Method for performing ophthalmosurgical operations using an autograft

Abstract

The claimed method for performing ophthalmosurgical operations includes forming a recipient bed and implanting an autograft consisting of a portion of the patient's own nail plate, which is shaped to fit the recipient bed, and which is sterilized and then kept in a dry environment prior to implantation. The autograft is similar in chemical composition and physical characteristics to the tissues of the eye, is not accompanied by an immune system rejection reaction, and adapts to the shape of the recipient bed as a result of natural swelling.

Claims

1. A method for performing an ophthalmosurgical operation, comprising: producing a recipient bed in an ophthalmological area of a patient; and implanting an autograft in the recipient bed in the ophthalmological area of the patient, wherein a material used for making the autograft is a fragment of the patient's own nail plate, wherein the autograft is formed as a solid form with a structure and geometric characteristics adaptable to a shape of the recipient bed, and wherein after sterilization and prior to implantation, the autograft obtained is held in a dry atmosphere.

2. The method of claim 1, in which the ophthalmosurgical operation includes refractive intrastromal keratoplasty.

3. The method of claim 1, wherein the autograft has a shape of one or more segments.

4. The method of claim 1, wherein the fragment of the nail plate is obtained from a grown nail.

5. The method of claim 1, wherein the fragment of the nail plate is obtained from the patient's nail under local anaesthesia.

6. The method of claim 1, wherein the autograft is made in a form of a half-ring with an arc of 150-170, a height from 50 m to 300 m, and inside and outside diameters of 4 mm and 5 mm, respectively.

7. The method of claim 1, wherein the autograft is made in a form of a ring with an inside diameter from 0.5 mm to 7 mm, an outside diameter from 1.0 mm to 16 mm, and a height from 50 m to 300 m.

8. The method of claim 1, wherein the autograft is made in a form of a positive lens with a diameter from 1 mm to 7 mm, and with a central hole with a diameter from 0.1 mm to 5 mm.

9. The method of claim 1, wherein the autograft is made in the form of a plate from 1 mm to 25 mm long, from 1 mm to 20 mm wide, and with a thickness of 10 m.

10. The method of claim 1, characterized in that the shape of the autograft is adapted mechanically using a diamond cutter monitored with an operating microscope or using laser processing.

11. A method of implanting an autograft, comprising: implanting an autograft into a recipient bed in an ophthalmological area of a patient, wherein the autograft is formed from a fragment of the patient's own nail plate, the autograft is a solid form having a structure and geometric characteristics adaptable to a shape of the recipient bed.

12. The method of claim 11, wherein the autograft is exposed to the recipient bed for a time period to adapt the autograft to the shape of the recipient bed as a result of natural swelling of the autograft due to moisture in the recipient bed.

13. The method of claim 11, comprising: (i) producing the recipient bed in the ophthalmological area of the patient prior to the step of implanting the autograft; and/or (ii) chemically treating the autograft prior to the step of implanting the autograft.

14. An ophthalmosurgical implant for a patient, comprising: an autograft comprising a fragment of the patient's own nail plate tissue, wherein the autograft is formed as a solid form with a structure and geometric characteristics adaptable to a shape of a recipient bed in an ophthalmological area of the patient for implantation in the recipient bed, and wherein after sterilization and prior to implantation, the autograft is held in a dry atmosphere.

15. The implant of claim 14, wherein the autograft is dimensioned to increase in size to adapt to the recipient bed upon implantation as a result of natural swelling of the autograft due to moisture in the recipient bed.

16. The implant of claim 15, wherein the autograft is configured to increase in volume to fill a tunnel of a corneal stroma of the patient upon transplantation.

17. The implant of claim 14, wherein the autograft is in a form of a half-ring with an arc of from 150 to 170, a height from 50 m to 300 m, and inside and outside diameters of 4 mm and 5 mm, respectively.

18. The implant of claim 14, wherein the autograft is in a form of a ring with an inside diameter from 0.5 mm to 7 mm, an outside diameter from 1.0 mm to 16 mm, and a height from 50 m to 300 m.

19. The implant of claim 14, wherein the autograft is in a form of a positive lens.

20. The implant of claim 14, wherein the autograft is in a form of a plate from 1 mm to 25 mm long, from 1 mm to 20 mm wide, and with a thickness of 10 m.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIGS. 1-9 show some possible shapes of the autograft that can be made from the nail plate.

