RU2741372C1 - Method for intraporous femtoscopic keratopigmentation for surgical correction of iris defects - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to ophthalmology. Intrastromal ring tunnel is formed with the help of a femtosecond laser with further filling of the tunnel with a dye. Self-sealing corneal cut is formed by means of a femtosecond laser at depth of 80 % of the corneal thickness to enter the tunnel. Corneal stroma is spread at this depth along a ring with an internal diameter of 4–5 mm with pitch of 0.1 mm and an external diameter of 6–8 mm with pitch of 0.1 mm. Then dye is introduced into formed tunnel with the help of cannula till complete filling of tunnel space. In a particular case, the self-sealing cornea cut can be made tangentially oriented, with one fracture or two fractures in the form of "zigzag" or "step" or two intersecting notches or can be made radially oriented two intersecting notches.EFFECT: method allows improving quality of life of patients due to disappearance of complaints on "light", improving uncorrected and corrected visual acuity due to achieving stable diaphragmatic effect.6 cl, 4 ex, 7 dwg

Description

The invention relates to medicine, specifically to ophthalmology, and is intended for correcting iris defects of various origins by the method of intracorneal femtolaser keratopigmentation.

Keratopigmentation (corneal tattooing) as a cosmetic procedure has been performed for many years, but only very recently there have been reports in the literature on the positive results of operations performed with a therapeutic purpose to eliminate complaints of flare and a decrease in the quality of vision in patients with iris defects. In modern ophthalmology, in order to compensate for the lost diaphragmatic function of the iris, various methods of keratopigmentation are used; it is carried out using pigments in the form of microparticles. There are superficial and intrastromal keratopigmentation techniques. The surface technique includes surface staining and surface automated keratopigmentation options. The intrastromal technique can be performed both manually and with femtolaser support, with one of the above methods forming an intrastromal tunnel and subsequently using a cannula to introduce a coloring biocompatible substance into the corneal area directly above the iris defect requiring correction.

The closest analogue of the method for carrying out intracorneal femtolaser keratopigmentation is a method that includes the formation of two intrastromal tunnels with the help of a femtosecond laser, located one above the other in the corneal stroma, with further filling of the tunnels with a dye. (Cornea Journal, 2012, # 31 (9): page 1071-1074. Femtosecond-assisted keratopigmentation double tunnel technique in the management of a case of Urrets-Zavalia syndrome. J.L. Alio, A.E. Rodriguez). Surgical intervention was performed with a 60-kHz IntraLase AMO femtosecond laser, Irvine, CA. Two corneal tunnels (superficial and deep) were formed. First of all, a tunnel was made at a depth of 400 microns, the outer diameter was 9.5 mm, the inner diameter was 6 mm, the energy was 2 mJ, and the vertical section was at 6 o'clock. The second (surface) tunnel was made at a depth of 200 microns, the outer diameter was 9.5 mm, the inner diameter was 6 mm, the energy was 2 mJ, and the vertical section was at 12 o'clock. A corneal dissector was used to open incisions and penetrate the tunnel. The pigment was injected into the intrastromal tunnel using a 30 G cannula. Dark pigment was injected into the deep tunnel for a more effective screening effect. The pigment was injected into the superficial tunnel, corresponding to the color of the patient's iris. After the operation, the result was a stable diaphragm effect.

The disadvantages of this method are the risk of perforation into the anterior chamber when a dye is injected into the deep-lying tunnel, the risk of injury to the structures of the anterior segment of the eye, the impossibility of performing two tunnels on anatomically thin corneas.

The task is to create a method for surgical correction of iris defects, characterized by intracorneal femtolaser keratopigmentation with the formation of one intrastromal tunnel and performing a self-sealing corneal incision to enter the tunnel.

The technical result is an increase in the quality of life of patients in connection with the disappearance of complaints of "flare", an increase in uncorrected and corrected visual acuity due to the achievement of a stable diaphragm effect.

