Phacoemulsification Cataract Research Articles

Impact of Peripheral Anterior Synechiae on the Outcome of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Primary Angle Closure Glaucoma and Cataract: A Multicenter Observational Study.

The combination of phacoemulsification, goniosynechialysis and goniotomy is an effective treatment for primary angle closure glaucoma patients with cataract, and this is not linked to the extent of preoperative peripheral anterior synechiae. To evaluate the impact of the extent of peripheral anterior synechiae (PAS) on the effectiveness and safety of combined phacoemulsification (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes with primary angle closure glaucoma (PACG) and cataract. This study included patients diagnosed with PACG and cataracts who underwent combined PEI and 120 degrees GSL plus GT (PEI+GSL+GT) between April 2020 and October 2022 at 10 ophthalmic institutes. Eligible patients were divided into 3 groups based on the extent of PAS: 180°≤PAS<270°, 270°≤PAS<360°, and PAS=360°. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. The study defined complete success as postoperative IOP within the 6-18mm Hg range and a 20% reduction from baseline without the use of topical medications. Qualified success was defined in the same way as complete success, but it allowed for the use of ocular hypotensive medications. Three hundred four eyes of 283 patients were included. The mean follow-up was 12.50±1.24 months. All groups experienced a significant reduction in IOP after the surgery ( P <0.05). There were no significant differences in final IOP, number of medications, and cumulative complete and qualified success rates among the 3 groups ( P >0.05). The groups with 270°≤PAS<360°had a higher frequency of hyphema compared with 180°≤PAS<270° ( P = 0.044). PEI+GSL+GT has proven to be an effective treatment for PACG with cataracts over a 1 year period. However, the outcome was not correlated with the preoperative extent of PAS.

Clinical study on the influence of phacoemulsification on retinal structure of senile cataract based on data mining.

With the improvement of the level of science and technology, diagnosis and treatment technology of ophthalmology has continuously improved, especially with the rise of optical coherence tomography. Alternative methods have enabled clinicians to obtain more information and make greater breakthroughs in the occurrence and development of many ophthalmic diseases. To investigate changes in retinal structure in the macular area of senile diabetic cataract patients undergoing cataract phacoemulsification. This was a prospective cohort study. A total of 68 cataract patients (78 eyes) who voluntarily received phacoemulsification combined with intraocular lens implantation in the Department of Ophthalmology of our hospital from December 2018 to December 2021 were selected. They were divided into A (diabetic) and B (non-diabetic) according to whether they were complicated with diabetes. There were 24 cases (28 eyes) in A and 44 cases (50 eyes) in B. Cataract patients were collected before and after surgery. Day, 1 week, and 1 month, data on the average thickness of the fovea retina and thickness of the retinal nerve fiber layer around the optic disc (average thickness, nasal thickness, topic side thickness, upper thickness, and lower thickness) were statistically analyzed analyze. The average retinal thickness of the macular fovea in Group A was found to be greater than that of Group B, however, there was no statistically significant difference between the two groups. At week one and week thirty, Group A's layer of retinal nerve fibers surrounding the optic disc thickened; there was no discernible difference between the two groups. One week and one month following surgery, however, showed a one-week difference in upper thickness compared to preoperative days. There was no discernible change between the preoperative and 1-day times. Both diabetic cataract patients and simple age-related cataract patients will have different degrees of increased foveal retinal thickness after surgery. However, the foveal retinal thickness of patients with diabetes increases more.

Ultrasound biomicroscopy analysis of ciliary muscle dynamics and its relation to intra-ocular pressure after phacoemulsification in dogs.

