Ultrasound Phacoemulsification Research Articles

Подходы в совершенствовании нормативной базы в отношении применения мультифокальных интраокулярных линз при хирургическом лечении катаракты

Ultrasound phacoemulsification with intraocular lens (IOL) implantation is the “gold standard” for cataract treatment. Considering the existing requirements for the quality of vision after surgery, there is an increasing demand from patients for IOL implantation, which provides comfortable vision not only at a long distance, but also at a short one without the use of reading glasses (IOL with multifocal properties). The analysis of the existing regulatory framework regarding the possibility and obligation of using this medical product in the provision of specialized medical care – surgical treatment of cataract within the framework of the state guarantee program shows the possibility of using this consumable material without the obligation of the medical organization to consider the wishes of the patient. The change in the structure of the payment tariff for medical care for patients with cataract in 2023, the reduction in the tariff for providing specialized medical care to patients with uncomplicated forms affected the availability of multifocal IOL for patients without specifying the way to obtain this type of service, which makes it relevant to analyze approaches to improving the regulatory framework regarding the use of multifocal intraocular lenses in cataract surgical treatment. There are unsettled clinical, organizational, and economic issues regarding the use of multifocal intraocular lenses (artificial lenses) in the surgical treatment of cataract. There are various approaches (clinical-organizational, economic, legal, information) to improving the regulatory framework, but the approach of decision makers should be complex based on a comprehensive assessment of the economic, clinical, and technological components. Approaches are only a means to achieve a goal: the development of a multifunctional system of state guarantees in the provision of medical services, rational use of available resources.

Zonular ligament abnormalities intermingled in acute primary angle closure: A diagnostic and therapeutic challenge

PurposeThis study aims to investigate patient characteristics with lens zonular ligament abnormalities in Acute Primary Angle Closure (APAC), identifying related risk factors, and evaluating the efficacy of Pilocarpine, a miotic agent. DesignRetrospective case-control study. MethodsConducted as a retrospective case-control study at Hebei Provincial Eye Hospital from January 1, 2019, to December 31, 2021, the study included APAC cases undergoing ultrasound phacoemulsification with or without glaucoma surgery. Zonular ligament status was determined by intraoperative indicators such as lens equator visibility post-mydriasis and anterior capsule wrinkling during capsulorhexis. Patients were categorized into APAC and APAC with Lens Subluxation (APACLS) groups. Demographic details, Central Anterior Chamber Depth (ACD), Axial Length (AL), ACD difference between eyes (ACDD), Lens Thickness (LT), Lens Position (LP), and Relative Lens Position (RLP) were recorded and compared. Pilocarpine's impact on intraocular pressure reduction was assessed. Statistical analysis involved bilateral t-tests (for normally distributed data comparing both eyes in each group), non-parametric tests (for comparing two groups with non-normally distributed data), binary logistic regression, and Receiver Operating Characteristic (ROC) curve analysis for cutoff value determination related to zonular abnormalities. ResultsThe APAC and APACLS groups showed no significant difference in age of onset (70.11 ± 8.67 years vs. 70.11 ± 8.67 years, P = 0.159) or axial length of the eye (22.35 ± 0.64 mm vs. 22.36 ± 0.78 mm, P = 0.929). In the APACLS group, LT was greater (5.24 ± 0.37 mm vs. 5.01 ± 0.36 mm, P = 0.011), ACD was shallower (1.42 ± 0.24 mm vs. 1.69 ± 0.24 mm, P = 0.000), and ACDD was larger (0.38 ± 0.22 mm vs. 0.18 ± 0.18 mm, P = 0.000). The LP was lower (4.04 ± 0.32 vs. 4.20 ± 0.22, P = 0.013), and RLP was also lower (0.18 ± 0.02 vs. 0.19 ± 0.01, P = 0.015) in the APACLS group. A shallow ACD and a large ACDD were identified as risk factors associated with lens zonular abnormalities in the affected eyes (ACD OR value 63.97, P = 0.027; ACDD OR value 0.029, P = 0.027). Using ROC curve analysis, the cutoff value for ACDD was determined to be 0.375 mm, and for ACD, it was 1.6 mm. After pupil constriction with Pilocarpine eye drops, the proportion of patients whose intraocular pressure normalized was 75.36 % (52/69) in the APAC group and 71.43 % (25/35) in the APACLS group. ConclusionACD and ACDD in the affected eye are indicative of increased risk for APACLS. An ACD <1.6 mm and ACDD >0.375 mm should prompt consideration of zonular ligament abnormalities. Pilocarpine as a miotic treatment is safe and effective for such patients.

