RU2398549C1 - Barrier-optical membrane - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: barrier membrane contains flat haptic part from elastic transparent material in form of circle with central hole. Additionally it contains detachable optic part, whose longitudinal symmetry axis coincides with optic axis. On lateral cylindrical surface of optic part on circumference, ring-shaped groove from 0.2 to 3.0 mm deep is made. Symmetry axis of groove is perpendicular to longitudinal axis and coincides with transverse axis of haptic part symmetry. Optic part is placed in central hole of haptic part coaxially with its longitudinal axis in such way that sections of anterior, posterior and internal cylindrical surface of haptic part entering the groove on its full depth, are congruent to it. On anterior surface of haptic part, at equal distance from its edge, two similar, parallel to each other grooves are made, and whole membrane is made from copolymers of acryl or vinyl row. ^ EFFECT: application of claimed invention will ensure fulfillment of function of optic correction of aphakia, and will stop outlet of silicon into anterior eye chamber. ^ 6 cl, 6 dwg, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of severe forms of retinal detachments in combination with postoperative aphakia, traumatic cataract, aniridia, lens subluxation (after injuries, with congenital pathology - Marfan syndrome, due to a gap cinnamon ligaments during cataract extraction), rupture of the lens capsule (for injuries, during operations), hemophthalmia; with severe penetrating wounds of the eyes with the introduction of a foreign body into the membranes of the eye.

After surgical treatment of recurrent retinal detachments with aphakia, which involves the introduction of silicone into the cavity of the eyeball, the silicone moves into the anterior chamber and its long contact with the cornea, which leads to the development of complications: epithelial-endothelial dystrophy, secondary glaucoma, uveitis. Therefore, there is a need to create a device to prevent the exit of silicone into the anterior chamber of the eye in the pathology of the iris-lens diaphragm, as well as performing the function of optical correction.

The closest analogue is the barrier membrane described in the method of preventing silicone dislocation in the anterior chamber during surgical treatment of recurrent retinal detachments during aphakia (RF patent for the invention No. 2192215 C1 of 07.26.2000), made of a film in the form of a circle with a diameter from 1.6 to 2.4 cm from an elastic transparent material (hydrogel based on poly-2-hydroxyethyl methacrylate or its copolymers with vinyl monomers or with collagen, while the water content in the hydrogel is from 20 to 60%) with a hole in the center of etrom 3 mm.

The disadvantages of this method are:

firstly, the barrier membrane does not perform the function of optical correction of aphakia; secondly, through a hole in the center of a membrane with a diameter of 3 mm with prolonged intravitreal tamponade with silicone, it can exit into the anterior chamber with the development of keratopathy and secondary glaucoma; thirdly, upon contact with the posterior surface of the iris, the membrane can cause a functional block due to the excessive elasticity of the structure.

The objective of the invention is to create a barrier-optical membrane design that allows you to perform the functions of optical correction of aphakia and prevent the release of silicone into the anterior chamber of the eye.

The technical result according to the invention is to achieve the maximum possible visual functions; the exclusion of silicone in the anterior chamber and, therefore, the prevention of complications, such as the development of keratopathy and secondary glaucoma; the exclusion of contact with the rear surface of the iris and, therefore, the exclusion of the functional block due to the presence of additional furrows.

The technical result is achieved by the fact that the barrier-optical membrane contains a flat haptic part of an elastic transparent material in the form of a circle with a central hole and further comprises a removable optical part, the longitudinal axis of symmetry of which coincides with the optical axis, an annular ring is made on the side cylindrical surface of the optical part a furrow with a depth of 0.2 to 3.0 mm, the axis of symmetry of the furrow is perpendicular to the longitudinal axis and coincides with the transverse axis of symmetry of the haptic part. In this case, the optical part is located in the central hole of the haptic part coaxially with its longitudinal axis so that the portions of the front, rear, and inner cylindrical surfaces of the haptic part that enter the furrow to its entire depth are congruent to it. On the front surface of the haptic part, at the same distance from its edge, two identical, parallel to each other grooves are made, which absorb the intraocular pressure drops, prevent coarse membrane dislocations, and also facilitate the implantation of the membrane and allow surgery through a minimum incision. In this case, the entire membrane is made of copolymers of acrylic or vinyl series.

One option is one in which the front and rear surfaces of the optical part are convex.

The second option is one in which the front surface of the optical part is convex and the back is flat.

The third option is one in which the front surface of the optical part is convex and the back concave.

The fourth option is one in which the front and rear surfaces of the optical part are concave.

The fifth option is one in which the front surface of the optical part is concave and the back is flat.

