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1.
Vestn Oftalmol ; 140(2. Vyp. 2): 190-195, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739150

RESUMO

Optical coherence tomography of the anterior segment of the eye (AS-OCT) is a non-invasive method based on the principles of optical reflectometry (measurement of the degree of backscattering of light passing through transparent or translucent media). Limitations of the first devices of this type were associated with insufficient image quality of the details of the anterior chamber angle and the posterior parts of the lens, primarily due to the "working" level of the scanning wavelength (within 800 µm). Fundamentally new possibilities in the structural and functional assessment of the anterior segment of the eye are associated with the introduction into clinical practice of swept-source AS-OCT device - the CASIA2 anterior optical coherence tomograph (Tomey Corporation, Japan). Its high scanning speed (50 000 A-scans per second) with a wavelength of 1310 µm allows high-quality visualization by building a scan at a depth of 13 mm. The previous model (CASIA SS-1000, Tomey Corporation, Japan) supported scan depth of only 6 mm. This review summarizes the results of research on the clinical use of CASIA2 tomograph.


Assuntos
Segmento Anterior do Olho , Tomografia de Coerência Óptica , Tomografia de Coerência Óptica/métodos , Humanos , Segmento Anterior do Olho/diagnóstico por imagem
2.
Vestn Oftalmol ; 140(2. Vyp. 2): 7-15, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739125

RESUMO

PURPOSE: This study compares the changes in the parameters of the anterior chamber of the eye using anterior segment optical coherence tomography (AS-OCT) in patients with a natural and artificial lens after treatment of neovascular age-related macular degeneration (nAMD) by multiple intravitreal injections (IVI) of anti-VEGF drugs. MATERIAL AND METHODS: The patients were divided into 2 groups: group 1 (control) included 30 patients (30 eyes) with a natural lens, group 2 - 30 patients (30 eyes) with an intraocular lens (IOL). AS-OCT was performed using the Revo NX tomograph (Optopol, Poland) to analyze anterior chamber depth (ACD) and the parameters of anterior chamber angle (ACA). Intraocular pressure (IOP) was measured with a contact tonometer ICare Pro. RESULTS: In patients with an IOL, the IOP level 1 minute after intravitreal injection (IVI) of an anti-VEGF drug was statistically lower than in the control group, on average by 17.8% during the first IVI and by 28.7% after 1 year of observation (p<0.001). ACD before treatment was statistically significantly higher in patients with IOL compared to patients of group 1 by an average of 39.3% (p<0.001). ACA from the nasal and temporal sides in the meridian 0°-180° before the start of treatment was statistically significantly wider in phakic patients than in the control group, by an average of 15.9±9.3° (p<0.001) and 16.9±8.2° (p<0.001), respectively. According to AS-OCT, there was no shift of the iris-lens diaphragm in patients with an IOL after multiple IVI of an anti-VEGF drug, in contrast to the control group. CONCLUSIONS: AS-OCT was used to determine for the first time the changes in the parameters of the anterior chamber of the eye in patients with a natural and artificial lens after multiple injections of an anti-VEGF drug in the treatment of nAMD.


Assuntos
Inibidores da Angiogênese , Biometria , Pressão Intraocular , Injeções Intravítreas , Tomografia de Coerência Óptica , Humanos , Masculino , Pressão Intraocular/efeitos dos fármacos , Pressão Intraocular/fisiologia , Feminino , Tomografia de Coerência Óptica/métodos , Idoso , Biometria/métodos , Inibidores da Angiogênese/administração & dosagem , Segmento Anterior do Olho/diagnóstico por imagem , Segmento Anterior do Olho/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tonometria Ocular/métodos , Pessoa de Meia-Idade , Degeneração Macular/tratamento farmacológico , Degeneração Macular/diagnóstico , Resultado do Tratamento
3.
Vestn Oftalmol ; 140(2. Vyp. 2): 28-33, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739128