This study investigates the relationship between ciliary muscle dynamics, thickness, and the regulation of intraocular pressure (IOP), focusing on the progression of cataracts and changes post-phacoemulsification. It explores how these factors impact canine ocular health, particularly in the context of cataract development and subsequent surgical intervention. Data was collected using Ultrasound Biomicroscopy (UBM) from dogs at the Veterinary Medical Teaching Hospital of Chungbuk National University, Korea. The study involved 57 eyes from 35 dogs, categorized into five groups: 13 normal eyes, 14 with incipient cataracts, 12 with immature cataracts, 6 with mature cataracts, and 12 post-phacoemulsification. UBM measurements assessed various ciliary muscle parameters including ciliary body axial length (CBAXL), ciliary process-sclera angle (CPSA), longitudinal fibers of ciliary muscle thickness (Lf-CMT), and longitudinal and radial fibers of ciliary muscle thickness (LRf-CMT). Findings indicated a decrease in CBAXL and an increase in Lf-CMT as cataracts progressed in severity. Post-phacoemulsification, there was a notable increase in CBAXL and a decrease in CPSA, Lf-CMT, and LRf-CMT, compared to both cataractous and normal eyes. Regression analysis revealed a significant positive association between CBAXL and IOP, alongside a negative association between Lf-CMT and IOP. These findings suggest that variations in ciliary muscle dynamics and thickness, as influenced by cataract progression and phacoemulsification, have distinct impacts on intraocular pressure. The study proposes that phacoemulsification leads to ciliary muscle contraction, causing an inward and anterior movement of the ciliary muscle. This movement results in the narrowing of the ciliary cleft and constriction of the unconventional outflow pathway, potentially causing an increased risk of glaucoma post-surgery. Our research contributes to understanding the anatomical and physiological changes in the canine eye following cataract surgery and underscores the importance of monitoring IOP and ciliary muscle dynamics in these patients.

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

Corneal morphology following use of Malyugin versus B-hex pupil expansion rings in small pupil phacoemulsification

Aim: The aim of the study is to evaluate changes in corneal parameters following the use of the Malyugin ring (MR) and B-Hex ring (BhR) in small pupil phacoemulsification. Methods: A prospective cross-sectional study. 51 eyes with small pupil underwent phacoemulsification with the use of MR and BhR as pupil expansion techniques. Best-corrected visual acuity (BCVA), endothelial cell counts density (ECD), coefficient-of-variation (CV), hexagonality, central corneal thickness (CCT), and intraocular pressure (IOP) were recorded on preoperative day and postoperative day 1 and day 30. Results: Mean age at presentation was 70.9 ± 4.1 years. The most common cause for small pupils was alpha-blockers used in benign prostate hypertrophy, followed by diabetes mellitus and pseudo-exfoliation syndrome. Mean preoperative BCVA (3/60–6/12), IOP (17.12 ± 2.81 mmHg), CCT (530.96 ± 44.47 μ), ECD (2347.96 ± 298.09 cells/mm2), 6A (48.92% ± 6.34%) and CV (39.50 ± 3.49) changed to BCVA (6/9–6/6), IOP (18.69 ± 1.91 mm of Hg), CCT (536.04 ± 37.61 μ), endothelial cell count (2201.15 ± 276.75 cells/mm2), 6A (45.12% ±4.99%), and CV (37.57 ± 3.37) at day 30 postoperatively after use of MR. Similarly, mean preoperative BCVA (3/60–6/12), IOP (16.40 ± 2.42 mmHg), CCT (532.40 ± 36.14 μ), ECD (2433.68 ± 162.01 cells/mm2), 6A (48.84% ± 3.73%), and CV (39.36 ± 3.915) changed to BCVA (6/9–6/6), IOP (17.68 ± 2.75 mmHg), CCT (546.88 ± 31.25 μ), ECD (2322.08 ± 167.97 cells/mm2), 6A (46.36% ± 3.25%) and CV (38.96 ± 4.43) at day 30 post-operatively after use of BhR. The average change was clinically insignificant at day 30. Conclusion: MR and BhRs are safe pupil expansion devices and the corneal parameters are in the acceptable range of any routine phacoemulsification for senile cataracts. Nevertheless, B-hR shows relatively less alteration in corneal parameters, when compared to MR.

