RU2779992C1 - Method for eliminating iridodialysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to ophthalmology, and can be used to eliminate iridodialysis. For this purpose, a tunnel 2 to 2.5 mm long is formed at the site of planned fixation of the iris to the sclera 2.5 mm from the limbus in the superior position through the conjunctiva in the sclera parallel to the limbus at a depth of 0.5 mm. A needle bent at an angle of 90° is inserted through the tunnel. Then the tip of the needle is rotated by 90° and, after perforating the sclera and the flat part of the ciliary body, removed parallel to the plane of the iris on top of the capsular bag, used to perforate the iris at 1 mm from the dialysis edge and removed to the anterior chamber. A prolene 6-0 thread is then inserted into the needle, wherein a first thickening is made on the side of the free end of the needle by melting the thread to a spherical mass, which is flattened, then the needle with the thread is removed to the outside, and the thread is tightened, pulling the iris to the sclera. The thread is cut, forming a second thickening by melting the thread to a spherical mass, which is buried in the scleral tunnel.

EFFECT: method provides a possibility of reducing the injury to tissues of the eye and lowering the risk of postoperative complications due to such fixation of the iris to the sclera by means of a staple made of suturing material.

1 cl, 1 ex, 2 dwg

Description

The invention relates to medicine, namely to ophthalmology, and is intended to eliminate iridodialysis.

A known method for eliminating iridodialysis, taken as a prototype, in which the conjunctiva is opened at the limbus in the projection of iridodialysis, then the injection needle 30G penetrates 2 mm from the limbus in the projection of iridodialysis into the anterior chamber filled with a viscoelastic drug. The needle perforates the torn part of the iris, a 6-0 prolene thread is inserted into the needle with a thickening made by melting the thread to a spherical formation, which is flattened. The needle with the thread is pulled out, the thread is pulled so that the iris matches the angle of the anterior chamber and a second thickening is formed by melting the thread to a spherical formation, which is covered with the conjunctiva without immersion in the sclera (https://www.healio.com/news/ophthalmology/20190702 /riveting-with-doubleflanged-polypropylene-suture-helps-repair-iridodialysis).

The disadvantage of this method is excessive traumatization of the tissues of the eye, due to the need to perform a wide incision of the conjunctiva and subsequent application of conjunctival sutures. In addition, there is a high probability of protrusion and inflammatory complications in the postoperative period.

The problem of the claimed invention is the development of an effective method for removing iridodialysis.

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 a method for eliminating iridodialysis, in which the iris is fixed to the sclera at least at one point by means of a staple made of suture material with a thickening at the ends, according to the invention, a tunnel 2-2 long is formed at the site of the planned fixation of the iris to the sclera, 5 mm in 2.5 mm from the limbus in the upper sector 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 ° is inserted, then the tip of the needle is turned 90 ° and after perforation of the sclera and the flat part of the ciliary the bodies are brought out parallel to the plane of the iris over the capsular bag, the iris is perforated at a distance of 1 mm from the edge of the separation and taken out into the lumen of the pupil, after which a 6-0 prolene thread is inserted into the needle, at the end of which, from the side of the free end of the needle, the first thickening is made by melting threads to a spherical formation, which is flattened, then the needle with the thread is pulled out, the thread is tightened, heating the attraction of the iris to the sclera, and cut off with the formation of a second thickening by melting the thread to a spherical formation, which is immersed in the scleral tunnel. The invention is illustrated by drawings.

In FIG. 1 shows a method for eliminating iridodialysis, after perforation of the iris, a thread with a thickening at the end is inserted into the needle.

In FIG. 2 - the same, the needle is removed from the sclera, the iris is drawn to the sclera, the spherical formation at the second end of the thread is immersed in the scleral tunnel.

The method is carried out as follows.

Depending on the size of iridodialysis, the iris 1 is fixed to the sclera 2 at one or more points. To do this, the end of the thread 3 prolene 6-0 is first melted to a length of about 10.0 mm with a heated coagulator to form a thickening 4 in the form of a spherical formation, which is flattened to give a flat rounded shape. After that, the needle 5 is bent at an angle of 90° with the help of a needle holder to form the lengths of the proximal and distal parts in accordance with the proportion 1/3:2/3. Needle 5 is used as an external guide for the suture material inside the sclera. Further, in the place of the alleged fixation of the iris 1, a tunnel 6 is formed 2-2.5 mm long 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 5 bent at an angle of 90 ° is inserted, direction the movements of which, after passing through the tunnel, change to 90° and after perforation of the sclera and the flat part of the ciliary body, they are removed parallel to the plane of the iris over the capsular bag, the iris is perforated at a distance of 1 mm from the edge of the separation and removed into the anterior chamber. Next, a thread 3 is inserted into the lumen of the needle 5 with a flattened thickening 4 at the end about one centimeter long so that the thickening 4 is at the free end of the needle 5. After that, the needle 5 with the thread 3 is pulled out, the thread 3 is pulled up to the required attraction of the iris 1 to sclera 2 and cut off, 5-7 mm away from sclera 2, the tip is melted to a thickening in the form of a spherical formation 7, which is immersed into the scleral tunnel 6 with tweezers. performed with immersion in the scleral tunnel with a rotation of 90° holds the iris tissue on the sclera. Depending on the size of iridodialysis, there may be several fixation points for the iris. All perform in the stated manner.

