[Comparative evaluation of positional stability of the «capsular bag + intraocular lens¼ complex in patients with lens subluxation]. / Sravnitel'naya otsenka stabil'nosti polozheniya kompleksa «kapsul'nyi meshok + intraokulyarnaya linza¼ u bol'nykh s podvyvikhom khrustalika.

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.

[Prevention of intraoperative miosis in femtosecond laser-assisted phaco surgery]. / Preduprezhdenie intraoperatsionnogo mioza v fakokhirurgii c primeneniem femtosekundnogo lazera.

INTRODUCTION: Prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification is a relevant problem of cataract surgery. PURPOSE: Development and clinical study of an effective method for preventing intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification. MATERIAL AND METHODS: Hybrid phacoemulsification was performed in 300 patients (300 eyes). The first group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day and 3 times in 2 hours before surgery at 30 minute intervals. The second group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day, 3 times in 2 hours before the surgery at 30 minute intervals, and 1 hour before the surgery an additional intramuscular injection of diclofenac. The third group (control, 100 eyes) 2 hours before the operation was prescribed instillations of 0.1% indomethacin, 3 times at 30 minute intervals. The diameter of the pupil was evaluated before the beginning of femtosecond laser stage and before the opening of anterior chamber during the second stage of the operation. RESULTS: When the interval between the femtosecond laser stage and emulsification of the nucleus fragments was maintained at less than 15 minutes, pronounced decrease of the pupil (more than 2 mm) was noted in 8.2% of cases in the first group, 6.7% in the second group and 14.1% in third (control) group; mean values of pupil narrowing were 0.68±0.27 mm in the 1st group, 0.63±0.25 mm in the 2nd group, and 0.93±0.39 mm (p<0.05) in the third group. CONCLUSION: The clinical study showed high efficiency of the proposed methods for prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phaco surgery. An important factor affecting intraoperative narrowing of the pupil is the time interval between the femtolaser stage of the operation and emulsification of the nucleus fragments, which should not exceed 15 minutes.

[Hypotensive efficacy of combined pathogenically oriented surgical treatment of cataract and primary open-angle glaucoma].

A new algorithm of combined surgical treatment of cataract and glaucoma was developed. It enables selection of a proper method of pathogenically oriented antiglaucomatous intervention, decreases surgical trauma, facilitates normalization of intraocular pressure and helps stabilizing the course of the disease. Another development is a modification of combined phacoemulsification and trabeculectomy ab interno, aimed at increasing visual and hypotensive results. Clinical studies showed high hypotensive efficacy of the combined pathogenically oriented surgical treatment of cataract and primary open-angle glaucoma.

[Determination of retention during phacoemulsification with AOL in patients with open-angle glaucoma].

Phacoemulsification is the most sparing technique of cataract removal in patients with open-angle glaucoma. The retention of intraocular fluid should be determined to choose a pathogenetically oriented antiglaucoma operation for uncompensated open-angle glaucoma (OAG). The study of the Schlemm's canal retrograde blood filling phenomenon may be a technique of the most informative value. The phenomenon was studied on 102 eyes (in 82 cases of glaucoma) during phacoemulsification, which indicated the high effectiveness and safety of the use of this intraoperative method. Its advantage is that manipulations are easy-to-use and accessible. This method is of particular value in treating patients with cataract concurrent with OAG, who are to undergo phacoemulsification with a one-stage pathogenetically oriented antiglaucoma operation.