Clinical examples of correct orientation of a toric intraocular lens in patients with postkeratotomic corneal ectasia

BACKGROUND: Surgical treatment of cataract in patients with postkeratotomic corneal ectasia has various features. First, difficulties arise when calculating the optical strength of an intraocular lens and its cylindrical component and determining the location of the main axes of astigmatism for toric intraocular lens implantation. Additionally, not all modern keratotopography installations are able to accurately determine the refractive power of the cornea in such patients owing to pronounced irregular astigmatism and a large difference in keratometric parameters in the main meridians. CLINICAL CASES DESCRIPTION: Two clinical cases of surgical treatment of cataract in combination with postkeratotomic keratectasia are presented. Patients underwent a standard preoperative ophthalmological examination. TMS-4 Tomey keratotopograph was used to accurately determine the refractive power of the cornea. The optical power of toric intraocular lens were calculated using the Holladay 2 formula with amendments for radial keratotomy and the Johnson Johnson VISIC online calculator. SN6AT9 intraocular lens (Alcon) and a Tecnis ZCT800 toric intraocular lens (Johnson Johnson) were implanted in patients. The orientation of the position of the cylinder axis of toric intraocular lens was performed perpendicular to the most flattened meridian, corresponding to the position of the keratectasia zone, determined by the most expanded keratotomy scar. Before surgery, the best corrected visual acuity of patient M was OD=0.2, OS=0.4 and that of patient K was OD=0.4, OS=0.2. After surgery, the best corrected visual acuity of patient M was OD=0.8, OS=0.8 and that of patient K was OD=0.8, OS=0.7. CONCLUSION: This study aimed to familiarize practicing ophthalmologists, clinical residents, and postgraduates with a possible treatment option for cataracts by phacoemulsification with implantation of a toric intraocular lens in patients with postkeratotomic keratectasia. The resulting high visual acuity and subjective satisfaction of patients indicate the accuracy of chosen treatment tactics. A reliable visual guide for choosing the cylinder axis is the meridian of the greatest degree of keratectasia (cornea flattening), which is determined by the maximally expanded keratotomy scar position. The intraocular lens cylinder axis is oriented perpendicular to the keratectasia meridian. Ultrasound phacoemulsification of cataract with implantation of a toric intraocular lens is an effective method for correcting induced ametropia after radial keratotomy against the background of postkeratotomy keratectasia with high astigmatism.

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

Surgical technique for aspiration of soft lens nucleus with preoperative femtosecond laser-assisted fragmentation

This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.

How does laser-assisted cataract surgery compare with standard ultrasound phacoemulsification for improving outcomes?

How does laser-assisted cataract surgery compare with standard ultrasound phacoemulsification for improving outcomes?

Clinical experience in rehabilitation of patients with Fuchs corneal dystrophy and cataract by ultrasonic phacoemulsification and descemetorhexis

