RU2772850C1 - Method for fixing the deployed complex "iol - capsular ring - capsular bag" - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology. To fix the dislocated complex "intraocular lens - capsular ring - capsular bag" in the upper sector of the eye, a tunnel 1.2 mm wide, 2-2.5 mm long is formed in the sclera in 2.5 mm from the limbus through the conjunctiva, parallel to the limbus at a depth of 0 .5 mm. A needle bent at an angle of 90-100° is inserted through the tunnel, then the tip of the needle is turned by 90, and after perforation of the sclera and the flat part of the ciliary body, the needle is passed under the complex, the capsular bag is perforated, passing the needle inside the capsular ring, and withdrawn into the lumen of the pupil. Then, through the corneal paracentesis in the lower sector, a 6-0 prolene thread is inserted, the first tip of which is inserted into the lumen of the needle and, together with the needle, is brought out. Next, the needle is re-passed through the tunnel, brought out under the iris over the capsular bag into the lumen of the pupil, after which the second tip of the 6-0 prolene thread is inserted into the needle, which, together with the needle, is brought out, forming a loop that captures the capsular ring. The ends of the thread are tightened, adjusting the degree of tension according to the position of the intraocular lens relative to the center of the pupil. The ends of the threads are cut and melted with a coagulator to form a single rounded thickening, which is immersed in the tunnel.

EFFECT: method reduces traumatization of eye tissues, reduces the risk of postoperative complications.

1 cl, 1 ex

Description

The invention relates to the field of medicine, namely to ophthalmology, and is intended for fixing the dislocated complex "intraocular lens - capsular ring - capsular bag".

The necessary conditions for the application of the method are the location of the unopened part of the capsular ring in the capsular bag in the upper sector, as well as an intact hyaloid membrane.

A method of fixing the deployed complex "IOL - capsular ring - capsular bag" is known, in which the deployed complex "IOL - capsular ring - capsular bag" is fixed to the iris of the eye (patent RU 2527912, application 18.07.2013, publ. 10.09.2014) .

The disadvantage of this method is the possibility of resorption of polypropylene threads 9.0 and 10.0 existing in the remote period with the occurrence of re-dislocation of the complex. In addition, when the complex is fixed to the iris, the pupil may be deformed, and the diaphragmatic function of the pupil may be impaired.

The closest analogue, taken as a prototype, is a method of fixing the deployed complex "intraocular lens - capsular ring - capsular bag", in which the deployed complex "IOL - capsular ring - capsular bag" is fixed to the sclera with polypropylene 10/0 threads (article "Method of scleral fixation of the deployed complex "Intraocular lens - capsular ring - capsular bag" (https://doi.org/10.25276/2312-4911-2019-5-79-82).

The disadvantage is the possibility of resorption of polypropylene 10.0 threads in the remote period with the occurrence of re-dislocation of the complex. Also, the disadvantage of this method is its invasiveness, due to the large amount of penetration of the sclera.

The problem of the claimed invention is the development of an effective and less traumatic method for fixing the deployed complex "IOL - capsular ring - capsular bag".

The technical result of the claimed invention is to reduce the traumatization of eye tissues, reduce the risk of postoperative complications.

To achieve the claimed technical result in the method of fixing the deployed complex "IOL - capsular ring - capsular bag", including fixing the complex with suture material to the sclera by the capsular ring, according to the invention, a tunnel 1.2 mm wide, 2-2.5 long is formed in the upper sector mm 2.5 mm from the limbus through the conjunctiva in the sclera parallel to the limbus at a depth of 0.5 mm, through which a needle bent at an angle of 90-100 ° is inserted, then the tip of the needle is turned 90 ° and after perforation of the sclera and the flat part of the ciliary body, the needle is carried out under the complex, the capsular bag is perforated, passing the needle inside the capsular ring, and withdrawn into the lumen of the pupil, then a 6-0 Prolene thread is inserted through the corneal paracentesis in the lower sector, the first tip of which is inserted into the lumen of the needle and, together with the needle, is brought out, then the needle re-pass through the tunnel, withdraw under the iris over the capsular bag into the lumen of the pupil, after which the second tip of the prolene 6-0 thread is inserted into the needle, which the rue together with the needle is brought out, forming a loop that captures the capsular ring, the ends of the thread are tightened, adjusting the degree of tension according to the position of the intraocular lens relative to the center of the pupil, the ends of the threads are cut and melted with a coagulator to form a single rounded thickening, which is immersed in the tunnel.

The method is carried out as follows.

The method is carried out with the location of the open part of the capsular ring in the upper sector. Pre-insulin needle 27G using a needle holder is bent at an angle of 90-100° with the formation of the lengths of the proximal and distal parts in accordance with the proportion 1/3:2/3. The needle is used as an external guide for the suture material inside the sclera. In the upper sector, a tunnel 2-2.5 mm long is formed 2.5 mm from the limbus with a 1.2 mm knife through the conjunctiva in the sclera parallel to the limbus at a depth of 0.5 mm. In the lower sector, corneal paracentesis is performed, a highly elastic preparation is injected into the anterior chamber and between the iris and the capsular bag in the upper part. A needle bent at an angle of 90-100° is inserted through the scleral tunnel. The needle at the end of the tunnel is turned by 90°, and after perforation of the sclera and the flat part of the ciliary body, the needle is passed under the complex, the capsular bag is perforated, passing the needle inside the capsular ring, and brought into the lumen of the pupil. Further, a 6-0 prolene thread is inserted through the corneal paracentesis in the lower sector, the first tip of which is inserted into the lumen of the needle and brought out together with the needle, then the needle is re-passed through the tunnel, brought out under the iris over the capsular bag into the lumen of the pupil, and then into the needle the second tip of the 6-0 prolene thread is inserted, which, together with the needle, is brought out, forming a loop that captures the capsular ring, the ends of the thread are tightened, adjusting the degree of tension according to the position of the IOL relative to the center of the pupil, the ends of the threads are cut at a distance of 5 mm from the sclera and melted with a coagulator with the formation of a single rounded thickening, which is immersed in the tunnel.

