Lens-iris Diaphragm Research Articles

“Bubble Behind Iris” Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes

Purpose: Performing Descemet membrane keratoplasty (DMEK) in vitrectomized eyes can be challenging, owing to the compromised stability of the iris–lens diaphragm. This study presents a “bubble behind iris” technique in DMEK to achieve a shallower anterior chamber in vitrectomized and pseudophakic eyes. Methods: The patients with vitrectomized eyes who underwent DMEK between October 2022 and March 2023 were enrolled in this study. Following the insertion of the donor tissue into the anterior chamber, a 30-gauge blunt cannula was used to introduce an air bubble posterior to the iris. The depth of the anterior chamber was confirmed before unfolding the graft. Subsequently, the air bubble was carefully replaced with balanced salt solution insertion using the blunt cannula, and the anterior chamber was filled with gas for graft attachment. Results: This study included 3 eyes of 3 patients (3 men; mean age 62.3 ± 8.5 years). The best spectacle corrected visual acuity and central corneal thickness improved in all eyes with no notable complications. Conclusions: The “bubble behind iris” technique is a straightforward and minimally invasive approach for maintaining an optimal anterior chamber depth during DMEK in vitrectomized and pseudophakic eyes.

Iris Reconstruction: A Surgeon's Guide.

Objectives: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris-lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. Methods: A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. Results: Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris-lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. Conclusions: Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance.

Клинический случай этапной хирургии последствий открытой травмы глаза

Purpose. To present a clinical case of staged surgical treatment of a patient with a battle-open eye injury. Material and methods. Patient M., born in 1976, with a condition after an open eye injury of the V degree, type B, zone II (1, 2, 3, 4, 5), with prolapse of the inner membranes, post-traumatic aniridia, post-traumatic aphakia, total hemophthalmos. From the anamnesis it is known that the patient during the shelling received several «blows» in the left side of the face. Primary surgical treatment of facial soft tissue wounds, left paraorbital area, lacerations of the upper eyelid laceration was performed. Prescribed with recommendations of conservative treatment of the left eye. The patient performed a phased surgical treatment of open eye trauma. Results. Surgical treatment was performed routinely, there were no intra- and postoperative complications. The recommended vitreoretinal and optico-reconstructive interventions ensure maximum functional, anatomical and cosmetic recovery of the operated eye. Conclusions. In stage surgical treatment of the consequences of open eye trauma, the duration of each surgical intervention is reduced. This minimizes intraoperative trauma to intraocular structures, which subsequently allows to assess the scope of optical reconstructive interventions and the need for surgical compensation of intraocular pressure. Similarly, delayed implantation of the actually required intraocular lens and iris-lens diaphragm ensures maximum refractive result and cosmetic effect. Keywords: fighting uncovered eye injury, stage-by-stage surgical treatment, optoreconstructive vitreoretinal surgery

ACETAZOLAMIDE INDUCED SECONDARY ANGLE CLOSURE GLAUCOMA: A RARE CASE REPORT

Introduction : Drugs such as topiramate, acetazolamide, methazolamide, buproprion, and trimethoprim- sulfamethoxazole potentially cause an elevation of IOP. Drug-induced glaucoma may be an ophthalmic emergency if not treated promptly and can results in permanent visual loss.
 Case Illustration : A 36-years-old female came to Glaucoma Unit at Cicendo National Eye Hospital with progressive blurred vision since 1 year ago, worsening in the past six months. Accompanying symptoms included pain, headache, halo, and conjunctival hyperemia. She had been diagnosed with glaucoma and received timolol maleate, acetazolamide, and glycerin. Seven days later, her visual acuity worsened to 3/60 ph 0.15 RE and 2/60 ph 0.15 LE, with high IOP in both eyes, with the higher IOP being >30 mmHg. The cup-to-disc ratio was 0.3 RE and 0,8 LE. The anterior segment showed shallow anterior chamber, mid-dilated pupil, and conjunctival injection (Figure 1.). Gonioscopy examination showed Schwalbe line of both eyes (Figure 2.). Acetazolamide was stopped, and one week later the condition resolved (Figure 3.).
 Discussion : Secondary angle closure glaucoma caused by acetazolamide is important to consider because most people tolerate acetazolamide well. The mechanism of closed-angle glaucoma can be pupillary block and non-pupillary block. Non-pupillary block is caused by thickening, forward movement the iris-lens diaphragm, rotation of the ciliary body, and choroidal effusion. This process is an idiosyncratic reaction to certain systemic drugs.
 Conclusion : Few cases were reported about secondary bilateral angle closure glaucoma due to acetazolamide. Treatment of angle closure glaucoma involves stopping acetazolamide