The technical result is achieved by the fact that in the method of carrying out intracorneal femtolaser keratopigmentation for surgical correction of iris defects, including the formation of an intrastromal annular tunnel using a femtosecond laser, with further filling the tunnel with a dye, according to the invention, using a femtosecond laser meter, a % of the corneal thickness to enter the tunnel, the corneal stroma is stratified at this depth along a ring with an inner diameter of 4-5 mm with a step of 0.1 mm and an outer diameter of 6-8 mm with a step of 0.1 mm, then into the formed tunnel using a cannula dye is introduced until the tunnel space is completely filled.

A self-sealing corneal incision can be made tangentially oriented, with one break, as shown in FIG. 3, or with two kinks in the form of a "zigzag" or "step", or two intersecting notches, as shown in FIG. 6.

A self-sealing corneal incision can be made radially with two intersecting incisions as shown in FIG. 7.

The method of carrying out femtolaser keratopigmentation according to the invention is carried out as follows.

The treatment of the operating field is carried out with 0.5% chlorhexidine solution twice. Alkain and vitabact are instilled into the conjunctival cavity. The operation is performed under local anesthesia and intravenous anesthesia. With the help of a femtosecond laser, the cornea is exfoliated in a ring at a depth of 80% of the corneal thickness, and a self-sealing corneal incision is also formed by the laser to enter the tunnel. Then, in the resulting intrastromal tunnel using a 30 G cannula, a dye is injected in an amount of 1 to 2 ml until the tunnel space is completely filled. The operation ends with the introduction of a solution of dexamethasone 0.3 ml and gentamicin 0.2 mm under the conjunctiva.

To create the effect of self-sealing of the entrance to the corneal tunnel, the software “Femto Visum: Corneal Tunnel” for the Femto Visum femtosecond laser was developed on the basis of Optosystems LLC. The parameters of the femtosecond laser used in the work: laser frequency 100 kHz-10 MHz; beam movement speed 5-200 mm / s; pulse energy 0.1-3 μJ.

The formed self-sealing corneal incision for entering the intrastromal tunnel can be tangentially oriented or radially oriented. Tangentially oriented cut can be made with one break or with two: zigzag or "step".

A radially oriented cut is made with only two intersecting cuts.

A tangentially oriented single-fracture cut is performed when the patient's corneal thickness is more than 550 μm, a tangentially oriented double-fracture cut in a zigzag shape or a "step" is performed when the patient's corneal thickness is less than 550 μm.

It is also possible to perform a cut with two intersecting incisions, while it can be both tangential and radially oriented, these types of operations can be performed in any anatomical situation, regardless of the thickness of the cornea.

The invention is illustrated by figures, where the position 1 denotes the corneal tunnel, 2 - the entrance to the tunnel, 3 - the intact part of the cornea. FIG. 1 shows a diagram of an operation with a tangentially oriented cut. FIG. 2 - with a radially oriented cut. FIG. 3 - with a tangentially oriented cut (with one break). FIG. 4 - with a tangentially oriented cut (zigzag, with two kinks) FIG. 5 is a diagram of an operation with a tangentially oriented cut. (in the form of a "step", with two kinks). FIG. 6 - with a tangentially oriented cut made with two intersecting cuts. FIG. 7 - with a radially oriented cut made with two intersecting cuts.

The claimed technical result is achieved due to the fact that

The formed self-sealing corneal incision for the entrance to the intrastromal tunnel prevents the migration, exit and loss of the dye, thereby ensuring a stable fixation of the dye in the tunnel, and, as a consequence, a sufficient diaphragm effect.

The method is illustrated by the following examples:

Clinical example 1

Patient B., 45 years old. The diagnosis of OD is a condition after surgical removal of the iris neoplasm, iris coloboma in the nasal segment from 14:00 to 17:00.

Upon admission: Complaints about "light", decreased visual acuity.

