RU2831212C1 - Method for transscleral flange fixation of intraocular lens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be used in ophthalmic surgical practice for fixation of haptic elements of an intraocular lens, IOL, if it is impossible to implant the IOL into a capsular sac or into a ciliary sulcus supported by an anterior lens capsule. That is ensured by forming corneal paracenteses at 3 and 9 hours, a tunnel limbal incision at 11 hours, as well as scleral pockets with preliminary separation of conjunctiva at 6 and 12 hours. Haptic elements of the IOL are stitched before implantation into injector with 6-0 polypropylene suture needle. Flanges fixed in haptic elements of the IOL are formed at the ends of the sutures with the help of a coagulator. Pre-pierced IOL is implanted into the posterior chamber of the eye with the help of an injector through a small corneal incision for 11 hours. Then, through the previously formed scleral pocket for 6 hours, the sclera is punctured with injection needle 29G parallel to the iris, which is used as a guide for a needle with a thread, which is introduced into the anterior chamber with the help of microtweezers and then through the scleral pocket. Similar manipulations are performed with a scleral approach for 12 hours. IOL is centered by pulling up the suture ends for 6 and 12 hours. Suture ends are cut off and external flanges are formed with subsequent immersion into the scleral pocket and the conjunctiva suturing in this area.

EFFECT: invention allows minimizing the risk of repeated IOL dislocation due to stable IOL fixation with reduced duration and traumatism of the operation.

1 cl, 2 ex

Description

The proposed method relates to medicine, in particular to ophthalmology, and can be used in ophthalmosurgical practice for the purpose of fixing the haptic elements of an intraocular lens (IOL) when it is impossible to implant the IOL into the capsular bag or into the ciliary groove with support on the anterior capsule of the lens.

The method is relevant both in the case of primary IOL implantation in complicated cataract surgery (phacoemulsification, intra- or extracapsular extraction) with critical damage to the lens capsule and/or ligamentous apparatus, and for secondary implantation in aphakia or removal of a dislocated lens/IOL.

There are known methods for fixing the haptic elements of the IOL transsclerally or by suturing to the iris in complicated cataract surgery or when secondary IOL implantation is necessary. There are no generally accepted approaches to IOL fixation in such situations, and the variety of these methods is characterized by the technical complexity and duration of the intervention and, in some cases, the lack of stable fixation in the long term when using 9-0 polypropylene threads and suture fixation (Wasiluk E. et al. The implantation of the scleral-fixed posterior chamber intraocular lens with 9/0 polypropylene sutures-long-term visual outcomes and complications // Advances in Medical Sciences. - 2019. - Vol. 64. - No. 1. Pp. 100-103).

A method of ciliary transscleral suture fixation of haptic elements of an intraocular lens for correction of aphakia is known (RU Patent No. 2455963). However, this method uses suture fixation with a 10-0 polypropylene thread, which in some cases is accompanied by late postoperative complications in the form of repeated dislocation of the IOL due to suture divergence. In addition, this method includes the formation of scleral flaps with their subsequent suturing, which also increases the duration of surgical intervention.

The closest analogue is the method of fixing the posterior chamber intraocular lens (Patent of the Russian Federation No. 2135136), which consists of cutting and separating the conjunctiva, cutting out superficial flaps of the sclera with the base towards the limbus in the area of the projection of the ciliary groove, in which two paired threads are passed in the area of the cut flaps of the sclera parallel to the horizontal axis of the eye and symmetrically relative to it. For this, a needle is used, which is injected into the corners of the base of one cut superficial flap equal to or larger than the optical part of the implanted lens. And it is brought out to the corresponding corners of the opposite superficial flap. The implanted lens is fixed between the paired threads. This method is not effective enough because it does not allow for precise centering of the lens horizontally, and the method is labor-intensive and time-consuming. Cases of repeated, repeated dislocation of the IOL into the vitreous cavity were identified.

The objective of the proposed invention is stable and reliable fixation of the IOL.

The technical result of the proposed method is the minimization of the risk of repeated dislocation of the IOL, a reduction in the duration and trauma of the operation.