Этапное обеспечение высокого профиля безопасности факоэмульсификации у пациента с сочетанной патологией кератоконусом I и IV стадией, набухающей катарактой и косоглазием

Purpose. Provision of preoperative preparation of the patient for the uncomplicated course of phacoemulsification and the postoperative period in a patient with cataracts. Material and methods. The paper presents a clinical case of phacoemulsification of swelling and immature cataracts in a patient N., 59 years old, with a diagnosis of keratoconus IV degree and I degree in the paired eye. In this regard, the patient was recommended to perform phacoemulsification surgery with implantation of intraocular Toric IOL and Tecnis Eyhance IOL on the paired eye to achieve maximum visual acuity in the distance, but maintaining high visual acuity in the eyes with keratoconus stages I and IV. 2 days before surgery, 4x instillations of the NSAID Indocollir (indomethacin) 0.1% (Bausch &amp; Lomb, USA) were prescribed to prevent an inflammatory reaction and maintain mydriasis during surgery. Also, to prevent surgical complications during phacoemulsification of swelling cataracts, instillations of carbonic anhydrase inhibitor (ICA) 2 r/s were prescribed to reduce IOP and reduce the volume of the vitreous body. Results. No complications were detected during the operations, and there was no tendency to myosis. After the operation, the patient was in the clinic for 1 hour. Instillations of Indocollir, antibiotic, corticosteroid and Cornergel (dexpanthenol 5%) are prescribed at night and in the morning. The patient removes the monofocal bandage in the morning and instillates Indocollir, antibiotic, corticosteroids and corneregel (5% dexpanthenol). On the 1st post/op day visual acuity was 0.1 best corrected 0.4. IOP of 18 mm Hg. On the 5th day, the antibiotic was canceled, and the steroid drug was replaced with instillations of the drug fluorometholone for 2 weeks, instillations of Indocollir and corneregel were continued until 4 weeks post/op. After phacoemulsification in the paired eye with implantation of a monofocal IOL Tecnis Eyhance, visual acuity on the 1st day was 0.7 and text No. 5 was read at a distance of 40 cm. In 1 month visual acuity in the distance was 1.0, reading text No. 7 at a distance of 35 cm. According to the OCT of the macular, no clinically significant edema was detected, and no inflammatory reactions were detected in the postoperative period, which indicates the effectiveness of prescribing the NSAID Indocollir 0.1% with rapid withdrawal of antibiotics and corticosteroids, which allowed to minimize the load on the surface of the eye. Conclusion. The preliminary administration of NSAID preparations (indomethacin 0.1%) a day before surgery before ultrasound phacoemulsification allows maintaining the necessary mydriasis for safe operation. Postoperative management of the patient on NSAIDs (indomethacin 0.1%) avoids prolonged instillation of corticosteroids. Implantation of a monofocal IOL with a gradual increase in optical power from the periphery to the center provides patients with keratoconus with high visual acuity in the distance and at an average distance. Key words: cataract surgery, phacoemulsification, combined pathology, keratoconus, NSAID, indomethacin, monofocal IOL

Подходы к комбинированной хирургии катаракты и глаукомы в условиях слабости связочного аппарата хрусталика

Purpose. To demonstrate the effectiveness of single-step phacoemulsification of cataracts and antiglaucoma surgery in conditions of weakness of the zonular apparatus. Methods. Patient N., 67 years old, came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) with complaints of decreased vision, increased intraocular pressure (IOP), and narrowing of the fields of view of the right eye. The diagnoses: OD Primary open-angle glaucoma 3v, Subluxation of the lens grade 1 OS Primary open-angle glaucoma 1a, OU Complicated cataract, Pseudoexfoliation syndrome. Carried out: autorefractokeratometry, visual acuity testing, computerized perimetry, biomicroscopy, gonioscopy, pneumotonometry, tonometry according to Maklakov, optical biometry. Considering the weakness of the lens zonules, the method of fixation of the intraocular lens (IOL) by optic capture technique was used. Results. Examination and evaluation one week post-operation: Visus 0.6 unc, IOP (pneumotonometry) 11 mmHg without hypotensive therapy; biomicroscopy: a calm eye with a well-expressed filtration bleb at the 12 o’clock position, well-adapted sutures, a transparent cornea of average depth, clear aqueous humor, moderate iris atrophy, round 3 mm pupil with pseudophakia at the pupil’s edge, IOL located in the capsular bag with haptics in the iridociliary groove, stable positioning. Fundus examination shows a pale optic nerve head, excavated with 0.8 cup-to-disc ratio, well-defined borders, narrowed vessels. Macular region appears normal. Conclusion. Combined cataract and glaucoma surgery in a patient with subluxated crystalline lens using the «optic capture» technique and Non-penetrating Glaucoma Surgery allowed preserving the correct and stable position of the IOL with normalization of intraocular pressure without the need for hypotensive therapy during a 1-year follow-up period. Key words: one-stage surgery, primary angle-closure glaucoma complicated by cataract, «optic capture»