Survey data:

Visual acuity OD = 0.6cyl-1.0ax90 = 0.8. IOP - 12.0 mm Hg,

Keratometry:

43.5 - 0 degrees

44.5 - 90 degrees

The cornea is transparent, the anterior chamber is of medium depth, the iris is subatrophic, the iris coloboma in the nasal segment is from 14:00 to 17:00. Deep-lying environments without visible pathology. Corneal thickness in the 5-7 mm zone according to computer pachymetry data: 560 microns.

Taking into account the patient's complaints and anamnesis (surgical removal of the iris neoplasm), it was decided to perform intracorneal femtolaser keratopigmentation to correct the iris defect. A self-sealing tangentially oriented corneal incision with one fracture and the formation of a corneal annular tunnel directly above the aniridia zone were performed using a femtosecond laser, the incision depth was 440 μm (80% of the corneal thickness). The inner diameter of the tunnel is 5 mm, the outer diameter is 8 mm. A dye in a volume of 1 ml was introduced into the corneal tunnel.

After the operation: no complaints, visual acuity 0.9, does not correct, IOP 12 mm Hg, the position of the dye is stable in the corneal stroma, does not go beyond the corneal tunnel, the iris defect is visually completely blocked. After 3 months: the patient No complaints, visual acuity 0.9, IOP 13 mm Hg, the position of the dye is stable in the corneal stroma, does not go beyond the corneal tunnel, the iris defect is visually completely blocked.

Clinical example 2

Patient T., 35 years old. The diagnosis of OS is a condition after a penetrating injury. Aniridium. Artifakia. In anamnesis 1 year ago, a penetrating wound of the eyeball, in the eye emergency department at the place of residence, primary surgical treatment was performed with the extraction of a traumatic cataract with implantation of a posterior chamber IOL and excision of the damaged iris.

Upon admission: Complaints about "light", decreased visual acuity.

Survey data:

Visual acuity OS = 0.3sph-1.0cyl-1.0ax100 = 0.8. IOP - 15 mm Hg,

Keratometry:

42.0 - 10 degrees

43.0 - 100 degrees

The cornea is transparent; in the upper-outer segment, the corneal scar is located in the limbal zone. The anterior chamber is of medium depth, the iris is subatrophic, aniridia in the outer segment from 1 to 5 o'clock. IOL in the correct position. Deep-lying environments without visible pathology.

Corneal thickness in the 5-7 mm zone according to computer pachymetry data: 510 microns.

Taking into account the patient's complaints, anamnesis (penetrating injury), it was decided to perform intracorneal femtolaser keratopigmentation to correct the iris defect. A self-sealing tangentially oriented corneal incision with two fractures and the formation of a corneal annular tunnel directly above the aniridia zone were performed using a femtosecond laser, the incision depth was 400 μm (80% of the corneal thickness). The inner diameter of the tunnel is 4 mm, the outer diameter is 7.5 mm. A dye in a volume of 1 ml was introduced into the corneal tunnel.

After surgery: no complaints, visual acuity OS = 0.4sph-1.0 = 0.9, does not correct, IOP 14 mm Hg, the position of the dye is stable in the corneal stroma, does not go beyond the corneal tunnel, defect After 3 months: the patient has no complaints, visual acuity OS = 0.4sph-1.0 = 0.9, does not correct, IOP 15 mm Hg, the position of the dye is stable in the corneal stroma, for the corneal tunnel does not go out, the defect of the iris is visually completely blocked.

Clinical case 3

Patient V., 47 years old. The diagnosis of OD is a condition after a penetrating injury. Aniridium.

A history of 1 year ago, a penetrating wound of the eyeball, in the eye emergency department at the place of residence, primary surgical treatment was performed with excision of the damaged iris.

Upon admission: Complaints about "light", decreased visual acuity.

Survey data:

Visual acuity OD = 0.3sph-1.5cyl-1.5ax135 = 0.8. IOP - 14 mm Hg,

Keratometry:

41.5 - 10 degrees

43.0 - 135 degrees

The cornea is transparent; in the upper-outer segment, the corneal scar is located in the sclerolimbal zone. The anterior chamber is of medium depth, the iris is subatrophic, aniridia in the outer segment from 7 to 10 o'clock, the lens is transparent. Deep-lying environments without visible pathology.

