Posterior Lens Capsule Research Articles

Lens capsule advanced glycation end products induce senescence in epithelial cells: Implications for secondary cataracts.

Posterior capsule opacification (PCO) is a common complication after cataract surgery. Residual lens epithelial cells (LECs) on the anterior lens capsule, after cataract surgery, migrate to the posterior lens capsule and undergo transdifferentiation into myofibroblast-like cells. Those cells synthesize excessive amounts of extracellular matrix and contribute to fibrosis during PCO. Cellular senescence, a phenomenon that increases with aging, has been implicated in several fibrotic diseases. Here, we have investigated the prevalence of senescent LECs within the lens posterior capsule and the ability of advanced glycation end products (AGEs) in lens capsules to induce senescence, contributing to PCO. Aged lens capsules from pseudophakic human cadaver eyes showed the presence of senescent LECs. In human capsular bags, LECs showed an age-dependent increase in senescence after 28 days of culture. Human LECs cultured on aged lens capsules for 3 days underwent senescence; this effect was not seen in LECs cultured on young lens capsules. Human LECs cultured on an AGE-modified extracellular matrix (ECM-AGEs) showed an AGE-concentration-dependent increase in the expression of senescence markers and reactive oxygen species (ROS) levels. Treatment with a RAGE antagonist and ROS inhibitor reduced the expression of senescence and fibrotic markers. Additionally, conditioned media from ECM-AGEs-treated cells induced the expression of fibrotic markers in naïve LECs. Together, these suggest that AGEs in the capsule induce senescence of LECs, which triggers the mesenchymal transition of neighboring non-senescent LECs and contributes to PCO.

Isolated posterior capsule rupture secondary to blunt ocular trauma: Case presentation and literature review

IntroductionAn isolated posterior capsule rupture (PCR) is a rare complication associated with traumatic cataracts. We report our findings in three cases of traumatic cataracts with isolated PCR caused by blunt ocular trauma. Presentation of casesCase 1: A 1.5-year-old boy was examined after his parents noticed that the center of the pupil of the left eye was white. The mother reported that the boy had fallen and bruised his left forehead 4 months earlier. Case 2: An 18-year-old boy had a traumatic cataract that developed one month after a blow to his eye. Case 3: A 13-year-old boy was treated for hyphema and high intraocular pressure after blunt trauma to his eye. Ten days later, a total cataract developed. Anterior segment optical coherence tomography revealed an isolated PCR with a protruding lens cortex, and ultrasonography showed vitreous opacities. DiscussionAn isolated PCR was observed intraoperatively in the center of the posterior lens capsule. The lens cortex was prolapsed into the PCR or into the vitreous cavity in Case 3. An intraocular lens (IOL) was implanted in the lens capsule or to the ciliary sulcus after vitrectomy in Case 3. Vision improved in all eyes. ConclusionsOur findings indicated that the external force by a trauma to the eye can lead to an isolated PCR with a protruded lens cortex in young patients. These PCRs can be successfully treated with the IOL implanted in or out of the capsular bag.

Endoscopic Surgery for Congenital or Acquired Cataract Associated with Persistent Fetal Vasculature: A Case Series.

Persistent fetal vasculature (PFV) is a congenital malformation caused by a failure in regression of the primary vitreous and hyaloid vessels. An abnormal PFV occurs in the anterior and posterior segments of the eye. Surgery for PFV carries the risk of retinal detachment. We report four cases of cataracts associated with PFV, in which our novel surgical technique with an intraocular endoscope was safely performed. Lensectomy and vitrectomy were performed in cases 1, 3, and 4, while lensectomy, vitrectomy, and intraocular lens implantation using an endoscope were performed in case 2. In all cases, after lens removal, a slit at the posterior lens capsule was created to avoid the retrolental fibrovascular membrane using underwater electric coagulation. Moreover, the endoscope was inserted, by which the intraocular region was observed to determine the treatment method for the fibrovascular membrane and vitreous stalk. No additional surgeries were required for complications before or after any of the surgeries. Using an endoscope during cataract surgery associated with PFV, observing the vitreous stalk at high magnification and ensuring safe treatment were possible. Endoscopic surgery could be considered an effective method for treating PFV-associated cataracts.