Clinical Aspects of Transient Myopia after Blunt Eye Trauma

Purpose: To investigate the clinical aspects of transient myopia after blunt eye trauma.Methods: The medical records of 32 patients treated at our hospital for from 2020 to 2022 traumatic microhyphema were analyzed retrospectively. The visual acuity, intraocular pressure, anterior chamber cells, anterior chamber depth, axial length, lens thickness, and refractive index were analyzed immediately after injury and after treatment. Patients with additional diseases such as vitreous and retinal hemorrhage, traumatic retinal detachment, iridodialysis, or orbital fracture were excluded. Correlations between the myopic changes and the amount of myopic refractive change caused by trauma were analyzed.Results: The 32 patients included 24 (75%) males and 8 (25%) females. The average myopic change was -3.03 ± 0.92 (range -1.00 to -5.25) diopters (D). The average change in anterior chamber depth due to trauma was -0.22 ± 0.11 mm, the change in lens diameter was 0.20 ± 0.09 mm, and the change in axial length was -0.07 ± 0.05 mm. The average change in refractive index due to ciliary spasm was -1.63 ± 0.65 D. The correlations between the change in refractive index and anterior chamber depth (r = 0.475, <i>p</i> = 0.008), traumatic ciliary spasm (r = 0.649, <i>p</i> < 0.001), and lens thickness (r = -0.184, <i>p</i> = 0.330) were determined.Conclusions: Factors such as ciliary spasm, change in the anterior chamber depth, anterior shift of the lens-iris diaphragm, and increased lens thickness affect the myopic changes caused by trauma. Of these, a shallower anterior chamber depth and ciliary spasm are highly correlated with the transient myopic changes.

Fluocinolone acetonide implant scleral fixation for cystoid macular edema in eyes with iris–lens diaphragm disruption

Abstract This is a two-center, case series of three patients with postoperative refractory cystoid macular edema (CME) and disruption of the iris–lens diaphragm, submitted to scleral fixation of fluocinolone acetonide implant. All patients achieved successful CME reduction with visual acuity improvement. The surgical procedure was uneventful in all cases; however, one patient developed hypotony with leakage from the scleral tunnel, which was successfully resolved with reinforcement of the suture and injection of viscoelastics in the anterior chamber. No case of implant migration was observed and patients did not report any visual field disturbances. Our results emphasize this surgical technique as an effective and safe procedure for patients with persistent CME and disruption of the iris–lens diaphragm.

Changes in intraocular pressure and biometric parameters of the anterior segment of the eye after intravitreal injections

This study compares the changes in the parameters of the anterior chamber of the eye using anterior segment optical coherence tomography (AS-OCT) in patients with a natural and artificial lens after treatment of neovascular age-related macular degeneration (nAMD) by multiple intravitreal injections (IVI) of anti-VEGF drugs. The patients were divided into 2 groups: group 1 (control) included 30 patients (30 eyes) with a natural lens, group 2 - 30 patients (30 eyes) with an intraocular lens (IOL). AS-OCT was performed using the Revo NX tomograph (Optopol, Poland) to analyze anterior chamber depth (ACD) and the parameters of anterior chamber angle (ACA). Intraocular pressure (IOP) was measured with a contact tonometer ICare Pro. In patients with an IOL, the IOP level 1 minute after intravitreal injection (IVI) of an anti-VEGF drug was statistically lower than in the control group, on average by 17.8% during the first IVI and by 28.7% after 1 year of observation (p<0.001). ACD before treatment was statistically significantly higher in patients with IOL compared to patients of group 1 by an average of 39.3% (p<0.001). ACA from the nasal and temporal sides in the meridian 0°-180° before the start of treatment was statistically significantly wider in phakic patients than in the control group, by an average of 15.9±9.3° (p<0.001) and 16.9±8.2° (p<0.001), respectively. According to AS-OCT, there was no shift of the iris-lens diaphragm in patients with an IOL after multiple IVI of an anti-VEGF drug, in contrast to the control group. AS-OCT was used to determine for the first time the changes in the parameters of the anterior chamber of the eye in patients with a natural and artificial lens after multiple injections of an anti-VEGF drug in the treatment of nAMD.

