RU2525274C1 - Iridectomy technique - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmosurgery and can be used for iridectomy. A tip of the 25-gauge vitreous cutter and an irrigation cannula are inserted into the anterior eye chamber through the formed paracentesis. Preserving the anatomical position of the iris is combined with forming an opening with using the vitreous cutter accompanied with irrigation with normal saline without suturing.

EFFECT: technique enables reducing injuries, providing its implementation with the fibrous or atrophic iris.

2 ex, 1 dwg

Description

The invention relates to medicine, in particular to ophthalmic surgery, and can be used in anti-glaucomatous operations, in the surgical treatment of cataracts with implantation of intraocular lenses and other eye diseases.

It is known to conduct iridectomy (colobic formation) with secondary glaucoma, which develops when the pupil is infected and “bombed” the iris with a Gref knife. Through the formed colobomas, the circulation of intraocular fluid is restored, while the intraocular pressure decreases (Eye diseases, edited by GI Eroshevsky and AA Bochkareva. M: Medicine, 1983, p. 236).

Known laser methods for iridectomy. In particular, the method of YAG laser iridectomy is used with a small anterior chamber or its absence (RF Patent for the invention No. 2223083 of 09/27/2002), with angle-closure glaucoma (RF Patent No. 2266089 of 07.07.2004).

The effectiveness of laser iridectomy for pigmented glaucoma is considered in the article by Schuko A.G., Yurieva T.N. et al. (Clinical Ophthalmology, 2007, No. 4, pp. 150-152).

Common disadvantages of laser iridectomy are:

- limited use,

- small sizes with a kolob,

- the ability to quickly overgrow with a kolob.

Known surgical methods for iridectomy include partial cutting off the iris tissue after it has been removed from the anterior chamber. So, in the review presented by the Ophthalmology Clinic “Sphere” of Professor E. Eskina (file: // loсlhost / G: / coloboma / Iridectomy%20O complications%20Microsurgery%20 glaucoma.mht), an operation technique has been proposed that includes highlighting the iris root, conjunctival incisions, entering the anterior chamber and falling out of the iris. If the iris does not fall out, it is removed with tweezers and with the help of corneal scissors cut off part of the iris parallel to the limbus. This technique is traumatic, accompanied by hypotension, reposition of the iris requires great care. The incision is made with a spear-shaped knife, and the injection direction may be incorrectly selected, which leads to injury to the ciliary body and lens.

A known surgical method of iridectomy, involving the removal of the iris with tweezers through the formed paracentesis and its partial excision (RF Patent No. 2402305, s. 03.15.2009, op. 27.10.2010. BI No. 30. Prototype).

The disadvantages of the prototype include:

- limited use, as with tweezers it is almost impossible to work with fibrosed irises, with its rubeosis or atrophy;

- in the process of hole formation, intraocular pressure decreases;

- Traction is not completely excluded.

The objective of the invention was the development of a quick, universal, atraumatic surgical method for performing iridectomy.

The essence of the invention lies in the fact that the tip of the vitreotome and a cannula for irrigation are introduced into the anterior chamber through the formed paracentesis. The tip of the vitreotome is brought to the area of the iris where an iridectomy is necessary and a hole with smooth edges is quickly formed with constant irrigation with saline.

The technical result from the implementation of the invention:

- the versatility of the method, since it can be used in any state of the iris: fibrosed, rigid or atrophic;

- constancy of the diameter of the hole;

- maintaining a constant intraocular pressure during the procedure;

- complete exclusion of traction;

- the exclusion of the use of viscoelastic;

- getting holes with smooth edges, which eliminates the possibility of overgrowing;

- safety, simplicity and speed of the procedure.

The proposed method is as follows:

Through paracentesis (1), an irrigation cannula with delivery (BSS), a balanced physiological saline solution, is introduced into the anterior chamber. Through the paracentesis (2), the tip of the vitreotome is inserted and brought to any place of the iris, (3) in which iridectomy is planned. By expanding the vitreot with the cutting window down (to the iris), aspiration and vitreot are turned on. After performing metered excision of the iris, the vitreotome tip is removed. Used by Alcon's 25 Gauge (G) Vitreot.

The proposed method is illustrated by clinical examples.

Example 1

Patient K., born in 1946, amb. map number 273681.

Ds: OD: complicated overripe cataract. Subluxation of the lens of the II degree.

OS: immature age-related cataract.

Vis OD = pp. 1. certae

Vis OS = 0.25 n / a

Operation OD: cataract phacoemulsification with implantation of the IOL RSP-3 with the formation of basal iridectomy at 3 hours according to the proposed method, d = 1.0 mm

At discharge: Vis OD = 0.5 + 0.5 ° = 0.6

Vis OS = 0.25 n / a

VGD OD-19 mm Hg

Example 2

Patient S., born in 1937, amb. Map number 2665551.

Ds OD: O / d I-II “A” Glaucoma. Complicated incomplete cataract.

OS: operated III "B" glaucoma. Rubeosis of the iris. Artifakia.

Vis OD = 0.2-2.0 ° = 0.45

Vis OS = 0.01 n / a

VGD OD = 21 mm Hg

OS = 28 mmHg

Operation OS: basal iridectomy according to the proposed method at 7 hours d = 1.0 mm.

At discharge:

Vis OD = 0.2-2.0 ° = 0.45

Vis OS = 0.01 n / a

IOP OD = 20 mmHg

OS = 25 mmHg

Claims (1)

A method of iridectomy, involving the formation of an opening in the iris, characterized in that a 25 G caliber vitreotome tip and an irrigation cannula are inserted into the anterior chamber of the eye through the formed paracentesis, preserving the anatomical position of the iris, a hole is formed in it using the vitreotome with concomitant irrigation with saline solution without suturing.

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