RU2682481C1 - Method for performing primary posterior capsulorhexis after implantation of intraocular lens - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For primary posterior capsulorhexis following phacoemulsification and intraocular lens implantation (ILI) low-molecular viscoelastic is introduced into capsular sac for ILI. High-molecular viscoelastic is then introduced into the anterior chamber above the ILI. Further, microperforation is performed in the center of the posterior capsule, and posterior capsulorhexis 4.0–5.0 mm in diameter is used to force the forceps using a free end of the posterior capsule. Then low-molecular viscoelastic is washed out first from under the ILI, then – high-molecular viscoelastic above the ILI and hydrates of the sections.EFFECT: method reduces the intraoperative and postoperative complications, such as the impossibility of implantation of the planned ILI and the vitreous body prolapse into the anterior chamber as a result of the anterior hyaloid membrane damage during the primary posterior capsulorhexis ensured by the permanent retraction of the anterior border membrane backwards due to the difference in molecular weights of the viscoelastic gels.1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used for the surgical treatment of opacities of the posterior lens capsule.

It is known that clouding of the posterior lens capsule is diagnosed in 4-90% of cases after cataract phacoemulsification is performed depending on its etiology, and in every fifth patient this requires subsequent intervention to restore visual function (Fedorov S.N. et al., 1997 p. 21-27). In cases with congenital cataracts, clouding of the posterior lens capsule develops in 100% of cases (Hosal BM et al. 2002, p. 28.).

There is a method of treating opacification of the posterior lens capsule by performing YAG laser dyscisia of the posterior capsule (A.D. Semenov et al., 1989, p. 1-5), as well as performing primary posterior capsulorhexis during cataract surgery (Balashevich L. I. et al. 2008, p. 36-41).

The closest analogue is a method of performing primary posterior capsulorhexis in the eyes with a fibrously changed posterior capsule before implantation of an intraocular lens, which involves the introduction of high molecular weight viscoelastic after phacoemulsification and leaching of the lens masses in the anterior chamber and capsule bag, puncture in the center of the posterior capsule and the formation of a circular circle based on it of the posterior capsule capsulorexis with a diameter of 3.0-4.5 mm with tweezers and collet scissors, characterized in that in a transparent area of the posterior cap the sula is broken by collet forceps, capsulorexis is continued on the densified fibrous part of the capsule with collet scissors to the transparent portion of the capsule, giving capsulorexis the desired direction, and so on, until completion of the primary posterior capsulorhexis (RF patent for invention No. 2601920).

The disadvantage of the closest analogue is that the primary posterior capsulorexis is performed before implantation of the intraocular lens, and the failure of the posterior capsulorexis can lead to undesirable consequences such as the inability to implant the planned model of the intraocular lens (IOL) and the implementation of the anterior vitrectomy, which increases the time of surgery and traumatic effect on the eye. The presence in the anterior chamber and capsular bag of only high molecular weight viscoelastic does not guarantee the stability of the anterior chamber from its emptying. Also, a sufficient displacement of the anterior hyaloid membrane is not achieved, which is necessary to prevent its damage and the vitreous body entering the anterior chamber of the eye.

The objective of the invention is to develop a method for performing primary posterior capsulorhexis, which allows intraoperatively ensuring transparency of the optical axis, which is extremely important when implanting IOLs with complex optics (bifocal, trifocal and toric models of IOLs) and to achieve the highest visual acuity in the late postoperative period.

The technical result of the proposed method is to reduce intraoperative and postoperative complications, such as the inability to implant the planned IOL and prolapse of the vitreous body in the anterior chamber due to damage to the anterior hyaloid membrane during primary posterior capsulorexis.

The technical result is achieved by the fact that in the method for performing primary posterior capsulorhexis, including the introduction of high molecular weight viscoelastic, according to the invention, after performing phacoemulsification and implantation of the IOL, a low molecular weight viscoelastic is introduced into the capsular bag under the IOL, then high molecular weight, then the back center is introduced into the anterior chamber above the IOL, then the back center in the anterior chamber the capsules perform microperforation, then, using the free edge of the posterior capsule, the posterior capsulorhexis diameter is performed with tweezers th 4.0-5.0 mm, then carry out leaching of low molecular weight viscoelastic first out of the IOL, then -vysokomolekulyarnogo viscoelastic IOL over hydration and cuts.

The technical result is achieved due to the fact that with the introduction of low molecular weight viscoelastic under the IOL, and high molecular weight viscoelastic over the IOL, due to the difference in the molecular weights of the viscoelastics, the front border membrane is constantly squeezed back, which prevents damage to the front hyaloid membrane and the vitreous body falling into the front chamber when performing manipulations with the posterior lens capsule.

