METHOD OF IMPLANTATION AND SUTURE FIXATION OF SOFT INTRAOCULAR LENS TO IRIS IN ABSENCE OF CAPSULAR SUPPORT Russian patent published in 2023 - IPC A61F9/07 A61F2/16 

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used for implantation and suture fixation of a soft intraocular lens (IOL) to the iris in the absence of capsular support. First outside the eye, before implanting an intraocular lens (IOL) into the anterior chamber, a thread is tied to the base of the upper haptic element at 12 o'clock position, both ends of which 10–15 mm long remain free. The IOL is inserted into the cartridge in such a way that the haptic element with the thread enters the eye last. A tunnel incision is formed. Viscoelastic is injected into the anterior chamber of the eye. The IOL is implanted into the anterior chamber, with two free ends of the threads remaining in the main incision, haptic elements in the meridian from 6 and 12 o'clock position. Through corneal paracenteses, two colobomas with a diameter of 0.2 mm are formed at 11:30 position and 12:30 position at the root of the iris using a vitreotome, “right” — 11:30 position, “left” — 12:30 position. In the anterior chamber, a spatula with a forked end is used near the node on the upper haptic to grab one end of the thread and bring it to the left side of the pupil zone. Then the other end of the thread is grabbed and brought to the right side of the pupil zone. Using a microhook, the right coloboma is entered through paracentesis at 11:30 position. The movement is performed under the iris, the right thread in the pupil area is grabbed and brought back through the coloboma to the paracentesis. Then, using a microhook, paracentesis is entered through into the left coloboma at 12:30 position, similar to the first. The left thread is grabbed in the area of the pupil and brought out through the coloboma into a paracentesis. Then the upper haptic element is inserted behind the iris at 12 o’clock position and both ends of the upper thread are pulled up. After this, the IOL body is moved beyond the plane of the pupil, leaving the lower haptic element in the anterior chamber. The ends of the threads brought into the paracenteses are pulled upward by the upper haptic element of the IOL until the base of the lower haptic element appears in the pupil area. At 6 o'clock position, paracentesis is performed and, using a vitreotome, one coloboma with a diameter of 0.2 mm is formed in the root of the iris. The needle and thread are passed transcorneal at 5:30 position. The root of the iris is pierced 2–3 mm from the lateral edge of the coloboma, passing the needle in the posterior chamber into the pupil zone, covering the lower haptic element under the inner surface. The needle is pulled out through the pupil zone into the anterior chamber. The needle is passed over the iris towards the angle of the anterior chamber and removed from the eye, piercing the cornea at 11:30 position. The passed thread is cut off above the eyeball. The lower haptic element is tucked behind the iris. Then, at 6 o’clock position, a microhook is used to go under the iris into the posterior chamber through paracentesis and coloboma. The pupil area is entered and the thread is grabbed above the outer surface of the lower haptic element. They thread is taken back to the coloboma and paracentesis at 6 o'clock position outwards. Then, using a microhook, the anterior chamber is entered through paracentesis into the area of the iris root at 5:30 position. The second end of the thread is grabbed at the injection site and brought out in the same way. Then a microhook is used to enter the paracentesis at 12:30 position. The second end of the thread removed through coloboma and paracentesis is grabbed at 11:30 position and withdrawn through paracentesis at 12:30 position. The IOL is pulled up and centered by the ends of the free threads located in the paracenteses at 12:30 position and 6 o'clock position. They are sequentially tied and tightened. The viscoelastic is washed out of the anterior chamber. The incisions are sealed using the hydration method.

EFFECT: invention makes it possible to safely and reliably perform microsurgical manipulations during surgery without the risk of damage to intraocular structures and the risk of luxation of the IOL into the vitreous body, with complete visualization of the stages of suturing the haptic elements of the IOL to the iris, while in the postoperative period the diaphragmatic function of the iris, the cosmetic shape of the pupil, as well as strong fixation and stable central position of the IOL relative to the optical axis of the eye remain stable.

1 cl, 2 ex