Corneal thickness in the 5-7 mm zone according to computer pachymetry data: 520 microns

Taking into account the patient's complaints and anamnesis (penetrating injury), it was decided to perform intracorneal femtolaser keratopigmentation to correct the iris defect. A self-sealing tangentially oriented corneal incision, made with two intersecting incisions, and the execution of the corneal annular tunnel directly above the aniridia zone were performed using a femtosecond laser, the incision depth was 415 μm (80% of the corneal thickness). The inner diameter of the tunnel is 5 mm, the outer diameter is 8.0 mm. A dye in a volume of 1 ml was introduced into the corneal tunnel.

After surgery: no complaints, visual acuity OD = 0.4sph-1.5 = 0.9, does not correct, IOP 13 mm Hg, the position of the dye is stable in the corneal stroma, does not go beyond the corneal tunnel, defect the iris is visually completely blocked. After 3 months: the patient has no complaints, visual acuity OD = 0.4sph-1.25 = 0.9, does not correct, IOP 15 mm Hg, the position of the dye is stable in the corneal stroma, for the corneal tunnel does not go out, the defect of the iris is visually completely blocked.

Clinical case 4

Patient K., 20 years old. The diagnosis of OU is congenital aniridia. Amblyopia.

Upon admission: Complaints about "light", decreased visual acuity of the left eye, intolerance to contact correction.

Survey data:

Visual acuity OS = 0.1cyl-2.0ax110 = 0.3, does not correct. IOP - 16 mm Hg,

Keratometry:

43.0 - 10 degrees

45.0 - 110 degrees

The cornea is transparent, complete aniridia, the lens is transparent. Deeper media without visible pathology.

Corneal thickness in the 5-7 mm zone according to computer pachymetry: 490 microns

Taking into account the patient's complaints and anamnesis, it was decided to perform intracorneal femtolaser keratopigmentation to correct the iris defect. A self-sealing radially oriented corneal incision, made with two intersecting incisions, and the execution of a corneal annular tunnel directly above the aniridia zone were performed using a femtosecond laser, the incision depth was 390 μm (80% of the corneal thickness). The inner diameter of the tunnel is 4.5 mm, the outer diameter is 7.5 mm. A dye in a volume of 1 ml was introduced into the corneal tunnel.

After surgery: no complaints, visual acuity OS = 0.2cyl-1.5ax110 = 0.4, does not correct, IOP 16 mm Hg, the position of the dye is stable in the corneal stroma, does not go beyond the corneal tunnel, defect the iris is visually completely blocked. After 3 months: the patient has no complaints, visual acuity OS = 0.2cyl-1.5ax110 = 0.4, does not correct, IOP 16 mm Hg, the position of the dye is stable in the corneal stroma, beyond the corneal tunnel does not come out, the defect of the iris is visually completely blocked.

Claims (6)

1. A method of carrying out intracorneal femtolaser keratopigmentation for surgical correction of iris defects, including the formation of an intrastromal annular tunnel with the help of a femtosecond laser with further filling of the tunnel with a dye, characterized in that with the help of a femtosecond laser, a self-sealing 80% thickness of the cornea is produced for into the tunnel, stratify the corneal stroma at this depth along a ring with an inner diameter of 4-5 mm with a step of 0.1 mm and an outer diameter of 6-8 mm with a step of 0.1 mm, then a dye is injected into the formed tunnel using a cannula until complete filling the space of the tunnel. 2. The method according to claim 1, characterized in that the self-sealing corneal incision is tangentially oriented. 3. The method according to PP. 1, 2, characterized in that the corneal cut is made with one fracture. 4. The method according to PP. 1, 2, characterized in that the corneal cut is made with two kinks in the form of a "zigzag" or "step". 5. The method according to PP. 1, 2, characterized in that the corneal incision is made by two intersecting incisions. 6. The method according to claim 1, characterized in that the self-sealing corneal incision is radially oriented and is made with two intersecting incisions.

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