Method for removing residual cortical masses migrated to equatorial region after cataract extraction in patients after keratoprosthetics

Abstract

FIELD: ophthalmology.SUBSTANCE: used to remove residual cortical masses that have migrated to the equatorial region after cataract extraction (CE) in patients after keratoprosthetics. To do this, the optical cylinder of the keratoprosthesis is unscrewed using a key. Residual cortical masses are visualized through the opening of the optical cylinder (OOC) and removed using a Simcoe cannula or a straight cannula with a flat tip mounted on a 10 ml syringe. The optical cylinder is screwed back in using a key.EFFECT: invention reduces the risk of developing intra- and postoperative complications and accelerates visual rehabilitation of patients by reducing the time of surgical intervention and without performing additional approaches.1 cl, 1 ex

Description

[0001] The invention relates to medicine, namely to ophthalmology, and can be used to remove residual cortical masses that have migrated to the equatorial region after cataract extraction (CE) in patients after keratoprosthetics.

[0002] One of the common comorbidities in patients with vascular leukomas is cataract, which is diagnosed both during keratoprosthesis implantation surgery and later after keratoprosthesis replacement. EK in eyes with vascular leukomas has its own unique characteristics and is often an extremely complex procedure.

[0003] If the leukoma is thin or uneven in thickness, a corneal prosthetic complex (CPC) is performed simultaneously with EC. CPC transplantation involves trepanation of a leukoma larger than 8 mm in diameter, allowing EC to be performed on an open palate and reducing the likelihood of residual lens material after EC due to the sufficient visualization area.

[0004] If the leukoma is uniform in thickness centrally and peripherally and is greater than 600 µm, the first stage of keratoprosthesis is performed—implantation of a support plate. After 6 months, the second stage is performed, which involves dissecting the leukoma tissue in the area of ​​the keratoprosthesis plug. If indicated, EK through the optical cylinder opening and screwing in the optical cylinder are performed. EK through the optical cylinder opening is associated with fewer intra- and postoperative complications than EK on an open palate. However, due to limited visualization (3 mm), intraoperative hypotony, anterior displacement of the vitreous due to its hydration, and the anatomical and topographic features of the anterior chamber, there is a risk of migration of residual lens material to the equatorial region of the capsular bag, which complicates its evacuation.During the first postoperative day, after intraocular pressure has been restored, lens fragments may migrate from the equatorial region into the optic zone, significantly reducing visual function and increasing the risk of secondary hypertension and inflammation. In this case, repeat surgery is required to remove any residual lens fragments.

[0005] The closest analogue is a method for removing fibrosis of the capsular bag in patients with aphakia after keratoprosthetics using three-port vitrectomy (Patent No. 2836086).

[0006] The technique involves inserting three 25G ports 4 mm from the limbal projection in the superior-outer, superior-inner, and inferior-outer quadrants. The limbal projection is determined intraoperatively using transillumination. An infusion system, a light guide, and a vitreous cutter are then inserted through the ports. The fibrotic capsular bag is removed along with residual cortical tissue over the maximum area using a vitreous cutter, followed by an anterior vitrectomy. The surgery concludes with removal of the ports and placement of scleroconjunctival sutures, if necessary.

[0007] The disadvantages of this method include the technical complexity of the surgical intervention, due to the implementation of additional scleral approaches and limited visualization through a 3 mm diameter optical cylinder, as well as the duration of the operation, the risk of intra- and postoperative complications, trauma to the structures of the anterior segment of the eye and high risks of damage to the elements of the keratoprosthesis.

[0008] The objective of the invention is to create a method for removing residual cortical masses that have migrated to the equatorial region after cataract extraction in patients in the delayed period after the second stage of keratoprosthetics.

[0009] The technical result is a reduction in the risk of developing intra- and postoperative complications and acceleration of visual rehabilitation of patients, which is achieved by shortening the time of surgical intervention, as well as the ability to remove residual cortical masses without performing additional approaches.

[0010] The method is as follows.

[0011] The optical cylinder is unscrewed using a wrench. Residual cortical masses are visualized through the optical cylinder opening (OC) and removed using a Simcoe cannula or a straight, flat-tip cannula attached to a 10 ml syringe. Finally, the optical cylinder is screwed back in using a wrench. It is important to note that this method should not be performed more than twice, as repeated unscrewing of the optical cylinder increases the risk of keratoprosthesis sleeve failure, which leads to a loss of seal and filtration of intraocular fluid, requiring removal of the keratoprosthesis and re-implantation of a new one.