BACKGROUND: The potential for peripheral corneal endothelial capabilities is a novel, poorly understood direction. The comprehensive development of various modifications of endothelial keratoplasty goes hand in hand with a lack of donor material. This explains the continuous search for safe tissue-preserving techniques.&#x0D; AIM: The aim of this study is to evaluate the clinical and functional results of treatment of patients with Fuchs corneal dystrophy and cataract using a combination of cataract ultrasound phacoemulsification and descemetorhexis.&#x0D; MATERIALS AND METHODS: The study included 3 patients (3 eyes), 3 women aged 65 to 78 (on average 73.6 7.5 years). The follow-up period in the postoperative period was 36 months. The inclusion criteria were: patient complaints about glare, blurred vision and cloudy vision in the morning; the location of the guttae in the central 5 mm zone, central corneal stromal edema less than 610 microns, the inability to count endothelial cells in the center, endothelial cells density on the periphery in the upper quadrant more than 1400 cells/mm2. All patients underwent phacoemulsification of cataract with IOL implantation and subsequent descemetorhexis in the 4 mm zone.&#x0D; RESULTS: At 1 month an increase in the central corneal thickness and a slight increase in uncorrected visual acuity (UCVA) and in best corrected visual acuity (BCVA). By the 3rd month, positive dynamics was present: an increase in UCVA and BCVA in all cases, a decrease in the central corneal thickness (559 20 m), resorption of stromal edema, increase in corneal transparency, possibility to calculate the endothelial cells density in the center (866 46 cells/mm2). At 36 months, the BCVA was 0.6, 0.4 and 0.5, respectively.&#x0D; CONCLUSIONS: Restoration of corneal transparency was achieved in 100% of cases (3 out of 3). An analysis of the clinical results of the descemetorhexis + phacoemulsification + IOL operation demonstrated an increase in visual acuity, an increase in corneal transparency and a decrease in stromal edema in patients with initial Fuchs corneal dystrophy and cataract. The possibility of not using donor material for the treatment of Fuchs corneal dystrophy is a promising trend. Further accumulation of material is required.

Qualitative and quantitative endothelium changes after cataract surgery: ultrasound phacoemulsification vs. nanolaser technique.

The aim of this study was to evaluate corneal endothelial cell density and morphology, central corneal thickness, and best visual acuity using ultrasound (US) phacoemulsification or nanosecond laser technique. Department of ophthalmology, Nabeul, Tunisia. Prospective cohort study. This study included eyes with nuclear cataracts with a density grade of 1, 2, 3, or 4 according to LOCS III, divided into two groups; group 1 had conventional US, and group 2 had nanosecond laser. The endothelial cell density (ECD), coefficient of variation (CoV) in cell size, percentage of hexagonal cells, central corneal thickness (CCT) and best visual acuity (VA) were evaluated during 24 months. Seventy-four eyes had uneventful surgery, 40 in group 1, 34 in group 2. Three procedures in group 2 required conversion to standard phacoemulsification. The mean ECD decreased from 2616.4 ± 194.6 cells/mm2 in group 1 preoperatively to 2088.4 ± 229.9 after 2 years. In group 2, it decreased from 2611.8 ± 186.5 cells/mm2 to 2276.4 ± 163.8 after 2 years. The change was statistically significant in both groups. The decline of the mean ECD in group 2 was significantly less important than in group 1 (p = <10-2). The mean percentage of hexagonal cells was 45.18 ± 4.9 preoperatively and 43.5% ± 6.6 after 2 years in group 1. In group 2, it remained almost stable with 45.6 ± 5.1 and 45.4% ± 6.6 preoperatively and after 2 years, respectively. Preoperatively, the mean CoV was 0.39 ± 0.037 in group 1 and 0.38 ± 0.04 in group 2. After 2 years, it was 0.38 ± 0.04 and 0.37 ± 0.038 in group 1 and group 2, respectively. The changes of the mean CoV and the mean percentage of hexagonal cells were significant in both groups, but the difference between the groups was significant only during the six first months postoperatively. In preoperative, the mean corneal central thickness was 509.7 ± 19.5 in group 1 and 510.3 ± 20.4 in group 2. In both groups, the mean corneal thickness increased on D1 postoperatively to 550.9 in group 1, and 528.2 in group 2. The mean corneal thickness decreased more rapidly after 1 week in group 2, to find the initial values. Visual acuity improved from 0.76 Log Mar ± 0.5 at enrolment to 0.45 Log Mar ± 0.2, and 0.033 Log Mar ± 0.086 in group 1 at 1 day post-operative and after 24 months, respectively and from 0.58 Log Mar ± 0.28 to 0.2 Log Mar ± 0.09 and 0.035 Log Mar ± 0.083, respectively in group 2. There was no significant difference in VA at each follow-up between groups except for day 1. Our study showed lower corneal tissue trauma, and lower endothelial cell loss in the laser cataract surgery compared to phacoemulsification.Clinical trial registration: (https://classic.clinicaltrials.gov/ct2/show/NCT05886283), identifier NCT05886283.

Comparison of ultrasound phacoemulsification and FemtoMatrix® PhotoEmulsification® cataract surgery.

