Method for implanting intracorneal lens

FIELD: medical engineering.

SUBSTANCE: method involves making arc-shaped incision in sclera in meridian interval where no eye muscle tendon fastening takes place at the depth of penetration beyond the episcleral layer. Then tunnel is built in sclera and corneal stroma layer directed towards the corneal optical center where a pocket coupled with lens in shape is built and implanted into the built pocket cavity. The lens is manufactured from biological polymer material and shaped as sphere, cylinder or prism.

EFFECT: enhanced effectiveness of treatment; reduced risk of nerve fiber injuries and infectious complications; reduced postoperative astigmatism; excluded lens dislocation.

6 cl, 2 dwg

 

The invention relates to medicine, in particular to ophthalmology, and can be used for implantation vnutribolnychnoy lenses when keratoplasty for the correction of refractive errors of the eye with hyperopia, myopia, astigmatism and improve vision in keratoconus, keratoconus, keratoglobus and macular degeneration.

Currently widely used methods of surgical improve farsightedness. So, there is a method of surgical correction of myopia and hyperopia by introducing a ring-shaped implant in the interlayer tunnel through four incision superficial layers of the cornea (Luengo V.M. Combined tunnel keratoplasty as a way for the correction of myopia. Diss. CMN, M., 1980, 133 S.).

The closest analogue of the claimed invention is a method of surgical correction of myopia and hyperopia by introducing an implant formed pocket through the incision in the corneal epithelium and superficial stroma layers (Belyaev V.S. and Some other issues refractive peoplelike corneal//Vestnik of ophthalmology, 1970, No. 2, pp.28-33).

The disadvantage of this method is the reduction of visual acuity with any correction in comparison with the preoperative maximum visual acuity, often this is caused by operating scars, reduction of twilight vision and slow recovery OST is the notes of view after a bright blinding eyes bright light, flash ("per-effect"). This is especially important for people driving the vehicles in the evening and at night. There are also complaints about the vision subjects that may be associated with the manifestation of aniseikonia.

Any mechanical (including surgical) and corneal damage entails the violation of her power and damage of nerves, which are located in large numbers predominantly in the superficial layers of the cornea.

The purpose of this invention is to provide a universal method of surgical improve vision by implanting the lenses, eliminating ingrown epithelium of the cornea along the formed pocket, bringing to a minimum the risk of infectious complications, a significant reduction in delayed complications of corneal astigmatism due to lack of postoperative scar, this virtually eliminates damage to the nerve fibers passing through the cornea radially from limb, and, consequently, the associated violation of its trophism, and sensitive intervali.

The invention consists in the surgical improvement of vision by implantation vnutribolnychnoy lenses. The method of implantation of the lens is performed by incision of the sclera under the upper eyelid in the interval Meridian from 9 to 12, 12 to 3, from 3 to 6 and from 6 to 12 hours, excluding the value itself Meridian 9, 12, 3 and 6 hours. P is akusherstvo give the interval Meridian from 12 to 3. The exception is the Meridian 9, 12, 3 and 6 hours is significant, because the data points are attached to the tendons of the muscles of the eyeball. In the case of the incision during the operation at the points specified Meridian, delayed healing and postoperative pain syndrome patient. Then hold the delamination of the sclera and corneal stroma, forming a pocket in the form of lenses, in which is inserted the implant lens.

Figure 1 shows the General structure of the eye: 1 - sclera, 2 - choroid, 3 - mesh shell, 4 - A. ciliaris post. brevis, 5 - n. opticus, 6 - A. ciliaris post.longa, 7 - v. vorticosa, 8 - m. rectus inf, 9 - a. ciliaris ant., 10 - circulus arteriosus major, 11 - iris, 12 - cornea, 13 - circulus arteriosus minor, 14 - conjunctiva, 15 - lens, 16 - ciliary body, 17 - A. ciliaris ant., 18 - m. rectus sup.

Figure 2 shows the anterior chamber angle (sagittal section): 1 - sclera, 2 - limbus corneae, 3 - conjunctiva, 4 - endothelium, 5 - substantia propria, 6 - cells, 7 - cornea, 8 - iris, 9 front - facing camera, 10 - rear camera, 11 - lens, 12 - zonula Zinnii, 13 - processus ciliares, 14 - corpus ciliare, 15 - m. ciliaris.