A Glistening Intraocular Lens: A Case Report

Introduction Cataract surgery with a posterior chamber intraocular lens (PCIOL) is one of the most performed surgeries in North America. A common complication of cataract surgery is the development of post-surgical opacities on the posterior lens capsule, known as posterior capsule opacification (PCO). When visually significant, PCO is treated with a YAG laser. Less commonly however, opacities can form within the lens implant itself known as lens glistening. Case Presentation An 86-year-old male patient with a history of macular retinoschisis and vitreoretinal traction in both eyes presented to the eye clinic with complaints of visual disturbance in the left eye over the course of 4 months. Clinical examination and diagnostic testing revealed stable retinal disease with new findings of PCIOLs with lens glistening, left eye greater than right eye. The patient was referred to the cataract surgeon and the decision was made to manage the lens glistening conservatively. Discussion Lens glistening can be managed with observation or intraocular lens (IOL) exchange depending on its impact on the patient’s quality of life or the degree to which the opacities preclude examination of the fundus.

A 3D in vitro model for assessing the influence of intraocular lens: Posterior lens capsule interactions on lens epithelial cell responses

Posterior Capsule Opacification (PCO), the most frequent complication of cataract surgery, is caused by the infiltration and proliferation of lens epithelial cells (LECs) at the interface between the intraocular lens (IOL) and posterior lens capsule (PLC). According to the “no space, no cells, no PCO” theory, high affinity (or adhesion force) between the IOL and PLC would decrease the IOL: PLC interface space, hinder LEC migration, and thus reduce PCO formation. To test this hypothesis, an in vitro hemisphere-shaped simulated PLC (sPLC) was made to mimic the human IOL: PLC physical interactions and to assess their influence on LEC responses. Three commercially available IOLs with different affinities/adhesion forces toward the sPLC, including Acrylic foldable IOL, Silicone IOL, and PMMA IOL, were used in this investigation. Using the system, the physical interactions between IOLs and sPLC were quantified by measuring the adhesion force and interface space using an adhesion force apparatus and Optical Coherence Tomography, respectively. Our data shows that high adhesion force and tight binding between IOL and sPLC contribute to a small interface space (or “no space”). By introducing LECs into the in vitro system, we found that, with small interface space, among all IOLs, acrylic foldable IOLs permitted the least extent of LEC infiltration, proliferation, and differentiation (or “no cells”). Further statistical analyses using clinical data revealed that weak LEC responses are associated with low clinical PCO incidence rates (or “no PCO”). The findings support that the in vitro system could simulate IOL: PLC interplays and predict IOLs’ PCO potential in support of the “no space, no cells, no PCO” hypothesis.

Accuracy of 10MHz ultrasonography for evaluation of posterior lens capsule in traumatic cataract.

To investigate the performance of 10MHz ultrasonography in detecting posterior lens capsule defects before traumatic cataract surgery. This retrospective analysis includes patients with traumatic cataracts who underwent cataract surgery. Preoperative 10MHz ultrasonography was performed to evaluate whether the posterior lens capsule was defective or intact, and the results were compared to the intraoperative findings. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa were calculated. The study included 140 eyes of 140 patients. There were 68 eyes with closed-globe injuries and 72 eyes with open-globe injuries. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa of 10MHz ultrasonography was 86.76%, 90.28%, 89.39%, 87.84%, 88.57% and 0.771, respectively. The accuracy was 86.11% and 91.18% in open-globe and closed-globe injury groups, respectively. The accuracy of 10MHz ultrasonography in evaluating the posterior lens capsule in traumatic cataracts is high. Preoperative 10MHz ultrasonography would help to make an appropriate surgical plan.