[0012] Significant differences of this method

[0013] The method allows for the removal of residual cortical masses while maintaining a relatively sealed anterior chamber by manipulating through a 3 mm diameter OOC.

[0014] The method allows to significantly reduce the risk of developing intra- and postoperative complications by reducing the time of surgical intervention and the absence of additional approaches.

[0015] The method allows for a one-time replacement of the optical cylinder in the presence of its defects or when it is necessary to adjust the length of the extraocular part due to its overgrowth.

[0016] The method is explained by the following example.

[0017] Patient A., 56 years old. Diagnosis: OU. Vascular corneal leukoma. Result of a chemical burn. OD. Subatrophy of the eyeball. OS. Condition after the second stage of keratoprosthetics. Aphakia.

[0018] A medical history indicates a burn from acetic acid at home 3.5 years ago. A penetrating keratoplasty was performed on the left eye at home. Due to graft opacification and severe limbal insufficiency syndrome, a decision was made to perform keratoprosthesis in the left eye. In 2022, the first stage of keratoprosthesis was performed, resulting in implantation of a keratoprosthesis support plate into the vascular leukoma. In 2023, the second stage of keratoprosthesis was performed at the Scientific and Technical Complex of the Moscow City Hospital, implantation of an optical cylinder with phakic correction. Best-corrected visual acuity at discharge was 0.6. Currently, the patient complains of decreased visual acuity in her left eye.

[0019] Biomicroscopy reveals a vascularized corneal leukoma in both eyes. In the left eye, the keratoprosthesis's optical cylinder is in the correct, central position, with no signs of aqueous humor filtration. Diffuse lens opacity is visible behind the optical cylinder. The underlying media are not ophthalmoscoped.

[0020] Visual acuity: OD – Visus = 1 / ∝ projectia lucis incerta; OS – 0.1. Intraocular pressure (IOP) is normal by palpation.

[0021] On OCT of the anterior segment of the left eye, the keratoprosthesis occupies the correct central position.

[0022] According to the electrophysiological study (EPS), the presence of gross changes in the right eye and minor changes in the left eye were revealed.

[0023] According to the B-scan data: the left eye has adjoining membranes, destruction of the vitreous body; the right eye has total retinal detachment, destruction of the vitreous body.

[0024] Considering the visual function potential of the left eye and the presence of cataract, cataract extraction was performed through the OOC, followed by screwing in an aphakic optical cylinder.

[0025] On the first postoperative day, biomicroscopy of the left eye revealed a vascularized corneal leukoma. The keratoprosthesis's optical cylinder was in the correct, central position, with no signs of aqueous humor filtration. Residual cortical masses were visible behind the optical cylinder, but the underlying media were not ophthalmoscopeable. A decision was made to remove the residual lens masses through the OOC.

[0026] The optical cylinder was unscrewed with a wrench and removed. Residual cortical masses were visualized through the OOC and removed with a Simcoe cannula. Finally, the optical cylinder was screwed back in with a wrench.

[0027] The early postoperative period was uneventful. Best-corrected visual acuity in the left eye was 0.5. Palpable intraocular pressure was normal.

[0028] Upon discharge from the hospital on the 7th day: the eye is calm, visual acuity: 0.5 with correction sph -1.5 D = 0.6. IOP is normal by palpation.

[0029] When examined 3 months later, the patient's eye was calm. Visual acuity: 0.5 with correction sph -1.0 = 0.7. IOP was normal by palpation.

[0030] After 6 months, the eye was calm upon examination. According to OCT, the keratoprosthesis was correctly positioned centrally. Visual acuity: 0.5 with correction sph -1.0 D = 0.7. Palpable intraocular pressure was normal.

Claims

A method for removing residual cortical masses that have migrated to the equatorial region after cataract extraction in patients undergoing keratoprosthetics, characterized in that the optical cylinder of the keratoprosthesis is unscrewed using a key, then the residual cortical masses are visualized through the opening of the optical cylinder and removed using a Simcoe cannula or a straight cannula with a flat tip mounted on a 10 ml syringe, then the optical cylinder is screwed back using a key.