Вариант использования лазерной фемтосекундной факофрагментации без лазерной капсулотомии в случае осложненной катаракты

Abstract

Purpose. To evaluate the effectiveness of using femtosecond phacofragmentation without laser capsulotomy in cataract phacoemulsification with a relatively narrow pupil against the background of pseudoexfoliation syndrome in combination with grade I lens subluxation. Material and methods. The subject of the study was a case of complicated cataract in patient Ya., 74 years old, with complaints of decreased vision in the right eye. Standard preoperative and postoperative examinations were performed. The patient underwent surgery using a phacoemulsifier (CenturionVisionSystem, Alcon, USA) with preliminary laser femtosecond support (Catalys TM Precision Laser System-Johnson&Johnson Vision). A three-part IOL AcrySof MA60AC (Alcon, USA) with an optical power of 22.0 diopters was implanted. The peculiarity of the operation was that at the stage of laser femtosecond support, only phacofragmentation was performed without capsulotomy. Result. In this case, only phacofragmentation was performed without the formation of capsulorhexis with laser femtosecond support of phacoemulsification against the background of a rigid, relatively narrow pupil, which made it possible to safely use the usual methods of mechanical pupil dilation followed by manual performance of capsulorhexis of the optimal diameter. On the 2nd day after the operation, visual acuity without correction was 0.5, with a correction of –0.75 diopters – 0.7. The result of surgical treatment in this case indicates that a separate use of femtosecond laser fragmentation of the lens without anterior capsulotomy is possible. In this case, it was applied taking into account the combined pathology: pseudoexfoliation syndrome, lens subluxation, relatively narrow pupil and the objective need to use the Malyugin ring, the planned method of fixing the IOL. The preserved anterior capsule made it possible to perform standard implantation of the Malyugin ring without any special features, followed by capsulorhexis of the optimal diameter. Conclusion. This example demonstrates the possibility of safely and effectively performing phacofragmentation without capsulorhexis at the stage of laser femtosecond support during cataract phacoemulsification, when the pupil diameter does not allow programming the optimal capsulorhexis size. Key words: ciliocapsular fixation, intraocular lens, pseudoexfoliation syndrome, femtosecond laser