An Integrated Stepwise Approach to the Treatment of Graft Disease in a Patient with an Implanted Iris Lens Diaphragm and Concomitant Postkeratoplastic Ametropia (Clinical Case)

The purpose: to analyze the clinical and functional results of the complex staged treatment of graft disease in patient with an implanted iris lens diaphragm and concomitant postkeratoplastic ametropia using descemet’s stripping endothelial keratoplasty using a femtosecond laser (FS-DSEK) and MyoRing implantation into a corneal graft using a femtosecond laser on the example of a clinical case. Methods. Patient M., 51 years old, was admitted with a diagnosis of the left eye: corneal transplant disease, condition after penetrating keratoplasty, iridoartifakia, avitria, optic nerve subatrophy, high myopia. To treat the graft disease, the patient underwent FS-DSEK using a FemtoVisum 1 MHz (Troitsk, Russia). Twelve months after FS-DSEK to correct irregular postkeratoplastic astigmatism and concomitant high-grade myopia detected after restoration of the transparency of the penetrating corneal graft, the MyoRing was implanted into the penetrating corneal graft using a femtosecond laser. Results. After performing FS-DSEK, the transparency of the penetrating corneal graft was completely restored, visometry, refractokeratometry, and keratopachymetric data were stabilized by 6 months after the operation. 12 months after FS-DSEK, uncorrected visual acuity (UCVA) increased from 1.6 to 1.2 LogMAR, best corrected visual acuity (BCVA) increased from 1.6 to 0.8 LogMAR. Loss of endothelial cell density of the posterior layered graft was 27.4 %. MyoRing implantation into a penetrating corneal graft made it possible to significantly increase the UCVA from 1.3 to 0.3 LogMAR and the BCVA from 0.8 to 0.2 LogMAR. The spherical component of refraction decreased from -6.25 to -0.75 D, the cylindrical component of refraction — from -9.25 to -1.25 D, the regularity, sphericity of the corneal graft and its biomechanical properties increased (corneal resistance factor increased from 8.2 to 9.4 mm Hg, corneal hysteresis — from 7.9 to 9.1 mm Hg). Conclusion. A complex staged technique of descemet’s stripping endothelial keratoplasty using a femtosecond laser followed by MyoRing implantation into the corneal graft using a femtosecond laser is an effective and safe method for treating graft disease in a patient with an implanted iris lens diaphragm and concomitant postkeratoplastic ametropia.

A novel technique of penetrating keratoplasty to prevent intraocular contents extrusion for infectious keratitis

PurposeTo evaluate the safety and the effectiveness of our novel penetrating keratoplasty for infectious keratitis.MethodsRetrospective, noncomparative, interventional case series of patients with infectious keratitis who received the novel penetrating keratoplasty technique were analyzed. A prepared plastic sheet was located between the diseased cornea and iris-lens diaphragm. After the diseased lesions were removed, the graft was positioned on the plastic sheet and sutured to the recipient bed. The plastic sheet was pulled out from the anterior chamber before the all interrupted sutures were placed. The intra- and post-operative complications, the outcome of the graft and the number of corneal endothelial cells were analyzed.ResultsA total of 82 eyes of 82 patients was included. The mean follow-up period was 29 ± 16 months (range from 13 to 45 months). No intraocular content extrusion, simultaneous cataract extraction and suprachoroidal hemorrhage occurred. Direct contact between the infectious cornea and the graft was successfully avoided. Greater than expected endothelial cell reduction or complications were not found.ConclusionsThis modified technique effectively prevents the extrusion of intraocular contents while avoiding the direct contact with donor endothelium during the procedure. The occurrence rate of complications such as endothelial cell loss is not higher than the conventional methods.