Clinical Features of Patients with Penetrating Eye Injury and Foreign Body Complicated by Endophthalmitis

Purpose: to study the clinical features of patients with penetrating eye injury and foreign body, complicated by endophthalmitis.Methods. 68 patients (68 eyes) with penetrating injury and ocular foreign body were included in the retrospective study, including 91.2 % males and 8.8 % females. The mean age was 50.00 [32.00; 60.00] years. The patients were divided into 2 groups: with endophthalmitis — 24 patients, without inflammation — 44 patients. All patients underwent standard ophthalmologic methods of examination.Results. The age of patients with endophthalmitis was significantly greater compared to patients without inflammation — 51.50 [46.25; 63.25] years and 36.50 [31.25; 58.50] years, respectively (p = 0.0446). In the first day after injury, only 25 % of patients asked for medical care (p = 0.0071). In patients with endophthalmitis according to biomicroscopy data on admission the following were significantly more frequent: eyelid edema (p &lt; 0.0001), purulent discharge (p &lt; 0.0001), total hyphema (p = 0.029), hypopyon (p &lt; 0.0001), iris edema (p &lt; 0.0001), fibrin in vitreous body (p = 0.0014), as well as its destruction (p = 0.0005). 87.5 % of patients with endophthalmitis showed absence of fundus reflex (p = 0.0105), and 25 % of patients with inflammation showed increased intraocular pressure (p = 0.0019). In patients with endophthalmitis, surgical treatment was performed: cataract phacoemulsification in 91.7 % of patients (p &lt; 0.0001), vitreoectomy in 87.5 % (p = 0.0098), enucleation of the eye in 12.5 % (p = 0.0165) and evisceration in 12.5 % (p = 0.0165). Bacterial culture in patients with endophthalmitis revealed Gram-positive microflora in 100 % of cases. There were also significant differences between the groups in the intravitreal, systemic and subconjunctival antibiotic therapy used.Conclusion. Patients with penetrating eye injury and foreign body, complicated by endophthalmitis, are characterized by more signs of inflammation, pronounced damage to the eye and its structures.

Cataract surgery in patients with diabetes mellitus. Prevention and optimisation of the diabetic macular edema therapy

Diabetes mellitus (DM) is a major public health problem, with approximately one third having signs of diabetic retinopathy (DR). In such patients, cataracts develop at an earlier age and 2–5 times more frequently. The incidence of macular edema (ME) after phacoemulsification of cataracts (FEC) in patients with diabetes has been shown to increase by 1.80 times and, in the presence of DR by 6.23. The critical period for retinal deterioration is 2 months after FEC, which requires an active therapy and monitoring. For patients with pre-existing diabetic macular edema (DME), If the cataract does not affect daily activities of patients with a pre-existing DME and the optical clarity is adequate, it is preferable to postpone surgical treatment in order to maximize retinal stabilization on OCT at two consecutive visits with a month’s interval between. In the case of severe impairment of lens transparency, FEC with an intravitreal injection of anti-VEGF 28 days or steroids 1 month before surgery under strict monitoring of the retinal condition using OCT is recommended. If macular changes are absent and there is a risk of developing DME, the use of nonsteroid anti-inflammatory drugs is necessary. Prophylactic intravitreal therapy is unacceptable in the absence of MO.

