A method of surgical correction of myopic astigmatism

 

The invention relates to ophthalmology and is intended for the correction of myopic astigmatism. Exercise effects on the cornea of the eye by UV pulsed laser having a Gaussian distribution of energy density in the cross section of the beam. The effect produced by the beam diafragmirovanija on the threshold of ablation laser forming on the cornea round spot with a diameter of 0.3-1.2 mm, with a pulse energy of 0.7 to 1.4 MJ, pulse duration 4-7 NS, pulse repetition rate from 100 to 300 Hz. Moreover, the cornea is produced by grid points of the scan, formed by equilateral triangles. The point of impact to form a polygonal shape, inscribed in an ellipse, the major axis of which coincides with the weak axis of astigmatism. Next, a grid scan repeatedly shift, and the impact made on the next point grid scan, falling between the points of the previous grid scan. The method allows to achieve uniformity of the surface after exposure, to reduce the operation time. 3 Il.

The invention relates to ophthalmology and is intended for the correction of myopic asthenia UV laser with a wavelength of 193 nm, with an intensity distribution having the shape of a truncated iris Gaussian distribution, forms a round spot on the cornea size 1-7 mm, the center of radiation is initially installed at a distance of 0-2 mm from the center of the optical zone of the eye. Then produce an elliptical scanning with variable angular velocity specified spots on the surface of the eye. The angular velocity is reduced in areas adjacent to the maximum axis of astigmatism, and increases in areas adjacent to the minimum axis of astigmatism. The major axis of the ellipse coincides with the main axis of astigmatism. Produce 5-20 rpm for 1 min for 0.5 to 5.0 min (see RF Patent №2192223).

However, this solution has significant drawbacks: a large number of surface heterogeneity and a great time of the operation.

The technical problem solved by this invention is to improve the uniformity of the surface after impact, reducing the time of the operation.

This technical problem is solved in that in the method of surgical correction of myopic astigmatism, is the impact on the cornea of the eye by UV pulsed laser having a Gaussian distribution is armirovannogo on the threshold of ablation laser radiation, forming on the cornea round spot with a diameter of 0.3-1.2 mm, with a pulse energy - 0,7-1,4 MJ, pulse duration - 4-7 NS, pulse repetition rate from 100 to 300 Hz, and the effects on the cornea produced by the grid points of the scan, formed an equilateral triangle, with the point of impact to form a polygonal shape, inscribed in an ellipse, the major axis of which coincides with the weak axis of astigmatism, then the grid scan repeatedly shift, the effect is produced at the point of the next grid scan, falling between the points of the previous grid scan.

Proposed by the authors of the essential characteristics of the invention is necessary and sufficient for an unambiguous positive solution to the stated technical problem.

The method is illustrated in the drawings, is shown in Fig.1-Fig.3.

In Fig.1 shows an example of distribution of energy density in the zone of operations of Fig.2 is an example of the operation in occasion of myopic astigmatism with the impact zone of 6.0 mm, Fig.3 - view And Fig.2 - the grid scan, formed by equilateral triangles.

The basis for the surgery, the authors have put the following theoretical scheme>x)=(x2/2· R1),

where R1and R2the radii of curvature of the cornea in the center in the directions of astigmatism.

The necessary change in the refraction of the cornea is produced by evaporation of the surface layers of the cornea to the desired shape by impact beam of ultraviolet laser with a wavelength of 193 nm, forming on the cornea round spot with a diameter of 0.3-1.2 mm, with a pulse energy - 0,7-1,4 MJ, pulse duration - 4-7 NS, pulse repetition rate from 100 to 300 Hz and with a Gaussian distribution 1 the energy density of radiation (Fig.1), limited by the threshold of ablation (formula 2)

W(x)=W0·exp(x2/2· S2),

W(x)=0, if xD

where D is the beam diameter corresponding to the threshold for ablation of the cornea;

W0the energy density in the radiation pulse in the center of the spot;

S - parameter Gaussian distribution.

To ensure the best quality of the surface of the cornea that leads to fewer aberrations and higher visual acuity, the impact of a narrow beam of laser radiation produced in the grid scan presented on Pietra 2 (Fig.2) denote the nodes of the grid scan formed by equilateral triangles 3 (Fig.3), circles of larger diameter 4 (Fig.2) indicate the place of impact of the laser beam in the process of removing one layer of the cornea during the operation.

In each horizontal line (Fig.3, A) the distance between the centers of the beams of laser radiation (grid scan) d is equal to 340 μm. The nodes in each subsequent row shift to the right relative to the previous distance d/2. The shortest distance h between rows is (formula 3)

Thus, the nodes described above lines form an equilateral triangle with 3 party d equal to 340 μm, and the elementary fragment of the proposed grid scan is an equilateral triangle.