Вторичная неопластическая глаукома, ключевые аспекты этиопатогенеза

Purpose. To analyze the literature on the main aspects of etiology, pathogenesis of secondary glaucoma in tumor diseases of visual organs. Material and methods. PubMed, Scopus and eLIBRARY databases for the period up to 2022 were used for article selection, and the following keywords were used in the mesh: secondary glaucoma, tumor, neovascularization, pigment dispersion (and the same phrases in Russian). Results. The literature review presents various pathological mechanisms of developing secondary glaucoma. The reasons of decreased outflow of intraocular fluid of drainage and embedded (uveoscleral) pathways, lead to the increase of intraocular pressure in neoplastic glaucoma and depend on the type of eye tumor, its localization and size. This determines the necessity for a differentiated approach to the treatment of patients with secondary glaucoma and the development of pathogenetically oriented methods of treatment. Conclusion. Almost all of the intraocular tumors can potentially lead to increase of intraocular pressure. The pathomechanisms of neoplastic glaucoma are very diverse, but the leading ones are blocking of the anterior chamber angle drainage zone by tumor, neovascularization of the anterior chamber angle structures and anterior iris-lens diaphragm displacement. In all cases, the increase in intraocular pressure is associated with the violation of aqueous humor outflow through the main drainage paths of the eye. Currently, secondary glaucoma is not given enough attention, but this problem is extremely relevant in ophthalmology. Key words: secondary glaucoma, tumor, neovascular, pigment dispersion

The role of anterior segment optical coherence tomography in the detection of predictors of ophthalmic hypertension associated with anti-VEGF injections

PURPOSE. To identify the predictors of increased intraocular pressure (IOP) after intravitreal injection (IVI) of an antiVEGF drug using anterior segment optical coherence tomography (AS-OCT), and to study changes in the iris-lens diaphragm produced by multiple injections in the treatment of neovascular form of age-related macular degeneration (nAMD).METHODS. IOP was measured with an ICare Pro tonometer before IVI, 1 minute after IVI, 30 minutes, 60 minutes and 180 minutes later. Anterior chamber depth (ACD), anterior chamber angle (ACA), and lens thickness were assessed using Revo NX tomograph (Optopol, Poland). The study was carried out before IVI, one month after the first IVI, one month after the third IVI, one year after the start of treatment. Axial length was measured once before IVI.RESULTS. An inverse correlation was found between axial length and an increase in IOP 1 min after IVI (r=0.65, p&lt;0.001). According to AS-OCT data, one year after the start of treatment there was a significant decrease in ACD compared to the data before treatment (p&gt;&lt;0.001), as well as a decrease in all parameters of ACA (p&gt;&lt;0.05). Shorter axial length (R2 =0.45, p&gt;&lt;0.05), shorter ACD (R2 =0.44, p&gt;&lt;0.05), smaller ACA on the nasal (R2 =0.37, p&gt;&lt;0.05) and temporal (R2 =0.39, p&gt;&lt;0.05) sides in patients with their own lens led to a greater rise in IOP 1 min after IVI.CONCLUSION. Predictors of a sharp increase in IOP after IVI of an anti-VEGF drug in patients with nAMD that can be detected with AS-OCT are shorter ACD and smaller ACA. The following prognostic model was determined — with a 1-mm decrease in the axial length, an increase in IOP by 2.3 mm Hg should be expected, a decrease in ACA from the temporal side by 1° leads to an increase in IOP of 0.28 mm Hg&gt;

A Modified Technique for Preventing Lens-Iris Diaphragm Retropulsion Syndrome in Vitrectomized Eyes during Phacoemulsification.