FREQUENCY OF CYSTOID MACULAR EDEMA ON OPTICAL COHERENCE TOMOGRAPHY IN TWO DIFFERENT TYPES OF CATARACT SURGERY

Cystoid macular edema (CME), also known as Irvine-Gass syndrome, has been recognized as a non-specific manifestation of various ocular conditions, with cataract surgery being a significant contributing factor. First reported by Sir Irvine in 1953 and further discussed by Sir Norton in 1966, CME following cataract surgery remains a topic of interest and concern in ophthalmology. The precise etiology of CME in post-cataract surgery patients remains elusive; however, it is widely accepted that post-surgical inflammation plays a pivotal role. To address this issue, we conducted a comparative study to assess the frequency of CME using spectral-domain optical coherence tomography (SD-OCT) in patients undergoing extracapsular cataract extraction (ECCE) versus phacoemulsification cataract surgeries. The study was conducted at the Department of Clinical Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences; Medical Teaching Institute Hayatabad Medical Complex, Peshawar, over a period of 6 months. Utilizing a randomized controlled trial design and non-probability consecutive sampling, we determined a sample size of 70 patients, with 35 patients allocated to each group (Group A: ECCE, Group B: Phacoemulsification). The age of the participants ranged from 50 to 85 years, with a median of 60 years and a mean of 65±8 years. Our findings revealed that CME was observed in 11% of patients in Group A and 6% in Group B, indicating a lower frequency in post-operative cases. However, the difference in CME incidence between ECCE and phacoemulsification cases was not statistically significant. These results suggest that the risk of CME in post-operative cases may be influenced by various factors, including surgical technique and patient-specific variables. In conclusion, our study contributes to the understanding of CME following cataract surgery and underscores the importance of continued vigilance and further research in this area. Improved surgical techniques and perioperative management may help mitigate the risk of CME and enhance patient outcomes in the postoperative period.

Quality of life of patients with an advanced stage of proliferative diabetic retinopathy after application of various vitrectomy technologies

Purpose: A comparative assessment of quality of life (QL) after the use of various vitrectomy (VE) technologies in patients with an advanced stage of proliferative diabetic retinopathy (ASPDR).Material and methods. We examined 132 patients aged 42 to 76 (average age 62.8 ± 2.4 years) who met the classification criteria of ASPDR: impossibility to estimate the area of neovascularization; the fundus of the eye in the posterior pole cannot be seen or can only partialy be seen using an ophthalmoscope; evidence of preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs and retinoschisis in the macular zone. All patients were divided into two groups, comparable in age, gender and visual status of the “healthy” eye: the main group (69 eyes), in which VE was performed according to the technique developed by the authors, and the control (63 eyes), in which the traditional VE technique was used. QL was assessed before surgery and 3 months after it using the VFQ-25 and QL-20 questionnaires.Results. QL was found to be higher when the new surgery technique was used: the data of VFA-25 showed a 12.9% increase (p &lt; 0.05) and QL-20 showed a 29.2% increase (p &lt; 0.01), which points to a higher clinical effectiveness of the newly developed surgical treatment technique than that of the traditional technique.Conclusion. The results obtained are related to the ophthalmological features of the developed surgical treatment of ASPDR: combined (phacoemulsification of cataracts + IOL + vitrectomy) one-stage intervention, lack of drainage of subretinal fluid, etc.), medication support (preliminary intravitreal administration of an angiogenesis inhibitor) and anesthesia (intervention under local anesthesia with intravenous sedation). The differences are most effectively identified using the special QL-20 questionnaire.

Расчет ИОЛ при комбинированной хирургии: факоэмульсификации катаракты и витрэктомии. Собственный опыт

