RU2129851C1 - Surgical method for treating the cases of aniridia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out nonpenetrating incisions on cornea to a half of its thickness, laminating it over the thickness circumferentially to the central optic zone. Unclosed intracorneal diaphragm is implanted into corneal recess. EFFECT: lowered risk of traumatic complications. 5 dwg

Description

 The invention relates to aniridia, namely to ophthalmology, and can be used for the surgical treatment of congenital and traumatic aneridia.

 A known method of intracorneal correction of aniridia / Fedorov S.N., Zuev V.K., Vagrov S.N., Osipov A.V., Isaenko M.V. Surgical correction of aniridia and iris defects // Ophthalmic surgery. - 1990. - N 2. - p. 20-22 /, including carrying out a non-through incision of the cornea with a length of 5-6 mm to half its thickness, delaminating the cornea over the entire area, including the central optical zone, implanting an intracorneal diaphragm from inert corneal layers made of inert hydrogel material, which is a ring with a diameter equal to the diameter of the cornea of the patient with an optical hole in the center. The operation ends with a continuous suture on the corneal incision.

 The disadvantage of this method is excessive trauma to the central optical zone of the cornea when it is delaminated, which leads to increased development of fibroplastic changes in it, proliferation of connective tissue, replacement of corneal structures with connective tissue fibers and malnutrition of the corneal tissue. As a result, in a large percentage of cases, gross dystrophic changes occur in the cornea, its central opacities, and the possible visual acuity in the postoperative period is also significantly reduced.

 The objective of the invention is to provide a method for the surgical treatment of aniridia to reduce the morbidity of surgical intervention, reduce the number of possible postoperative complications, increase visual acuity after surgery and improve the cosmetic effect.

 The technical result achieved by using the present invention is to reduce the morbidity of surgical intervention, reduce the number of possible postoperative complications, increase visual acuity after surgery due to the integrity of the central optical zone of the cornea and reduce neurotrophic changes in the corneal tissue.

 The technical result is achieved by the fact that in the method of surgical treatment of aniridia, including a non-through corneal incision half of its thickness, exfoliation of the cornea along the same thickness, implantation into the formed corneal pocket of an annular intracorneal diaphragm, two non-perforated corneal incisions are made at 10 and 14 hours in length no more than 2 , 5-3 mm, and the delamination is performed concentrically in a limb along the ring to the central optical zone of the cornea with a diameter equal to the diameter of the pupil in a healthy eye, first through the right azrez, then through a left section and between the slits, whereupon implanted Intracorneal an open aperture in the corneal pocket.

 Intracorenal diaphragm is made, for example, from bioinert synthetic fibers / according to AC 1474907 /; from porous tetrafluoroethylene / Lamberts D. W., Grandon S.C. A new alloplastiс material for oftalmic surgery // Oftolmic surgery 1978.- N 9. - p. 35-42 /; from hydrogel based on opaque poly-2-hydroxyethyl methacrylate /U.S. Pat. N, 5.300, 116 /.

 The method can significantly reduce the percentage of gross dystrophic changes in the cornea, eliminate its central opacification, reduce the invasiveness of surgery, maximize visual acuity after surgery and improve the cosmetic effect.

 The optimal length of the produced corneal incisions is 2.5 - 3 mm. An increase in the length of the incision leads to excessive trauma to the cornea, while their reduction makes the operation technically impossible.

 The invention is illustrated by drawings, where in FIG. 1-5 respectively depict the steps of the operation. On the cornea 1, the central optical zone 2 is marked out, 1 mm from the limb 3 to the cornea, two non-through corneal incisions 4 are made, the cornea 1 is stratified to the central optical zone 2, the corneal pocket 5 is formed and the open annular intracorneal diaphragm 6 is implanted into the corneal pocket 5 2. Put two interrupted suture 7 on the corneal incisions 4.

 The method is as follows.

 Epibulbar anesthesia is performed with 1% dicaine solution, retrobulbar anesthesia with 2% novocaine solution and akinesia. The marking of the central optical zone 2 of the cornea 1 with a diameter of 3.5 mm is performed. Using a dosed diamond knife, stepping back 1 mm from the limbus 3 to the cornea, two non-through sections of the cornea 4 are made into half of its thickness 2.5 - 3 mm in size at 10 and 14 hours. The right part of the corneal pocket 5 is formed by curving to the left through a right incision 4 through the right incision 4 to a depth of half the thickness of the cornea to the marked central optical zone 2. Similarly, the left part of the corneal pocket 5 is formed through the left corneal incision 4 by the curved right exfoliator 5. Finish the formation of the corneal pocket 5 by delimiting the distance between cuts 4. Using a spatula, an open intracorneal diaphragm 6 is implanted into the formed corneal pocket 5. Two interrupted sutures 7 n are applied. and corneal sections 4. Under the conjunctiva, dexazone and antibiotic solutions are administered.

 Indication for the use of the method is congenital and traumatic aniridia.

 Example 1. Patient P., 25 years old, diagnosis: congenital aniridia of the right eye. Visual acuity of the right eye / OD / = 0.1 n / a; visual acuity of the left eye / OS / = 0.2 n / K. Electroretinography: OI - a moderate decrease in retinal function.

 An operation was performed on the right eye according to the above method. Two non-through corneal incisions were made, a corneal pocket was formed and an intracorneal diaphragm was implanted.

 Visual acuity 3 months after surgery 0.3.

 The operation and the postoperative period proceeded without complications. During the control examinations throughout the observation period / 1 year / the eye is calm, the cornea in the central optical zone is transparent, at the periphery it is painted in the natural color of the iris. Visual functions are stable.

 Example 2. Patient Yu., 34 years old, diagnosis: traumatic aniridia of the right eye.

 Visual acuity of the right eye / OD / = 0.4 n / K. Visual acuity of the left eye / OS / = 1.0. Electroretinography: OI - moderately reduced retinal function.

 An operation was performed on the right eye according to the above method. Visual acuity 3 months after surgery 0.6. The operation and the postoperative period proceeded without complications. During the control examinations throughout the observation period / 1 year / the eye is calm, the cornea in the central optical zone is transparent, at the periphery it is painted in the natural color of the iris. Visual functions are stable.

 The proposed method produced 11 surgical interventions in patients with aniridia. 6 eyes with congenital aniridia and 5 eyes with traumatic aniridia were operated on to achieve lasting positive results after surgery.

Claims (1)

 A method for the surgical treatment of aniridia, including a non-through corneal incision at half its thickness, stratification of the cornea along the same thickness, implantation of a ring-shaped intracorneal diaphragm in the corneal pocket, characterized in that two non-perforated corneal incisions are made at 10 and 14 hours in length no more than 2, 5 - 3.0 mm, and the delamination is performed concentrically along the ring to the central optical zone of the cornea with a diameter equal to the diameter of the pupil in the healthy eye, first through the right incision, then through the left incision and between the incisions, after which an open intracorneal diaphragm is implanted into the corneal pocket.

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