in the area of the pupil they grab the right thread and bring it back through the coloboma into the paracentesis, then with a microhook they enter through the paracentesis into the left coloboma at 12 :30 o'clock, by analogy with the first, grab the left thread in the pupil area and bring it through the coloboma into paracentesis, after which the upper haptic element is inserted behind the iris at 12 o'clock and both ends of the upper thread are pulled up, after which the IOL body is moved beyond the plane pupil, leaving the lower haptic element in the anterior chamber, by the ends of the threads brought out into the paracenteses, the iol is pulled up by the upper haptic element until the base of the lower haptic element appears in the pupil area, at 6 o'clock a paracentesis is performed and, using a vitreotome, is formed at the root of the iris one coloboma with a diameter of 0.2 mm, the needle and thread are passed transcorneal at 5:30 o'clock, the iris root is pierced 2-3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil area, covering the lower haptic element under the inner surface , exit through the pupil zone into the anterior chamber, the needle is passed over the iris in the direction of the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 o’clock, the drawn thread is cut off above the eyeball, the lower haptic element is tucked behind the iris, then at 6 - at 10 o'clock, with a microhook, through paracentesis and coloboma, they enter under the iris into the posterior chamber, go out into the pupil zone, grab the thread above the outer surface of the lower haptic element, bring it back into the coloboma and paracentesis at 6 o'clock outwards, then with a microhook they enter the anterior chamber through paracentesis into the zone of the iris root at 5:30 o'clock, grab the second end of the thread at the place of its injection and bring it out in the same way, then use a microhook to enter the paracentesis at 12:30 o'clock, grab the second end of the thread brought out through the coloboma and paracentesis at 11:30 o'clock and remove it through paracentesis at 12:30 o'clock. The IOL is pulled up and centered by the ends of the free threads located in the paracenteses at 12:30 and 6 o'clock, they are sequentially tied and tightened, the viscoelastic is washed out of the anterior chamber, and the incisions are sealed using the hydration method.

The technical result achieved by using the invention is a safe and reliable position of the IOL in the eye during microsurgical manipulations, eliminating the risk of damage to intraocular structures and luxation of the IOL into the vitreous body, complete visualization of the stages of suturing the haptic elements of the IOL to the iris, as well as improving the quality and visual acuity in the postoperative period.

The method is carried out as follows. Outside the eye, before IOL implantation in the anterior chamber, a 10-00 polypropylene thread is tied to the base of the upper haptic element (12 o'clock) with three knots, both ends of the thread 10-15 mm long remain free. The IOL is inserted into the cartridge so that the haptic element with the thread enters the eye last. After that, a tunnel incision is made and viscoelastic is injected into the anterior chamber of the eye. The IOL is implanted into the anterior chamber, while the two free ends of the threads remain in the main incision (ensuring temporary fixation of the IOL in the anterior chamber, regardless of the size of the pupil), haptic elements in the 6 and 12 o'clock meridian. Through corneal paracenteses, two colobomas with a diameter of 0.2 mm are formed at 11:30 and 12:30 at the root of the iris (“right” - 11:30 and “left” - 12:30) using a vitreotome. In the anterior chamber, with a spatula with a forked end near the node on the upper haptic, one end of the thread is grabbed and brought to the left side of the pupil zone, then the other end of the thread is grabbed and brought to the right side of the pupil zone. Using a microhook, they enter the right coloboma through the paracentesis at 11:30 o'clock, pass under the iris, grab the right thread in the pupil area and bring it back through the coloboma into the paracentesis. Then, using a microhook, they enter through the paracentesis into the left coloboma at 12:30 o’clock in the same way as the first, grab the left thread in the pupil area and bring it out through the coloboma into the paracentesis. Then the upper haptic element is inserted behind the iris at 12 o’clock and both ends of the upper thread are pulled up. Thus, the IOL is securely fixed to the upper haptic element and is completely protected from “falling” onto the fundus. After this, the IOL body is moved beyond the plane of the pupil, leaving the lower haptic element in the anterior chamber. The ends of the threads brought into the paracenteses are pulled upward by the upper haptic element of the IOL until the base of the lower haptic element appears in the pupil area. At 6 o'clock, paracentesis is performed and, using a vitreotome, (one) coloboma with a diameter of 0.2 mm is formed in the root of the iris. The needle and thread are passed transcorneal at 5:30 o'clock, the iris root is pierced 2-3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil zone, covering the lower haptic element under the inner surface, exiting through the pupil zone into the anterior chamber . The needle is passed over the iris towards the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 o'clock. The passed thread is cut off above the eyeball. The lower haptic element is tucked behind the iris. Then, at 6 o’clock, with a microhook, through paracentesis and coloboma, they enter under the iris into the posterior chamber, exit into the pupil zone, grab the thread above the outer surface of the lower haptic element, bring it back into the coloboma and paracentesis at 6 o’clock outside. Then, using a microhook, they enter the anterior chamber through paracentesis into the zone of the iris root at 5:30 o'clock, grab the second end of the thread at the place of its injection and bring it out in the same way. Thus, the captured lower haptic element and the edge of the iris coloboma 2-3 mm from 5:30 to 6:00 fall into the resulting loop. Then, using a microhook, they enter the paracentesis at 12:30 o'clock, grab the second end (right) of the thread (extracted through the coloboma and paracentesis at 11:30 o'clock) and withdraw it through the paracentesis at 12:30 o'clock. Thus, the fixed upper haptic element and the iris between the colobomas fall into the resulting loop. Then the IOL is pulled up and centered at the ends of the free threads located in the paracenteses at 12:30 and 6 o’clock, and they are sequentially tied and tightened. Next, the viscoelastic is washed out from the anterior chamber, and the incisions are sealed using the hydration method.

