RU-2861577-C1 - METHOD FOR SURGICAL TREATMENT OF PATIENTS WITH INCOMPETENT KERATOTOMY SCARS AND COMPLICATED CATARACT AT LONG-TERM PERIODS AFTER RADIAL KERATOTOMY

Abstract

FIELD: medicine; ophthalmology. SUBSTANCE: incompetent keratotomy scar (IKS) is opened, the epithelium in the IKS area is scarified, and washed with physiological saline. 0.1 ml of prepared autologous platelet-rich plasma (PRP) is injected. Then, interrupted sutures are placed, evenly distributed along the entire length of the IKS, using nylon 10.0 thread, passing the thread through the IKS in the thickness of the stroma, covering the upper 2/3 of the corneal stroma thickness. When 1 keratotomy scar is dehisced, 3 interrupted sutures are placed, wherein the distance of the needle entry and exit from the edges of the IKS - the suture length increases as the sutures are placed from the part of the IKS closer to the centre of the cornea to its periphery, namely 0.8 mm from the edge of the IKS, 1.0 mm from the edge of the IKS, 1.2 mm from the edge of the IKS, the distance between the interrupted sutures is 2-3 mm. When more than 1 keratotomy scar is dehisced, interrupted sutures are placed on the IKS, alternating their number according to the pattern 3/2/3, where for the IKS with 2 interrupted sutures, the needle entry and exit are made at 1.0 mm from the edge of the IKS and 1.2 mm from the edge of the IKS, the distance between the interrupted sutures is 4 mm. EFFECT: possibility of achieving closure of the IKS diastasis, reducing the risk of dehiscence. 1 cl, 5 dwg, 1 ex

Inventors

• Petukhova Alena Alekseevna
• Sergei Iurevich Kopaev
• Ilinskaia Irina Anatolevna
• Mikhalochkina Mariia Vladimirovna
• Bulykin Zakhar Andreevich

Dates

Publication Date

20260506

Application Date

20251101

Claims (1)

1. A method for surgical treatment of patients with failed keratotomy scars and complicated cataracts in the late stages after radial keratotomy, characterized in that the failed keratotomy scar (FKR) is opened, the epithelium in the FKR area is scarified, the area is washed with saline, 0.1 ml of prepared autologous platelet-rich plasma (PRP) is introduced, then interrupted sutures are applied, evenly distributed along the entire length of the FKR, using a 10.0 nylon thread, passing the thread through the FKR in the thickness of the stroma, covering the upper 2/3 of the thickness of the corneal stroma, while with the divergence of 1 keratotomy scar, 3 interrupted sutures are applied, while the distance of the puncture and puncture from the edges of the FKR - the length of the suture increases as the sutures are applied from the part of the FKR closer to the center of the cornea to its periphery, namely 0.8 mm from the edge of the NKR, 1.0 mm from the edge of the NKR, 1.2 mm from the edge of the NKR, the distance between the interrupted sutures is 2-3 mm; if there is a divergence of more than 1 keratotomy scar, interrupted sutures are applied to the NKR, alternating their number according to the 3/2/3 scheme, where in the NKR with 2 interrupted sutures, the puncture and puncture are performed at 1.0 mm from the edge of the NKR and 1.2 mm from the edge of the NKR, the distance between the interrupted sutures is 4 mm.

Description

The invention relates to medicine, namely to ophthalmology, and can be used for the surgical treatment of complicated cataracts with incompetent keratotomy scars (IKS). Radial keratotomy (RK) was one of the most frequently performed refractive surgeries of the 20th century. In clinical practice, physicians encounter the consequences of this procedure, namely, morphological and topographic changes in the cornea. In particular, in the late period, such patients may experience secondary post-keratotomy keratectasia, characterized by increased refractive error in the inferior cornea due to peripheral protrusion and irregular astigmatism. It is believed that this irregularity arises from disruption of the biomechanical properties of the cornea due to uneven scarring and diastasis of the keratotomy scar (RK) margins. The type of blade used for RK and, consequently, the type of corneal scarring, are believed to play a key role in the "consistency" of the incisions. Diamond blades have been shown to be superior due to their greater safety and effectiveness. The use of metal blades contributed to coarse scarring, which reduced the refractive effect of the surgery in the early post-keratotomy period. However, in the late post-operative period, keratotomy scars created with metal blades are more consistent, and in such cases, scar divergence is less common. Currently, the number of patients with a history of RK and complicated cataracts is increasing. Physicians face challenges in calculating intraocular lens (IOL) placement in eyes after RK, especially in the presence of NCR, which further complicates achieving the target refraction. Treatment for such patients must be performed in several stages. The closest analogue is the method of fixing insolvent keratotomy scars in patients at late stages after anterior radial keratomy (Patent of the Russian Federation No. RU 2719913), which consists in scarifying the epithelium in the area of the NKR, forming a continuous U-shaped suture, and if two NKRs are located nearby, then the needle with the thread is inserted, stepping back from the center of the cornea by 7-8 mm and from the lateral edge of one of the NKRs by 0.5-0.8 mm, the thread is passed through this NKR in the thickness of the corneal stroma, the puncture is made through the edge of the second NKR, located lateral to the first NKR, stepping back from the edge of 0.5-0.8 mm, then the puncture is made on the side of the puncture, parallel to the NKR, stepping back 2-3 mm from the puncture, while the thread is passed in the thickness of the corneal stroma, the puncture is made on the side of the first puncture, symmetrically to the second injection, after which the ends of the thread are tied, the remaining part of the thread is cut, the knot is immersed in the corneal stroma; if the number of adjacent RCCs is more than two, then the needle with the thread is inserted at a distance of 7-8 mm from the center of the cornea and 0.5-0.8 mm from the lateral edge of one of the outer RCCs - the first RCC, the thread is passed through this RCC in the thickness of the corneal stroma, the puncture is made through the edge of the second RCC located medially to the first RCC, then the puncture is made through the lateral edge of the second RCC, passes in the thickness of the corneal stroma and the puncture is made through the medial edge of the next RCC, and the puncture is made through the lateral edge of the same RCC, such alternation of punctures and punctures is carried out sequentially and regardless of the number of RCCs, at the final RCC the puncture is made at a distance of 0.5-0.8 mm from the edge of the RCC located lateral to the previous RCC, and the puncture is made on the side of the puncture, parallel to the RCC, stepping back 2-3 mm from it, then the specified sequence of actions is repeated in reverse order until After the first CRC, the final puncture is made through the lateral edge of the first CRC, 0.5-0.8 mm from the edge and 2-3 mm from the initial puncture. The ends of the suture are then tied, the remaining suture is cut, and the knot is inserted into the corneal stroma. The disadvantages of this method include the inability to achieve a complete seal in all cases. Furthermore, if the suture breaks during the application of a continuous U-shaped suture, its functionality is lost, leading to depressurization of the corneal occlusion, requiring re-suture. The objective of the invention is to create a method for treating patients with NCR and complicated cataracts, allowing for optimization of IOL calculations and achieving improved visual acuity in the postoperative period. The technical result of the invention is to achieve closure of the diastasis of the NKR and reduce the risk of depressurization. The method is carried out as follows: in patients with NCR and complicated cataractA blood sample is taken 30 minutes before surgery, before premedication, to obtain platelet-rich plasma (PRP) using the method