The method of operation of laser-assisted in situ keratomileusis

 

(57) Abstract:

The invention relates to the field of ophthalmology and is intended for refractive surgery. Form a flap in the cornea. Turn it to the side of the stem, which carries the flap. Fold the flap in half. When the flap closes the attachment legs of the flap to the cornea at a width of 0.5-1.0 mm Method allows us to simplify the operation of laser-assisted in situ Keratomileusis and reduce the risk of complications. 2 Il.

The present invention relates to medicine, more specifically to ophthalmology? and can reduce the risk of complications during operations specialized laser-assisted in situ Keratomileusis (LASIK).

Modern prior art method of operation excimer laser specialized Keratomileusis (LASIK), including instaliranje anesthetic in the operated eye, peeling of the superficial flap of the cornea, his lifting up, the effects on the stroma of the cornea by the laser beam with the purpose of vision correction, reposition flap (Kremer F., Dutek M Excimer laser in situ keratomileusis // J. Refract. Surg. - 1995. - Vol. 11. - Suppl. - P. 244-247).

A disadvantage of the known method are complications, because after the surgery can be vrastan the om LASIK done the cut flap of the cornea, to cut the corneal flap uses a microkeratome, when exposed to a microkeratome, the pressure is on the epithelium, the edges of the epithelium as if stretched before it separates from the cornea. If you use a scalpel, and its effects on the cornea will be the tension of the epithelium in the separation from the cornea. The edge of the epithelium will be larger than the size of the flap, the surgeon wanted to separate.

The closest way of specialized laser-assisted in situ Keratomileusis is a process involving the formation of a corneal flap, turn it to the side where the leg to which is attached a flap, the impact on stroma beam excimer laser and reposition the flap in the box on the cornea. The operation thus requires the presence of an opaque flap, for example, in a known way valve made of plastic or metal. During laser-assisted in situ Keratomileusis place of attachment of the flap to the cornea must be protected from laser exposure. The surgeon must use one hand to close the place secures the flap to the cornea, and at the same time to observe the fixation of gaze of the patient. You may touch the corneal flap that traumatize the ablation zone of the horn is about difficult to put in the corneal bed (see J. J. Machat, S. G. Slade, L. E. Probst "The Art of LASIK" Slack Incorporated, USA, 1999, p.355-356).

The disadvantage of this method is the possibility of damage to the leg of a flap of the cornea, resulting in nonhealing defects of the cornea, and further to the appearance of irregular astigmatism, which reduces the effect of the operation.

The technical result of the claimed method specialized laser-assisted in situ Keratomileusis is a simplification due to the withdrawal of the methods of the valve and reducing the likelihood of complications.

The technical result is achieved in the way of specialized laser-assisted in situ Keratomileusis, including the formation of the corneal flap, turn it to the side where the leg to which is attached a flap, the impact on stroma beam excimer laser and reposition the flap in the bed of the cornea, and the flap is folded in two layers and the edge closes the place where it is attached to the cornea at a width of 0.5 to 1.5 mm

According to the invention is achieved protection stroma from ablation and does not occur veins tension during laying of the flap. If you still undesirable ablation will be taken to the epithelial layer and part of his alleroed, it will not entail seriously the mu (the thickness of the epithelium is 40-60 μm) and the partial ablation of the epithelium rapidly regeneriratia. In addition to the epithelial flap was not grown in the epithelium, is not affected by the operation, the edges cut at 0.5 to 1.0 mm. Stowage flap, according to the proposed method is performed by one movement of a spatula, shifting it in the bed of the cornea, because with the addition of the flap it will always be tears, and the flap of the cornea will slide forward, instantly defeating. If you do not fold the flap, it dries up during the operation and it is more difficult to lay in the bed.

During the operation, after the separated flap of the cornea, the surgeon folds it several times. The flap can be folded in half and the edge of his will to protect the point of attachment of the flap to the cornea.

In Fig. 1 illustrates the placement of the flap by a known method, and Fig. 2 under the proposed. As can be seen from the figures, the surgeon folds the flap of the cornea twice and the edge of the flap closes the bracket legs to the cornea. During operations it was found that if in this case the edge of the flap will be influenced by a laser beam, it is not the effect of what could be known. The specified width of 0.5-1.0 mm allows operation with protected leg flap for smaller width sushestvuete will affect the quality of the operation.