At the present stage of development of ophthalmic surgical technique, indications for simultaneous cataract phacoemulsification and pars plana vitrectomy are constantly expanding, however, there is a problem of predicting refractive results, which is due to the difficulty of determining the effective position of the intraocular lens (IOL) in the eye without the presence of a vitreous body. Purpose. Assessment of the accuracy of the preoperative calculation of IOL in the eyes during combined surgery — cataract phacoemulsification and vitrectomy on the state of postoperative refraction. Material and methods. Combined surgery of cataract phacoemulsification and vitrectomy of pars plana with a caliber of 25 Gage was performed in 51 people (51 eyes) aged 70.4 ± 8.4 years. The calculation of IOL before surgery was carried out according to the data of a preoperative examination on an optical biometer IOL-Master-700 (Carl Zeiss, Germany), keratopography was performed on a rotary Scheimpflug camera (Oculus, Germany). The data on SRK-T with a range of more than 22.5 mm and Hoffer-Q with a range of less than 22.5 mm were used as a basis. Results. There were no complications during the operations and in the postoperative period. Preoperative uncorrected visual acuity (UCVA) was 0.21 ± 0.2 (0.05 to 0.8) and the best-corrected visual acuity (BCVA) was 0.44 ± 0.22 (from 0.1 to 0.9). The correction is from –9.0 D to +7.75 D (–0.61 ± 2.71 D). 6 months after the operation, the UCVA was 0.67 ± 0.22 (from 0.05 to 1.0), the BCVA was 0.9 ± 0.2 (from 0.3 to 1.0), respectively, while the correction was from –1.25 D to +1.0 D (–0.17 ± 0.94 D). The deviation from the expected refraction of the target at 1 week after surgery was ± 0.5 D, at 6 months after surgery ± 0.4 D, which turned out to be statistically insignificant (p &gt; 0.05). Conclusions. 1. Combined surgery phacoemulsification and vitrectomy in combination of cataracts with pathology of the vitreomacular interface, significantly increases visual acuity after surgery (by 0.43 ± 0.03, p &lt; 0.001). 2. Changes in clinical refraction during implantation of IOL based on hydrophobic acrylic in combined surgery are not statistically significant (an average shift of ± 0,4–0,5 D, p &gt; 0.05), which allows us to apply generally accepted formulas for calculating the effective position of IOL without using correction factors. Keywords: IOL calculation, cataract phacoemulsification, vitrectomy

К вопросу расчета ИОЛ у пациентов с витреоретинальной патологией

Purpose. To estimate the probability of a change in the calculated IOL after microinvasive vitrectomy 25G in patients with operated macular rupture. Methods. A retrospective analysis of patients operated on for a macular rupture with a diameter from 400 microns to 1000 microns was performed. The exclusion criteria were: the axial length of the eye is less than 22.0 mm and more than 26.0 mm, recurrence of previously operated macular ruptures, the presence of concomitant ocular pathology that can affect the final postoperative result (macular degeneration, glaucoma, diabetic and postocclusive retinopathy), the presence of previously performed surgical interventions on the retina. The study involved 64 eyes, of which 34,37 % (22 eyes) with a native lens; 14,06 % (9 eyes) with artifacia before vitrectomy; 6,25 % (4 eyes) vitrectomy with cataract phacoemulsification and IOL implantation and 45,31 % (29 eyes) cataract phacoemulsification with IOL implantation was performed within 4–9 months after primary vitrectomy. These patients were the study group. The comparison parameters are best corrected visual acuity, K1, K2, Ave. K1, Ave. K2, Axis, Ave. K2-K1, axial length of the eye, Ave. axial length of the eye, as well as calculated models of IOL and implantable after vitreoretinal surgery. Results. The change in the optical strength of the IOL occurred in 44,82 %. The change in the IOL model is 37,93 %. The change in the optical strength and model of the IOL is 20,68 %. The change in the optical strength of the previous IOL model is 24,1%. The change in the strong axis of more than 20 ° with the previous IOL parameters is 13,79 %. Only in 27,58 % there were no changes in the calculation of IOL. Conclusion. An individual approach to the calculation and selection of intraocular lenses in patients with vitreoretinal pathology allows implantation of all types of IOLs with maximum patient satisfaction with the functional result. Keywords: biometric indicators, IOL, vitrectomy, cataract, phacoemulsification, keratometry

Отдаленные результаты этапного хирургического лечения осложненной начальной катаракты у пациентов с далекозашедшей диабетической ретинопатией