To introduce a novel technology currently under final development before regulatory approvals for the furtherment of cataract surgery, using the FemtoMatrix® laser system, and to demonstrate its safety and efficacy as compared to standard ultrasound phacoemulsification. Thirty-three patients with bilateral cataracts were operated on with one eye undergoing PhotoEmulsification® treatment on the FemtoMatrix® device and the contralateral eye receiving the control procedure, i.e., standard ultrasound phacoemulsification treatment. The number of "zero-phaco" procedures (denoting that I/A alone was sufficient to aspirate the lens fragments and that no ultrasound energy was needed) was recorded and Effective Phaco Time (EPT) values were compared. The patient follow-up was 3 months. Thirty-three eyes from a population with a mean cataract grade of 2.6 were treated on the FemtoMatrix®, of which 29 were "zero-phaco" (88%). All patients were operated on by a single surgeon who was a relative novice to the technology (63 patients treated prior to this study). Conversely, of the 33 fellow eyes who underwent standard ultrasound phacoemulsification, none were zero-phaco (0%) - all required varying degrees of ultrasound energy to make lens aspiration possible. The mean EPT was significantly lower in the PhotoEmulsification® laser group (0.2 ± 0.8 s) than in the phaco group (1.3 ± 1.2 s) (p < 0.0001). The safety profiles of the two procedures were comparable, with no device-related adverse events noted. FemtoMatrix® is a promising femtosecond laser platform that, when compared to phacoemulsification, significantly decreases or eliminates EPT altogether. The system is used to perform PhotoEmulsification®, making zero-phaco cataract procedures feasible including in high-grade cataracts (>3). It enables personalized treatment by automatically measuring and adapting the laser energy required to obtain the most efficient cutting of the crystalline lens. This new technology appears to be safe and effective in cataract surgery.

Клиническая оценка эффективности применения оригинального способа хирургического лечения катаракты у пациентов с заболеваниями макулы, получающих анти-vegf терапию

Aim. To evaluate the effectiveness of an original method of cataract surgical treatment in patients with macular diseases receiving anti-VEGF therapy according to registered indications. Methods. A retrospective data analysis of patients who received complex treatment, including ultrasound phacoemulsification in combination with intravitreal injections of angiogenesis inhibitors (IVIAI; ranibizumab, aflibercept) before and after surgery and prolonged anti-inflammatory therapy (betamethasone injections into sub-Tenon's space), was carried out. The study group consisted of 20 patients (including 12 women, average age 77.0 years, predominant (65 %) nosology was is neovascular age-related macular degeneration) who received anti-VEGF therapy for at least 12 months before and after surgery and did not have gross compliance violations in this period. Results. An increase in best corrected visual acuity (decimal chart) was recorded from 0.18 before phacoemulsification to 0.47 1 month after surgery (p &lt; 0.01), followed by maintaining the achieved values after 12 months (0.48, p &lt; 0.01); decrease in central retinal thickness during the year of treatment prior to surgery from 392.4 µm to 262.6 µm (p &lt; 0.01), remaining stable in the next 12 months (229.2 µm, p = 0.61). The average number of IVIAI performed 12 months after phacoemulsification was statistically significantly less than in the year preceding the operation (3.05 and 4.10, respectively, p &lt; 0.01). Conclusion. High efficiency and safety of the proposed treatment method in patients with combination of cataract and macular diseases indicated for anti-VEGF therapy have been confirmed. Key words: cataract, phacoemulsification, method of treatment, macular diseases, anti-VEGF therapy.

Сравнительный анализ ультразвуковой и фемтолазер-ассистированной факоэмульсификации у пациентов с первичной эндотелиальной дистрофией роговицы Фукса

Comparative analysis of ultrasound and femtolaser-assisted phacoemulsification in patients with primary endothelial Fuchs corneal dystrophy

Comparative Assessment of the Flowmetry Indicators Dynamics in Ultrasound and Femtolaser Phacoemulsification

