RU2254108C1 - Traumatic and secondary cataract surgery method for preventing pupil capturing when implanting posterior chamber lenses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves placing collagen copolymer ring covered with steroid preparation and antibiotic layer after having implanted a posterior chamber lens between iris back surface and frontal posterior chamber lens surface. Ring thickness is equal to 0.18-0.2 mm, its external diameter being 8.8-9.2 mm and internal diameter 4.5-4.7 mm large. The ring is centered in a way that its hole center coincides with optical posterior chamber lens part center. The operation is finished with anterior chamber depth restoration and incision sealing.

EFFECT: enhanced effectiveness of prophylaxis.

2 cl

Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used in surgery of traumatic and secondary cataracts.

The reason for pupil capture in cataract surgery is extracapsular and mixed fixation of posterior chamber lenses (ZKL), as well as inadequately short flaps of the anterior capsule in case of intracapsular fixation. In the presence of anteroposterior synechia and post-traumatic deformity of the capsular sac, ZKL is usually implanted with fixation of its supporting elements into the groove of the ciliary body, however, a similar position of ZKL predisposes to the development of pupil capture. The pupil grip, as a rule, is formed against the background of the postoperative inflammatory process, due to the "tightening" of the iris under the edge of the optic lens. The development or relapse of the posterior synechia contributes to the formation of pupil capture. The risk of pupil capture is especially great in pediatric patients, prone to the formation of synechia and fibrosis. The highest likelihood of an inflammatory process with a plastic component in the early postoperative period, in connection with which it is precisely within 2-3 months after surgery that the possibility of pupil grip formation is increased. The resulting pupil seizure causes a chronic injury of the iris in the area of its contact with the edge of the optical part of the ZKL, promotes the development of severe fibrosis of the posterior capsule, the formation of the pupil film, and their relapse after surgical capsulectomy.

There is a method of preventing the formation of pupil capture, which consists in ensuring full-fledged intracapsular fixation of its haptic elements (Bobrova NF, Yenukidze DZ. IOL implantation in a capsular bag in case of traumatic cataracts in children // Laser refractive and intraocular surgery. Russian scientific conference. Russian scientific conference . - St. Peter. 2002. - P.87).

However, this method can be carried out only if there is an intact anterior capsule of the lens or the preservation of adequately high flaps of the anterior capsule. Otherwise, due to the presence of an iris injury during synechiotomy, a recurrence of posterior synechia develops during the operation, leading to the capture of the pupil. Subsequently, the contact “the edge of the optical part of the ZCL - the pigment epithelium of the iris” causes chronic irritation of the iris, which plays an important role in the pathogenetic chain of pupil capture. Chronic irritation of such a reactive structure as iris tissue supports a sluggish inflammatory process, contributing to an ever greater “pulling” of the iris under the edge of the optic lens, an increase in the length of the pupil grip, and the development of severe fibrosis of the posterior capsule and its relapse after capsulectomy.

The objective of the invention was to develop an effective method for the prevention of pupil capture in surgery for traumatic and secondary cataracts during implantation of ZKL, as well as in other clinical situations characterized by the absence of adequate height flaps of the anterior lens capsule.

The technical result is the absence of pupil capture and complications associated with it - a reduction in the number of inflammatory complications in the early stages after surgery, prevention of the formation of recurrent fibrous pupil film, a reduction in the number of reoperations for these complications and, accordingly, an increase in the functional effect of surgical intervention.

The technical result is achieved by the fact that in the method for preventing pupil capture according to the invention, after implantation of ZKL, a collagen copolymer ring from 0.18 to 0.2 mm thick in a dehydrated form is introduced into the anterior chamber (after hydration, from 0.35 to 0, 42 mm) with an outer diameter of 8.8-9.2 mm and an inner diameter of 4.5-4.7 mm, having a coating of a steroid preparation and an antibiotic. Dexamethasone is used as a steroid preparation, and gentamicin or kefzol as an antibiotic. The ring is located between the back surface of the iris and the front surface of the ZKL and centered so that the opening of the ring coincides with the optical part of the ZKL. After implantation, the rings restore the depth of the anterior chamber and complete the operation by sealing the incisions.

The technical result is achieved due to the fact that

1. The ring is placed directly under the iris, and its hole is placed on the optical part of the ZKL so as to achieve the coincidence of the centers of the opening of the ring and the optical part of the ZKL. Moreover, the diameter of the optical part of the ZKL is 0.8-1.2 mm higher than the inner diameter of the ring with the formation of a concentric "belt" due to the dense adherence of the ring to the front surface of the ZKL. The periphery of the ring is localized on the haptic part of ZKL. This position of the ring provides a mechanical barrier to the formation of anteroposterior synechiae, blocks access to the pupil edge of the iris under the edge of the optic lens and creates reliable prevention of the development of pupil capture in the early and long-term after surgery.