The inventive method allows to reduce the traumatization of eye tissues, reduce the risk of postoperative complications.

Patient B., 46 years old. Admitted for surgical treatment with complaints of decreased vision in the right eye for four years. At the age of thirteen there was a contusion of the right eye, the corrected vision after it was 0.5. There were no operations, no drops drip.

Visual acuity at admission - visus OD=0.3 sph -1.0D cyl -4.0 ax 10°=0.6, visus OS=1.0.

Keratometer of the right eye 44.0-41.5 100°; left eye 43.0-42.25 80°.

Intraocular pressure - Pi OD 16 mmHg, Pi OS 12 mmHg

Anterior-posterior axis (APA) of the right eye - 25.12 mm, AP of the left eye - 24.01 mm.

Biomicroscopically: on the right eye - transparent cornea, anterior chamber of medium depth, iridodialysis from 15.30 to 17.30, clouding in the nucleus, in the anterior cortical layers of the lens. The fundus of the eye - the optic disc (OD) - pale pink with clear contours, the arteries are slightly narrowed, the visible periphery is unchanged.

Gonioscopy - the angle of the anterior chamber (ACC) is open, of medium width, ++ pigmentation, detachment of the iris from the root from 15.30 to 17.30.

Diagnosis - the consequences of contusion of moderate severity of the right eye: traumatic cataract, partial iridodialysis, myopia 1 degree, complex myopic astigmatism, axial anisometropia. An operation was performed on the right eye - ultrasonic phacoemulsification through a 2.2 mm corneal tunnel. Implanted toric intraocular lens centered along the axis of 105°. A viscoelastic preparation was introduced into the anterior chamber. Fixation of the iris carried out according to the claimed method. At the same time, one end of the Prolene 6/0 thread was melted to a length of about 10 mm with a coagulator until it thickened in the form of a spherical formation, after which the melted tip was immediately flattened with needle holder jaws to give a flat rounded shape. A tunnel 2-2.5 mm long was formed 2.5 mm from the limbus at 16.00 hours (at the site of the planned fixation of the iris) through the conjunctiva in the sclera parallel to the limbus at a depth of 0.5 mm, along which a curved at an angle of 90° was introduced. in a ratio of 1/3:2/3 injection needle 27G. Next, the tip of the needle was turned 90°, and after perforation of the sclera and the flat part of the ciliary body, it was brought out parallel to the plane of the iris over the capsular bag, the iris was perforated at a distance of 1 mm from the edge of the detachment, and brought into the anterior chamber. Through the main incision, using collet tweezers, the free tip of the prepared 6-0 prolene thread was placed into the anterior chamber and inserted into the lumen of the needle about 1 cm long. 5-7 mm from the sclera, the tip was melted to form a thickening in the form of a spherical formation, which was immersed in the scleral tunnel. The toric IOL was axially centered, and the viscoelastic preparation was removed from the anterior chamber.

After surgery - visus OD=0.9 cyl -0.5 D ax 35°=0.95 Pi OD 16 OS 11

Biomicroscopically: in the right eye - the cornea is transparent, the anterior chamber is of medium depth, the Tyndall phenomenon is 0 degree, the pupil reaction is 1 degree, the pupil is round, there is no iridodialysis, the IOL is centered.

Claims (1)

A method for eliminating iridodialysis, in which the iris is fixed to the sclera at least at one point by means of a staple made of suture material with a thickening at the ends, characterized in that a tunnel 2-2.5 mm long is formed at the site of the planned fixation of the iris to the sclera in 2 .5 mm from the limbus in the upper sector 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 ° is inserted, then the tip of the needle is rotated 90 ° and, after perforation of the sclera and the flat part of the ciliary body, is withdrawn parallel to the plane the iris over the capsular bag, the iris is perforated at a distance of 1 mm from the edge of the tear and taken out into the anterior chamber, after which a 6-0 prolene thread is inserted into the needle, at the end of which, from the side of the free end of the needle, the first thickening is made by melting the thread to a spherical formation , which is flattened, then the needle with the thread is pulled out, the thread is pulled up, ensuring the attraction of the iris to the sclera, and weeding out cabins with the formation of the second thickening by melting the thread to a spherical formation, which is immersed in the scleral tunnel.

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