Application of optical coherence tomography in the assessment of the posterior lens capsule during anti-angiogenic therapy

This study uses optical coherence tomography method to analyze the risks of developing changes in the posterior lens capsule in patients after IVI of an anti-angiogenic drug. The study involved 100 people (14 men and 86 women) with a natural lens and neovascular age-related macular degeneration (nAMD). The average age was 70.57±7.98 years. During the study (12 months), all patients underwent IVI of an anti-angiogenic drug aflibercept in the treat-and-extend (T&E) mode. All subjects were divided into 2 groups: with a total number of IVI less than 10 - group 1 (50 patients), and more than 10 IVI - group 2 (50 patients, of which 49 were included in the study). All patients underwent OCT using the Optopol REVO NX device (Poland) with the Anterior B-scan Wide protocol before inclusion in the study, as well as after 3, 6 and 12 months. It was found that the risk of developing a posterior lens capsule rupture, visualized using OCT, depends on the total number of IVI (correlation coefficient 0.473 p=0.001): the more IVI, the higher the probability that damage to the posterior capsule will occur after the next IVI, and after the 15th injection the risk of developing damage to the posterior capsule increases sharply. The astudy analyzed the risk factors for the development of posterior lens capsule damage that can be detected using OCT, and presented three risk groups for the development of rupture (or damage) of the posterior lens capsule depending on the number of intravitreal injections performed.

OCT angiography findings in posterior persistent fetal vasculature

Aims/Purpose: To report optical coherence tomography angiography findings in a patient presenting unilateral posterior persistent fetal vasculature (PVF).Methods: We report the case of a 19‐year‐old female patient with longstanding visual impairment of the left eye (LE). Patient was assessed with multimodal imaging including color fundus photography, swept source optical coherence tomography (SS‐OCT) and SS‐OCT angiography (SS‐OCTA) of the macula and the optic disc.Results: The patient had a history of unilateral visual impairment of unknown aetiology and consulted for a routine examination. Best corrected visual acuity was 10/10 in the right eye (RE) and limited to counting fingers in the LE. Ophthalmological examination of the LE revealed a mild exophoria, a quiet anterior segment, a vestigial capsular bag and an inferonasal whitish spot at the posterior lens capsule corresponding to Mittendorf's dot. Dilated fundus examination of the LE showed a lack of foveal reflex, retinal vessel contraction associated to the presence of a fibrovascular stalk extending from the OD to the crystalline lens via the vitreous humour, corresponding to fibrovascular contraction of the persistent and hyperplastic Cloquet's canal. No associated retinal detachment was noted. The clinical diagnosis of posterior PVF was confirmed. Macular SS‐OCT revealed retinal thinning with absence of foveal pit. Optic disc SS‐OCT highlighted a hyporeflective tubular structure overlying a Bergmeister'papilla. Cross‐sectional SS‐OCTA detected a flow signal at the level of Bergmeister's papilla, but no confirmed flow signal was identified at the level of the fibrovascular stalk.Conclusions: PVF is a rare condition characterized by fetal remnant from developmental vascular system defects, clinically recognized in its three forms (anterior, posterior and combined). OCT‐angiography is a useful non‐invasive tool to confirm of persistent hyaloid artery patency and assess risk of vascular complications. Contraction of the fibrovascular mass is prone to tractional retinal detachment and repeated episodes of intravitreal or intracapsular haemorrhage. Monitoring is therefore recommended even in adulthood.

The efficacy of tobramycin dexamethasone combined with pranoprofen in middle-aged and elderly post-cataract patients and the value of improving inflammatory factor levels.

To analyze the effect of tobramycin dexamethasone combined with pranoprofen on middle-aged and elderly patients after cataract surgery. In this retrospective study, the clinical data from 108 middle-aged and elderly patients who had cataract surgery in the Second Hospital of Longyan between January 2021 and December 2023 were collected. The patients were divided into two groups based on treatment methods, a control group (n=54) that received tobramycin dexamethasone treatment, and an observation group (n=54) that treated with additional pranoprofen. The treatment effects in the two groups were compared. Significant differences were observed between the groups at 1 day, 1 week, 3 weeks, and 5 weeks post-treatment in terms of ocular symptom scores, signs scores, and intraocular pressure levels (all P < 0.05). The observation group demonstrated lower levels of inflammatory markers post-treatment (P < 0.05). Additionally, at 1 week, 3 weeks and 5 weeks after treatment, significant differences were noted in anterior chamber flare value, best-corrected visual acuity (BCVA), macular center thickness, degree of corneal edema, and posterior lens capsular opacity grading scores (all P < 0.05). The incidence of increased intraocular pressure and conjunctival congestion was 3.7% in the observation group, slightly lower than 7.41% in the control group (P > 0.05). The combination of pranoprofen and tobramycin dexamethasone can improve the inflammatory reaction, ocular symptoms, anterior chamber flare value, macular center thickness, corneal oedema, and clarity of the posterior lens capsule in middle-aged and elderly cataract patients. This regimen also helps restore intraocular pressure and visual acuity of the patients, with relatively low adverse reactions, indicating an ideal clinical outcome.