The advantages of the proposed barrier optical membrane according to the invention are that:

1) it avoids the main complications, such as epithelial-endothelial dystrophies, secondary glaucoma, sluggish uveitis, arising from prolonged contact of silicone and the cornea;

2) the membrane allows for simultaneous correction of aphakia and tamponade of the vitreous cavity with silicone, excluding its exit to the anterior chamber and contact with the corneal endothelium;

3) the membrane allows the pupil to expand in the postoperative period to monitor the dynamics of the fundus and additional manipulations without the risk of silicone penetrating the anterior chamber;

4) a collapsible design of the barrier-optical membrane allows separate implantation; the ability to access the posterior pole of the eye during repeated surgical interventions without violating the integrity of the anatomical iris-lens diaphragm by disassembling the membrane inside the eye, removing silicone through a removable optical part, as well as the possibility of implanting the membrane through small incisions.

The invention is illustrated in figures 1-6, figure 1 shows a top view of the barrier optical membrane, figure 2 is a view a from figure 1, in which the front and rear surfaces of the optical part are convex; figure 3 shows the optical part, in which the front surface is convex and the back is flat; the figure 4 shows the optical part, in which the front surface is convex and the rear concave; figure 5 shows the optical part, in which the front and rear surfaces are concave; figure 6 shows the optical part, in which the front surface is concave and the rear is flat.

The barrier-optical membrane contains a flat haptic part 1 of a transparent transparent elastic material with a central hole 2, a removable optical part 3, its longitudinal axis of symmetry 4 coincides with the optical axis, an annular groove 5 is made around the circumferential surface of the optical part 3, the axis of symmetry 6 of the groove 5 is perpendicular to the longitudinal axis 4, coinciding with the transverse axis of symmetry 7 of the haptic part 1. The removable optical part 3 has a front 8 and a back 9 surface, on the periphery of the hapti eskoy portion 1 there are three holes 10 for fixing the optical barrier-membrane, and on the front surface of the haptic part 1, at the same distance, two identical mutually parallel grooves formed on its edge 11.

The barrier-optical membrane can be made of copolymers of acrylic (from 10% to 90%) or vinyl series (from 10% to 90%).

A barrier-optical membrane is implanted for a long time, which allows for repeatedly operated patients to achieve persistent medical, social and professional rehabilitation.

The implantation of a barrier-optical membrane is carried out as follows: at 12 o’clock, a corneal tunnel incision is made using a peak knife. Viscoelastic is introduced into the anterior chamber, the haptic part 1 of the barrier-optic membrane is implanted for the iris or for the remains of the iris and for the remains of the lens capsule (if any), fix it in a ciliary groove with threads for openings 10. Next, a removable optical part 3 is implanted into the front camera and install it in the Central hole 2 of the haptic part 1. Viscoelastic is washed out of the front camera. The corneal incision is sutured with a thread of 10.0. Further, according to the indications, tamponade of the vitreous cavity is carried out with silicone.

Implantation of a barrier-optical membrane is one of the stages of surgery for a combined vitreoretinal pathology.

Clinical examples:

Example 1

Patient V., 29 years old. Diagnosis: OS - The outcome of a penetrating wound of the cornea, partial aniridia, traumatic cataract, retinal detachment, the state after primary surgical treatment (GKO), high degree hyperopia.

On admission: visual acuity OS - light perception with the correct projection, intraocular pressure (IOP) - 23.0 mm Hg As a result of the injury, a rupture of the anterior and posterior lens capsules occurred. The operation was performed according to the above method. Lensvitrectomy, retinal mobilization, tamponade by perfluororganic compound (PFOS), implantation and fixation of the haptic part of the barrier-optical membrane were performed, then a removable optical part was installed in the central hole of the haptic part, in which the front and back surfaces are convex. Retinal endolasercoagulation was performed; PFOS was replaced by silicone. After surgery: visual acuity - 0.05; IOP - 24 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. 3 months after surgery: visual acuity increased to 0.2 with correction; IOP - 21 mm Hg, the retina is adjacent, the position of the barrier-optical membrane is correct.

Example 2

Patient P., 30 years old. Diagnosis: OD - Lens subluxation of 2 tbsp; traumatic retinal detachment with a margin from the dentate line in the lower quadrants of up to 120 degrees, total hemophthalmus, condition after penetrating scleral wound and PHO, moderate hyperopia.

On admission: visual acuity OD - light perception with the correct projection, IOP - 23.0 mm Hg The patient decided to undergo surgical treatment according to the above method. Lensvitrectomy, removal of blood from the vitreous cavity, excision of epiretinal membranes, retinal mobilization, PFOS tamponade were performed. The haptic part of the barrier-optical membrane was implanted and fixed in the ciliary sulcus, then a removable optical part is installed in the central hole of the haptic part, in which the front surface is convex and the back is flat. Next, endolaser coagulation around retinal defects was carried out, replacing PFOS with silicone. The postoperative period without features. After surgery: visual acuity - 0.1 with correction; IOP - 22 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. 3 months after surgery: visual acuity increased to 0.5 with correction; IOP - 20 mm Hg, the retina is adjacent, the position of the barrier-optical membrane is correct.