When performing LASIK are happy to use to separate the surface of the corneal flap, the diameter of the circular flap is from 6 to 11 mm and a thickness of 160 μm. Currently, the flap is not cut completely, and leave on the leg, i.e., the flap is connected with the entire cornea small plot last. After microkeratome flap lift, turn in the direction of the leg, hold excimer laser ablation of the stroma, and then produce reposition the flap.

Modern ophthalmology uses for refractive surgery excimer lasers operating on a mixture of argon-fluoride with a wavelength of 193 nm, of which the most promising is the Nidek laser - 5000 2s. Its advantages include the use of small energy density, which allows to reduce trauma to the cornea to reduce the acoustic impact, in addition, the temperature in the ablation zone is almost not increased. The beam delivery system eliminates the formation of the Central island, which is often a complication and leads to astigmatism when using broad-based lasers.

When preparing the patient hold the instillation anastatica immediately before surgery, and the eye must be the century as an area of discomfort. Additional anesthesia, corneal zone valve is not required because the manipulation is virtually painless. The choice of antibiotic less important due to the fact that the risk of infection when LASIK is lower than with PRK. The main purpose of antibiotic - reducing development risk of bacterial inflammation.

Since the content of water in the middle of the corneal stroma more than at its surface, there may be more frequent cases of hypercorrection, as a rule, the correction for the difference in the hydration already included in the program of the laser. However, some surgeons have sought to reduce the water content on the surface of the slice. You can use several methods: the removal of moisture by using a flat spatula, processing corneal bed surgical swab or other material, deep stromal dehydration using a special device. This is done by blowing the cut surface with sterile air at intervals equal to the series of laser pulses.

For successful operation it is the correct preparation of the microkeratome. In the set microkeratome includes: fixing a vacuum ring, inelectronics, which provides translational movement keratome and cutting magic cube MOV is depth. The microkeratome equipped with a disposable replacement blades, inserted in the cylinder immediately before the operation.

Surgical preparation of the patient's eye on the operating table includes immobilization century hard blepharostoma, protection against ingress of eyelashes on the impact and especially in the mechanism keratome, a bandage for contralateral eyes, marking the cornea. Marking of the cornea is made for the alignment of the fixation ring and the valve when it repositions. Currently used by a variety of markers. The common feature is the use of the Central ring (typically 3 mm in diameter) and several predialing asymmetric linear labels. Linear marks help just put a flap on stromal bed.

During the operation of the fixation vacuum ring must be installed exactly in the center, it is a uniformly covers the area of the limb. In the groove of the ring creates a negative pressure, due to which it is firmly fixed to the surface of the eyeball. Then using aplantic tonometer, Barraquer measured pressure. For a successful LASIK procedure, it is necessary that the value of nutrigen which can lead to serious complications. Then you can start the process keratectomy, which is actually fully automated. Using a thin spatula, fold the flap is separated from the stroma and leans back on the leg. Care should be taken to position the stem of the folding flap, because its excessive bending can cause creases after surgery, but with little displacement of the flap on the stem can be part of the energy of the laser beam. An important step is to reposition the hinged flap. Before you lay the hinged flap, you need to rinse the surface of the stroma and to moisten the flap. The hinged flap is accurately centered on the tag token.

These places, where the flap is separated from the cornea exposed to the label. Used to label various dyes such as rose Bengal. As a spatula may be used in a variety spatula, but it is best to use a spatula, Barraquer.

So far it has made 11 operations in the proposed method, complications were found.

Method of performing laser-assisted in situ Keratomileusis, including the formation of the corneal flap, turn it to the side of the stem, which carries the flap, the impact of n is ia flap in its folded twice, in this case, the edge of the flap closes the attachment legs of the flap to the cornea at a width of 0.5 - 1.0 mm

 

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Blueparrott // 2143854
The invention relates to medicine, namely to ophthalmology, and can be used for operations on the eyeball

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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