Биоптический подход к эксимерлазерной хирургии при сочетанной патологии роговицы и хрусталика

Abstract

Purpose. To consider a biooptical approach to excimer laser surgery for combined pathology of the cornea and lens. Material and methods. The work is based on 20-year clinical observations of the results of excimer laser refractive, opto-reconstructive and medical surgery in combined pathology of the cornea and lens based on a biooptical approach (more than 1500 operations). Particular emphasis was placed on the cycloplegic functional test and the use of stromal saturation with 0.25% chilled to +5–7 °C isotonic riboflavin solution during photoablation. The studies used modern diagnostic devices OPD-scan, RTVue XR100 and TMS-5 and excimer ophthalmic lasers from various companies. Results. In case of combined refractive pathology of the cornea and lens, the cycloplegic test made it possible to more accurately determine the degree of ametropia, its accommodative component with compensation of corneal astigmatism, and the presence of lens astigmatism. In all cases, the determination of the volume of photorefractive ablation was calculated taking into account the contribution of the cornea and lens to the formation of ametropia and aberrations of the optical system of the eye. The diameter of the optical and transition zone during photorefractive ablation was calculated depending on the state of the pupil diameter in photopic and mesopic conditions. Obtained in the course of studies on the OPD-Scan device, objective information on the difference between the pupil width in mesopic and photopic conditions made it possible to individualize the sizes of the optical and transition zones during photorefractive ablation, to avoid the «Halo» and «Gler» effects. Photoablation with saturation of tecorneal stroma with riboflavin reduced the response of aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome, and provided earlier stabilization of optical refractive indices. Conclusion. When performing excimer laser refractive, opto-reconstructive and therapeutic operations with combined pathology of the cornea and lens, a biooptical approach is required, taking into account the leading role of the cornea and lens in the formation of the optical system of the eye and visual acuity. Keywords: biooptics, photoablation, excimer laser corneal surgery