RESUMO

Intravitreal injection (IVI) of anti-angiogenic drugs is one of the most common therapeutic procedures in ophthalmology. In recent years, a new non-contact study method has been developed - anterior segment optical coherence tomography (AS-OCT), which allows the formation of three-dimensional images of the lens and provides more detailed information about its structure and morphology. PURPOSE: This study uses optical coherence tomography method to analyze the risks of developing changes in the posterior lens capsule in patients after IVI of an anti-angiogenic drug. MATERIAL AND METHODS: The study involved 100 people (14 men and 86 women) with a natural lens and neovascular age-related macular degeneration (nAMD). The average age was 70.57±7.98 years. During the study (12 months), all patients underwent IVI of an anti-angiogenic drug aflibercept in the treat-and-extend (T&E) mode. All subjects were divided into 2 groups: with a total number of IVI less than 10 - group 1 (50 patients), and more than 10 IVI - group 2 (50 patients, of which 49 were included in the study). All patients underwent OCT using the Optopol REVO NX device (Poland) with the Anterior B-scan Wide protocol before inclusion in the study, as well as after 3, 6 and 12 months. RESULTS: It was found that the risk of developing a posterior lens capsule rupture, visualized using OCT, depends on the total number of IVI (correlation coefficient 0.473 p=0.001): the more IVI, the higher the probability that damage to the posterior capsule will occur after the next IVI, and after the 15th injection the risk of developing damage to the posterior capsule increases sharply. CONCLUSION: The astudy analyzed the risk factors for the development of posterior lens capsule damage that can be detected using OCT, and presented three risk groups for the development of rupture (or damage) of the posterior lens capsule depending on the number of intravitreal injections performed.


Assuntos
Inibidores da Angiogênese , Injeções Intravítreas , Receptores de Fatores de Crescimento do Endotélio Vascular , Proteínas Recombinantes de Fusão , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Feminino , Masculino , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Idoso , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/efeitos adversos , Cápsula Posterior do Cristalino/diagnóstico por imagem , Cápsula Posterior do Cristalino/efeitos dos fármacos , Pessoa de Meia-Idade , Degeneração Macular/tratamento farmacológico , Degeneração Macular/diagnóstico
4.
Vestn Oftalmol ; 140(2. Vyp. 2): 21-27, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739127

RESUMO

The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems. PURPOSE: This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation. MATERIAL AND METHODS: The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months. RESULTS: Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation. CONCLUSION: The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.


Assuntos
Retinopatia Diabética , Acuidade Visual , Cirurgia Vitreorretiniana , Humanos , Retinopatia Diabética/cirurgia , Retinopatia Diabética/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Cirurgia Vitreorretiniana/métodos , Cirurgia Vitreorretiniana/efeitos adversos , Vitrectomia/métodos , Vitrectomia/efeitos adversos , Idoso , Adulto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
5.
Vestn Oftalmol ; 140(2. Vyp. 2): 73-79, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739134

RESUMO

The management protocol for patients with neovascular age-related macular degeneration (nAMD) involves multiple intravitreal injections (IVI) of anti-VEGF drugs. The ability to reduce the peak intraocular pressure (IOP) rise is greatly important in clinical practice. PURPOSE: This study evaluates the effect of topical hypotensive drugs on the short-term IOP rise after IVI of anti-VEGF drugs in patients with nAMD. MATERIAL AND METHODS: The prospective study included 80 patients with newly diagnosed nAMD. Before the start of treatment, the patients were divided into 4 groups of 20 people each: 1st - controls, who received no prophylactic drugs, in the 2nd, 3rd and 4th groups local instillations of one drop of hypotensive drugs brinzolamide 1%, brinzolamide-timolol, brimonidine-timolol were performed in the conjunctival sac twice: 1 day before the injection (at 20:00) and on the day of the injection 2 hours before the manipulation (at 08:00), respectively. IOP was measured in each patient using ICare Pro non-contact tonometer before injection, as well as 1 min, 30 and 60 min after injection. RESULTS: Prophylactic use of hypotensive drugs was associated with a significant decrease in IOP immediately after IVI compared to the same parameter in the 1st group (p<0.001), the maximum decrease in IOP values was observed when using a fixed combination of brimonidine-timolol by 12.1 mm Hg compared to the controls (p<0.001), the combination of brinzolamide-timolol reduced IOP by 8.5 mm Hg (p<0.001), brinzolamide 1% led to the smallest decrease in IOP - by 5.1 mm Hg (p<0.001). CONCLUSION: Study patients that received instillations of brimonidine-timolol combination of one drop into the conjunctival sac 1 day before the injection and on the day of the injection showed the maximum decrease in IOP compared to patients of the other groups.