Lens-iris diaphragm retropulsion syndrome (LIDRS) is common in vitrectomized or high myopic eyes during phacoemulsification. We evaluated the results of a modified technique for cataract treatment using phacoemulsification in vitrectomized eyes. In this retrospective study, we enrolled thirty-four vitrectomized eyes treated with modified phacoemulsification (Modified Group) and nineteen vitrectomized eyes treated with routine phacoemulsification (Control Group). The modified technique comprised irrigation with a balanced salt solution underneath the pupil before phacoemulsification instrument entry, lens implantation and stromal hydration to stabilize the anterior chamber and equilibrate the pressure between the anterior chamber and posterior cavity. We compared the incidences of intra and postoperative complications and visual outcomes between modified and routine phacoemulsification. Pain, LIDRS and difficulty in stromal hydration were significantly more common in the Control Group than in the Modified Group (p < 0.05). There were no significant differences in the rates of posterior capsular rupture, iris trauma, lens dislocation, or posterior capsular opacification between the Modified and Control Groups (p > 0.05). However, there was no significant difference in visual acuity between the groups (p > 0.05). Complications such as loss of nuclear fragments into the vitreous cavity, cystoid macular edema, retina redetachment, suprachoroidal hemorrhage and vitreous hemorrhage did not occur either intra or postoperatively in any of our patients. Our modified technique prevents LIDRS and complications arising during cataract surgery in vitrectomized eyes. Aside from this, the results of modified and routine phacoemulsification are similar in vitrectomized eyes.

Rehabilitation of patients with posttraumatic aniridia and secondary glaucoma

This study analyzes the long-term results of rehabilitation of patients with posttraumatic aniridia and glaucoma. The study included 310 patients (310 eyes) with posttraumatic aniridia who had artificial iris-lens diaphragm (ILD) MIOL-Raduzhka implanted in 2002-2022. Before ILD implantation, 61 patients (22.8%) had secondary glaucoma. Among them 35 patients (11.3%) underwent various modifications of glaucoma surgery. In 26 patients (8.6%), intraocular pressure (IOP) was compensated medically before ILD implantation. Until the third month after ILD implantation, there was a trend for IOP increase in some patients. Decompensation was noted in 8 (22.9%) out of 35 patients who had underwent glaucoma surgery. IOP decompensation was observed in 21 (80.8%) of 26 cases in patients with glaucoma compensated by drugs before ILD implantation. After ILD implantation, glaucoma appeared for the first time in 21 patients (6.8%) out of 310. In order to compensate IOP after ILD implantation, Ahmed valve implantation was performed most often - in 35 cases (70%) out of 50, deep sclerectomy - in 5 cases (10%), non-penetrating deep sclerectomy - in 4 cases (8%), micropulse transscleral laser cyclophotocoagulation (MP-TSCPC) - in 5 cases (10%), endoscopic cyclophotocoagulation (ECP) - in 1 case (2%). ILD implantation in patients with posttraumatic aniridia and secondary glaucoma should be performed with IOP compensated without hypotensive therapy and not earlier than 6-12 months after glaucoma surgery. The most optimal glaucoma surgery types in this group of patients are Ahmed valve implantation and MP-TSCPC.

Malignant glaucoma: A therapeutic challenge

Malignant glaucoma is a rare condition characterized by an acute rise of intraocular pressure rise with a very shallow anterior chamber, generally following anterior segment surgery. The mechanism leading to malignant glaucoma is that in an anatomically predisposed eye, the anterior rotation of the ciliary body induces misdirection of aqueous flow into or behind the vitreous body, increasing vitreous volume, resulting in anterior displacement of the iris–lens diaphragm, axial and peripheral anterior chamber flattening, and secondary angle closure. The aim of this article is to report a case of malignant glaucoma to discuss about the risk factors involved and therapeutic approaches that are useful in managing such cases.

Posterior Segment Air Injection-Assisted Descemet Membrane Endothelial Keratoplasty in Pseudophakic and Vitrectomized Eyes.