The sclera (1 to 1, 2) or protein shell composed of dense collagen fibers, contains a significant amount of elastic fibers and relatively few cells, the thickness of the sclera varies from 0.5 to 1 mm Sclera poor vessels, and only relatively loosely built its outer layers, the so-called episclera contain the larger number of vessels. The front part of the sclera is covered by the conjunctiva.

On the connecting edge of the sclera with cornea formed shallow translucent groove - limb (2 in figure 2)Vstavlenna in the sclera at the front transparent cornea has five layers, surface - epithelium, then is structureless Romanova shell, then the stroma, which adjoins the unstructured and flexible descemet's membrane, coated on the back surface of one layer of endothelial cells.

The dashed line is the course of surgical procedures on the eye according to the proposed method of implantation vnutribolnychnoy lenses.

The method is as follows.

Under a surgical microscope celebrate optical zone diameter corresponding to the diameter (shape) implantable vnutribolnychnoy lenses, and the Meridian of the incision. The conjunctiva usepreview from the sclera. Then perform an incision in the anterior part of the sclera in the interval Meridian from 9 to 12 and from 12 to 3 hours (in the absence of attachment of the tendons of the muscles of the eyeball, preferably from 12 to 3 hours), up to 8 mm away from the limbus (for example, 0.5-5.0 mm) are arcuate incision of the sclera to the depth of penetration of the layer episclera (for example, 200-450 μm). The depth of cut sequentially in layers of the sclera and corneal stroma create a tunnel to the boundaries marked op the practical zone of the cornea. The formed tunnel washed with balanced salt solution and implanted lens. The edges of the conjunctival incision is sealed with thermocautery or suture.

Dosage refractive effect of the operation is achieved by the lens characteristics (dimensions - diameter, thickness, volume of sphere, cylinder, prism; dioptries; material and its depth in the stroma of the cornea, as well as the location of the Meridian of the incision and the optical zone.

The progress of the operation on implantation of the lens shown in dotted lines in figure 1 and 2.

Specific example:

Implantation vnutripolostnyh lenses made in the following way: had the arcuate incision of the sclera in the Meridian 2 hours on the penetration depth for the layer episclera, the convexity facing the limbu (frown incision) to a depth of 150 μm. Then rasseivatele in the layers of the sclera and corneal stroma create the tunnel in the direction of the optical center of the cornea. Form a pocket in the form of lenses. Formed channel thoroughly washed with balanced salt solution. Then insert the lens into the pocket. After implantation of the lens edge of the conjunctival incision is sealed with thermocautery.

In the postoperative period were instillation of antibiotic drops. The total follow-up period was 60 days. In the bushes the whole time of observation of infectious complications, ingrowth of epithelium, the cornea is not marked.

The result of the implantation lens according to the proposed method achieves the following technical result:

1. Minimized damage to the nerve fibers passing through the cornea radially from the limb and, therefore, the associated violation of its trophism and sensitive intervali;

2. Excluded ingrowth of corneal epithelium along the formed pocket;

3. Significantly reduced corneal astigmatism, because there is no incision in the cornea and, therefore, postoperative scar of the cornea;

4. Hardly any dislocation of the lens in the pocket corresponding in width to the diameter (shape) of the lens;

5. Reduced postoperative infectious complications.

1. The method of implantation vnutribolnychnoy lens, characterized in that exercise arcuate incision in the sclera, in the range of Meridian, where there is no attachment of the tendon of an eye muscle, the penetration depth for the layer episclera, then in the layers of the sclera and corneal stroma create the tunnel in the direction of the optical center of the cornea, where they form a pocket in the shape of the lens, where it is implanted.

2. The method according to claim 1, characterized in that the arcuate incision in the sclera is carried out in the interval Meridian from 12 to 3 o'clock

3. The method according to claims 1 and 2, characterized in that the solution is in the sclera carried out to a depth of 200-450 microns.

4. The method according to claims 1 to 3, characterized in that pocket in the cornea form the shape of the lens.

5. The method according to claims 1 to 4, characterized in that the lens has the shape of a sphere, cylinder, prism.

6. The method according to claims 1 to 5, characterized in that the lens is made of a polymer of biological material.



 

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

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