The invention is illustrated by the following clinical examples:

Example 1.

A 60-year-old female patient was admitted with complaints of lack of objective vision in her right eye without spectacle correction. In the anamnesis, 3 months ago, phacoemulsification of a complicated cataract was performed without IOL implantation in the right eye. After surgery, visual acuity of the right eye was 0.02 sph+11.0=0.7 n/k.

Upon admission, visual acuity of the right eye was 0.02 sph+11.0=0.8-0.9 n/k. Intraocular pressure (IOP) 19 mmHg.

With biomicroophthalmoscopy: the eye is calm, the cornea is transparent, the anterior chamber is deep, the moisture is transparent, the iris is subatrophic, the pupil is round, with a diameter of 3.0 mm. Aphakia, the vitreous cavity is transparent, the anterior hyaloid membrane is preserved. The fundus reflex is pink. The fundus is without gross focal pathology.

Ultrasound B-scan data of the right eye: partial PVD, the membranes are adjacent throughout.

Diagnosis: OD Postoperative aphakia.

Surgical treatment was performed as described above.

Before implantation of the IOL model Alcon SA60AT in the anterior chamber, a 10-00 polypropylene thread was tied to the base of the upper haptic element (12 o'clock) with three knots, both ends of the thread 10-15 mm long were left free. The IOL was inserted into the cartridge so that the haptic element with the thread entered the eye last. A tunnel incision was made, and the anterior chamber of the eye was filled with viscoelastic. The IOL was implanted into the anterior chamber, while the two free ends of the threads remained in the main incision, the haptic elements in the 6 and 12 o'clock meridians. Through corneal paracenteses, two colobomas with a diameter of 0.2 mm were formed at 11:30 and 12:30 at the root of the iris (“right” - 11:30 and “left” - 12:30) using a vitreotome. In the anterior chamber, using a spatula with a forked end near the node on the upper haptic, one end of the thread was grabbed and brought to the left side of the pupil zone, then the other end of the thread was grabbed and brought to the right side of the pupil zone. Using a microhook, we entered the right coloboma through the paracentesis at 11:30 o'clock, passed under the iris, grabbed the right thread in the pupil area and brought it back through the coloboma into the paracentesis. Then, using a microhook, we entered through the paracentesis into the left coloboma at 12:30 o’clock in the same way as the first, grabbed the left thread in the pupil area and brought it out through the coloboma into the paracentesis. After that, the upper haptic element was inserted behind the iris at 12 o’clock and both ends of the upper thread were pulled up. The IOL body was then moved beyond the plane of the pupil, leaving the inferior haptic element in the anterior chamber. The ends of the threads brought into the paracenteses were pulled upward by the upper haptic element of the IOL until the base of the lower haptic element appeared in the pupil area. At 6 o'clock, paracentesis was performed and, using a vitreotome, a coloboma with a diameter of 0.2 mm was formed in the root of the iris. The needle and thread were passed transcorneal at 5:30 o'clock, the root of the iris was pierced 2-3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil zone, covering the lower haptic element under the inner surface, exiting through the pupil zone into the anterior chamber . The needle was passed over the iris towards the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 o'clock. The passed thread was cut off above the eyeball. The lower haptic element was tucked behind the iris. At 6 o'clock, with a microhook, through paracentesis and coloboma, they entered under the iris into the posterior chamber, went out into the pupil zone, grabbed the thread above the outer surface of the lower haptic element, brought it back into the coloboma and paracentesis at 6 o'clock outside. Then, using a microhook, they entered the anterior chamber through paracentesis into the zone of the iris root at 5:30 o'clock, grabbed the second end of the thread at the site of its injection and brought it out in the same way. Then, using a microhook, they entered the paracentesis at 12:30 o'clock, grabbed the second end (right) of the thread (extracted through coloboma and paracentesis at 11:30 o'clock) and brought it out through paracentesis at 12:30 o'clock. Then the IOL was pulled up and centered by the ends of the free threads located in the paracenteses at 12:30 and 6 o'clock, and they were sequentially tied and tightened. After this, the viscoelastic was washed out from the anterior chamber, and the incisions were sealed using hydration.