In the area of operation of the required diameter of the point of impact to form a polygonal shape, inscribed in the ellipse 5. The major axis of the ellipse coincides with the weak axis of astigmatism. If the major axis of the ellipse is greater than the diameter of the optical zone, he clipped the diameter of the optical zone. Next, a grid scan repeatedly shift, the effect is produced at the point of the next grid scan, falling between the points of the previous grids. The number of shifts svedeniya operations cylindrical lens consists of a set of microlenses with an optical power of about - of 0.3 Diopters. In turn, each lens consists of a set of planar layers elliptical. The area of the layers is reduced in the vertical direction. As a result of exposure N pulses is filled grid scan and removed one flat layer of the cornea. As a result of evaporation of the corneal tissue will be obtained corneal surface described by equation (formula 3), in the General case, which is not the equation of a parabola

Preparing for surgery about the correction of myopic astigmatism, implemented by the proposed method involves conducting a refractive diagnosis of the patient's eye, which includes the definition of subjective refraction, visual acuity, ophthalmometry, echobeatz, corneometry, computer keratotopografii.

The influence of laser radiation on the cornea of the patient's eye are produced at the grid points of the scan, proposed by the authors formed by equilateral triangles, by the described algorithm. The initial data for calculation are the initial refraction of the cornea, the corneal thickness, the desired change of refraction, the diameter of the zone of influence, the dependence of the thickness of the removed layer from densely settled: antibiotics (for example, R-R of chloramphenicol 0,25%) for 7-10 days 4-6 times a day. With 3-day for 2-3 months prescribed topical corticosteroids (eg, dexamethasone 0.1%) of the scheme (from six pits in a single day before backfilling at maturity).

Example 1.

Patient N., 24 years old, diagnosis: high myopia, complex myopic astigmatism moderate left eye.

Visual acuity: OS=0,01 sph-9,5 D cyl-3.0 D ax 164=0,7. Refractometry: 164° =-9,5 D, 74° =is 12.5 D. Ophthalmometry: 164° =42,25 D, 74° =45,25 D. Corneometry in the center=547 microns.

Surgery was performed according to the method.

After 7 days, during examination:

Visual acuity: OS=0,7. Refractometry: 164° =-0,25 D, 74° =-0,5 D. Ophthalmometry: 164° =33 D 74° =33,25 D.

Conclusion: the result of the operation managed to correct myopic and astigmatic components of refraction of the eye and to achieve maximum visual functions.

Example 2.

Patient 0., 26 years old, diagnosis: simple myopic astigmatism high degree left eye.

Visual acuity: OS=0,05 cyl-5,5 D ax 90 or=0.6. Refractometry: 180° =-5,0 D, 90° =-0,25 D. Ophthalmometry: 180° =44,50 D, 90° =39,0 D. Corneometry in the center=522 mm.

Surgery was performed according to the method.

Conclusion: Astigmatism was corrected without changing the refraction of the eye in the opposite Meridian.

Example 3.

Patient E., 18 years old, diagnosis: mild myopia, complex myopic astigmatism weak left eye.

Visual acuity: OS=0,1 sph-cyl 1,5 D-1,75 D ax 170° =1,0. Refractometry: 80° =-3,25 D 170° =-1,5 D. Ophthalmometry: 80° =42,75 D 170° =41,00 D. Corneometry in the center=501 mm.

Surgery was performed according to the method.

After 7 days, during examination:

Visual acuity: OS=1,0. Refractometry: 79° =0,0 D, 169° =-0,25 D. Ophthalmometry: 79° =39,50 D, 169° =39,75 D.

Conclusion: High postoperative visual acuity was due to complete correction of myopia and astigmatism.

The use proposed by the authors of the method of operation can improve the uniformity of the surface after exposure, to reduce the duration of the operation.

Claims

A method of surgical correction of myopic astigmatism, is the impact on the cornea of the eye by UV pulsed laser having a Gaussian distribution of energy density in the cross section of the beam, characterized in that the impact of production is amerom 0.3-1.2 mm, with pulse energy - 0,7-1,4 MJ, pulse duration - 4-7 NS, pulse repetition rate from 100 to 300 Hz, and the effects on the cornea produced by the grid points of the scan, formed an equilateral triangle, with the point of impact to form a polygonal shape, inscribed in an ellipse, the major axis of which coincides with the weak axis of astigmatism, then the grid scan repeatedly shift, the effect is produced at the point of the next grid scan, falling between the points of the previous grid scan.



 

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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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