The way the correction of high myopia and complex myopic astigmatism medium and high

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and is intended for the correction of refraction. Perform surgical correction of astigmatic component method front keratotomy. The spherical component treated by implantation of negative fakecheck intraocular lens. The time interval between the two surgery on the same eye for at least 6 months. The method provides a treatment of previously incurable group of patients with a high degree of myopia in combination with complex myopic astigmatism medium and high. 2 C.p. f-crystals.

The invention relates to medicine, namely to ophthalmology.

There is a method of treatment of myopia and myopic astigmatism (C. N. Fedorov, V. C. Durnev. "Surgical correction of complex myopic astigmatism method front keratotomy". - Ophthalmological journal, No. 4, 1979, pp. 210-213).

However, using this technique, to eliminate spherical component in myopia over 7,0 D in combination with an astigmatic component is completely impossible.

The objective of the invention is to provide a method for correcting high who eat coherent combining neprostogo method of surgical correction - front dosed keratotomy - abdominal - implantation negative fakecheck IOL.

The technical result that is achievable with the use of the invention is the treatment of previously incurable group of patients with a high degree of myopia in combination with complex myopic astigmatism medium and high.

The technical result is achieved by the fact that in the known method the correction of myopia and complex myopic astigmatism, including surgical correction of astigmatic component method front keratotomy, according to the invention, the spherical component treated by implantation of negative fakecheck IOL; however, the time interval between the two surgery on the same eye for at least 6 months.

One variant of the invention is one in which initially carry out the astigmatic keratotomy for the correction of astigmatic component.

Another option is one in which initially eliminate spherical component with implantation of negative fakecheck IOL.

The way the implementation of the original resolve complex myopic astigmatism by conducting various types of astigmatic front keratotomy (longitudinal, tangential and others) using known computer programs in accordance with individual parameters of the patient's eye.

In sterile conditions after local anesthesia with 1% solution dikaina patient impose blueparrott. The patient fixes his gaze on the light source operating microscope. Is the marking of the cornea with a special timer-markers are printed on the surfaces of brilliant greens. Moreover, some Central optical zone and future cuts. The number, length and depth of the incisions are calculated in advance using a special computer program. Next micrometer dosed with a knife with a diamond blade put ceratotrichia incisions on the cornea in accordance with the markup. Incisions are washed with saline solution. Perform the injection of the antibiotic under the conjunctiva, remove blueparrott, apply a sterile dressing.

After at least 6 months on the same eye correction of high myopia with implantation of negative fakecheck IOL.

While patients are retro-bulbar anesthesia by injection of 2.0 ml of a mixture of 4% procaine and lidocaine. Akinesia of 4.0 ml of 2% is limb length 6.0 mm is carried out with a diamond blade. In front of the camera introduces viscoelastic visiter to protect the corneal endothelium. Next is the implantation of negative fakecheck intraocular lens, the optical power which is calculated in advance individually in accordance with a specially developed nomogram. When implantation of the intraocular lens consistently impose its lower haptic portion in the posterior chamber of the eye between the iris and natural lens, impose 1 hub seam on the area of the cross section and having upper haptic part of the intraocular lens behind the iris in the posterior chamber. Removed viscoelastic, the area of the overlap section 4-5 hub 10-0 sutures. Under the conjunctiva injected with 0.3 ml of dexasone and 0.3 ml of antibiotic, take blueparrott, impose monocular with a sterile dressing.

According to the invention by variant II initially eliminate spherical component of myopia by implantation of negative fakecheck IOL, and then after at least 6 months on the same eye spend the elimination of astigmatic component using one of the options astigmatic front keratotomy.

The progress of operations implantation negative fakecheck IOL and asthmatically IOL is not in compliance with the original degree of astigmatism and the position of its axis, and with the data obtained after implantation and slightly different from the original.

Our proposed method is thus a combination of neprostoi and abdominal refractive surgery. It allows you to change the approach to treatment and to achieve a positive result in a large group of previously incurable patients with high myopia in combination with complex myopic astigmatism medium and high. Attempts to treat this group of patients using only one of the above methods do not give the desired result and complete restoration of vision in patients, because either remain high residual myopia after keratotomy) or a large astigmatism (after implantation negative fakecheck IOL).

For implantation negative fakecheck IOL characterized by the ability to accurately refractive calculating and predicting when Troubleshooting spherical component of myopia. Due to this, immediately after surgery achieving the desired refractive effect, which does not have a subsequent influence the healing process and which remains stable without any hesitation at all periods of observation. Another advantage of the proposed methods for the I.

Example 1. Patient M., aged 26. Diagnosis: high myopia, complex myopic astigmatism moderate left eye, refractive amblyopia weak.

Visual acuity OS = 0,02 sph. - 14,5 D cyl. - 4.0 D ax 0o= 0,6/

Ophthalmometry: 90o- 40,0 D; 0o- 40,0 D/

The first phase of the operation - front longitudinal keratotomy. On the 7th day visual acuity OS = 0,05 sph. - 14,0 D = 0.6.

Ophthalmometry: 90o- 40,0 D; 0o- 39,75 D.

After 6 months produced the 2nd phase of the operation - implantation negative fakecheck IOL - 14,0 D.

During examination after 2 days visual acuity OS = 0,8 without correction. Ophthalmometry: 90o- 40,0 D; 0o- 40,0 D. Vision consistently.

Example 2. Patient O., 32 years. Diagnosis: high myopia, complex myopic astigmatism high degree right eye, refractive amblyopia weak.

Visual acuity OD = 0,01 sph. - 20,0 D cyl. - 5,0 D ax 0o= 0,4.

Ophthalmometry: 90o- 46,0 D; 0o- 41,0 D.

The first stage of the correction of high myopia by implantation of negative fakecheck IOL optical power - 20,0 D.

2 days:

Visual acuity OD = 0,08 cyl. - 4,5 D ax 0o= 0,4.

On the 7th day visual acuity OD = 0,4 cyl. - 0,5 ax 0o= 0,5.

Ophthalmometry: 90o- 41,5 D; 0o- 41,0 D.

1. The way the correction of high myopia and complex myopic astigmatism medium and high, including surgical correction of astigmatic component method front keratotomy, characterized in that the spherical component treated by implantation of negative fakecheck intraocular lens, while the time interval between the two surgery on the same eye for at least 6 months.

2. The method according to p. 1, characterized in that initially eliminate astigmatic component.

3. The method according to p. 1, characterized in that initially eliminate spherical component.

 

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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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