This study aimed to present a novel technique for Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic and vitrectomized eyes. The sterile air was injected into the posterior eye segment (anterior vitreous cavity) as a barrier to prevent the fluid of the vitreous cavity flowing into the anterior chamber, levitating the iris-lens diaphragm to flatten the anterior chamber during the surgery. This approach assists in the unfolding of the donor endothelial graft, helping to perform DMEK surgery on patients with a posterior intraocular lens (IOL) and vitrectomy. Four cases presented with corneal endothelial decompensation (pseudophakic bullous keratopathy) with previous IOL implantation and vitrectomy underwent DMEK with this technique. The Descemet endothelial graft unfolding time after air injection was 68.75 ± 8.96 seconds. No graft displacement occurred during the surgery. The uncorrected and corrected distance visual acuities were improved in 3 of 4 patients. The corneas were transparent, and there was no graft detachment observed postoperatively in all 4 patients. The posterior eye segment air injection can reduce the difficulty of unfolding the DMEK graft in patients after IOL implantation and vitrectomy and the potential intraoperative and postoperative complications, allowing for easy performance of DMEK surgery on pseudophakic and vitrectomized eyes for corneal endothelial dysfunction.

Endodiathermal Tautening of Floppy or Irregular Iris in Endothelial Keratoplasty (Iridodiathermy).

Floppy or irregular irides may be seen during endothelial keratoplasty in complex cases or in eyes with damaged irides and may cause uneven air fill, retro-pupillary air escape, anterior bowing of iris, forward movement of lens-iris diaphragm, shallowing of anterior chamber (AC), bellowing and floppiness of iris, uneven AC depth, difficulty in inserting and opening graft, iris trauma, intraoperative bleeding, and iridodialysis. We present a technique of iridodiathermy for tautening and flattening such irides. With continuous irrigation using AC maintainer, the bipolar endodiathermy probe tip is applied in localized spots to midperipheral iris in the affected area with power and duration adjusted to induce mild localized shrinkage and tightening of iris stroma. Such iris tautening decreases its floppiness and prevents anterior bowing, excessive mobility, irido-corneal touch, and peripheral anterior synechiae formation. It provides a stable AC with regular depth and improved, uniform, and nonmigratory air fill, thus decreasing intraoperative challenges.

Clinical and morphological aspects of the development of secondary ophthalmic hypertension in uveal melanoma

Ophthalmic hypertension is mostly associated with medium- or large-sized melanomas. The pathogenesis of persistent IOP elevation in uveal melanoma is not fully understood at present. Purpose. To analyze the clinical and morphological mechanisms of the development of secondary ophthalmic hypertension in patients with uveal melanoma. Material and methods. The case histories of 26 patients with T3N0M0-T4N0M0 uveal melanoma were analyzed retrospectively from 2015 to 2019. The main group included 18 patients with secondary monolateral IOP elevation while the control group was composed of 8 patients with normal IOP. Tumors in both groups were comparable in size. All patients underwent eradication treatment (enucleation/exenteration). Enucleated eys were histologically examined. Results. Pronounced pathological changes of the iridocorneal angle, iris and ciliary body were found morphologically in all specimens with elevated IOP. The following dominating mechanisms ofophthalmic hypertension were detected: iris and anterior chamber angle neovascularization; tumor-associated chronic uveitis; obstruction of trabecular meshwork by cellular elements (pigment-rich macrophages, blood cells, inflammatory cells); fibrosis and deformation of trabecular meshwork and Schlemm's canal; closed angle glaucoma with lens-iris diaphragm shift; tumor invasion into the angle. Conclusions. Investigation of morphological changes in patients with UM and found resemblances with already studied non-tumor forms of glaucoma may help find previously undetectable receptors for the development of targeted anti-tumor drugs.

