SU1801429A1 - Method for extraction of cataract - Google Patents

Description

UNION OF SOVIET

SOCIALIST

REPUBLIC

.... SU .......... 1801429A1 (51) 5 A 61 F 9/00 __________ ___________

(21) 4863500/14 (22) 04.09.90 (46) 03/15/93. Bul, No. 10 (71) Donetsk State Medical Institute. Gorky (72) K.P. Pavlyuchenko, I.I. Bobrova, Z.F. Belousova and S.E. Ivashchenko (56) Shmeleva V.V. Cataract, 1981,114-120.

(54) METHOD FOR EXTRACTION OF CATARACTS (57) The invention relates to medicine, namely to ophthalmology. The essence of the invention: an incision is made in the fibrous capsule of the eye, the mydriatic is inserted into the anterior chamber of the eye, the lens is fixed with two needles inserted into it in the opposite direction, and then the anterior lens capsule is resected and the lens nucleus and lens masses are removed.

The most common surgical treatment for cataracts is extracapsular extraction. This is because the preserved posterior lens capsule serves as a barrier that keeps the vitreous in a normal position and separates it from the moisture of the anterior chamber, which significantly reduces the likelihood of postoperative complications.

In diseases accompanied by a weakening or partial damage to the ligamentous apparatus of the lens (for example, pseudoexfoliation syndrome, subluxation of the lens, etc.), ligamentous apparatus damage may occur during surgery, which negates the advantages of extracapsular cataract extraction. Therefore, in such cases, most ophthalmosurgeons prefer to perform cryocyst extraction of cataracts.

The aim of the invention is to reduce postoperative complications during extracapsular cataract extraction in diseases accompanied by weakening or partial damage to the ligamentous apparatus of the lens.

The essence of the invention is that after the expansion of the pupil, the lens is fixed with an injection of two needles inserted in the opposite direction.

. The method is as follows.

After anesthesia with novocaine 2% and dicain 0.25%, an eyelid extender is placed on the eyelids, the fixation suture on the upper rectus muscle, the mucous membrane are cut off from the limbus from 2 to 10 hours and separated to the equator of the eyeball. · A perpendicular cut is made along the limb from 10 to 2 hours, in the deep layers of the incision, two corneal paracentesis are made along its edges, a 1% mesatone is introduced into the anterior chamber, fixing needles are inserted through paracentesis and injected into the lens towards each other. At 12 h, another corneal paracentesis is performed, cystotomy is introduced through it, and the anterior lens capsule is resected (Fig. 1). Then, fixing needles and a cystotome are removed from the anterior chamber, open the anterior chamber on the limb for 2 to 10 hours, mechanically remove the lens nucleus and lens masses, stitch the incision in the limb, restore the

1801429A1 the lower chamber of the eye with physiological saline, the mucous membrane is pulled to the limb and fixed with two interrupted sutures for 2 and 10 hours. The operation is completed by subconjunctival administration of antibiotics and corticosteroids.

The development of the method is based on experimental studies on 5 isolated eyes. Under an operating microscope, a perpendicular incision was made along the limb from 10 to 2 hours, in the deep layers of the incision, fixing needles were inserted into the anterior chamber through paracentesis and injected towards each other. At 12 h, another corneal paracentesis was performed, cystotomy was introduced through it, and the anterior lens capsule was resected. Then, fixing needles and a cystot were removed from the anterior chamber; they opened the anterior chamber along the limb from 2 to 10 hours, mechanically removed the lens nucleus and lens masses, sutured the incision in the limb, and restored the anterior chamber of the eye with physiological saline. In no case of surgical intervention on an isolated eye according to the described methodology was noted. damage to the ligamentous apparatus of the lens.

The conducted experimental studies showed the possibility of surgical intervention on an isolated eye according to the described technique, which served as the basis for conducting clinical trials of the proposed method. Clinical trials were conducted in the clinic of eye diseases of Donetsk State Medical Institute. Gorky.