The technical result is achieved by the fact that in the method of transscleral flange fixation of the intraocular lens, corneal paracenteses are used at 3 and 9 o'clock, a tunnel limbal incision at 11 o'clock, as well as scleral pockets with preliminary separation of the conjunctiva in the zone at 6 and 12 o'clock, and the haptic elements of the IOL are stitched before implantation into the injector with a 6-0 polypropylene thread.

The method is implemented as follows. The surgical approaches are corneal paracenteses at 3 and 9 o'clock, a tunnel limbal incision at 11 o'clock, and scleral pockets with preliminary separation of the conjunctiva in the 6 and 12 o'clock zone. The haptic element of the IOL is sutured with a needle with a 6-0 polypropylene thread before implantation into the injector; a flange is formed at the end of the thread using a coagulator, which is fixed directly in the haptic element of the IOL. The paired haptic element is sutured in a similar manner. The pre-sutured IOL is implanted into the posterior chamber of the eye using an injector through a small corneal incision at 11 o'clock. Through this incision, the ends of the threads with needles are held outside the eye. Then, through the previously formed scleral pocket at 6 o'clock, the sclera is punctured with a 29G injection needle parallel to the iris - this injection needle is used as a guide for the needle with a thread, which is inserted into the anterior chamber using microtweezers and then through the scleral pocket. Similar manipulations are performed with the scleral access at 12 o'clock. After the IOL is centered by pulling the ends of the thread at 6 and 12 o'clock, the ends of the threads are cut and external flanges are formed with subsequent immersion in the scleral pocket and suturing of the conjunctiva in this area.

The invention is illustrated by the following examples.

Example 1

Patient K., 64 years old, underwent surgery on September 18, 2021, for complicated cataract of the left eye (OS Phacoemulsification with IOL implantation), in the postoperative period, he noted an improvement in visual acuity. Two years later, he went to the local clinic complaining of severe visual discomfort in the left eye, visual acuity 0.2 n/c. A diagnosis of IOL decentration in the left eye was made. Surgical intervention was performed - IOL repositioning according to the proposed method. In the postoperative period, correct IOL centering is noted, no protrusion of the flange elements under the scleral flap, visual acuity increased to 0.7 b/c.

Example 2

Patient F., 73 years old, underwent surgery on 10/14/2022 for complicated cataract of the right eye (OD Phacoemulsification without IOL implantation). The surgery was complicated by a violation of the integrity of the capsular bag, in connection with which a decision was made to perform secondary IOL implantation as the second stage of surgical treatment. Four months later, the patient was hospitalized as planned for secondary IOL implantation with additional fixation. Preoperative visual acuity of the right eye was 0.05 sph +10.0 = 0.6. The surgery was performed using the proposed method. In the postoperative period: the eye is calm, the IOL is in the correct position, the flange elements under the scleral flap are not visualized, visual acuity increased to 0.8 b/c.

Claims (1)

A method of transscleral flange fixation of an intraocular lens, characterized by the fact that corneal paracenteses are formed at 3 and 9 o'clock, a tunnel limbal incision at 11 o'clock, as well as scleral pockets with preliminary separation of the conjunctiva in the zone at 6 and 12 o'clock, the haptic elements of the IOL are sutured before implantation into the injector with a needle with a 6-0 polypropylene thread, flanges are formed at the ends of the threads using a coagulator, fixed in the haptic elements of the IOL, the pre-sewn IOL is implanted into the posterior chamber of the eye using an injector through a small corneal incision at 11 o'clock, through this incision the ends of the threads with needles are held outside the eye, then through the previously formed scleral pocket at 6 o'clock a puncture of the sclera is made with a 29G injection needle parallel to the iris, which is used as a guide for the needle with thread, which is inserted into the anterior chamber using microtweezers and then through the scleral pocket, similar manipulations are performed with scleral access at 12 o'clock, the IOL is centered by pulling the ends of the thread at 6 and 12 o'clock, the ends of the threads are cut and external flanges are formed with subsequent immersion in the scleral pocket and suturing of the conjunctiva in this area.