Simulation of the effect of capsular opacification on retinal illumination

Posterior capsular opacification is the most common complication after cataract surgery with intraocular lens implantation. Different strategies have been proposed to avoid PCO including 360° continuous sharp edges of the posterior IOL optics rim, haptics angulations, or surface modification of the optics. However, depending on the IOL material and surgical technique 20 to 60% of eyes require Nd:YAG laser capsulotomy in the first 2 years after cataract surgery. In this talk we would like to define a scattering model for the posterior lens capsule and perform raytracing through the pseudophakic eye with a scattering capsule to investigate the impact of biometric parameters on the scatter characteristics and contrast transfer of the eye.

Оценка метода профилактики девиации ирригационного потока при факоэмульсификации с использованием дисперсивного вискоэластика (Вискоблок) в аспекте состояния витреолентикулярного интерфейса

Purpose. Evaluate state of the vitreolenticular interface before surgery, during phacoemulsification of cataract, and in the early postoperative period. To assess the effectiveness of «Viscoblock» method application during phacoemulsification to prevent intraoperative irrigation fluid misdirection syndrome by blocking the penetration of irrigation fluid through the zonular fibers through injecting dispersive ophthalmic viscosurgical device behind the iris. Material and methods. We operated 49 patients (50 eyes) diagnosed with age-related cataracts. All patients were divided into two groups. In the first group, we performed phacoemulsification with hydrophobic intraocular lens (IOL) implantation and application of the «Viscoblock» method. This group included 24 patients. In the second group, we performed phacoemulsification with hydrophobic IOL implantation using standard technique, it included 25 patients. All patients underwent standard ophthalmological examination and specific additional ones: ultrasound biomicroscopy – UBM Aviso (Quantel Medical, France); spectral optical coherence tomography OCT (Solix, Optovue, USA). Surgical treatment was performed under the control of an operating microscope equipped with intraoperative OCT (Lumera Rescan 700, Carl Zeiss, Germany). Results. According to preoperative diagnostics and it's UBM data, all patients in the first and second groups showed abnormalities in lens zonular fibers. According to OCT data before the surgery, no cases of anterior hyaloid membrane (AHM) detachment were detected. During the surgery, AHM detachment was observed in 24% of cases in first group and in 56% of cases in second group. Intraoperative iris prolapses occurred in 8% of cases only in the first group. Posterior capsule rupture was observed in only 1 patient in second group. Conclusion. Our technique, «Viscoblock», allows us to limit the penetration of irrigation fluid through the Zonula ciliaris in 76% of cases. However, it should be noted that the method does not provide complete prevention of AHM detachment, as it may already exist in some patients. Additionally, we cannot exclude partial washout of viscoelastic substance during the surgery, which can reduce the tamponade effect. Key words: vitreo-lenticular interface, Berger's space, intraoperative fluid misdirection syndrome, optical coherence tomography, ultrasound biomicroscopy, «Viscoblock», cataract, lens zonular fibers, vitreous body, posterior lens capsule, anterior hyaloid membrane, intraocular lens

Комбинированная операция на переднем и заднем отрезках глаза с дооперационным разрывом задней капсулы