Assuntos
Inibidores da Angiogênese , Pressão Intraocular , Injeções Intravítreas , Hipertensão Ocular , Sulfonamidas , Humanos , Masculino , Feminino , Idoso , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/prevenção & controle , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Inibidores da Angiogênese/administração & dosagem , Estudos Prospectivos , Sulfonamidas/administração & dosagem , Resultado do Tratamento , Anti-Hipertensivos/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tonometria Ocular/métodos , Pessoa de Meia-Idade , Timolol/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Tiazinas/administração & dosagem , Degeneração Macular/tratamento farmacológico , Degeneração Macular/diagnóstico
6.
Vestn Oftalmol ; 140(2. Vyp. 2): 123-128, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739141

RESUMO

Effective and atraumatic removal of a soft lens nucleus requires different surgical techniques compared to phacoemulsification of a dense nucleus. PURPOSE: This study was conducted to develop a non-ultrasound technique for emulsification of a soft lens nucleus. MATERIAL AND METHODS: Fifty-seven patients (57 eyes) underwent surgery. In 23 cases, early or immature cataracts were detected, and in 34 cases, lens removal was performed for refractive purposes in high myopia and complex myopic astigmatism. Phacoemulsifier Centurion Vision System (Alcon Laboratories, Inc., USA) was used for the surgery. Aspiration of soft lens nucleus was done using a rotational technique. The following aspects were evaluated in the course of the surgery: the volume of the required irrigation solution, and the frequency needing to involve ultrasound for complete emulsification of the lens nucleus. Intraoperative and postoperative complications were also assessed. RESULTS: The surgery was uneventful in all cases. There were no violations of the integrity of capsulorhexis edge. The need for short pulses of minimal power ultrasound during the removal of the soft lens using this technique arose only in 11 (19.3%) cases. The effective ultrasound time was less than 1 second. The required volume of irrigation solution was 33.0 (24.0; 43.0) ml, which does not differ significantly from that in ultrasonic phacoemulsification. CONCLUSIONS: The use of modern phacoemulsifiers providing a high vacuum level allows successful removal of a soft lens without using ultrasound, which prevents its negative impact on the ocular tissues. The use of adequate surgical techniques, including the optimal direction of rotation of the lens nucleus in the rotational technique, improves the efficiency of soft lens nucleus removal.


Assuntos
Facoemulsificação , Humanos , Masculino , Feminino , Facoemulsificação/métodos , Pessoa de Meia-Idade , Catarata , Resultado do Tratamento , Núcleo do Cristalino/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Idoso
7.
Vestn Oftalmol ; 140(2. Vyp. 2): 129-135, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739142

RESUMO

The influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy and hydrodynamic parameters of phacoemulsification remains insufficiently studied. PURPOSE: This study evaluates the influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy, hydrodynamic parameters of phacoemulsification, and the degree of corneal endothelial cell loss. MATERIAL AND METHODS: Hybrid phacoemulsification was performed in 336 patients (336 eyes) with grade IV immature cataract according to the Buratto classification in three age-matched groups. Group 1 included 103 patients (103 eyes) who underwent hybrid phacoemulsification with preliminary femtosecond laser-assisted fragmentation of the nucleus with a «pizza¼ pattern (division of the nucleus with 10 radial cuts). Group 2 included 112 patients (112 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «cylinders¼ pattern (division of the nucleus with 8 radial cuts in combination with 5 circular cuts). Group 3 included 121 patients (121 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «grid¼ pattern (division of the nucleus with 8 radial cuts in combination with multiple mutually perpendicular cuts in the central zone in the form of a grid with a 0.5 mm cell). Effective ultrasound time and the volume of irrigation solution for emulsification of the lens nucleus fragments were determined during the operation. The loss of corneal endothelial cells was assessed 3 months after surgery. RESULTS: The minimum effective ultrasound time was noted after using the "grid" pattern - 4.05 (2.88; 4.74) s, which was significantly less than with the "cylinders" pattern - 4.97 (3.78; 5.88) s and the "pizza" pattern - 6.15 (4.52; 7.75) s (p<0.05). The effective ultrasound time when using the "cylinders" pattern was significantly less than with the "pizza" pattern (p<0.05). The volume of irrigation solution used for emulsification of the lens nucleus fragments was significantly less in the "grid" pattern - 41.5 (33.5; 49.5) ml compared to the "cylinders" patterns 58.5 (51.0; 66.0), p<0.05 and "pizza" pattern 75.0 (66.0; 83.5), p<0.01. The volume of irrigation solution when using the "cylinders" pattern was significantly less than when using the "pizza" pattern (p<0.05). The loss of corneal endothelial cells after using the "grid" pattern was 8.82 (7.59; 9.87)%, which was significantly less than after the "cylinders" patterns - 9.97 (8.81; 10.83)%, p<0.05 and "pizza" - 11.70 (10.62; 12.97)%, p<0.05. At the same time, the loss of endothelial cells after using the "cylinders" pattern was significantly less than after the "pizza" pattern (p<0.05). CONCLUSIONS: The choice of the optimal pattern of preliminary femtosecond laser-assisted fragmentation of the lens nucleus provides a significant decrease in the energy and hydrodynamic parameters of phacoemulsification and, accordingly, the loss of corneal endothelial cells.