The method is as follows.

Processing the surgical field and drip anesthesia are performed. After phacoemulsification and implantation of the IOL, a low molecular weight viscoelastic (for example, Provisc) is introduced into the capsule bag under the IOL, and a heavier high molecular weight viscoelastic (for example, Chealon GV) is introduced into the anterior chamber over the IOL. The difference in molecular weights of viscoelastics ensures a constant pushing of the anterior border membrane backwards, which ensures safety during manipulations with the posterior capsule. Then, microperforation is performed in the center of the posterior capsule with an insulin needle bent at the end. After that, using the free edge of the posterior capsule, posterior capsulorhexis with a diameter of 4.0-5.0 mm is performed using capsular tweezers. Next, leaching of viscoelastic is first carried out from under the IOL, then above it and hydration of the sections. The operation is considered completed.

The invention is confirmed by the following examples.

Example 1: Patient N., 66 years old

Diagnosis of the right eye: Complicated cataract, Pseudoexfoliation syndrome.

Before surgery: Vis OD - 0.05 sph +6.5 D cyl -0.75 D ax 85 ° = 0.1 is not corrected

IOP - pneumonometry:

OD - P0 = 14 mm Hg .;

Echobiometry: OD - Axl - 23.11

ACD - 3.05

Lens - 3.25

The density of endothelial cells - SD OD - 1580 cells / mm ²

Status opthtalmicus: OD - the cornea is transparent, the anterior chamber is of medium depth, atrophy of the pigment border of the iris I degree, the pupil is round, pseudoexfoliation along the edge of the pupil. The lens is cloudy. The fundus is not ophthalmoscopic.

The patient underwent phacoemulsification of a cataract with implantation of an IOL HOYA iSert 251 (optical power 23.0) with the formation of posterior capsulorexis with a diameter of 4.0 mm according to the invention. At discharge: Vis OD = 0.6 sph - 0.5 = 0.8

IOP OD P0 = 15 mmHg

The density of the endothelial cells of diabetes OD - 1550 cells / mm ²

Objectively: OD - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the IOL position is correct, in the posterior capsule there is a rounded opening of the posterior capsulorexis 4.0 mm in diameter. The optic nerve disc (optic nerve disc) is pale pink, the borders are clear, the retina is not changed in the macular region. According to optical coherence tomography (OCT), the retina in the macula is not changed. During the operation, damage to the anterior hyaloid membrane and prolapse of the vitreous into the anterior chamber were not observed.

Example 2: Patient M., 53 years old

Left Eye Diagnosis: Postcapsular Cataract

Before surgery: Vis OS - 0.4 sph +2.5 D cyl -0.5 D ax 115 ° = 0.5 not corrected

IOP - pneumonometry:

OS - P0 = 13 mmHg;

Echobiometry: OS - Axl - 24.3

ACD - 3.15

Lens - 2.96

The density of endothelial cells - SD OS - 1654 cells / mm ²

Status opthtalmicus: OS - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round. The lens is clouded in the posterior cortical layers. Optic nerve disc pale pink, clear boundaries, in the macular region, the retina is not changed.

The patient underwent cataract phacoemulsification with implantation of Acrysof IQ IOL (optical power 23.5) with the formation of posterior capsulorexis with a diameter of 5.0 mm according to the invention.

At discharge: Vis OS = 0.8 sph 0.25 cyl -0.25 ax 120 ° = 1.0

IOP OS P0 = 13 mmHg

The density of endothelial cells of diabetes mellitus OS - 1640 cells / mm ²

Objectively: OS - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the IOL position is correct, in the posterior capsule there is a rounded opening of the posterior capsulorexis with a diameter of 5.0 mm. Optic nerve disc pale pink, clear boundaries, in the macular region, the retina is not changed. According to OCT, the retina in the macula is not changed.

During the operation, damage to the anterior hyaloid membrane and prolapse of the vitreous into the anterior chamber were not observed.

Claims (1)

A method of performing primary posterior capsulorhexis, including the introduction of high molecular weight viscoelastic, characterized in that after performing phacoemulsification and implantation of an intraocular lens (IOL), a low molecular weight viscoelastic is introduced into the capsular bag under the IOL, then a high molecular weight capsule is inserted into the anterior chamber above the IOL, then the back molecular center is inserted into the anterior chamber; microperforation, then, using the free edge of the posterior capsule, with the help of tweezers perform posterior capsulorhexis with a diameter of 4.0-5.0 mm, then the wire ie leaching of low molecular weight viscoelastic first out of the IOL, and then - on a high viscoelastic IOL and hydration cuts.