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PURPOSE: To evaluate the early results of femtosecond laser application in phacoemulsification of cataracts of different density. MATERIAL AND METHODS: Femtosecond laser-assisted phacoemulsification cataract surgery was performed on 277 patients (390 surgeries) with II-IV degree lens nuclear density. RESULTS: The use of femtosecond laser for capsulorexis and lens nucleus fragmentation enables forming of a well-shaped, properly sized, and accurately centered aperture in the anterior lens capsule, reduces the equivalent time of ultrasound exposure (by 30% in average) and decreases the total time of nuclear fragments emulsification by a third. CONCLUSIONS: Femtosecond laser-assisted phacoemulsification is a highly effective and safe surgical technique that takes the surgery to a new level. By analogy with cardiovascular surgery this direction of improvement of cataract treatmentmay be called "hybrid phacoemulsification". Hybrid approach in cardiovascular surgery is promising and progressive. It combines the possibilities of conventional and minimal invasive endovascular surgery, considerably reducing intraoperative trauma during open-heart procedures. In cataract surgery the use of femtosecond laser in combination with classical ultrasound phacoemulsification enables closed-eye performance of certain technical stages that are usually fraught with complications.

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Modern methods of astigmatism correction in lens surgery are reviewed in the article. Keratorefractive, including laser-assisted, and intraocular techniques employing different models of toric intraocular lenses (IOL) are described. Current state of the problem is analyzed. Implantation of toric IOLs enables precise correction of corneal astigmatism simultaneously with cataract phacoemulsification.

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Methods of intraocular lens (IOL) calculation in non-standard clinical situations have been developed and introduced. These include a formula that improves the calculation accuracy in patients with relatively short anterior-posterior axis and another method for eyes after previous radial keratotomy. A comparative clinical evaluation of the proposed methods has been performed. The results indicate good perspectives for their use in ocular surgery.

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A study was performed to compare three techniques of phakoemulsification (PE) (use of iris retractors, capsular ring and their combination) in 315 patients (407 eyes) with cataract and lens subluxation of different degree. A PE technique was proposed and studied in clinic using developed method of extracapsular fragmentation of two nuclear halves. Proposed and clinically approved surgical techniques (10 years follow-up) as well as differentiated approach for choosing surgical method in patients with lens subluxation let perform surgery less traumatically with minimal complication rate, get excellent and stable results during long-term follow-up.

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Comparative analysis of intrastromal corneal segments Keraring implantation using either femtosecond laser or manual technique to create corneal tunnel in 47 patients (47 eyes) with keratoconus stage II-III is presented. Refractional and functional results in groups with femtosecond laser and manual technique did not show significant difference. The main advantage of femtosecond laser revealed in the study is technical simplification of intrastromal tunnels creation.

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Clinical study is performed to estimate the efficacy of Oftaquix in cataract phacoemulsification with intraocular lens (IOL) implantation. Obtained results show that Oftaquix prescription two days before surgery allows to eliminate bacterial agents from conjunctival cavity on the day of surgery. Significant and stable antibacterial effect is demonstrated. Bacteriological study on the 19-21 day after surgery revealed bacterial growth in 6.7% of patients in experimental group and in 30% of patients in control group.

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This comparative clinical study has indicated the importance of correctly choosing a formula to calculate the focal power of an intraocular lens (IOL) in the short ocular anteroposterior axis (APA). The most accurate and comparable formulas SRK II and SRK/T at the mean ocular APA values have significant errors at an APA of less than 21 mm. The new empirical formula allows the accuracy of calculation of the focal power of IOL to be increased in the short ocular APA as compared with other currently used formulas.

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Morphometric studies using a laser retinal thickness showed great differences in the impact of hydromonitoring phacofragmentation and ultrasound phacoemulsification on the thickness of the central retinal region. Unlike ultrasound phacoemulsification, hydromonitoring phacofragmentation caused no transient increase in the thickness of the central retinal area. The performed studies revealed no correlation between the equivalent time of ultrasound and ultrasound phacoemulsification and the changes in the thickness of the central retinal region and fovea.

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Ultrasound and optical coherent biometries were used to study the influence of the biometric parameters of the anterior segment of the eyeball on the precision of calculation of the focal power of an intraocular lens (IOL). A clinical study has demonstrated that among the biometric parameters of the anterior segment of the eyeball, there is a close correlation of miscalculation of IOL focal power with the diameter of the cornea "from white to white" and accordingly with the diameter of the floor of the corneal segment. Based on the findings, the authors have developed a procedure for calculating the focal power of an IOL for cases of the disproportion of the corneal segment to the IOL length of the eyeball.

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Intraocular and spectacular chromatographic correction was comparatively studied by examining blindness and spatial contrast sensitivities in 81 patients (116 eyes) after implantation of achromatic and chromatic hydrophobic acrylic intraocular lenses (IOL). Spectacular chromatic correction with yellow filters was additionally used in patients with achromatic IOL. 1.5-2 years after surgery for developed posterior capsular opacities, higher ergonomic vales remained in patients with intraocular chromatic correction than in those who had achromatic IOL and had undergone additional spectacular chromatic correction.

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We conducted a study for the purpose of developing a phacoemulsification technique for patients with high myopia optimized for the specificity of myopic eye. The study involved 124 (165 eyes) patients with high myopia and cataract. The lens density in operated patients was of degrees II-IV according to Buratto. The anterior-posterior axis of the eyeball ranged from 26.5 to 34.00 mm. the patients were shared between the experimental (92 eyes) and control (73 eyes) groups with respect to a used surgical technique. A modified procedure was applied in the experimental groups and the basic technique was used in the control group. The time of lens extraction, the volume of used irrigation liquid and the frequency rate of intra- and postoperative complications were the criteria in efficiency evaluation. The study showed the modified surgical procedure of phacoemulsification to ensure a better visualization, to reduce the load on the lens ligamentous apparatus and to facilitate, as much as possible, manipulations made on the lens nucleus of myopic eye; it also cuts the time of cataract lens extraction, which ensures a less volume of used irrigation liquid.

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