Example 3

Patient F., 17 years old. Diagnosis: Marfan syndrome, OD - coloboma of the iris, dislocation of the lens, retinal detachment.

On admission: visual acuity OD - hand movement in the face, IOP - 22.0 mm Hg The patient decided to undergo surgical treatment according to the above method. Lensvitrectomy, excision of epiretinal membranes, retinal mobilization, PFOS tamponade were performed. The haptic part of the barrier-optical membrane was implanted and fixed in the ciliary sulcus, then a removable optical part (+25 Dptr) was installed in the central hole of the haptic part, in which the front surface is convex and the back concave. Next, endolasercoagulation was carried out, replacing PFOS with silicone. The postoperative period without features. After surgery: visual acuity - 0.3 with correction; IOP - 20 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. After 9 months, the silicone was removed and the removable optical part (+ 19 Dptr) was replaced, taking into account the change in refraction after removal of the silicone. After surgery: visual acuity increased to 0.6; IOP - 23 mm Hg, the retina is adjacent, the position of the barrier-optical membrane is correct.

Example 4

Patient V., 30 years old. Diagnosis: OD - Postoperative aphakia, silicone tamponade. Condition after radial impression of sclera, subtotal vitrectomy, retinal laser coagulation. Myopia of a high degree. Emulsified silicone in the anterior chamber.

On admission: visual acuity OD - light attenuation with the correct projection, IOP - 26.0 mm Hg, eye length - 27.34 mm. The operation was performed according to the above method with the removal of emulsified silicone. Retina mobilization, PFOS tamponade, implantation and fixation of the haptic part of the barrier-optical membrane were performed, then a removable optical part was installed in the central hole of the haptic part, in which the front and rear surfaces are concave. PFOS was replaced by silicone, retinal endolasercoagulation. After surgery: visual acuity - 0.2; IOP - 17 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. 3 months after surgery: visual acuity increased to 0.3 with correction; IOP - 18 mm Hg, the retina is adjacent, the position of the barrier-optical membrane is correct.

Example 5

Patient D., 49 years old. Diagnosis: OS - Relapse of operated retinal detachment, iris coloboma, aphakia, operated open-angle glaucoma IIa, moderate myopia.

On admission: visual acuity OS - light perception with the correct projection, IOP - 23.0 mm Hg The operation was performed according to the above method. Vitrectomy, retinal mobilization, PFOS tamponade, implantation and fixation of the haptic part of the barrier-optical membrane were performed. Next, a removable optical part is installed in the central hole of the haptic part, in which the front surface is concave and the back is flat. Retinal endolasercoagulation was performed; PFOS was replaced by silicone. After surgery: visual acuity - 0.2; IOP - 24 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. After 3 months, silicone was removed through the central hole of the haptic part by temporarily removing the removable optical part. After removing the silicone during the operation, the optical part is installed back. After surgery: visual acuity increased to 0.4 with correction; IOP - 21 mm Hg, the retina is adjacent, the position of the barrier-optical membrane is correct.

Thus, this method is effective in the treatment of severe forms of retinal detachments in combination with postoperative aphakia, traumatic cataract, aniridia, lens subluxation (after injuries, with congenital pathology - Marfan syndrome, due to rupture of the zinc ligaments during cataract extraction), rupture of the lens capsule (with injuries, during operations), hemophthalmus; with severe penetrating wounds of the eyes with the introduction of a foreign body into the membranes of the eye. This requires the removal of the lens, vitrectomy, implantation of a barrier-optical membrane and prolonged silicone tamponade.

Claims (6)

1. A barrier membrane containing a flat haptic part of an elastic transparent material in the form of a circle with a central hole, characterized in that the membrane further comprises a removable optical part, the longitudinal axis of symmetry of which coincides with the optical axis, an annular ring is formed on the lateral cylindrical surface of the optical part a furrow with a depth of 0.2 to 3.0 mm, the axis of symmetry of the furrow is perpendicular to the longitudinal axis and coincides with the transverse axis of symmetry of the haptic part, while the optical h The part is located in the central hole of the haptic part coaxially with its longitudinal axis so that the portions of the front, rear, and inner cylindrical surfaces of the haptic part, which enter the furrow to its entire depth, are congruent to it, on the front surface of the haptic part, at the same distance from its edge, made two identical, parallel to each other furrows, and the entire membrane is made of copolymers of acrylic or vinyl series. 2. The barrier membrane according to claim 1, characterized in that the front and rear surfaces of the optical part are convex. 3. The barrier membrane according to claim 1, characterized in that the front surface of the optical part is convex, and the rear is flat. 4. The barrier membrane according to claim 1, characterized in that the front surface of the optical part is convex and the back is concave. 5. The barrier membrane according to claim 1, characterized in that the front and rear surfaces of the optical part are made concave. 6. The barrier membrane according to claim 1, characterized in that the front surface of the optical part is concave, and the rear is flat.

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