RU2731885C2 - Method for preventing pigmented glaucoma accompanying syndrome of pigment dispersion - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology, and can be used for preventing the development of pigmental glaucoma accompanying syndrome of pigment dispersion. Transparent crystalline lens is removed by phacoemulsification with implantation of the posterior-chamber intraocular lens (IOL). Eyelid skin is treated with an antiseptic solution, a blepharostat is established, a corneal tunnel incision 2.2–2.75 mm is made at 10 o'clock, a paracentesis is applied at 2 o'clock. Mesaton, Lidocaine, Dye, Visco Protector are introduced into the anterior chamber. Performing circular continuous capsulorhexis. Perform hydrodissection, hydrodelinisation and crystalline lens mobilization. Phaco-fragmentation is carried out by phacopump method. Irrigation-aspiration of the crystalline lens mass is performed. Viscoelastic is then implanted with an injector using an injector. That is followed by aspiration of the viscoelastic, the anterior chamber is reconstituted with BSS solution, the incision is sealed by hydration.

EFFECT: method enables eliminating the possibility of the pathological iridosonular contact, prevents the possibility of developing pigmental glaucoma accompanying the syndrome of pigment dispersion.

1 cl, 4 dwg, 1 ex

Description

The use of the known method relates to medicine, in particular to ophthalmology, and can be used to prevent the development of pigmentary glaucoma (PG) with pigment dispersion syndrome (SPD).

SPD is a consequence of the special structure of the anterior segment of the eye, in which there is a prolapse of the iris at the root, due to a higher level of intraocular pressure in the anterior chamber than in the posterior one. This leads to the development of pathological contact of the pigment layer of the iris with the anterior capsule of the lens, zinn ligaments and processes of the ciliary body. Pathological contact leads to the release of pigment, which in turn leads at the beginning of the process to an episodic, and then to a constant increase in intraocular pressure, i.e. the process passes into the GHG stage. SPD, in more than half of the cases, leads to the development of PG.

The size of the lens in young people (anteroposterior) at rest of accommodation is about 3.5 mm. The size of the posterior chamber intraocular lens (anteroposterior) is less than 0.5 mm. In the presence of iris prolapse at the root, even the normal size of the lens contributes to the development of pathological iridosonular contact, which leads to the release of pigment, increased intraocular pressure and the development of pigmentary glaucoma.

From the technical field, a surgical method for preventing the development of PG in SPD is known - carrying out a preventive laser iridotomy [Carassa RG, Bettin P, Fiori M, Brancato R. Nd: YAG laser iridotomy in pigment dispersion syndrome: an ultrasound biomicroscopic study. Br J Ophthalmol. 1998; 82 (2): 150-153; Karickhoff JR. Pigmentary dispersion syndrome and pigmentary glaucoma: a new mechanism concept, a new treatment, and a new technique. Ophthalmic Surg. 1992; 23 (4): 269-77], carried out by means of laser iridotomy using a YAG laser with the application of pulses with a power of up to 3.0 mJ in the area of maximum thinning of the pigment layer of the iris. The disadvantage of this method is that not in all cases this leads to the restoration of the anatomically correct structure of the anterior segment of the eye and, therefore, the disease progresses and passes into the PG [Jampel HD. Lack of effect of peripheral laser iridotomy in pigment dispersion syndrome. Arch Ophthalmol. 1993; 111 (12): 1606; Reistad CE, Shields MB, Campbell DG, Ritch R, Wang JC, Wand M. The influence of peripheral iridotomy on the intraocular pressure course in patients with pigmentary glaucoma. J. Glaucoma. 2005; 14 (4): 255-9]. Other methods of preventing the development of PG in SPD are currently not known.

The known method of phacoemulsification of a transparent lens with implantation of a posterior chamber intraocular lens (IOL) [Lyle W.A., Jin G.J. Clear lens extraction to correct hyperopia // J. Cataract Refractive Surgery. - 1997. - Vol. 23. - P. 1051-1056; Clear lens phacoemulsification for correction of high myopia / Pucci V., Morselli S., Romanelli F. Et al. // J. Cataract Refractive Surgery. - 2001. - Vol. 27. - P. 896 - 900], successfully used in ophthalmology as a way to correct ametropia. However, the authors of the present invention have found that this method also has a number of advantages and advantages when used to prevent the development of PG in SPD (in comparison with the known laser iridotomy): when removing a transparent lens by phacoemulsification and implantation of a posterior chamber IOL, the possibility of pathological iridosonular contact is completely eliminated , which, in turn, provides high efficiency in preventing the possibility of GHG development during SPD.

The purpose of the proposed method is the use of a known method for a new purpose: for the prevention of the development of PG with SPD.

This goal is achieved by using the method of phacoemulsification of a transparent lens with implantation of a posterior chamber IOL to prevent the development of PH in SPD.