Assuntos
Catarata , Hidrodinâmica , Terapia a Laser , Núcleo do Cristalino , Facoemulsificação , Humanos , Facoemulsificação/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Núcleo do Cristalino/cirurgia , Catarata/diagnóstico , Terapia a Laser/métodos , Resultado do Tratamento , Idoso , Acuidade Visual
8.
Vestn Oftalmol ; 140(2. Vyp. 2): 109-115, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739139

RESUMO

Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a femtosecond laser. PURPOSE: This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. MATERIAL AND METHODS: The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. RESULTS: The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. CONCLUSIONS: Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.


Assuntos
Facoemulsificação , Humanos , Adulto , Masculino , Feminino , Facoemulsificação/métodos , Terapia a Laser/métodos , Catarata , Resultado do Tratamento , Núcleo do Cristalino/cirurgia , Sucção/métodos , Acuidade Visual
9.
Vestn Oftalmol ; 139(3): 119-125, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37379118

RESUMO

Modern approach to refractive laser surgery features three main types of lamellar surgery. Two of them are types of open laser keratomileusis (LASIK and femtosecond laser-assisted LASIK), and the third - closed (SMILE). All of these techniques allow achieving good clinical outcomes but differ in possible complications. This article reviews the complications of femto-LASIK and specifically the post-operative cavitation injuries, describes the mechanism of their occurrence, variants of their course, and presents the prevention measures.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/efeitos adversos , Córnea , Luz , Ceratoplastia Penetrante
10.
Vestn Oftalmol ; 139(3. Vyp. 2): 21-27, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37144365

RESUMO

The article presents authors' original methods of phaco surgery that can be used in disorders of the capsular-zonular apparatus of the lens. The cataract surgery techniques for lens subluxation developed and introduced into clinical practice allow using the most physiologically correct intracapsular intraocular lens (IOL) fixation in the vast majority of cases. The introduction of femtosecond laser at key stages of phacoemulsification in complicated clinical situations reduces the dependence of the results on the human factor and allows performing removal of complicated cataracts at a qualitatively new level.


Assuntos
Extração de Catarata , Catarata , Cristalino , Lentes Intraoculares , Facoemulsificação , Humanos , Cristalino/cirurgia , Extração de Catarata/efeitos adversos , Extração de Catarata/métodos , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Implante de Lente Intraocular/métodos , Catarata/complicações , Catarata/diagnóstico
11.
Vestn Oftalmol ; 139(3. Vyp. 2): 46-50, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37144368

RESUMO

Age-related macular degeneration (AMD) develops in people aged 50 years and older, its pathogenesis involves progressive destruction of the retinal pigment epithelium and Bruch's membrane. There are eight currently known anti-VEGF drugs for treating the neovascular form of AMD, four of them have already been registered and are used in clinical practice. The first registered drug was pegaptanib, which selectively blocks VEGF165. Subsequently, a molecule with a similar mechanism of action was developed and named ranibizumab, which is a humanized monoclonal Fab fragment; it was specifically designed for ophthalmology. Its advantage over pegaptanib was neutralization of all active VEGF-A isoforms. Aflibercept and conbercept are recombinant fusion proteins that act as soluble decoy receptors for VEGF family proteins. Phase III data from the VIEW 1 and 2 studies showed that intraocular injections (IVI) of aflibercept every 1 or 2 months for a year resulted in comparable functional outcomes to monthly IVI of ranibizumab for one year. The next molecule for anti-VEGF therapy that showed effectiveness was brolucizumab - a single-chain fragment of a humanized antibody that binds with high affinity to various VEGF-A isoforms. Simultaneously with studying brolucizumab, another study was conducted involving Abicipar pegol, but that drug showed a high rate of complications. The latest drug registered for the treatment of neovascular AMD is faricimab. The molecule of this drug is a humanized immunoglobulin G antibody that acts on two key points of angiogenesis: VEGF-A and angiopoietin-2 (Ang-2). Thus, the strategy for advancing anti-VEGF therapy lies in the development of molecules with greater efficiency (better effect on newly formed vessels leading to resorption of exudate in the retina, under the neuroepithelium and under the retinal pigment epithelium), which allows not just to preserve vision, but to also significantly improve it when there is no macular atrophy.