Purpose. To evaluate the efficacy of second-stage phacoemulsification (PE) of complicated initial cataract after vitreoretinal surgery (VRS) in patients with advanced proliferative diabetic retinopathy (PDR). Material and methods. 216 patients with PDR and complicated initial cataract who underwent surgery were included. These patients were divided into four groups according to their management. In the group I patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade was performed as the first step, followed by the second step — PE+IOL implantation + silicone oil removal. In the group II PE was performed simultaneously with VRS and silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the group III patients were subjected to a two-step surgical procedure: VRS with gas tamponade performed as the first step in their treatment; followed by the second step, PE and the IOL implantation. In the group IV PE performed simultaneously with VRS with gas tamponade. Results. Patients in subgroup I and group III had better functional results than those in subgroup II and group IV, respectively (p &lt; 0,001). The subgroup IIa (n = 9; 14.5 %) showed higher incidence of NVG than the subgroup Ia (n = 2; 3.2 %), p = 0.027. There also was a higher rate of NVG in group IV (n = 6; 19,3 %) compared to group III (n = 1; 3,1 %), p = 0,04. Conclusion. Phacoemulsification of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS. In addition, it contributes to reduction of number and severity of postoperative complications. Keywords: proliferative diabetic retinopathy; vitreoretinal surgery; phacoemulsification

Клинический случай факоэмульсификации катаракты после термокератопластики в анамнезе

Purpose. To present a clinical case of cataract phacoemulsification in a patient with a thermokeratoplasty in anamnesis. Material and methods. Patient M., went to the clinic with complaints of decreased vision, “fog” in front of both eyes, especially in front of the right one. In the anamnesis 30 years ago, she had thermokeratoplasty for high degree hypermetropia (+8.00D) in both eyes. Due to the existing complaints and the presence of cataracts in both eyes, cataract phacoemulsification was performed with the implantation of toric IOLs in both eyes. Results. When evaluating the results in the longterm postoperative period (1 year after surgery), it was revealed that despite the difficulties that the surgeon faces when calculating intraocular lenses in patients after keratorefractive operations, we managed to achieve high visual acuity. Conclusions. The presented clinical case indicates that the measurement of the refractive power of the cornea using a modern scanning keratotopograph, the axial length of the eye using a noncontact biometer, the use of modern formulas for calculating the IOL, as well as the experience of an ophthalmic surgeon, allow achieving high functional results in the rehabilitation of patients with this pathology. Keywords: thermokeratoplasty, phacoemulsification of cataract, toric intraocular lens

Комбинированный метод лечения рефрактерного диабетического макулярного отека

Purpose. To determine the effectiveness of the anatomical and functional results of treatment of refractory diabetic macular edema after removal of the inner limiting membrane using the latest generation anti-VEGF drug. Material and methods. We examined 6 patients with 1st type and 2nd type diabetes mellitus. The average age of the subjects was 47.45 ± 27.15 years. Of these, there were 4 women and 2 men. 1st type diabetes mellitus was detected in 2 people, in other patients — 2nd type. 3 patients had previously undergone pan-retinal photocoagulation (from 1st to 2nd stages). All patients received intravitreal injections (anti-VEGF) of Eylea (4–5 injections) during the last year. According to the optical coherence tomogram (OCT), macular edema was recorded, recurring on average after 1.36 ± 0.85 months. All patients underwent surgical treatment. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. A microinvasive subtotal vitrectomy was performed with the removal of the posterior layers of the vitreous body and proliferative membranes fixed to the retina. The removal of the inner boundary membrane was performed after its staining in the size of two to three diameters of the optic disc without any tamponade. After 2 months, two patients had an increase in retinal thickness in the fovea. These patients received one injection of Vabismo. Results. The compared groups did not differ in morphofunctional characteristics. In the postoperative period, there was a tendency to increase visual acuity and decrease retinal thickness, regression of hard exudates in 4 patients. In 2 patients, an increase in retinal thickness in the fovea was noted after 2 months. After intravitreal injection of the latest generation anti-VEGF drug (Vabismo), these patients also showed an increase in visual acuity, regression of solid exudates and a decrease in retinal thickness. Conclusion. Microinvasive subtotal vitrectomy with removal of the inner limiting membrane in combination with intravitreal injection of the latest generation anti-VEGF drug (Vabismo) is an effective method of treating refractory diabetic macular edema. Keywords: anti-VEGF, Vabismo, diabetic macular edema, intravitreal injections, optical coherence tomogram, subtotal vitrectomy, inner boundary membrane