Структурные особенности глаза при регматогенной отслойке сетчатки в условиях афакии и артифакии

When choosing the tactics of surgical treatment in conditions of combined pathology, in particular aphakia and rhegmatogenous retinal detachment (RRD), an important point is the change of the iris-lens diaphragm anatomy. During biomicroscopy, changes in the anterior part of the eye were detected in patients with pseudophakia and aphakia (groups 1 and 2). Signs such as unevenness of the anterior chamber of the eye, atrophy of the pigment border of the iris and its vascularization occur in patients of both groups. The distinctive feature of the morphology of the anterior segment of the eye in group 1 patients is local opacification of the periphery of the cornea. There is also a tendency to an increase of indicator of the anterior chamber irregularity in group 1 patients. Analyzing the data obtained during ophthalmoscopy of the vitreous cavity, signs such as deformation of the foveolar profile, cystic edema of the macula, presence of subretinal fluid, presence of hemorrhages, as well as germination of newly formed vessels did not differ significantly. A distinctive feature of the change in the structural parameters of the vitreous cavity according to optical coherence tomography (OCT) is presence of vitreomacular traction syndrome in group 1 patients. Despite the absence of the iris-lens diaphragm in group 1 patients, no significant differenc in BCVA was revealed, however, taking into account the structural features of the anterior part of the eyeball, a significant change in refraction of 3.82 times was revealed in group 1 patients. Key words: aphakia; rhegmatogenous retinal detachment; vitreomacular traction syndrome.

Iris Fixation via External Pentagram Suturing.

Extensive anterior synechia of the iris can result in the gradual disappearance of the anterior chamber. It is one of the most common outcomes of both oculopathy and complicated post anterior segment surgery. This can impact visual function and lead to bullous keratopathy, making it one of the most complex clinical problems. Conventional anterior chamber plasty will partially create the anterior chamber, but the anterior chamber disappears again in some cases. The main reasons are: (1) the iris lens diaphragm is loose with atrophied and tension-free iris so that the aqueous humor circulation will push and squeeze the iris forward; (2) the effect of "roller" formed in the process of inflammation or restoration will change the iris structure from peripheral anterior synechia (PAS) to extensive anterior synechia again; (3) the fibration will result in synechia from iris to the cornea. In such cases, corneal endothelium deficiency can't stop the aqueous humor from entering the cornea. This results in persistent corneal edema post-conventional anterior chamber plasty, resulting in progressive rubbing and lachrymation. Therefore, anterior chamber plasty is not the first choice for patients without surgical indications of Descemet's stripping automated endothelial keratoplasty (DSAEK). However, this can be performed in patients with surgical indications who plan to receive DSAEK. A unique method of iris fixation via external pentagram suturing anterior chamber plasty (PSACP) is described here. The present technique is also compared with the conventional anterior chamber plasty. PSACP and DSAEK might be an effective way to cure the bullous keratopathy with extensive anterior synechia of the iris and disappeared anterior chamber.

Изменения иридо-хрусталиковой диафрагмы на фоне трех загрузочных интравитреальных инъекций anti-VEGF препарата

Purpose. To use anterior segment optical coherence tomography (AS-OCT) to evaluate the lens-iris diaphragm after intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF). Material and methods. Twenty patients scheduled for IVI of anti-VEGF for the treatment of neovascular age-related macular degeneration (NVAMD) were enrolled in this study. All patients underwent a standard ophthalmological examination and AS-OCT. Intraocular pressure (IOP) was measured before IVI, after 1 minute, 30 minutes and after 3 hours. Results. The average thickness of the lens was 5.65 ± 0.7 mm. The mean anterior chamber (AC) depth before IVI was 2.584 ± 0.33 mm, one month after the 1 st IVI was 2.563 ± 0.34 mm, one month after the 3 rd IVI was 2.543 ± 0.34 mm; there was a significant decrease in the size of the AC depth after three injections by an average of 0.0409 ± 0.03 mm (p &lt; 0.05), and a lower AC depth was associated with a greater rise in IOP immediately after the injection ( = 0,412, p &lt; 0,05). There is significant narrowing of the temporal and nasal anterior chamber angle in the meridian 0–180° before the treatment and one month after three loading doses (p &lt; 0,05). Conclusions. After three loading IVI, there are significant changes in the lens-iris diaphragm were observed in patients with NVAMD according to AS-OCT data. It is necessary to analyse long-term results in a larger sample of patients to further study the mechanisms of increased IOP after IVI. Keywords: anti-VEGF drugs, intravitreal injection, intraocular pressure, lens-iris diaphragm.