RU2427354C1 - Method of treating aphakia - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, namely to ophthalmology and is intended for treatment of aphakia. Implantation of artificial silicon capsule with central hole on anterior and posterior surface behind iris is performed through tunnel cut of cornea. Intracapsular ring is implanted into artificial capsular sac with suturing artificial capsular sac with intraocular ring. Fixed is to sclera in projection of iridociliary sulcus with 2-5 interrupted sutures. Soft IOL is implanted into cavity of artificial capsule. ^ EFFECT: method ensures prevention of IOL dislocation and stability of selected correction with possibility of reimplantation. ^ 5 dwg, 3 ex

Description

The present invention relates to medicine, namely to ophthalmology, and is intended for the treatment of aphakia.

The prior art.

Currently, the development of high-tech ophthalmic surgery aphakia is more nonsense than the patient’s eye condition. However, in a number of cases it is really impossible to implant an intraocular lens into a capsule bag, for example, with complete luxation of the lens.

Intraocular lenses are more often used to correct aphakia than contact or spectacle correction. Many authors point to the possibility of their implantation even in children of 2 years of age.

Successful preliminary results of cataract phacoemulsification with intracapsular fixation of IOL with extensive but incomplete detachments of the zinc ligament determine the prospects of rehabilitation of this severe group of patients. Intracapsular cataract surgery becomes realistic even when the lens is completely separated, however, in these cases, it is necessary to provide additional fixation of the capsule bag complex - IOL - intracapsular ring to the iris or sclera (I.E. Ioshin, PPTagiyeva. Phacoemulsification of the cataract from the intracapsular implant implant zinned ligaments. "Ophthalmosurgery" No. 1, 2005, p.123-126), which is really complicated by the highly probable rupture of the patient’s own lens capsule.

For the treatment of aphakia, the use of artificial optical structures of the eye of various models with their hemming to the sclera and iris of the eye is known. To do this, use special intraocular lenses with fixation on the iris or with hemming of the iris-lens diaphragms of various designs to the sclera.

There is a method of treating complicated aphakia (RU 96104631, 08/10/1998), which consists in laser irradiation of the iris, in which through irregular argon laser coagulation of the iris is performed at the site of the projection of the central optical zone, then an Nd: YAG laser is formed in the same place a through hole, after which the presence of central vision and its acuity are checked and the artificial lens is implanted in the anterior chamber, leading the supporting elements of the artificial lens behind the iris. The disadvantage of this method is the impossibility of medical mydriasis, postoperative iridocyclitis with the formation of posterior synechiae, the inability to carry out intraocular correction with soft multifocal and toric IOLs.

It is known to use a barrier-optical membrane (RU 2371148, 10.27.2009) made of an elastic transparent material from copolymers of acrylic or vinyl series. An optical barrier diaphragm is used to prevent silicone oil from entering the front chamber and correct aphakia. It contains an optical part in the form of a lens and a flat haptic part lying in the main plane of the lens with a diameter of 10 to 15 mm, while the membrane contains two grooves on the front surface of the haptic part, tangential to the optical part and parallel to each other, from one to the other edge of the haptic part. The disadvantage of this method is the difficulty in calculating the optical power of the barrier-optical diaphragm, the inability to perform intraocular correction with other soft and multifocal, toric IOLs.

It is known to use an artificial iris lens for correcting aniridia and aphakia (RU 2007106517, 08.28.2008). The iris-crystalline diaphragm, made of a monolithic disk-shaped of elastic material, contains the optical part and the haptic part in the form of a colored ring with supporting arcuate closed elements located at the periphery equidistant from each other. Inside the volume of the colored ring of the haptic part of the diaphragm, drawings were made of the same material as the diaphragm, simulating both the shape and color of the net-radial pattern of the iris of the human paired eye, in an amount corresponding to the number of primary colors highlighted on the iris of the paired human eyes. The disadvantages of this method are the difficulty in calculating the optical power and color of the iris-lens diaphragm and, accordingly, further manufacturing, as well as the lack of multifocal and toric irid-lens diaphragms.

The closest analogue of the present invention is a method for intraocular correction of aphakia, which allows for the correction of aphakia by suturing the IOL to the sclera (Lyie WA, Jin JC Secondary intraocular lens implantation: anterior chamber vs. posterior chamber lenses // Ophthalmic Surg. - 1993. - Vol.24 . - P.375-381). The disadvantages of the method is the difficulty in calculating the optical power of the IOL associated with possible complications in the form of a dislocation of the lens and the corresponding changes in the selected correction.

Disclosure of invention

The objective of the invention is to develop a new approach to the intraocular correction of aphakia.

The technical result of the invention is the lack of dislocation of the intraocular lens with the corresponding stability of the selected correction and the possibility of reimplantation of the IOL if necessary.

The technical result is achieved due to the use of an artificial capsular bag with an intracapsular ring fixed to the sclera as an intraocular lens retainer.

The method is illustrated by the following drawings (figures 1-5), where figure 1 - implantation of the intracapsular ring through a Central hole in the front surface of the capsule bag; figure 2 - intracapsular ring in working condition; figure 3 - flashing an artificial capsule of the lens with the capture of the intracapsular ring and sclera in the area of the iridociliary sulcus with 4 sutures; figure 4 - fixing 4 interrupted sutures to the sclera, previously stitched capsule bag with the capture of the intraocular ring; figure 5 - implantation of a soft intraocular lens through the Central hole of the front surface in the capsule bag and where 1 is the front surface of the artificial capsule with a Central hole; 2 - back surface with a central hole; 3 - intraocular ring; 4 - seams stitching the capsule bag with the capture of the intracapsular ring; 5 - seams stitching the sclera in the region of the iridociliary sulcus, fixing the capsule bag to the sclera; 6 - nodal suture regulating the position of the capsular bag in the posterior chamber of the eye; 7 - an intraocular lens implanted in a capsule bag.