Assuntos
Ranibizumab , Degeneração Macular Exsudativa , Humanos , Pessoa de Meia-Idade , Idoso , Ranibizumab/uso terapêutico , Fator A de Crescimento do Endotélio Vascular , Inibidores da Angiogênese/uso terapêutico , Acuidade Visual , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico , Injeções Intravítreas
12.
Vestn Oftalmol ; 137(1): 40-45, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610148

RESUMO

Studying the use of femtosecond laser in patients with complicated cataracts remains a topical issue in phaco surgery. PURPOSE: To comparatively analyze the results of using hybrid (femtosecond laser-assisted) phacoemulsification in hypermature cataract in patients with lens subluxation. MATERIAL AND METHODS: The study included 78 patients (78 eyes) with hypermature cataract in combination with lens subluxation of I-II degree. In the 1st group (45 eyes) capsulorhexis was performed using a femtosecond laser. In the 2nd group (33 eyes) manual capsulorhexis was performed. RESULTS: On the first day after surgery, best corrected visual acuity of 0.8-1.0 was obtained in 57.8% of cases in the 1st group and 33.3% in the 2nd group. Transient corneal edema during the first 1-3 days was noted in 4.4% of cases in the 1st group and in 15.2% - in the 2nd group of patients. Pachymetry in the center of the cornea showed an increase in its thickness on the 1st day after surgery from 0.564±0.027 mm to 0.591±0.033 mm in the 1st group and from 0.561±0.023 mm to 0.637±0.043 mm (p<0.05) in the 2nd group of patients. The loss of corneal endothelial cells amounted to 10.9±1.8% in the 1st group and 17.4±2.9% in the 2nd group (p<0.05). Macular edema with decreased visual acuity confirmed by OCT was detected in the 1st group of patients in 2.2% of cases, in the 2nd group - in 9.1% of cases. With a follow-up period of up to 3 years, IOL optics decentration by more than 1 mm was detected in 2.2% of cases in the 1st group of patients and in 12.1% of cases in the 2nd group. CONCLUSION: Femtosecond laser-assisted capsulorhexis significantly improves the results of surgery in patients with hypermature cataract combined with lens subluxation.


Assuntos
Extração de Catarata , Catarata , Terapia a Laser , Subluxação do Cristalino , Facoemulsificação , Catarata/complicações , Catarata/diagnóstico , Células Endoteliais , Humanos , Lasers , Implante de Lente Intraocular , Subluxação do Cristalino/complicações , Subluxação do Cristalino/diagnóstico , Facoemulsificação/efeitos adversos , Acuidade Visual
13.
Vestn Oftalmol ; 136(5. Vyp. 2): 204-208, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063965

RESUMO

Prevention of the anterior capsular contraction syndrome (ACCS) in the late postoperative period in patients with lens subluxation is a current problem of phacoemulsification (PE). PURPOSE: To develop and clinically evaluate a differentiated method of surgical prophylaxis against ACCS during PE in patients with lens subluxation. MATERIAL AND METHODS: Phacoemulsification surgery with in-the-bag IOL implantation and postoperative follow-up were carried out in 192 patients (192 eyes) with cataract and lens subluxation. In all patients, complete anterior capsulorhexis at the beginning of the surgery was not possible. A differentiated approach was used for capsulorhexis extension at the final stage of the operation after in-the-bag IOL implantation. Three groups of patients were formed according to the three most common clinical situations. RESULTS: There were no signs of ACCS development in as many as 189 (98.4%) cases. In 3 (1.6%) cases, slight narrowing of the anterior capsulorhexis opening was noted, however, with no effect to the IOL position and functional results of the operation. CONCLUSION: The differentiated approach to anterior capsulorhexis in patients with lens subluxation allowed to perform phacoemulsification with in-the-bag IOL implantation and to avoid ACCS development in the late postoperative period.


