Patent Application
20200337832
The present invention pertains to the technical field of ophthalmic surgery, and specifically pertains to a method of sutureless intrascleral haptic-hook lens implantation
Over the development of intraocular lens suspension in recent years, a number of new technologies and methods have been derived, ranging from the traditional suture fixation to scleral fixation emerged in recent 2 years, with continuous progress and development. The scleral fixation has incomparable advantages compared to the suture fixation: no suture exposure, no suture fracture, small possibility of lens offset, simple operation and less time consuming, reduction of intra-operative iatrogenic injuries. There are many methods for intrascleral fixation, the main difference among which focus on different treatments to lens haptic. Agarwal and Oh et al. have proposed a method of covering lens haptics with scleral flaps, with the aid of biological glue. Takayama K et al. have proposed a method of embedding lens haptics into intrascleral tunnels other than below scleral flaps, which possesses a better stability. Ohta T et al. have invented a Y-shaped scleral incision for the lens haptic fixation, meanwhile the tightness of the incision has been enhanced.
However, there were also certain inadequacies in the intrascleral fixation: on the one hand, the operation was a little complicated, the length and depth of intrascleral tunnels were difficult to control, and there was the possibility of scleral flap fracture; on the other hand, there was a chance of intraocular lens haptic slippage, thus causing lens offset, even dislocation, etc.
To overcome the defects in the prior art, the present invention provides a method of sutureless intrascleral haptic-hook lens implantation.
The technical solution employed in the present invention is: a method of sutureless intrascleral haptic-hook lens implantation, comprising the following steps:
(1) for subjects not undergoing vitreous surgery, conventional vitrectomy or anterior vitrectomy was conducted in advance, a lateral corneal incision 1 was made and a perfusion tube 100 was placed at the anterior chamber 401, two opposing conjunctival incisions 103 of 3.0 mm, symmetrical at 180°, were cut on the conjunctiva 102 outside the margin of cornea 101;
(2) two puncture openings 2 were made at 1.5-2.0 mm outside the margin of cornea 101 with a 26G pinhead, forming two puncture channels 201, the spacing distance between the two puncture openings 2 was 1 mm, the puncture openings 2 were parallel to the margin of cornea 101 and formed an angle of 30° with the surface of the sclera, the puncture directions of the two puncture openings 2 were opposite, making the puncture channels 201 profiled in a splayed pattern, and a lamellar sclera incision 202 was cut in the distance of 1 mm between the two puncture openings 2, forming a groove 3;
(3) the same operations as those in step (2) were conducted at the 180° symmetrical sides of the opposing corneas 101 at the two puncture openings 2 of step (2), forming two puncture openings 2 at the other side and the groove 3 between them, the puncture openings 2 at the two places and the grooves 3 between them were set symmetrically at 180°;
(4) a main corneal incision 4 of 3.0 mm was made over the cornea 101, through which the intraocular lens 403 was pushed into the anterior chamber 401, leaving one haptic 5 outside the main corneal incision 4, a 25G membrane forceps 402 went into the eye from the puncture opening 2 on one side, grasping one haptic 5 of the intraocular lens 403 and pulling it out of the eye through one puncture opening 2, similarly the other haptic 5 of the intraocular lens 403 was grasped from the puncture opening 2 on the other side and pulled out of the eye through the puncture opening 2 on this side;
(5) the haptic 5 fixed outside the eye was bent and then folded back into the vitreous cavity 501 through the adjacent puncture opening 2, just leaving the haptic 5 of the intraocular lens 403 exposed outside the sclera embedded in the groove 3 formed by the lamellar sclera incision 202 between two adjacent puncture openings 2, the haptic 5 was adjusted to make the intraocular lens 403 to be centered;
(6) the perfusion tube 100 was removed, the main corneal incision 4 was watertight, the conjunctival incisions 103 were sewed with absorbable suture to complete the implantation and fixation of the intraocular lens 403.
The two pairs of puncture openings 2 set symmetrically opposing at 180° were set at the positions of 4 o'clock and 10 o'clock on the clock dial respectively.
The conjunctival incisions 103 set symmetrically opposing at 180° were set at the positions of 4 o'clock and 10 o'clock on the clock dial respectively.
The intraocular lens 403 was a 3-pieces posterior chamber intraocular lens, the haptic 5 of which employed polyvinylidene fluoride (PVDF) as the support, the haptic 5 was in a C shape, which formed an angle of 5° with the lens body.
The closed conjunctival incisions 103 in step (6) were sewed or closed by electrocoagulation.
The puncture openings 2 in step (2) formed an angle of 30° with the surface of the sclera, making the puncture channels 201 profiled in a splayed pattern.