VARIANT EMBODIMENTS OF THE INVENTION

(2) The shapes of the graft, which determine the efficacy of the treatment, are known per se by specialist ophthalmic surgeons and are not the subject matter of the present invention (FIGS. 1-9). The element may be modeled with respect to shape and dimensions using a diamond cutter monitored with an operating microscope, as noted in the aforementioned work by V. P. Sitnikov, or in some other known way, for example using laser cutting and milling on cutting machines, by means of which the nail plate material is given the necessary geometric parameters. The resultant article with the specified parameters undergoes chemical treatment if required, and then it is sterilized, and held in a dry atmosphere for drying, after which it is ready for implantation. The area of the patient's nail plates means it is possible to make corneal segments in the form of half-rings with an arc of about 160, with a cross section of triangular shape and thickness of 150-350 m, outside and inside diameters of approx. 5.6 mm and 4.4 mm respectively, i.e. with the same dimensions as Keraring segments made from polymethylmethacrylate.

(3) The operation is performed by the usual surgical techniques developed for example for implantation of intrastromal disks and segments, moreover in the present invention a new technical result is achieved: adaptation of the element to the shape of the tunnel in the corneal stroma after implantation, as a result of natural swelling. Furthermore, the nail plate is similar in structure and composition to the corneal stroma, it is the body's own tissue, it will not be encapsulated and will not prevent nutrients being transported to the tissues of the eye.

(4) Some examples of carrying out the invention are presented below.

Example 1

(5) Intrastromal keratoplasty. Autografts are made individually depending on the parameters required for the patient, taking into account the degree and stage of the disease and the expected result. The operation is performed under local anesthesia. The patient's visual axis is determined by noting the reflected light with fixation of the eye on a light source. Then using a marker, a 5-7-millimeter zone is marked, simultaneously marking the strong meridian of the cornea and the diameter of the tunnel to be formed. A nonpenetrating incision with a length of 1-1.2 mm is made with a keratotomy knife. Intrastromal tunnels are formed using a special layer separator in the aforementioned zone, clockwise and counterclockwise to a predetermined depth. Segments from the patient's nail plates of the calculated thickness and length depending on the disease stage, type of ectasia, spherical equivalent, myopic and cylindrical component of refraction, are implanted. In the case of asymmetric ectasia, the thicker segment was placed in the lower hemisphere, and the thinner segment in the upper hemisphere. The patient is prescribed instillations of antibiotics and anti-inflammatory preparations.

Example 2

(6) Intrastromal keratoplasty using an autograft in the form of a half-ring. Intrastromal tunnels were formed using a FEMTO LDV laser (ZIEMER, Switzerland) with wavelength of 1040-1060 nm, pulse repetition frequency of 1 MHz, pulse duration of 250 femtoseconds and pulse energy of 100 nJ. The operation was performed using an LCS (Lamellar Corneal Surgery) tip for ICR (intracorneal rings) of the FEMTO LDV module. The following parameters are entered in the program of the computer controlling the laser: model, arc length, thickness of the intrastromal segment and axis of the strong meridian.

(7) After applying local anesthesia, the patient's eyelids are fixed using a blepharostat, the LCS tip is fitted, and the patient fixes his gaze on the red fixation dot. Under the control of the computer program, the laser beam forms nonpenetrating tunnels. Then with a diamond knife, a 1-mm radial nonpenetrating incision is made on the principal meridian. The segments are introduced into the tunnel using forceps and a hook; they must be located symmetrically, away from the edge of the incision. We used corneal segments made from the patient's own nail plates, having the shape of a half-ring with an arc of 160, and height of 100-250 m, inside diameter of 4.4 mm, and outside diameter of 5.6 mm (FIG. 2). Instillations of anti-inflammatories, antibacterials and restorative preparations were made postoperatively.

Example 3

(8) Intrastromal keratoplasty using a ring-shaped transplant. An intrastromal whole ring is made from nail plate individually, taking into account the degree of myopia to be corrected and the expected calculated result. The operation is performed under local anesthesia. An intrastromal pocket was formed using a PocketMaker microkeratome. The depth of formation of the intrastromal pocket is determined individually, depending on the degree of myopia.

(9) After applying local anesthesia, the patient's eyelids are fixed using a blepharostat, the PocketMaker microkeratome is set up, and the patient fixes his gaze. Under the surgeon's control, the PocketMaker microkeratome forms a corneal pocket of the required depth and width, taking into account the myopia to be corrected and/or myopic astigmatism. The ring is implanted in the pocket formed, using forceps. Once fitted, the ring is centered relative to the optical axis of the eye using a push-and-pull hook. The operation ends with introduction of solution of antibiotic under the conjunctiva and fitting of a therapeutic lens on the cornea. We used autografts from the patient's own nail plates, having the shape of a ring, with height from 50 to 300 m, inside diameter from 1 mm to 7 mm, and outside diameter from 1.5 mm to 10 mm (FIG. 1). Instillations of anti-inflammatories, antibacterials and restorative preparations were made postoperatively.

Example 4

(10) Implantation of an intrastromal lens. Intrastromal lenses are made taking into account the degree of hypermetropia and/or presbyopia to be corrected and the expected calculated result. The operation is performed under local anesthesia. An intrastromal pocket was formed using a FEMTO LDV laser by the technology described in example 2.