The method is carried out as follows. After the diagnosis of SPD, the patient undergoes an operation - removal of the transparent lens by phacoemulsification with implantation of a posterior chamber IOL according to the standard technique: the skin of the eyelids is treated with an antiseptic solution, a blepharostat is installed, a corneal tunnel incision 2.2-2.75 mm is performed at 10 hours, paracentesis at 2 hours , Mezaton, Lidocaine, Dye, Viscoprotector are injected into the anterior chamber, circular continuous capsulorhexis is performed, hydrodissection, hydrodelineation and mobilization of the lens nucleus are performed, phacofragmentation is performed by the phacochop method, irrigation is performed - aspiration of the lens masses, then under the cover of the viscoelastic device, implantation is performed viscoelastic, the anterior chamber is restored with BSS solution, the incision is sealed with hydration. In the postoperative period, the state of the anterior segment of the eye is monitored by ultrasonic biomicroscopy to confirm the absence of pathological iridosonular contact zones.

Thus, the use of the known method of phacoemulsification of a transparent lens with the implantation of a posterior chamber IOL for a new purpose in ophthalmology can make a significant result in the prevention of the development of PH in SPD.

The invention is illustrated by the following data. Clinical example.

A 34-year-old patient complained of poor distance vision.

Objective status.

Right eye (OD) Visus 0.02 with SPH-3.75, CYL-1.00, AX 163 = 0.9;

Left eye (OS) Visus 0.02 with SPH-3.75, CYL-1.00, AX 12 = 0.8.

After cycloplegia, the refraction data did not change.

Both eyes (OU). The eyelids are not changed. The conjunctiva is pale pink. There is no detachable. The cornea is transparent, with pronounced spraying of pigment on the endothelium. The anterior chamber is of medium depth. The moisture is transparent. The iris is structural, the pigment border is preserved, the pigment is sprayed over the iris surface. The pupil is rounded, reacts to light. Iris prolapse at the root, iridodenesis. Lens - on the posterior capsule in the optical zone, local opacity. The vitreous body is transparent. The fundus of the eye: the optic disc is pale pink. The boundaries are clear, peripapillary atrophy of the choroid, scleral semiring. Central disc excavation. Arteries and veins of medium caliber, moderately twisted. Macula is not changed. On the periphery - no peculiarities.

OD: intraocular pressure (IOP) according to Maklakov 20 mm Hg. Art.

OS: IOP according to Maklakov 20 mm Hg. Art.

According to the data of ultrasonic biomicroscopy of the anterior segment of the eye (right eye - Fig. 1, left eye - Fig. 2), pronounced prolapse of the iris at the root, pathological contact of the pigment layer of the iris with the anterior surface of the lens and the Zinn ligaments, the size of the lenses of both eye 3.62 mm, anterior chamber depth 3.96 mm.

Gonioscopy of both eyes revealed a very wide angle, iris prolapse at the root, iridodenesis, intense pigmentation of all structures of the anterior chamber angle.

On the basis of all studies, the diagnosis OU was made: “Moderate myopia. Complex myopic astigmatism, mild. Pigment dispersion syndrome ".

Considering the presence of pigment dispersion syndrome in both eyes against the background of mild myopia, the patient was offered two options for surgical treatment:

- removal of a transparent lens with implantation of an intraocular lens;

- laser peripheral iridotomy.

08/18/2018 removal of the transparent lens with IOL implantation OS.

08/25/2018 removal of the transparent lens with implantation of IOL OD.

One month after removal of the transparent lens with IOL implantation on the OU:

OD: Visus 1.0, IOP IOPcc 11.3 mm Hg. Art.

OS: Visus 1.0, IOP IOPcc 10.1 mm Hg. Art.

Ultrasonic biomicroscopy OU: the zone of pathological contact of the pigment layer of the iris with the anterior surface of the lens and zinn ligaments is absent (Fig. 3, 4).

Claims (1)

A method for the prevention of pigmentary glaucoma in pigment dispersion syndrome, including the removal of a transparent lens by phacoemulsification with implantation of a posterior chamber intraocular lens (IOL): the skin of the eyelids is treated with an antiseptic solution, a blepharostat is installed, a corneal tunnel incision 2.2-2.75 mm at 10 hours, paracentesis at 2 o'clock, Mezaton, Lidocaine, Dye, Viscoprotector are injected into the anterior chamber, circular continuous capsulorhexis is performed, hydrodissection, hydrodelineation and mobilization of the lens nucleus are performed, phacofragmentation is performed using the phacochop method, irrigation-aspiration of the lens masses is performed, then under the cover of the viscoelator then the viscoelastic is aspirated, the anterior chamber is restored with BSS solution, the incision is sealed with hydration.

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