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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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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.

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Comparison study of new fragmentation technique of dense nucleus in ultrasound phacoemulsification is performed. Proposed method of dense nucleus fragmentation allows to decrease equivalent time of ultrasound exposure using Ozil and NeoSoniX techniques. Minimal loss of corneal posterior epithelial cells was showed in combination of developed nucleus fragmentation technique with torsional phacoemulsification (Ozil). Combination of new fragmentation technique of dense nucleus (IV stage) with Ozil technique results in significant decrease of surgical trauma and time of rehabilitation.

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Comparative study of posterior corneal epithelium showed that ultrasound torsional phacoemulsification (OZil) at present is the most preserving technique with regard to posterior epithelium damage. Hidromonitoring phacofragmentation has comparable results in grade II nucleus density in terms of posterior epithelial cell loss. Torsional phacoemulsification in patients with grade IV nucleus density is the most effective and preserving low-energy technique of cataract removal.

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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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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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