In the postoperative period, antibacterial and anti-inflammatory therapy was carried out. The early postoperative period was uneventful.

1 month after surgery: Vis OD: 0.9 n/k. IOP 19 mmHg.

With biomicroscopy: the eye is calm, the cornea is transparent, the anterior chamber is deep, the aqueous humor is transparent, the iris is subatrophic, at 6, 11:30 and 12:30 hours the colobomas are functional, the pupil is round, 3.0 mm in diameter. The IOL is in the posterior chamber, centered, fixed with two interrupted sutures to the iris at 5:30 and 12 o'clock. The vitreous cavity is transparent. The fundus reflex is pink. The fundus is without focal pathology.

Example 2.

A 76-year-old patient was admitted with complaints of low vision in the left eye for a year.

Upon admission, visual acuity of the left eye was 0.05 n/k. Intraocular pressure (IOP) 20 mmHg.

With biomicroophthalmoscopy: the eye is calm, the cornea is transparent, the anterior chamber is of medium depth, uneven, the moisture is transparent, the iris is subatrophic, the pupil is round, 3.0 mm in diameter, pseudoexfoliative material is deposited along the edge of the pupil and on the anterior capsule of the lens. Iridophacodonesis. Pronounced opacities of all layers of the lens. The fundus reflex is weakened. Details of the fundus are not ophthalmoscoped.

Ultrasound B-scan data of the left eye: complete PVD, the membranes are adjacent throughout.

Diagnosis: OS Complicated cataract. Lens subluxation grade 2-3. Pseudoexfoliation syndrome.

During phacoemulsification of the cataract of the left eye, the capsular bag of the lens was torn off along the entire circumference; the incompetent bag was removed using tweezers. The anterior hyaloid membrane is intact. Then we began implantation and suturing of the IOL model Alcon SN60WF according to the above proposed method.

Before IOL implantation in the anterior chamber, a 10-00 polypropylene thread was tied to the base of the upper haptic element (12 o'clock) with three knots, both ends of the thread 10-15 mm long remained free. The IOL was inserted into the cartridge so that the haptic element with the thread entered the eye last. A tunnel incision was made, and the anterior chamber of the eye was filled with viscoelastic. The IOL was implanted into the anterior chamber, while the two free ends of the threads remained in the main incision, the haptic elements in the 6 and 12 o'clock meridians. Through corneal paracenteses, two colobomas with a diameter of 0.2 mm were formed at 11:30 and 12:30 at the root of the iris (“right” - 11:30 and “left” - 12:30) using a vitreotome. In the anterior chamber, using a spatula with a forked end near the node on the upper haptic, one end of the thread was grabbed and brought to the left side of the pupil zone, then the other end of the thread was grabbed and brought to the right side of the pupil zone. Using a microhook, we entered the right coloboma through the paracentesis at 11:30 o'clock, passed under the iris, grabbed the right thread in the pupil area and brought it back through the coloboma into the paracentesis. Then, using a microhook, we entered through the paracentesis into the left coloboma at 12:30 o’clock in the same way as the first, grabbed the left thread in the pupil area and brought it out through the coloboma into the paracentesis. After that, the upper haptic element was inserted behind the iris at 12 o’clock and both ends of the upper thread were pulled up. After this, the body of the IOL was moved behind the plane of the pupil, leaving the lower haptic element in the anterior chamber. The ends of the threads brought out into the paracenteses were pulled upward by the upper haptic element of the IOL until the base of the lower haptic element appeared in the area of the pupil. At 6 o'clock, paracentesis was performed and, using a vitreotome, a coloboma with a diameter of 0.2 mm was formed in the root of the iris. The needle and thread were passed transcorneal at 5:30 o'clock, the root of the iris was pierced 2-3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil zone, covering the lower haptic element under the inner surface, exiting through the pupil zone into the anterior chamber . The needle was passed over the iris towards the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 o'clock. The passed thread was cut off above the eyeball. The lower haptic element was tucked behind the iris. At 6 o'clock, with a microhook, through paracentesis and coloboma, they entered under the iris into the posterior chamber, went out into the pupil zone, grabbed the thread above the outer surface of the lower haptic element, brought it back into the coloboma and paracentesis at 6 o'clock outside. Then, using a microhook, they entered the anterior chamber through paracentesis into the zone of the iris root at 5:30 o'clock, grabbed the second end of the thread at the site of its injection and brought it out in the same way. Then, using a microhook, they entered the paracentesis at 12:30 o'clock, grabbed the second end (right) of the thread (extracted through coloboma and paracentesis at 11:30 o'clock) and brought it out through paracentesis at 12:30 o'clock. Then the IOL was pulled up and centered by the ends of the free threads located in the paracenteses at 12:30 and 6 o'clock, and they were sequentially tied and tightened. After this, the viscoelastic was washed out from the anterior chamber, and the incisions were sealed using hydration.