Технология предварительной радиальной ИАГ-лазерной факофрагментации в хирургическом лечении катаракты

Purpose. To represent the technology of preliminary radial YAG laser phacofragmentation in the surgical treatment of cataracts. Material and methods. The technology of preliminary radial YAG laser phacofragmentation has been used in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution since 2016. The basis of the technology is the transcorneal endocapsular formation of radial cracks of the lens core for its subsequent fragmentation during ultrasonic phacoemulsification of cataracts (FEC). The total number of pulses ranges from 95 to 150. Results. In the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, preliminary radial YAG laser phacofragmentation was performed on 9468 eyes with cataracts of 2–4 degrees of density from 2016 to 2023. After YAG laser fragmentation of the lens core, its radial separation occurs according to the «snowflake» type, which consists of 3 layers and «petals» extending from cavitation bubbles that clearly outline the core. The clinical and functional state of the eyes after preliminary YAG laser phacofragmentation indicated the absence of reactive inflammation from the anterior and posterior segment of the eye, which was confirmed by biomicroscopy and ultrasound ophthalmoscanning data. Conclusion. The technology of preliminary radial YAG laser phacofragmentation is a safe and effective method that allows you to achieve uniform separation of lens fibers along the formed fragmentation zones, which correspond to subsequent nuclear fracture zones during the nuclear fragmentation stage during ultrasonic FEC. Key words: radial YAG laser phacofragmentation, cataract, ultrasonic phacoemulsification of cataract

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M &amp; J Western Regional Institute of Ophthalmology (M&amp;J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M &amp; J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value &amp;#60;0.05 was taken as significant.: MSICS &amp; phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS &amp; phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

Evaluation of Cataract Surgery Outcomes in Geriatric Population with Geriatric Depression Scale

Objective: The aim of this study was to show the changes in geriatric depression scale (GDS) scores in patients undergoing senile cataract surgery.&#x0D; Methods: A total of 74 patients aged 60 years and older who underwent cataract surgery with phacoemulsification for senile cataract were included. All patients were evaluated with the GDS before cataract surgery and at the third month after surgery.&#x0D; Results: The mean GDS in the preoperative period was 10.22 ± 5.01, while the mean GDS score in the postoperative period was 8.2 ± 4.92. There was a positive correlation (r=0.680 for preoperative and r=0.801 for postoperative) between visual acuity and GDS score in the preoperative period (p

LASIK is associated with early cataract surgery in healthy patients.

To evaluate the association between LASIK and early cataract phacoemulsification surgery (PE). A matched case-control study was conducted. Cases were otherwise healthy adults with a history of LASIK. Groups were paired according to corrected-distance visual acuity (CDVA), axial length, and cataract grade. A total of 213 patients were included. 85 patients were classified as post-LASIK group and 128 as controls. The mean age at the time of LASIK was 42.32 ± 9.24years. The mean CDVA before PE was 0.29 ± 0.19 Log MAR in post-LASIK group and 0.34 ± 0.22 Log MAR in controls (p = 0.07). The mean axial length was 23.99 ± 1.78mm in post-LASIK group and 23.62 ± 0.98mm in controls (p = 0.085). The mean nuclear cataract grading was 1.36 in post-LASIK group and 1.47 in controls (p = 0.34). The mean age at the time of PE was 60.18 ± 7.46years in post-LASIK group and 67.35 ± 9.28 in controls (p < 0.0005). The difference between the mean age of LASIK and the mean age of PE was 17.85 ± 5.72years. There was a positive association between the post-LASIK group and the age of PE ≤ 55years (OR: 4.917, 95% CI: 2.21-10.90, p < 0.001). LASIK may be associated with early PE. Patients with LASIK had a 7-year earlier PE compared to a matched control group.