2. In the early postoperative period, the ring, due to coating with a steroid drug and an antibiotic, has an anti-inflammatory effect, which is enhanced by the localization of the drug depot under such a reactive structure as the iris. Thus, the location of the ring contributes to a smooth course of the postoperative period precisely at those times when the risk of developing inflammatory complications is greatest. The contact of the ring and, accordingly, its coating with the entire inner surface of the iris provides prevention of the development of posterior synechia due to the maximum approximation of pharmacological preparations to the immediate place of formation of posterior synechia.

3. In the long term after the operation, the absence of posterior synechia interrupts the pathogenetic chain of pupil capture and concomitant fibrous pupil film, prone to relapse.

The method is as follows. After standard processing of the surgical field, the conjunctival flap is separated in the corresponding segment and the anterior chamber is opened. After performing the preparatory stages of the surgical intervention, through the basal coloboma of the iris, the posterior synechiae are separated, forming a space for implantation of ZKL and the ring. After the implantation of ZKL, the tweezers are inserted into the anterior chamber with tweezers to tie the ring when folded in half. During implantation, one part of the ring is immediately brought under the iris, placing it between the front surface of the ZKL and the pigment leaf of the iris, the other part of the ring is left on the surface of the iris. Then, having put the trowel into the folded ring, they straighten it in the front chamber, both in that part which is under the iris and in the part located on the iris. A putty knife hook and a putty knife are introduced into the front chamber. With a crochet-trowel, the edge of the iris is lifted, and with a spatula, the ring is moved and brought under the raised part of the iris. Then, with a spatula, if necessary, center the ring, achieving the coincidence of the center of its hole with the center of the optical part of the ZKL. The operation is completed by restoring the anterior chamber and sealing the incisions.

The invention is illustrated by the following example.

Patient K., 8 years old. He was admitted for surgical intervention in the children's department of MNTK MG with a diagnosis of: The right eye - secondary (post-traumatic) cataract. The left eye is healthy. At the age of 7 years, the child suffered a penetrating wound in his right eye. At the place of residence on the day of the injury, the primary surgical treatment was performed with the removal of the traumatic cataract in the right eye. Vision of the right eye after surgery 0.5. 3 months after the operation, secondary cataracts formed.

When examining the right eye - a penetrating, fused with the iris peripheral scar of the cornea. Depth of the anterior chamber 3.5 mm. Subatrophy of the iris. The pupil is 3.5 mm; the pupil does not react to light due to planar posterior synechiae. In the area of the pupil, a dense fibrous film is ophthalmoscopically. Underlying environments are not visible.

Visual acuity of the right eye is the correct light projection. IOP - 17 mmHg

The operation on the child’s right eye was performed according to the proposed method - synechiotomy of planar posterior synechia, secondary cataract capsulectomy, implantation of ZKL with fixation of its supporting elements into the groove of the ciliary body and implantation of a collagen copolymer ring coated with dexazone and kefzol to prevent pupil formation. The postoperative period was characterized by a smooth course with the absence of an inflammatory reaction. During the entire period of hospital stay, the ring occupied a central position with the coincidence of the central hole with the optical part of the ZKL. The pupil area is free of fibrous film. There were no signs of pupil grip formation. Visual acuity after surgery is 0.6. When examined within 1 and 1.5 years after surgery, the ring is in the correct position. There is no pupil capture. Visual acuity of the right eye 0.7.

The invention is an effective way to prevent a common complication of surgery of traumatic and secondary cataracts during implantation of ZKL - pupil capture. The method provides the prevention of not only pupil capture, but also its attendant complications - sluggish inflammatory process and the formation of fibrous pupil film, prone to relapse. The method is technically simple, does not complicate the surgical procedure, provides a smooth course of the postoperative period, reduces the length of the patient’s hospital stay and the number of reoperations due to complications.

Claims (2)

1. A method for the prevention of pupil capture in surgery for traumatic and secondary cataracts during implantation of a posterior chamber lens (ZKL), characterized in that after implantation of ZKL, a ring of collagen copolymer 0.18-0.2 mm thick is placed between the posterior surface of the iris and the anterior surface of the ZKL dehydrated form, with an outer diameter of 8.8 - 9.2 mm and an inner diameter of 4.5 - 4.7 mm, coated with a steroid and antibiotic, while the ring is centered so that the center of the ring opening coincides with the center of the optical part ZK . 2. The method according to claim 1, characterized in that dexamethasone is used as a steroid preparation, and gentamicin or kefzol is used as an antibiotic.