RU2809202C1 - Method for increasing clinical and functional results of correction of myopia and myopic astigmatism when performing femtosecond lenticule extraction using clear technology - Google Patents

Abstract

FIELD: medicine; ophthalmic surgery.

SUBSTANCE: invention can be used to improve the clinical and functional results of correction of myopia and myopic astigmatism when performing femtosecond intrastromal lenticule extraction with a small incision using the CLEAR technology (Corneal Lenticule Extraction for Advanced Refractive Correction). To do this, after lenticule extraction, the surface layer of the cornea is adapted to the stroma. The outer surface of the cornea is smoothed with a micro-tap from the limbus to the opposite part of the limbus through the centre of the cornea in all meridians. In each meridian, 7-8 movements are performed in both directions, while compressing the cornea.

EFFECT: invention makes it possible to achieve a more even surface of the cornea in the optical zone, reduces corneal irregularity, and also achieves a tighter fit to the surgical surface, which helps to improve visual acuity at an earlier stage, reducing rehabilitation time and increasing patient satisfaction.

1 cl, 1 ex

Description

The invention relates to medicine, namely to ophthalmic surgery, and can be used to improve the clinical and functional results of correction of myopia and myopic astigmatism when performing femtosecond intrastromal lenticule extraction with a small incision using the CLEAR (Corneal Lenticule Extraction for Advanced Refractive Correction) technology) .

One of the fundamentally new areas of refractive surgery is the correction of refractive errors by performing a small incision without the formation of a corneal flap. Changing the curvature of the cornea is carried out by forming a lenticule in its stroma, which is required for the desired correction and is removed through a minimal incision (Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol. 2011 Mar;95(3):335-9).

For the low-energy femtosecond laser platform, a new application for the correction of myopia and myopic astigmatism was developed - CLEAR (Corneal Lenticule Extraction for Advanced Refractive Correction)), which allows recognizing the diameter of the pupil, compensating for cyclotorsion and its operational control, thereby ensuring a stable refractive effect ( FEMTOLDV. www.ziemergroup.com (23 December 2020), prototype.

Since the movement of the laser beam during surgery using CLEAR technology occurs in a spiral from the periphery to the center, after the formation of the lenticule, a “bump” is formed in the central zone of the cornea, which reduces the thickness of the upper layer of the cornea, prevents the correct adaptation of the corneal surface after extraction of the lenticule and prolongs the rehabilitation period for patients.

The proposed invention solves the problem of increasing the clinical and functional results of correction of myopia and myopic astigmatism when performing femtosecond intrastromal lenticule extraction using CLEAR technology.

The essence of the method is that when performing an intervention to correct myopia and myopic astigmatism using the method of femtosecond intrastromal lenticule extraction using CLEAR technology, after lenticule extraction, the surface layer of the cornea is adapted to the stroma, carefully smoothing the outer surface of the cornea with a microtap from the limbus to the opposite part of the limbus through the center corneas in all meridians, and in each meridian at least 7-8 movements are carried out in both directions, while compressing the cornea.

The technical result from the implementation of the invention is to provide a more even surface of the cornea in the optical zone, reduce the irregularity of the cornea, and also achieve a tighter fit to the surgical surface, which helps to improve visual acuity at an earlier stage, reducing rehabilitation time and increasing patient satisfaction.

The method is carried out as follows.

The operation is performed under local drip anesthesia. The vacuum ring of the laser unit is docked with the surface of the eyeball, centered, and cuts are planned. After femtodissection, a tunnel is programmed under one incision above the upper space of the lenticule, under the other - under the lower space of the lenticule. After dividing the upper and lower planes, the lenticule is captured and removed as a single block. The corneal pocket is washed and the surface layer of the cornea is adapted to the stroma using a microtapfer, carefully smoothing the outer surface of the cornea from the limbus to the opposite part of the limbus through the center of the cornea in all meridians, and in each meridian at least 7-8 movements are carried out in both directions, carrying out this compression of the cornea.

The method is illustrated by the following clinical example.

Example 1. Patient T., 24 years old.

I contacted the Tambov branch of the Federal State Institution "National Medical Research Center" MNTK "Eye Microsurgery" named after. S.N. Fedorov with a diagnosis of OS - moderate myopia.

Manifest refraction OS sph - 4.25 cyl - 0.75 х 124°.

Pachymetry: 554 microns.

Corneal radius 7.34 mm.

The average K value is 44.50 diopters.

The pupil diameter in mesopic conditions is 6.5 mm.

Visual acuity OS without correction 0.03 with correction 1.0.

The patient underwent refractive surgery on the cornea OS: using a Ziemmer LDV Z8 femtolaser unit using the Clear method. A lenticule 91 microns thick was formed intrastromally with a lateral microaccess of 2.0 mm.

Sector separation was performed using a spatula through a 2.0 mm inlet. The vacuum ring of the laser unit was docked with the surface of the eyeball, centering and planning of the incisions were carried out. After femtodissection, programming was performed under one incision for a tunnel above the upper space of the lenticule, under the other, under the lower space of the lenticule. After dividing the upper and lower planes, the lenticule was captured and removed as a single block. The corneal pocket was washed and the surface layer of the cornea was adapted to the stroma using a microtap, carefully smoothing the outer surface of the cornea from the limbus to the opposite part of the limbus through the center of the cornea in all meridians, making 8 movements in each meridian in both directions and thereby compressing the cornea.

On the first day after surgery:

Left eye - manifest refraction sph + 0.25 cyl - 0.25 ah 2°.

Visual acuity without correction 1.0 n/k.

Check-up one month after surgery:

Left eye - manifest refraction sph + 0 cyl - 0.25 х 6°.

Visual acuity without correction 1.0 n/k.

Thus, extremely high visual acuity without correction was obtained in the operated left eye with a minimal recovery period.

Claims (1)

A method for increasing the clinical and functional results of correction of myopia and myopic astigmatism when performing femtosecond lenticule extraction using the CLEAR technology, characterized in that after extraction of the lenticule and washing of the corneal pocket, the surface layer of the cornea is adapted to the stroma using a microtouch, smoothing the outer surface of the cornea from the limbus to the the opposite part of the limbus through the center of the cornea in all meridians, and in each meridian 7-8 movements are carried out in both directions.