Assuntos
Cápsula do Cristalino , Lentes Intraoculares , Facoemulsificação , Capsulorrexe , Humanos , Cápsula do Cristalino/cirurgia , Implante de Lente Intraocular/efeitos adversos , Facoemulsificação/efeitos adversos
14.
Vestn Oftalmol ; 136(5. Vyp. 2): 248-253, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063973

RESUMO

The review presents the history of development and improvement of methods for intraocular lens (IOL) exchange. Existing techniques of IOL exchange are comparatively analyzed.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Olho Artificial , Estudos Retrospectivos , Acuidade Visual
15.
Vestn Oftalmol ; 136(5. Vyp. 2): 254-259, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063974

RESUMO

The review discusses modern problems of intraocular lens (IOL) exchange. Making an adequate choice between IOL reposition and IOL exchange in pseudophakic patients with problems of lens fixation remains a largely unsolved issue. The literature data shows a noticeable increase in the number of supporters of retropupillary fixation of an iris-claw lens during the exchange procedure.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Olho Artificial , Humanos , Iris , Acuidade Visual
16.
Vestn Oftalmol ; 136(4): 105-109, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32779463

RESUMO

Prevention of decentration and dislocation of the "capsular bag + intraocular lens" (IOL) complex in the late postoperative period is an actual problem of surgical treatment of patients with pronounced lens subluxation. PURPOSE: To conduct a comparative clinical study of positional stability of the "capsular bag + IOL" complex in the late postoperative period after application of a combined technique of capsular bag fixation in patients with subluxation of the lens. MATERIAL AND METHODS: Phacoemulsification (PE) with in-the-bag IOL implantation and postoperative observation was performed in 213 patients (234 eyes) with cataract and pronounced lens subluxation. The 1st group consisting of 138 patients (153 eyes) underwent capsular bag fixation of the combined technique with simultaneous use of 4 modified iris-retractors and one or two capsular tension rings (CTRs). The 2nd group included 75 patients (81 eyes) who in the course of PE had their capsular bag fixed beyond the edge of capsulorhexis with only 4 modified iris-retractors. Preoperative state of the lens and the evaluation of the frequency and degree of decentration of the «capsular bag + IOL¼ complex in the postoperative period were performed using data acquired with ultrasound biomicroscopy (UBM). RESULTS: Significant (more than 1 mm according to UBM) IOL's optic decentration was observed in the 1st group after applying the combined capsular bag fixation technique in 12 (7.8%) cases, and in the 2nd group after isolated use of modified iris-retractors in 48 (59.3%) cases. CONCLUSION: The use of the combined capsular bag fixation technique not only improves the conditions for carrying out PE with in-the-bag IOL implantation in patients with pronounced lens subluxation, but also contributes to a substantial (an average of 8 times) reduction in the incidence of significant decentration of the «capsular bag + IOL¼ complex in the late postoperative period.


Assuntos
Subluxação do Cristalino , Lentes Intraoculares , Facoemulsificação , Capsulorrexe , Humanos , Implante de Lente Intraocular , Complicações Pós-Operatórias/cirurgia
17.
Vestn Oftalmol ; 135(5. Vyp. 2): 235-240, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31691666

RESUMO

The article reviews morphofunctional changes and complications after using modern methods of out-of-the-bag implantation of the intraocular lens (IOL). Literature data shows that the smallest morphofunctional changes in intraocular structures and the best results are obtained after retropupillary implantation of an iris-claw lens and transscleral fixation of posterior chamber IOL.


Assuntos
Implante de Lente Intraocular , Cristalino , Lentes Intraoculares , Olho Artificial , Iris
18.
Vestn Oftalmol ; 135(3): 104-108, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31393453

RESUMO

The article reviews the main modern methods of out-of-the-bag IOL implantation. Literature data shows that the most pressing question to date is comparative assessment of retropupillary iris-claw lens implantation and trans-scleral posterior chamber IOL fixation.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Iris , Técnicas de Sutura
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