Features of primary IOL implantation in patients with history of chronic uveitis

Purpose. To determine possible postoperative complications and methods of their prevention in patients with history of chronic uveitis who underwent Phacoemulsification of cataract with primary IOL implantation. Material and methods. In this article we give clinical analysis of complications after phacoemulsification with primary IOL implantation in patients with history of chronic uveitis. 5 patients with this pathology were hospitalized during 2020. Results. In this work, we provide literature data on the topic of primary IOL implantation in such patients. Currently there is no united opinion on managing such patients. Nevertheless, many authors agree that by using acrylic lenses, prolonged pharmacotherapy, uveitis remission of more than 3 months primary IOL implantation can be safe, and we can get high visual acuity [14]. In hard cases, some authors used primary IOL implantation with primary posterior capsulorhexis, which helped them to lower rate of postoperative complications [2, 3, 11, 21, 24]. Nevertheless, there are cases where IOL cause untreatable uveitis and therefore the question of lens explanation arises [8]. Conclusion. When solving the question of primary IOL implantation during extracting cataract in patients with chronic uveitis for maximum safety we should consider the following: history of the patient's background disease and systemic treatment he is getting, frequency of former uveitic attacks, laboratory data at the time of operation. The patient needs preliminary sanitation of all possible sources of inflammation and infection, pharmacotherapeutical preparation (both topical and general). After operation patient is needed prolonged anti-inflammatory therapy (NAIDS and Corticosteroids) and dynamic observation despite calm eye condition. Key words: uveitis, cataract phacoemulsification, iol implantation.

Optical coherence tomography of pseudophakic eyes after primary posterior capsulorhexis in pseudoexfoliation syndrome

Purpose to study vitreolenticular interface (VLI) and central retinal thickness after primary posterior capsulorhexis (PPC) in pseudoexfoliation syndrome (PEX). Material and methods. We conducted a dynamic OCT-evaluation of the macular morphology (47 cases) and of the VLI (39 cases) in patients with PEX in early and long term period after uncomplicated cataract surgery with PPC. In the long term period a comparative OCT-evaluation of the macula was performed in 129 patients with PEX (159 eyes) in different groups: after phacoemulsification with and without PPC, after Nd:YAG laser capsulotomy for secondary cataract, and in the control group of non-operated eyes. Results. The OCT-evaluation made it possible to visualize two significant features of VLI after PPC intact anterior hyaloid and restoration of the capsule barrier. It took 38 days for full adhesion. Secondary cataract in the PPC area was detected in one case in the long-term period. Dynamic OCT-evaluation of the macula in the main group revealed a statistically unreliable increase in the macular thickness (3.4%) in post-op period at 13 months with subsequent regression. Such changes were within the limits of physiological norm. In the remote period, comparative OCT-evaluation of the macula in different groups did not reveal statistically significant differences with the control group. Conclusion. OCT-evaluation at different post-op terms revealed the formation of stable vitreolenticular relationships and absence of clinically significant macular edema. Secondary cataract in the PPC area was detected only in one case.

Modified method of performing primary posterior capsulorhexis aftermultifocal IOL implantation

Актуальность. Помутнение задней капсулы хрусталика диагностируют в 4-90% случаев после выполнения факоэмульсификации катаракты в зависимости от её этиологии, и у каждого пятого пациента это требует последующего вмешательства для восстановления зрительных функций. Пациенты, которым была имплантирована мультифокальная интраокулярная линза (ИОЛ) крайне чувствительны к любым нарушениям прозрачности зрительной оси, что обосновывает выполнение первичного заднего капсулорексиса для профилактики помутнения задней капсулы в позднем послеоперационном периоде. Цель. Оценка безопасности и эффективности выполнения первичного заднего капсулорексиса согласно предложенному способу у пациентов после имплантации мультифокальных ИОЛ. Материал и методы. Всего обследовано и прооперировано пациентов 34 (40 глаз). Средний возраст пациентов составил 57,1±7,0 лет. Представлена оригинальная методика выполнения первичного заднего капсулорексиса, отличительной особенность которой является введение низкомолекулярного когезивного вискоэластика под ИОЛ, а высокомолекулярного вискоэластика над ИОЛ, а также выполнение капсулорексиса после имплантации ИОЛ. Во всех случаях имплантировали бифокальную ИОЛ Acrysof IQ Restor. Срок наблюдения составил от 6 до 60 (13,4±10,2) месяцев. Результаты. Значимых интра- и послеоперационных осложнений выявлено не было. Отмечено увеличение НКОЗ с 0,13±0,11 до 0,85±0,21 вдаль и 0,77±0,21 вблизи, МКОЗ с 0,25±0,20 до 0,93±0,13вдаль и 0,83±0,21 вблизи через 6 месяцев после операции (p <0,05). Выводы. Полученные данные свидетельствуют о безопасности и эффективности предложенной методики. Для определения показаний и противопоказаний необходимо проведение сравнительного исследования с пациентами с сохраненной задней капсулой хрусталика и мультифокальной коррекцией.

Factors of the Risk of Developing a Secondary Cataract and Recommendations for Conducting a Primary Posterior Capsulorhexis

Relevance. At the present stage, cataract surgery techniques perfectly cope with the task of restoring the transparency of the optic system of the eye, which makes it possible to quickly restore visual functions and patient performance. Throughout the world, there is a trend of cataract surgery in the initial stages, recommending that patients do not wait for cataract ripening. However, as practice has shown, this leads to an increase in the number of patients with secondary cataract.Goal. To develop recommendations and ways of preventing secondary cataract.Materials and methods. A comparative analysis of two groups of patients who applied for laser dyssia (192) and operated on cataracts (2590) for one calendar year was carried out. The interrelation of a type of a cataract and development of opacifications of a back capsule is analyzed.Results. In patients with myopia, which is a sign of complicated cataracts, the risk of developing secondary cataract is 3.5 times higher with a high degree of statistical significance (p <0.005). The following is the risk of diabetes mellitus of both types, as a sign of complicated cataract with concomitant pathology, which increases the risk of developing a secondary cataract up to 3 times (p <0.01). Immature cataract stages according to our observations also with statistical reliability (p <0.01) increase the risk of secondary cataract development by 1.4 times.Conclusions. Taking into account the revealed clinical risk factors for the development of secondary cataracts, we proposed recommendations for the primary posterior capsulorhexis with a transparent posterior capsule: myopia, diabetes mellitus of both types, initialandimmaturecataracts