Обоснование патогенетической направленности поэтапной световой иммобилизации в макулярной и витреоретинальной хирургии

Abstract

Purpose. To substantiate the pathogenetic orientation of staged light immobilization in macular and vitreoretinal surgery. Material and methods. Literature data and own longterm clinical observations of the results of vitreoretinal, optoreconstructive, microsurgical and laser therapeutic, optical and refractive operations were analyzed. Particular emphasis was placed on the results of photostress-testing and differential aberrometry in macular and vitreoretinal pathology in combination with ametropia (150 eyes, 96 patients). Results. Studies have shown that changes in the retina and surgical operations for macular and vitreoretinal pathology create conditions, when the usual physiological light load begins to have a damaging effect on the retina and aggravate the course of the disease. The latter indicates the expediency of using various techniques for limiting the light load on the retina. This requires a gradual smooth transition from complete to various options for partial light immobilization. In all cases, optical photoprotection from external UV radiation, complete correction of ametropia and associated optical aberrations were shown This was indicated by a positive correlation between defocus and higher-order aberrations with an increase in visual acuity recovery time after a photostress-test. The timing of such immobilization should take into account the severity of the pathological process and the specific type of surgical intervention. This can be realized with a large arsenal of spectacle, contact, intraocular photochromic and spectral lenses that block the violet rays of visible light and attenuate the flow of rays of the blue spectral range. If full optical correction of ametropia, induced irregular astigmatism and higher order aberrations is impossible, their personalized laser correction is shown according to keratotopography and aberrometry data. This is indicated by the revealed positive correlation between the recovery time of visual acuity after the photostress-test, defocus, and higher-order aberrations. Conclusion. Gradual light immobilization in macular and vitreo-retinal surgery has a pathogenetic focus and should be more widely used in ophthalmic practice. Keywords: light immobilization, deprivation, photoprotection, macular and vitreo-retinal surgery