Example 1. Patient M., 68.year, case history No. 125502. Operation 31.05.90, was admitted to the hospital with a diagnosis of mature age-related cataract, pseudoexfoliation syndrome of the right eye. Visual acuity of the right eye is equal to the light perception with the correct light projection. Conducted cataract extraction according to the claimed method. After instillation of chloramphenicol 0.25% and dicine 0.25%, the surgical field is treated with 96% ethyl alcohol and a solution of brilliant green. 2 ml of 2% novocaine was introduced retrobulbarly, as well as in the thickness of the eyelids and along the upper rectus muscle. An eyelid extender is placed on the eyelids, on the upper rectus muscle is a fixing suture, the mucous membrane is cut off from the limbus from 2 to 10 hours and is separated towards the equator of the eyeball. A perpendicular incision was made along the limb from 10 to 2 hours, two corneal paracentesis were made in the deep layers of the incision along its edges, 0.2 ml of mesatone 1% was introduced into the anterior chamber, fixing needles and punctures were inserted through the crystalline lens towards each other 5 . At 12 h, another corneal paracentesis was performed, cystot was inserted through it, and the anterior lens capsule was resected. The fixing needles and cystot were removed from the anterior chamber, 10 the anterior chamber was opened along the limb from the anterior chamber, the anterior chamber of the eye with physiological saline was pulled up to the limbus and fixed with two nodular sutures for 2 and 10 hours. 0.5 ml of dexazone and 0 were introduced under conjunctiva. , 1 ml of gentamicin. Monocular aseptic dressing. The postoperative course is smooth. The patient was discharged from the clinic on the 12th day after the operation. Visual acuity with a correction of ± 10.0 D is 0.6. There were no signs of damage to the ligamentous apparatus of the lens (prolapse of the vitreous, inversion of the margin of the posterior capsule) either during the operation or in the postoperative period.

PRI me R 2. Patient N /, 77 years old, medical history No. 127000. Operation 1.06.90. He was admitted to the hospital with a diagnosis of mature adult cataract, lens subluxation, pseudoexfoliation syndrome of the right eye. Upon admission, iridodoneson was determined, the anterior chamber recess for 13 hours.

• Visual acuity of the right eye is equivalent to light sensation with dubious light projection. Conducted cataract extraction according to the claimed method. After instillations of chloramphenicol 0.25% and dicain 0.25%, the surgical field was treated with ethyl alcohol 96% and a solution of brilliant green. 2 ml of 2% novocaine was introduced retrobulbarly, as well as in the thickness of the eyelids and along the upper rectus muscle. An eyelid extender is placed on the eyelids, a fixative suture is placed on the upper rectus 45 muscle, the mucous membrane is cut off from the limb from 2 to 10 hours and separated to the equator of the eyeball. A perpendicular incision was made along the limb from 10 to 2 hours in the deep layers of 50. Two corneal paracentesis was made on the edges of the incision, 0.2 ml of mesatone 1% was introduced into the anterior chamber, fixing needles and punctures were inserted through the crystalline lens towards each other. 55 At 12 h, another corneal paracentesis was performed, a cystot was inserted through it, and the anterior lens capsule was resected. The fixing needles and cystotomes were removed from the anterior chamber, ___ the middle chamber was opened on the limb from 2 to h, the lens nucleus and lens mass were mechanically removed, sutures were made on the incision in the limb, the anterior chamber of the eye was restored with physiological saline, the mucous membrane was pulled up to the limb and 5 is fixed with two interrupted sutures for 2 and 10 hours. 0.5 ml of dexazone and 0.1 ml of gentamicin are administered under the conjunctiva. Monocular aseptic dressing. The postoperative course is smooth. The patient was discharged from the clinic 10 days after surgery. Visual acuity with a correction of ± 11.0 D is 0.1. Low visual acuity was explained by partial atrophy of the optic nerve. With ophthalmoscopy on the fundus, 15 decoloration of the optic nerve is determined, its boundaries are clear, the vessels are narrowed. The field of view is concentrically narrowed to 5-25 from the fixation point. No signs of damage to the ligamentous apparatus of the crystalline lens were observed either during one-20 walkthroughs or in the postoperative period.

The absence of damage to the ligamentous apparatus of the lens during operations and in the postoperative period indicates the effectiveness of the proposed method for cataract extraction and allows recommending it for implementation in clinical practice ..

Claims (1)

Claim A method for cataract extraction, including an incision of the fibrous capsule of the eye, insertion of mydriatic into the anterior chamber of the eye, resection of the anterior capsule of the lens, removal of the nucleus of the lens and lens masses, distinguishing this. that, in order to reduce trauma in the presence of weakness of the connected lens apparatus, resection of the anterior lens capsule is carried out after fixing the lens with two needles inserted into it in the opposite direction.