The method is carried out in the following way.

A corneal tunnel incision is made.

An artificial silicone capsule bag with a central hole on the front and back surfaces is implanted into the posterior chamber of the eyeball for the iris, where it is straightened through a corneal tunnel incision if necessary.

Perform the implantation of the intracapsular ring into an artificial capsule bag (Fig.1-2).

A capsule with a ring and sclera is stitched in the projection of an iridociliary sulcus (Fig. 3).

Tie 2-5 nodal sutures on the surface of the sclera (figure 4).

A soft intraocular lens is implanted in an artificial capsular bag (Fig. 5).

Example 1

Patient L., 30 years old. Diagnosis: OD - Contusion of the eyeball with luxation of the lens into the vitreous body.

At admission: visual acuity of OD with sph. + 11.0 diopters = 0.6; IOP - 22.0 mm Hg, eye length - 27.3 mm. The patient undergoes a vitreotomy with removal of the luxured lens. At the same time, an organofluorine compound (PFOS) is introduced into the vitreous body cavity to raise the luxured lens to the iridocrystal diaphragm. The lens is removed with a loop.

To correct the aphakic state of the eye, a posterior chamber IOL is implanted from a "Mushroom" type copolymer with fixation to the iris of the eyeball. After surgery, the patient's visual acuity of 0.4.

However, after 2 months, the patient noted an increase in IOP, corneal edema and a change in eye correction by 3 diopters. The reason is the displacement (deflection) of the IOL towards the anterior chamber. Reconstructive iridectomy did not restore the depth of the anterior chamber and the position of the IOL.

The patient is re-hospitalized, and a previously delivered lens is removed through a tunnel incision. The operation was performed according to the presented method.

An artificial silicone capsule was implanted, having central openings on the front and back surfaces designed to facilitate IOL implantation without preliminary capsulorexis on the front surface and as an optical hole on the back. Next, this capsule bag is straightened, and an intracapsular ring is inserted into it to tension the walls. This complex is fixed to the sclera through the intraocular ring with 4 interrupted sutures in the region of the iridociliary sulcus.

After surgery, visual acuity is 0.1; IOP - 17 mmHg, there is no silicone in the anterior chamber, the retina is adjacent. 3 months after surgery: visual acuity increased to 0.4 with correction; IOP - 18 mmHg, the retina is adjacent, the position of the artificial capsule and IOL is correct.

Thus, there is no IOL dislocation, stable correction is provided.

Example 2

Patient 3., 49 years old. Diagnosis: OS - the outcome of a penetrating wound of the cornea, partial aniridia, traumatic cataract, retinal detachment, condition after primary surgical treatment (PCO).

On admission: visual acuity OS - light perception with the correct projection, 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, PFOS tamponade were performed. An artificial lens capsule consisting of an anterior and posterior surface with central holes in them was implanted and fixed with 3 interrupted sutures in the iridociliary sulcus. A capsule with a ring, previously implanted there, is stitched with 3 sutures. The location of the capsule bag in the rear chamber was adjusted by tensioning the nodal joints securing to the sclera. Then, a posterior chamber soft IOL was implanted into the capsule bag and endolasercoagulation of the retina was carried out, and 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 artificial capsule and the IOL implanted in it is correct.

Example 3

Patient J., 20 years old. Diagnosis: OD - lens subluxation of 2 tbsp., Traumatic retinal detachment with a margin from the dentate line in the lower quadrants up to 120 degrees, total hemophthalmus, condition after penetrating scleral wound and PHO.

On admission: visual acuity OD - light attenuation with the correct projection, IOP - 25.0 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, circular episcleral filling with a silicone tourniquet 4 mm in diameter were performed. An implanted capsule is sewn into the posterior chamber of the eye with 5 sutures through the intracapsular ring. An artificial lens capsule consisting of an anterior and posterior surface with central holes in them was fixed with 5 interrupted sutures in the iridociliary sulcus through the sclera. The location of the capsule bag in the rear chamber was adjusted by tensioning the nodal joints securing to the sclera. Then a posterior soft IOL was implanted into the capsule bag.

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 mmHg, the retina is adjacent.

However, after 2 years, the patient, on his own initiative, decides to change the posterior chamber IOL to multifocal.

The patient underwent a repeated tunnel incision of the cornea. Through it, an IOL is removed and a multifocal IOL is implanted with the same corrective force into the same artificial capsule bag without damage. Nodal sutures retaining the capsular bag to the sclera in the iridociliary sulcus were also preserved. There was no bleeding. After surgery, the visual acuity of the patient is 0.5 with correction.

Thus, the proposed method allows for accurate intraocular correction, to implant in the eyes any type of soft intraocular lenses (toric, mono, multifocal) in the absence of a lens capsule of its own.

Claims (1)

A method of treating aphakia, including implantation of an intraocular lens (IOL), characterized in that first, an artificial lens capsule made of silicone with a central opening on the front and back surfaces is placed in the cavity through the iris, an intracapsular ring is placed in its cavity, and the capsule is inserted into the intracapsular ring and fixed to the sclera in the projection of the iridociliary sulcus with 2-5 interrupted sutures, after which a soft IOL is placed in the capsule cavity.

Images