Method operations of laser-assisted in situ keratomileusis after photorefractive keratectomy

 

(57) Abstract:

The invention relates to ophthalmology. The method includes overlaying the operated eye vacuum ring, the formation of the corneal flap with the microkeratome, the loosening of the flap in the side of the stem, photoablation stroma of the cornea with a laser beam. Prior to forming the microkeratome flap on the corneal surface is applied a viscoelastic substance, and the pedicle of the flap is located, for 12 hours. The method allows to increase the reliability of fastening of the flap during the operation.

The invention relates to medicine, more specifically to ophthalmology, and allows operations specialized laser-assisted in situ Keratomileusis with less likelihood of complications.

Operation specialized laser-assisted in situ Keratomileusis (LASIK) in contrast to photorefractive keratectomy is not on the surface of the cornea, and in the thickness of its stroma (under the flap), this process was called Keratomileusis. In the beginning of the operation using a microkeratome flap of the corneal epithelium turns, is laser ablation of the stroma of the cornea, then the flap is put back in place.

There is a method of carrying out laser which is microkeratome, the formation of the corneal flap with the microkeratome, the loosening of the flap to the side where it is connected to the cornea, the effects on the stroma of the laser beam.

The disadvantage of the operation according to this technique is that when performing LASIK after photorefractive keratectomy there is a danger of stretching, tearing or slipping corneal epithelium when the pressure head moving microkeratome. The reason for this is uneven fixation of the epithelium in different zones and the degree of thinning. In addition, because of the preliminary photorefractive keratectomy, which failed and led to the emergence of flair, resulting in LASIK surgery, the cut surface of the cornea may be less smooth than it could be on neoperabelnoy the cornea, and this in turn leads to an increase in the possibility of amplification of optical aberrations. According to our data, moreover, the frequency of epithelial damage when conducting specialized laser-assisted in situ Keratomileusis after photorefractive keratectomy is quite high, about 67% (see "LASIK" J. G. Pallikaris, D. S. Siganos, SLACK lncorporated,1999, p.305-309).

The technical result of the proposed method is to improve the reliability of operation La the Oia laser-assisted in situ Keratomileusis after photorefractive keratectomy, includes applying the eye of the vacuum ring, the separation of the corneal flap with the microkeratome, the loosening of the flap to the side where it is connected to the valve stem, the effects on the stroma of the cornea with a laser beam, and before occupational microkeratome flap on the corneal surface is applied viscoelastics substance and the leg flap is located on the 12 hours.

When performing LASIK after photorefractive keratectomy there is a danger of stretching, tearing and slipping the corneal epithelium when the pressure head moving microtome. The reason for this is uneven fixation of the epithelium in different zones and the degree of thinning. In addition, because of the preliminary photorefractive keratectomy, which failed and led to the emergence of flair, which resulted in surgery LASIK, the cut surface of the cornea may be less smooth than it could be on neoperabelnoy the cornea, and this in turn leads to an increase in the possibility of amplification of optical aberrations. The location of the legs 12 hours enhances epithelialization of the ablation zone, because when you blink the eyelid protects the epithelial flap. The number viskoelasticnog matter what the surgery excimer lasers, working 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 the operation, and the eyes should be closed, because the blinking reduces the effectiveness of anesthesia, it is recommended to apply a solution of anesthetic eyelids as a zone 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, it is possible 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 included fixing the vacuum ring, inelectronics, which provides translational movement keratome and slicing motion of the blade with a frequency of 12,000 rpm, a set of interchangeable heads or fixed cards for holding sections of different depths. 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. Markirovshchitsa 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 magnitude of intraocular pressure was not less than 65 mm RT.article In no event it is impossible to start the operation at low pressure, it can lead to serious complications. After that, you can start the procedure 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 molarity hinged flap, you need to carefully wash the surface of the stroma and to moisten the flap.

The hinged flap is accurately centered on the label of the token. These places, where the flap is separated from the cornea exposed to the label. Used to label various dyes such as rose Bengal.

Can be used in a variety spatula, but it is best to use a spatula, Barraquer.

Method of performing laser-assisted in situ Keratomileusis after operations photorefractive keratectomy, including the imposition on the operated eye vacuum ring, the formation of the corneal flap with the microkeratome, the loosening of the flap in the side of the stem, photoablation stroma of the cornea with a laser beam, characterized in that prior to formation of the microkeratome flap on the corneal surface is applied a viscoelastic substance and the leg flap is located at 12 hours.

 

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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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