Nowadays intravitreal drug administration occupies one of the leading places in the structure of the treatment of eye diseases. the technique for performing this manipulation is simple and universal. however, there may be complications during it. among them are transient ophthalmohypertension, uveitis, endophthalmitis, as well as damage to the lens and retina. a clinical case of surgical treatment of patient d., aged 81, with damage to the posterior lens capsule and fast cataract development was analyzed. Тhe operation was performed on the device EVa (dorc). retrobulbar anesthesia with ropivacaine (ropivacaine Kabi) FrESEnIUS KaBI norgE, aS (norway) 5.0 ml. paracentesis was performed at 2 and 10 o’clock, tunnel 2.2 mm, introduction of viscoelastic discoVisc (alcon). Сapsulorhexis 4 mm was performed using capsular tweezers. the swollen lens masses were washed with an irrigation-aspiration system. 25g ports were installed 3 mm from the limbus in the lower outer, upper outer, upper inner segments of the eyeball. Тotal vitrectomy was performed in the usual mode (vitreotome cuts 10 thousand per minute and irrigation 70 mm hg). the dislocated lens was also removed using a vitreotome with a frequency of 4,000 cuts per minute. Implantation of the intraocular lens rayone hydrofobic aspheric +22.0 diopters (rayner Intraocular lenses limited, United Kingdom) on the anterior capsulorhexis. Fixation of the Iol was not required because the diameter of the anterior rexis of 4 mm (which is smaller than the diameter of the Iol optics of 6 mm) made it possible to hold the lens. Interrupted 7/0 vicryl sutures were put on the sclera. Тhe approach to surgical treatment chosen by us, based on the patient’s history, examination, tactics of performing surgical intervention, showed its timeliness and effectiveness. Keywords: intravitreal injections, complications, damage of the lens capsule, lens luxation

Анализ интраоперационных и ранних послеоперационных осложнений при факоэмульсификации катаракты

Relevance. Despite the high level of cataract surgery, in some cases complications arise that lead to a decrease in visual functions, an increase in the duration of inpatient treatment and additional economic costs. Analysis of the results of cataract phacoemulsification helps to increase the effectiveness of predicting complications and their prevention. Aim. Analysis of intraoperative and early postoperative complications in cataract surgery for 2021–2022, conducted on the basis of the 2nd ophthalmological department of the State Budgetary Institution “N.A. Semashko Regional Clinical Hospital” Ryazan, Russia. Material and methods. Retrospective analysis of 66 case histories of patients who had complications in the intra- and postoperative period of cataract surgery. Results. Intraoperative complications included: posterior capsule opening (22 cases), dislocation of lens masses into the vitreal cavity (10 cases), hemorrhagic ciliochoroidal detachment (4 cases), expulsive hemorrhage (2 cases), hyphema (2 cases). In the postoperative period, the following complications were detected: hyphema – 2, hemophthalmos-4, ciliochoroidal detachment – 5, dislocation of intraocular lens (IOL) – 5, retained lenticular material in the anterior chamber – 4, exudative reaction – 12, keratopathy – 6, pupillary block – 1, endophthalmitis – 1. Conclusion. The improvement of the phacoemulsification technique together with the preoperative preparation of patients with cataracts made it possible to achieve a low level of intra- and postoperative complications (1.16% in 2021 and 0.89% in 2022, respectively, of all operated patients with cataracts). However, after analyzing the nature of complications, we identified a number of patterns: among intraoperative complications, the most common is the opening of the posterior capsule of the lens (0,29%), among postoperative – an exudative reaction (0,16%). Keywords: сataract phacoemulsification, complications of cataract phacoemulsification, rupture of the posterior lens capsule, exudative inflammatory eye response, expulsive hemorrhage.

A Rare Case of Vitreous Cyst

A patient with a unilateral congenital vitreous cyst attached to the posterior lens capsule is now described, with its photographic appearance.