(11) After applying local anesthesia, the patient's eyelids are fixed using a blepharostat, the tip of the FEMTO LDV laser is fitted, and the patient fixes his gaze on the red fixation dot. Under the control of the computer program, the laser beam forms an intracorneal pocket. Then a radial nonpenetrating incision is made with a diamond knife. A segment in the form of a positive lens is introduced into the tunnel using forceps and a hook through the incision. The lens must be located centrally, away from the edge of the incision. Instillations of anti-inflammatories, antibacterials and restorative preparations were made postoperatively. We used corneal lenses made from the patient's nail plates, having the shape of a positive lens with a diameter from 1 mm to 5 mm and with a central hole from 0.1 mm to 3 mm. After implantation in the cornea, the intracorneal lens acts like a camera diaphragm, adjusting the depth of field, creating the possibility of near vision and distance vision. The principle of the action of this insert is that it blocks some light rays from nearby objects, which in presbyopia are not focused on the retina. This principle is the principle of the pinhole diaphragm, as used in photography, it provides depth of focus, and the result is clear vision at any distances.

Example 5

(12) Applying a keratoprosthesis for treating severe opacification of the cornea of the eye. Through-application of a keratoprosthesis is carried out in a single step. After corneal trepanation, the keratoprosthesis is fitted along the visual axis of the eye until the supporting plate comes into contact with a pocket formed beforehand in the middle layers of the corneal stroma. Under general anesthesia, the conjunctiva is cut away from the limbus with a circular incision and is separated from the sclera. The rectus muscles are taken on the thread of the holder. Using a trepan (diameter 5 mm), the cornea is perforated and removed. The prepared keratoprosthesis is fitted by passing the rear section of the optical element through the hole in the cornea until the supporting plate rests on its surface. The supporting plate of the keratoprosthesis is inserted in the previously prepared circular pocket in the corneal stroma and is fixed with interrupted sutures. The operation is completed by applying interrupted sutures on the conjunctiva.

(13) The prosthesis is an optical element, fixed in a hole in a supporting base, which is made from an autograft, the patient's own nail plate, which does not lead to breakdown of the corneal tissue, rejection of the keratoprosthesis and formation of a retroprosthetic membrane. The supporting base has thickness decreasing in the radial direction from the center to the periphery, owing to which there is strong fixation of the supporting base of the keratoprosthesis and greater competence of treatment.

Example 6

(14) Drainage for prophylaxis of scarring of the filtration zone in surgical correction of ophthalmic hypertension in the treatment of glaucoma. This is intended to provide directed and controlled outflow of intraocular fluid (IOF) from the anterior chamber of the eye via the intrascleral space.

(15) The operation is performed in any of the free sectors of the globe between the rectus muscles. A single rectangular flap 10-12 mm long and 6 mm wide is formed, and is turned back onto the cornea. Near the limbus, after preliminary determination of the projection of Schlemm's canal, deep layers of the filtering zone are excised together with the sinus and trabecular meshwork in the form of a triangle with the dimensions 2.02.02.0 mm. Basal iridectomy is performed through the triangular hole obtained. A nail plate autograft of rectangular shape with dimensions of 56 mm is laid on the bottom of the scleral bed, completely covering the region of sinus trabeculectomy. The scleral flap was placed on top of the autograft, and then the flap was fixed at its apex with one U-shaped suture and with interrupted sutures along the sides on both sides, gripping the nail plate autograft in a single step. The operation led to a significant decrease in intraocular pressure, which in subsequent periods of observation gradually increased within the range of normal variation (16-22 mmHg); a year after the operation it was on average 19.61.6 mmHg, and it then stabilized at a level of about 20 mmHg (p>0.18). In the early postoperative period there was a smooth increase in the coefficient of the ease of outflow of aqueous, and by three months it had reached normal values (on average 0.21 mm/min/mmHg), which was evidence of the presence of controllable filtration of chamber aqueous into the intrascleral space, as well as functioning of the filtration zone for remote periods.

(16) This indicated formation of an active drainage zone in the intrascleral space and active outflow of chamber aqueous from the anterior chamber. Examination of visual acuity showed that the operation leads to an increase in visual acuity, and its level remains stable in all periods of observation.

(17) Investigation at various times after surgery for glaucoma using a nail plate autograft showed gradual disappearance of signs of edema of the eye membranes and improvement in condition of the optic nerve. Restoration of the drainage function of the eye led to restoration of the structure of the eye membranes.

(18) For specialists in the field of ophthalmic surgery it will be obvious that various modifications and changes may be made to the present invention without departing from the essence or scope of the claims, which have not been reflected in the foregoing embodiment examples of the invention.