Device for enzymatic irrigation-aspiration of cataract

 

(57) Abstract:

The invention relates to ophthalmology. Irrigation and suction tube are enclosed in a cylindrical housing with a major hole in its side surface. The working ends of the tubes are curved. The device is further provided with a tube for feeding the enzymatic solution. Additional tube is located between the suction and irrigation tubes and parallel to them. The ends of the suction and additional tubes go into the main bore of the housing, and the end of the irrigation tube go into the hole on the side of the case at its core holes. The technical result of the invention is the provision of a complete, minimally traumatic removal not only soft cortical layers, but also dense nucleus of the cataract by using facilitiesare effect of enzymes in the mode of irrigation-aspiration. 2 Il. /

The invention relates to medical equipment, namely to surgical instruments.

The closest analogue is known device for irrigation-aspiration of cataract, comprising a housing in which two hollow tubes for suction and irrigation, and additional tube in corebox out in specified housing bore (see EN 2069552 c 1/27.11.96, 5 l).

This device does not allow to aspirate the dense fabric of the lens, in particular tissue cores cataract lens, which necessitates its mechanical fragmentation and continuous phacoemulsification.

The problem solved by this invention is the provision of a complete, minimally traumatic removal not only soft cortical layers, but also dense nucleus of the cataract.

The technical result is achieved in that the device for irrigation - aspiration of cataract, comprising a housing in which two hollow tubes for suction and irrigation and an additional tube in the casing on its side surface at the end of the main hole at the ends of the suction and additional tubes come in specified housing bore, and a tube for aspiration and irrigation are parallel to each other, an additional tube for delivery of enzymatic solution is located between and parallel to them, and the end of the irrigation tube goes into the hole on the side surface of the main body holes.

The essence of the proposed technical solution is illustrated by a drawing, which shows Scrooge) incision (Fig.2). Device for enzymatic irrigation-aspiration consists of a cylindrical body 1 having two holes on the side surface at the face end: irrigation 2 and base 3. In the body cavity of the enclosed parallel to each other and to the longitudinal axis of the housing hollow tube for irrigation 4, aspiration 5 and an additional pipe to supply the enzymatic fluid 6. The suction tube ends with a hole 7 in the horizontal plane located at the main hole. Additional handset for filing enzymatic fluid has a hole 8 in the vertical plane, which is located between the base and the suction holes.

The alleged device is used as follows. End end device with holes placed in the plane of incision and injected into the anterior chamber, in the upper pole of the capsular bag side of the main hole to the surgeon and make a removal of the catarrhal masses. Removal of dense cataract mass is achieved by the fact that in space, facing the main hole 3 on the side surface at the face end of the housing, a high facilitiesa concentration of the enzyme, coming out of the hole 8. Irrigator> Control of the balance between the amounts of irrigation, enzymatic and suction fluids is provided a material part, representing either the multi-function system monitor control used in conventional systems irrigation-aspiration, or a system consisting of two syringes, operating on the principle of the irrigation-aspiration (not shown). In both irrigation syringes and enzymatic solutions are in front of the piston and are connected by flexible pipes respectively with irrigation and additional tubes. Positionsmovie space syringe for irrigation fluid and syringe for enzymatic solution through flexible tubes are connected with a double cannula suction tube of the proposed device. When the supply of irrigation fluid and enzyme solution in positionsnum space creates negative pressure, which gives the effect of suction of the suction fluid. A closed system allows to regulate separately as the feed rate of the irrigation fluid and the feed rate of the enzyme. To improve facilitiesare effect in the main hole of the proposed device, the feed rate of the enzyme may Bigali aspiration due to the constant vector direction of fluid flow to the suction hole eliminates the possibility of entering a highly concentrated solution of the enzyme in the intracapsular space. Thanks to monitor balance control amounts of irrigation and enzymatic fluid, on the one hand, and aspirinum on the other, in the space in the front end of the device creates a high concentration of enzyme, which digests dense cataract mass coming through the main hole. The device is made to remove lenticular masses of the capsular bag.

The use of the invention will improve the efficiency and sustainability of the principle of the irrigation-aspiration of cataract due to the complementary use of the enzyme. The invention will reduce the invasiveness of the surgical procedure during cataract extraction with a dense core and reduce the number of postoperative complications.

Device for irrigation-aspiration, comprising a housing in which two hollow tubes for suction and irrigation and an additional tube in the casing on its side surface at the end of the main hole at the ends of the suction and additional tubes go into the main bore of the housing, wherein the tube for aspiration and irrigation are parallel to each other, additional pipe goes into the hole on the side of the main hole.

 

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FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva. Direct muscle is exposed and separated. Forceps is applied to the separated muscle 4-7 cm far from the place of its attachment to sclera. The muscle is notched to 1/2 of its width 1-2 mm far from the forceps on the proximal side. The muscle is bluntly exfoliated. Muscle flap is turned to after cutting it from sclera. The flap end is sutured to sclera 1-5 mm distal from the previous attachment place. Eyeball is displaced in conjunctival sack to opposite side with respect to the feeble muscle. Interrupted sutures are placed on conjunctiva incision.

EFFECT: enhanced effectiveness in correcting large squint angles.

4 dwg

FIELD: medicine.

SUBSTANCE: method involves cutting off external wall of Schlemm's canal on the whole width extent of internal scleral flap bed after making non-penetrating deep sclerectomy operation. At least three drains are entirely introduced into Schlemm's canal lumen and arranged all over the whole circumference of the Schlemm's canal. Hydrated hydrogel is used as draining polymer material. The hydrogel contains 0.5-5.0% aminocaproic acid solution, etamzylate solution and diprospan solution.

EFFECT: increased and retained hypotensive action; increased distance between internal and external wall of Schlemm's canal; reduced risk of traumatic complications in implanting drains; avoided inflammatory response of eye structures.

1 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves introducing device for fixing retina rupture edges into vitreous cavity after having done subtotal vitrectomy. The device has a pair of microsurgical needles connected to each other with surgical thread. Required number of needle pairs is introduced in succession to have required number of straight segments for fixing rupture edge. Needle ends are brought out in pairs together with thread to external sclera surface and cut, and the thread ends are fixed near the sclera surface.

EFFECT: reduced risk of traumatic complications; reliability of retina rupture edges fixation.

3 cl

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

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