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Prevention and treatment of anterior capsular contraction syndrome (ACCS) is a relevant problem in cataract surgery. PURPOSE: The study was performed to develop a femtosecond laser-assisted technique for anterior capsulotomy in anterior capsular contraction syndrome and assess its preliminary results in preventing the progression of pathological changes in the capsular bag. MATERIAL AND METHODS: The examination and femtosecond laser-assisted treatment without additional surgical intervention was performed in 6 patients (6 eyes) aged 69 to 73 years with anterior capsular contraction syndrome. Femtosecond laser-assisted anterior capsulotomy was performed using the VICTUS system (Technolas Perfect Vision, Germany). Capsulotomy diameter was 4.0-4.5 mm, laser radiation energy - 9000 nJ, laser exposure depth 900-1000 µm. RESULTS: The diameter of the anterior capsulotomy before treatment was 2.85 mm [2.75; 2.93]. After 1 month, the diameter of the anterior capsular opening was 2.88 mm [2.78; 2.96] (p>0.05). One year after femtosecond laser intervention, the anterior capsulotomy opening was almost the same shape and diameter - 2.84 mm [2.74; 2.94] (p>0.05). CONCLUSION: Femtosecond laser-assisted circular capsulotomy is an effective and safe method for preventing the progression of anterior capsular contraction syndrome in the absence of severe IOL decentration and for maintaining the diameter of the anterior capsular opening of at least 2.5-3.0 mm.
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Extracción de Catarata , Oftalmología , Exposición a la Radiación , Humanos , Ojo , Rayos LáserRESUMEN
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.
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Extracción de Catarata , Catarata , Terapia por Láser , Subluxación del Cristalino , Facoemulsificación , Catarata/complicaciones , Catarata/diagnóstico , Células Endoteliales , Humanos , Rayos Láser , Implantación de Lentes Intraoculares , Subluxación del Cristalino/complicaciones , Subluxación del Cristalino/diagnóstico , Facoemulsificación/efectos adversos , Agudeza VisualRESUMEN
The review summarizes the results of surgical treatment of cataracts in patients with keratoconus. The major challenges of phacosurgery in keratoconus are associated with intraocular lens (IOL) power calculation, choice of the most appropriate IOL model and additional interventions required to stabilize keratectasia and reduce corneal irregularity.
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Catarata , Queratocono , Lentes Intraoculares , Catarata/complicaciones , Catarata/diagnóstico , Humanos , Queratocono/diagnóstico , Queratocono/cirugía , Óptica y Fotónica , Refracción OcularRESUMEN
Postoperative state of the corneal endothelium is the most important criterion for evaluating the safety of cataract phacoemulsification. PURPOSE: To compare the intraoperative energy load and postoperative state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification. MATERIAL AND METHODS: The study analyzed surgical outcomes of 603 patients (714 eyes) divided into 3 groups: 225 patients (267 eyes) underwent modified femtosecond laser-assisted phacoemulsification (1st group), 237 patients (278 eyes) underwent standard femtosecond laser-assisted phacoemulsification (2nd group), and 141 patients (169 eyes) who underwent torsional phacoemulsification (3rd group). The follow-up period lasted up to 2 years. RESULTS: In patients with grade II lens density (here and further - L. Buratto classification is used), effective ultrasound time was 0.56±0.11 s in the 1st group, 0.83±0.17 s in the 2nd group, and 2.78 ± 0.51 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade III lens density effective ultrasound time was 2.04±0.37 s in the 1st group, 2.97±0.53 s in the 2nd group, and 4.59±0.91 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, effective ultrasound time was 3.95±0.81 s in the 1st group, 5.11±1.03 s in the 2nd group, and 8.37±1.73 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade II lens density, loss of endothelial cells was 3.3±1.1% in the 1st group, 3.7±1.2% in the 2nd group, and 4.3±1.2% in the 3rd group (p(1-2)>0.05; p(1- 3)<0.05; p(2-3)<0.05). In patients with grade III lens density, loss of endothelial cells was 5.1±1.4% in the 1st group, 5.7±1.5% in the 2nd group, 7.2±1.7% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, loss of endothelial cells was 8.9±2.1% in the 1st group, 10.1±2.3% in the 2nd group, and 13.3±2.5% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2- -3)<0.05). CONCLUSION: Both techniques of femtosecond laser-assisted phacoemulsification significantly reduce the effective ultrasound time (p<0.05) and the degree of corneal endothelial cells loss (p<0.05) compared with torsional phacoemulsification.
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Endotelio Corneal , Facoemulsificación , Células Endoteliales , Humanos , Terapia por Láser , Implantación de Lentes Intraoculares , Estudios ProspectivosRESUMEN
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.
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Extracción de Catarata , Terapia por Láser , Miosis/prevención & control , Facoemulsificación , Humanos , Rayos Láser , PupilaRESUMEN
Prevention and treatment of cataract surgery complications in patients with lens subluxation remains one of the current problems of phaco surgeries. PURPOSE: To develop and to test the surgical technique for reimplantation of in-the-bag dislocated intraocular lenses (IOL) or sulcus-fixated IOL. MATERIAL AND METHODS: Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus fixated IOL dislocation (28 eyes) were analyzed. The follow-up period lasted 1-3 years. RESULTS: In all cases the dislocated IOL was removed and retropupillary iris-claw 'Artisan' IOL implantation was performed. After the IOL exchange, visual acuity improved in all patients, while the fixation of retropupillary IOL remained stable. CONCLUSION: This surgical technique of dislocated IOL exchange coupled with retropupillary implantation of 'Artisan' IOL provides reliable anatomic and functional results.
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Implantación de Lentes Intraoculares , Lentes Intraoculares , Humanos , Iris , Complicaciones Posoperatorias , Reimplantación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Surgical treatment of intraocular lens (IOL) with late dislocation remains one of the current problems of ophthalmology. PURPOSE: To evaluate specific morphofunctional changes in the eye after dislocated IOL exchange with retropupillary-fixated iris-claw IOL. MATERIAL AND METHODS: Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus-fixated IOL dislocation (28 eyes) were analyzed. The follow-up period was 1-3 years. RESULTS: Increase in visual acuity and stable retropupillary fixation of the IOL was observed in all cases after reimplantation. Mean endothelial cell loss after 3 months was 6.9±1.3% in the group with preoperative density of >1200 cells/mm2 and 12.3±2.7% in the group with preoperative density of <1200 cells/mm2. There was no significant increase in intraocular pressure after IOL reimplantation. The incidence of clinical cystoid macular edema with decreased visual acuity was 4.7%, which is significantly more frequent than in patients after uncomplicated phacoemulsification with in-the-bag IOL implantation. CONCLUSION: Retropupillary implantation of iris-claw IOL provides stable fixation, good functional outcomes with low complication rates and is suitable for reimplantation in eyes without adequate capsular support.