EFFECT: method allows to reduce traumatization of eye tissues, reduce the risk of postoperative complications.

Clinical example

Patient M., 84 years old.

Admitted for surgical treatment with complaints of decreased vision of the right eye for six months. Denies injury. Since 2011, he has been registered with a diagnosis of glaucoma in both eyes. In 2011, cataract phacoemulsification was performed with IOL implantation, trabeculotomy in both eyes. Phacodesis was present in the right eye before surgery, and a 12 mm capsular ring was implanted. I instilled timolol 0.5% 2 times a day in both eyes.

Visual acuity at admission - Vis OD 0.1 sph -1.0=0.15 cyl -1.0 ax 130°=0.2, Vis OS 0.32 cyl -1.25 ax 85°=0.6.

Keratometer of the right eye 44.5-43.5 40°; left eye 44.75-43.75 75°.

Intraocular pressure - Pi OD 25.3 / 23.5, Pi OS 19.3 / 18.6.

PZO of the right eye - 23.94 mm, PZO of the left eye - 23.91 mm.

Biomicroscopically: in the right eye - the cornea is transparent, the anterior chamber is 2.8 mm deep, iris subatrophy, pseudoexfoliation along the pupillary edge, the complex "IOL - capsular ring - capsular bag" is displaced downwards, the upper haptic element of the IOL is visible in the lumen of the pupil, the capsular ring is inside capsular bag. The fundus of the eye - ONH is pale with clear contours, E/D - 0.9, in the macular region - drusen, arteries are narrowed.

Gonioscopy - CPC open, ++ pigmentation.

Diagnosis - pseudophakia, dislocation of the complex "IOL - capsular ring - capsular bag" 2 degrees according to Lorento, open-angle 2 in (op, m) glaucoma of the right eye. Artifakia, open-angle 2a (op, m) glaucoma of the left eye. Age-related macular degeneration "dry form" of both eyes.

An operation was performed in November 2020 on the right eye - reposition with fixation of the IOL-capsular ring-capsular bag complex behind the capsular ring to the sclera using a 6.0 prolene thread and non-penetrating deep sclerectomy.

Fixation of the deployed complex "IOL - capsular ring - capsular bag" according to the claimed method is performed as follows. A scleral tunnel 2.5 mm long was formed with a disposable knife (1.2 mm) at 2.5 mm from the limbus parallel to it at 11.30 o'clock; . At the end of the tunnel, the needle was turned 90°, and after perforation of the sclera and the flat part of the ciliary body, it was passed under the complex "IOL - capsular ring - capsular bag", the capsular bag was perforated, passing the needle inside the capsular ring, and the tip of the needle was brought into the lumen of the pupil, then through paracentesis in the lower sector, using collet tweezers, the first end of the prolene 6.0 thread was inserted into the needle for about 10 mm. The needle was removed with the thread out and through the same tunnel the needle is again passed under the iris over the capsular bag into the anterior chamber. The second end of the prolene 6.0 thread was inserted through paracentesis into the needle in a similar way and removed through the tunnel, forming a loop that captured the capsular ring. The loop was pulled up by the ends of the thread until the correct central position of the IOL was reached. Both ends of the thread were cut off about 5 mm from the conjunctiva, melted together using an electric wireless coagulator to form a single rounded thickening, which was then immersed in a tunnel.

Then, at 13 hours, non-penetrating microinvasive deep sclerectomy was performed with conjunctival suture vicryl 10.0.

After the operation, the IOL is in the correct position, fibrosis of the posterior capsule, the filtration cushion is pronounced.

V OD - 0.45 Pi OD 18 OS 15.

After 1 month, YAG was performed - discission of a secondary cataract in the right eye, the IOL occupies a central position, V OD - 0.5 cyl -0.5 ax 110°=0.6 Pi OD 19.

Claims (1)

A method for fixing a deployed complex "IOL - capsular ring - capsular bag", including fixing the complex to the sclera with suture material for the capsular ring, characterized in that a tunnel 1.2 mm wide, 2-2.5 mm long in 2 is formed in the upper sector, 5 mm from the limbus through the conjunctiva in the sclera parallel to the limbus at a depth of 0.5 mm, through which a needle bent at an angle of 90-100 ° is inserted, then the tip of the needle is turned 90 ° and after perforation of the sclera and the flat part of the ciliary body, the needle is passed under the complex, the capsular bag is perforated, passing the needle inside the capsular ring, and brought out into the lumen of the pupil, then a 6-0 prolene thread is inserted through the corneal paracentesis in the lower sector, the first tip of which is inserted into the lumen of the needle and brought out together with the needle, then the needle is re-passed through the tunnel , is brought out under the iris over the capsular bag into the lumen of the pupil, after which the second tip of the 6-0 prolene thread is inserted into the needle, which, together with the needle, is brought out, forming a loop, behind grasping the capsular ring, the ends of the thread are tightened, adjusting the degree of tension according to the position of the intraocular lens relative to the center of the pupil, the ends of the threads are cut and melted with a coagulator to form a single rounded thickening, which is immersed in the tunnel.