The present invention has the following benefits: the present invention provides a method of sutureless intrascleral haptic-hook lens implantation, which improves the fixation process of the lens haptics, allowing the lens haptics to be bent and folded back into the vitreous cavity to generate a better stability, avoiding the complication of intrascleral fixation haptic slippage, meanwhile forming a sclera lamellar groove between two adjacent scleral incisions to bury the lens haptics, which method may be adapted to patients in need of intraocular lens implantation while without sufficient capsular support, such as aphakia, lens or intraocular lens dislocation, etc. This method enhances the stability and centrality of the lens, the surgical procedures are simple and easy to master, which reduces the operation time. In the cases implemented currently, we have not found the complications such as incision leakage, retinal detachment, endophthalmitis, tilt or dislocation of the intraocular lens, vitreous hemorrhage, and the like, and the postoperative visual acuities of patients have been significantly improved.
Wherein, 1—lateral corneal incision, 2—puncture opening, 3—groove, 4—main corneal incision, 5—haptic, 100—perfusion tube, 101—cornea, 102—conjuctiva, 103—conjunctival incision, 201—puncture channel, 202—lamellar sclera incision, 401—anterior chamber, 402—membrane forcep, 403—intraocular lens, 501—vitreous cavity.
The present invention now will be further illustrated in combination with
After anesthetization, for patients not undergoing vitreous surgery, conventional vitrectomy or anterior vitrectomy was conducted in advance, a lateral corneal incision was made at the position of 2 o'clock and a perfusion tube 100 was placed at the anterior chamber 401, two conjunctival incisions 103 of 3.0 mm were cut on the conjunctiva 102 outside the margin of cornea 101, at the positions of 4 o'clock and 10 o'clock respectively; two puncture openings 2 were made at the position of 4 o'clock, in a distance of 1.5-2.0 mm outside the margin of cornea 101 with a 26G pinhead, forming two puncture channels 201, the spacing distance between the two puncture openings 2 was 1 mm, the puncture openings 2 were parallel to the margin of cornea 101 and formed an angle of 30° with the surface of the sclera, the puncture directions of the two puncture openings 2 were opposite, making the puncture channels 201 profiled in a splayed pattern, and a lamellar sclera incision 202 was cut in the distance of 1 mm between the two puncture openings 2, forming a groove 3; and then the same processes were conducted at the symmetrical position of 10 o'clock, as shown in
A main corneal incision 4 of 3.0 mm was made over the cornea 101, through which the intraocular lens 403 was pushed into the anterior chamber 401, leaving one haptic 5 outside the main corneal incision 4, a 25G membrane forceps 402 went into the eye from the puncture opening 2 on one side, grasping one haptic 5 of the intraocular lens 403 and pulling it out of the eye through one puncture opening 2, similarly the other haptic 5 of the intraocular lens 403 was grasped from the puncture opening 2 on the other side at the position of 10 o'clock and pulled out of the eye through the puncture opening 2 on this side; as shown in
The haptic 5 fixed outside the eye was bent and then folded back into the vitreous cavity 501 through the adjacent puncture opening 2, just leaving the haptic 5 of the intraocular lens 403 exposed outside the sclera embedded in the groove 3 formed by the lamellar sclera incision 202 between two adjacent puncture openings 2; as shown in
The lens haptic 5 looks like a fishhook as shown in figures, with the tip in the vitreous cavity 501; as shown in
The main corneal incision 4 was watertight, the conjunctival incisions 103 were sewed with absorbable suture to complete the implantation and fixation of the intraocular lens 403, as shown in
The fact that the haptic 5 of the intraocular lens 403 could be bent smoothly and folded back into the vitreous cavity 501 was related to the use of Matrix AcrylicAurium 400 intraocular lens 403 in the operation, wherein the haptic 5 employed polyvinylidene fluoride (PVDF), which was in a revised C shape, and formed an angle of 5° with the lens body. Finally, the main corneal incision 4 was watertight, the conjunctival incisions 103 were sewed with 8-0 absorbable suture.
Our improved technique was conducted in 15 patients. This technique, in combination with vitrectomy, has removed the vitreous bodies of all patients partially or completely. The average preoperative BCVA is 0.82 logMAR units, and is 0.44 logMAR units in the follow-up visit after 6 months (Table 1). The follow-up visit after the patients come back shows good lens center and stable tactile fixation (
a compared by Fisher exact test;
The method of sutureless intrascleral haptic-hook lens implantation proposed in the present invention may be adapted to patients in need of intraocular lens 403 implantation while without sufficient capsular support, such as aphakia, intraocular lens 403 or lens dislocation, etc. This method enhances the stability and centrality of the lens, the surgical procedures are simple and easy to master, which reduces the operation time. In the cases implemented currently, we have not found the complications such as incision leakage, retinal detachment, endophthalmitis, tilt or dislocation of the intraocular lens 403, vitreous hemorrhage, and the like, and the postoperative visual acuities of patients have been significantly improved.
It should be understood to persons skilled in the relevant art that the present invention has been described following the above detailed description, while the inventive ideas of the present invention were not restricted to the present invention, and any variations employing the ideas of the present invention should be included in the protection scope of the claims.
The above descriptions were only the preferred embodiments of the present invention, the protection scope of which should not be limited by the above embodiments, and all technical schemes within the spirit of the present invention all belong to the protection scope of the present invention. It should be noted to persons of ordinary skills in the art that several improvements and modifications without departing from the principle of the present invention also should be deemed as the protection scope of the present invention.