Glutaredoxin 2 protects lens epithelial cells from epithelial-mesenchymal transition by suppressing mitochondrial oxidative stress-related upregulation of integrin-linked kinase

Glutaredoxin 2 (Grx2), a mitochondrial glutathione-dependent oxidoreductase, is crucial for maintaining redox homeostasis and cellular functions in the lens. The oxidative stress-induced epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) is related to posterior capsule opacification. In this study, we investigated the effects of Grx2 on oxidative stress-induced EMT in LECs during posterior capsule opacification. We found that Grx2 expression was substantially decreased during the EMT of LECs and in a mouse model of cataract surgery. Deletion of Grx2 aggravated the generation of reactive oxygen species, including those that are mitochondria-derived, and promoted the proliferation and EMT of the LECs. This was reversed by Grx2 overexpression. In vivo, proteomic liquid chromatography-mass spectrometry analysis showed that integrin-linked kinase (ILK) was significantly upregulated in the lens posterior capsule of a Grx2 knockout (KO) mouse model. Compared with that of the wild-type group, the expression of ILK and EMT markers was increased in the Grx2 KO group which was reversed in the Grx2 knock-in group. Inhibition of ILK partially blocked Grx2 knockdown-induced EMT and prevented the increased phosphorylation of Akt and GSK-3β and the nuclear translocation of β-catenin in the Grx2 KO group. Finally, inhibition of the Wnt/β-catenin pathway partially blocked the Grx2 knockdown-induced EMT. In conclusion, we demonstrated that Grx2 protects LECs from oxidative stress-related EMT by regulating the ILK/Akt/GSK-3β axis.

A patient with a Berger’s space filled by silicone oil

BackgroundTo report a case in which silicone oil accidentally entered Berger’s space (BS) after vitrectomy and to explore the effective treatments and possible etiological mechanisms.Case presentationA 68-year-old male underwent vitrectomy and silicone oil injection for the treatment of retinal detachment (RD) in the right eye. Six months later, we noticed an unexpected lens-like round translucent substance located behind the posterior lens capsule and diagnosed it as BS filled by silicone oil. Subsequently, we conducted vitrectomy and the drainage of the silicone oil in BS in the second surgery. A 3-month follow-up showed significant anatomic recovery and visual recovery.ConclusionsOur case report presents a patient with silicone oil entering BS after vitrectomy and provides photographs of BS from a relatively unique perspective. Furthermore, we illustrate the surgical treatment procedure and reveal the possible etiology and prevention method of silicon oil entering BS, which will provide good insights for clinical diagnosis and treatment.

Blau syndrome with persistent fetal vasculature: a case report

BackgroundBlau Syndrome (BS) is a rare autosomal dominant noncaseous granulomatous disease caused by mutations in the NOD2 gene. The disease is characterized by granulomatous dermatitis, symmetrical arthritis, and uveitis, which, if left untreated, can progress to blindness. The diagnosis of BS can be challenging because of its rarity and overlap with other rheumatologic disorders. Early detection of ocular involvement is critical to prevent vision loss and improve the prognosis of patients with BS.Case presentationIn this report, we present a case of a five-year-old Chinese girl diagnosed with BS one year ago after presenting with a systemic rash and urinary calculi. Genetic testing was recommended by a physician, and a heterozygous mutation of the NOD2 gene c.1538T > C (p.M513T) was identified. Eight months ago, due to bilateral corneal punctate opacity, we had examined and diagnosed bilateral uveitis, bilateral corneal zonal degeneration, persistent fetal vasculature (PFV) in the right eye, and perivascular granuloma in the right eye. As a result, Vitrectomy was performed on the right eye, resulting in a significant improvement in visual acuity from 1/50 on the first day after surgery to 3/10 after 1 week. After 6 months, the visual acuity of the right eye was maintained at 3/20, but opacification of the lens posterior capsule was observed. Follow-up appointments are ongoing to monitor the condition of the affected eyes. Our report underscores the importance of prompt detection and management of ocular involvement in BS accompany with PFV to prevent vision loss and improve patient outcomes.ConclusionsThis report details the case of a child diagnosed with BS who accompanied a periretinal granuloma and PFV in the right eye. Regrettably, the left eye was observed to have no light perception (NLP) with the fundus not being visible. The occurrence of ocular complications in patients with BS, must be closely monitored to prevent vision loss and enhance treatment outcomes. This case underscores the importance of prompt diagnosis and management of ocular complications in patients with BS to prevent further damage and optimize patient outcomes.

"Capsule drape wrap"-a new technology for iridoschisis management during phacoemulsification.