In the postoperative period, antibacterial and anti-inflammatory therapy was carried out. The early postoperative period was uneventful.

1 month after surgery: Vis OS 0.8 sph - 0.5=1.0. IOP 22 mmHg.

With biomicroscopy: the eye is calm, the cornea is transparent, the anterior chamber is deep, the aqueous humor is transparent, the iris is subatrophic, at 6, 11:30 and 12:30 hours the colobomas are functional, the pupil is round, 3.0 mm in diameter. The IOL is in the posterior chamber, centered, fixed with two interrupted sutures to the iris at 5:30 and 12 o'clock. The vitreous cavity is transparent, destruction. The fundus reflex is pink. The fundus is without focal pathology.

Thus, the proposed invention makes it possible to safely and reliably perform microsurgical manipulations during surgery without the risk of damage to intraocular structures and the risk of luxation of the IOL into the vitreous body, with complete visualization of the stages of suturing the haptic elements of the IOL to the iris, while the diaphragmatic function of the iris is preserved in the postoperative period, cosmetic shape of the pupil, as well as strong fixation and stable central position of the IOL in relation to the optical axis of the eye.

Claims (1)

A method of implantation and suture fixation of a soft intraocular lens (IOL) to the iris in the absence of capsular support, which consists in the fact that at the first stage outside the eye, before implantation of the IOL in the anterior chamber, a thread is tied to the base of the upper haptic element for 12 o'clock with three knots, both ends of a thread 10-15 mm long remain free, then the IOL is inserted into the cartridge so that the haptic element with the thread enters the eye last, after which a tunnel incision is formed and viscoelastic is introduced into the anterior chamber of the eye, then the IOL is implanted into the anterior chamber, while two free ends of the threads remain in the main incision, haptic elements are placed in the 6-12 o’clock meridian, through corneal paracenteses with a vitreotome, two colobomas are formed at 11:30 - “right” and 12:30 - “left” in the root of the iris with a diameter of 0.2 mm, after that, in the anterior chamber, with a spatula with a forked end near the node on the upper haptic, one end of the thread is grabbed and brought to the left side of the pupil zone, then the other end of the thread is grabbed and brought to the right side of the pupil zone, using a microhook they enter through paracentesis into the right coloboma at 11:30 o'clock, pass under the iris, in the area of the pupil the right thread is grabbed and brought back through the coloboma into the paracentesis, then with a microhook they enter through the paracentesis into the left coloboma at 12:30 o'clock by analogy with the first, grab the left thread in the pupil area and bring it through the coloboma into paracentesis, after which they insert the upper haptic element behind the iris at 12 o’clock and pull up both ends of the upper thread, then move the IOL body beyond the plane of the pupil, leaving the lower haptic element in the anterior chamber, Using the ends of the threads brought out into the paracenteses, the upper haptic element of the IOL is pulled upward until the base of the lower haptic element appears in the area of the pupil, at 6 o'clock a paracentesis is performed and, using a vitreotome, a coloboma with a diameter of 0.2 mm is formed in the root of the iris, the needle and thread are passed transcorneal at 5:30 o'clock, the iris root is pierced 2-3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil zone, covering the lower haptic element under the inner surface, exiting through the pupil zone into the anterior chamber, the needle is passed over with the iris in the direction of the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 o'clock, the drawn thread is cut off above the eyeball, the lower haptic element is tucked behind the iris, then at 6 o'clock with a microhook through paracentesis and coloboma they enter under the iris into the posterior chamber, go out into the pupil zone, grab the thread above the outer surface of the lower haptic element, bring it back into the coloboma and paracentesis at 6 o’clock to the outside, then with a microhook they enter the anterior chamber through paracentesis into the zone of the iris root at 5:30 o’clock, grab the second end of the thread at the site of its injection and bring it out in the same way, then use a microhook to enter the paracentesis at 12:30 o’clock, grab the right end of the thread brought out through the coloboma and paracentesis at 11:30 o’clock, and withdraw it through paracentesis at 12:30 o'clock, tighten and center the IOL by the ends of the free threads located in the paracentesis at 12:30 and 6 o'clock, sequentially tie and tighten them, then wash out the viscoelastic from the anterior chamber, the incisions are sealed by hydration method.