To introduce a new technique for iridoschisis management during phacoemulsification: "capsule drape wrap". "Capsule drape wrap" technique was used for an 80-year-old man with idiopathic iridoschisis in the right eye during phacoemulsification. The inserted flexible nylon iris hooks to hold anterior capsule in place, the margin of the anterior capsule could act as drape wrap, tracking the fibrillary iris strands firmly from free floating and stabilizing the capsular bags simultaneously. The eye with iridoschisis was successfully treated. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there were no intraoperative complications such as tear of the iris, hyphema, iris prolapse, loss of mydriasis, or rupture of the posterior lens capsule during phacoemulsification. The best-corrected visual acuity was increased by 0.1 (logMAR) 6mo after the surgery. "Capsule drape wrap" for iridoschisis is easily manageable, prevents further disruption to the loose iris fibers and ensures the stability of capsule-iris complex simultaneously, consequently minimizing the risk of surgical complications in phacoemulsification.

Изучение влияния различных методов удаления вискоэластика при факоэмульсификации возрастной катаракты на интраоперационное и раннее послеоперационное состояние интерфейса «интраокулярная линза – капсула хрусталика»

Purpose. To study the effect of various methods of removing ophthalmic viscosurgical device (OVD) in phacoemulsification (PE) of senile cataracts (SC) on intraoperative and early postoperative state of «intraocular lens – posterior lens capsule» (IOL – PLC) interface. Material and methods. Optical coherence tomography (OCT) was performed intraoperative, 2 hours after surgery, on the 1st and 5th days after surgery to study the state of IOL – PLC interface and its parameters in 92 eyes of 92 patients at PE. Results. Intraoperative OCT control showed that when using irrigation and aspiration, full contact IOL – PLC occurred only in 9.8 % of the eyes, after additional impulse-irrigation – in 100 % of the eyes. On the 5th day surgery, significantly better parameters of the IOL – PLC interface (diastasis between the lens and the capsule, size of PLC folds) were detected in the eyes, where IOL pneumocompression was performed as additional method of removing OVD. Conclusion. The study of features of IOL – PLC interface during PE SC and in early postoperative period showed its instability and pronounced variability of the OCT picture. Intraoperative OCT monitoring of state of the IOL – PLC interface revealed greater efficiency of impulseirrigation method in comparison with irrigation and aspiration method in removing OVD from the lens capsule. The use of the method of pneumocompression of the lens capsule made it possible to obtain significantly better indicators of diastasis between the IOL and PLC and the depth of capsule folds 5 days after surgery (p &lt; 0.05). Keywords: phacoemulsification, senile cataract, posterior lens capsule, «intraocular lens – posterior lens capsule» interface

Интраоперационная периферическая капсулотомия при цилиокапсулярной фиксации: да или нет?

Purpose. To obtain clinical confirmation of the need for intraoperative peripheral capsulotomy with cilio-capsular fixation. Material and methods. Clinical results of phacoemulsification of complicated cataract with femtosecond laser accompaniment against the background of pseudoexfoliation syndrome, grade I subluxation in a 65-year-old patient in the early postoperative period.In addition to standard examination methods, optical coherence tomography of the anterior segment of the eye was used. During the operation, cilio-capsular fixation of a three-part IOL was used without peripheral capsulotomy of the anterior capsule. In the early postoperative period, due to the developed capsular block, YAG laser dissection of the posterior lens capsule was used. Results. On the 3rd day after the operation, the maximum corrected visual acuity increased and amounted to 0.7, IOP – 12 mm Hg. Art.; before surgery – 0.3 and 22 mm Hg, respectively. According to optical coherence tomography after YAG laser discission, a sufficient decrease in the depth of the retrooptic space was determined, which indicates the absence of signs of a capsular block. Conclusion. During the study, it was found that in the absence of communication between the capsular bag with the anterior chamber, a capsular block is formed during cilio-capsular fixation. This necessitates intraoperative peripheral capsulotomy. Key words: capsular block, capsulotomy, capsular-ciliary fixation, three-part intraocular lens, pseudoexfoliative syndrome