An important point in cataract surgery, especially in view of performing operations on an outpatient basis and increasing surgical activity, is the need to minimize trauma to the delicate structures of the anterior segment of the eyeball, reduce the likelihood and number of complications and obtain high functional results in the shortest possible time. Purpose of the study: to carry out a comparative assessment of the flowmetry indices dynamics in accordance with the calculation of the tolerant intraocular pressure (TIAP) in patients after femtolaser cataract extraction (FLEK) and ultrasound FEC. The study included 125 patients aged 50 to 60 years, who underwent surgery for cataracts. The patients were divided into two groups. Standard ultrasound PE was performed in patients of group 1, and FLEK in patients of group 2. All patients underwent a standard ophthalmological examination, as well as flowmetry, reflecting the state of the volumetric ocular blood flow (OVF), with the calculation of the tolerant intraocular pressure (TIОP) index, which serves to determine the individually-adequate ophthalmotonus and ocular blood flow. The study was carried out before the operation, after 1 day, on the 3rd, 7th days and 1 month after the operation. Analysis of the data indicates that both during phacosurgery by the method of traditional ultrasound PE and hybrid PE, a transient increase in IOP occurs, which is most pronounced on the 1st and 3rd day. With a transient increase in IOP, a decrease in the OVF indicator was noted, respectively, the calculated TIOP indicator also changed, but the excess was no more than 3–5 mm Hg.

Phaco-UCP; combined phacoemulsification and ultrasound ciliary plasty versus phacoemulsification alone for management of coexisting cataract and open angle glaucoma: a randomized clinical trial

BackgroundVarious surgical techniques have been described, to be combined with cataract surgery in glaucoma patients, aiming for an additional reduction of intraocular pressure (IOP), hence minimizing the burden of anti-glaucoma medication (AGM). Ultrasound ciliary plasty (UCP) is a recent microinvasive glaucoma surgery (MIGS) recommended for primary and refractory glaucoma. This study was conducted to evaluate the safety and efficacy of a new technique; combined phacoemulsification and ultrasound ciliary plasty (Phaco-UCP) as a primary surgical treatment for coexisting cataract and open angle glaucoma.MethodsA randomized clinical trial, including 61 eyes of 61 patients with visually significant cataract and open angle glaucoma, randomized to either Phaco-UCP (study group; 31 eyes) or phacoemulsification alone (Phaco-alone) (control group; 30 eyes). Primary outcomes included reduction in IOP and/or the number of AGM. Secondary outcomes included visual acuity improvement and complications. Qualified Success was defined as an IOP reduction ≥ 20% from baseline value, with an IOP 6–21 mmHg, with no additional AGM or glaucoma surgery. Failure was defined as either < 20% IOP reduction, despite AGM use, the need of glaucoma surgeries or serious complications.ResultsAt 18 months postoperatively, Phaco-UCP group had a median IOP reduction of 7 mmHg (Q1, Q3 = 3, 10) compared to 2 mmHg (Q1, Q3 = 2, 3) in Phaco-alone group (P < 0.001). Phaco-UCP group had significantly higher success rate at all time points reaching 67.7% at the last follow-up versus 16.7% only in Phaco-alone group (P< 0.001). The median number of AGM significantly decreased from [3 (Q1, Q3 = 2, 4), 3 (Q1, Q3 = 2,3)] respectively, (P =0.3)] at baseline to [1 (Q1,Q3 = 1, 2), 2 (Q1,Q3 = 2, 2)] respectively, (P < 0.001)] at 18 months postoperatively. No serious intraoperative or postoperative complications were encountered in either group.ConclusionPhaco-UCP is a simple, safe and effective procedure for management of coexisting cataract and open angle glaucoma.Trial registrationClinicalTrials.gov identifier, NCT04430647; retrospectively registered. June 12, 2020.

Results of surgical treatment of complicated uveal cataract

A retrospective analysis of the results of surgical treatment of complicated uveal cataracts of different origin. The study analyzed the results of surgical treatment of uveal cataract in 30 patients (34 eyes) who were divided into three groups by uveitis etiology. The first group included 11 patients with spondyloarthritis associated with the HLA-B27 antigen; the second group included 10 patients with juvenile chronic arthritis and spondyloarthritis, negative for HLA-B27 antigen; the third group consisted of 9 patients with other systemic autoimmune diseases and uveitis of unknown etiology, also negative for the HLA-B27 antigen. The average age of the patients was 35.8±2.6; 30.8±3.8 and 34.0±2.3 years, respectively. Four patients (6 eyes) with juvenile chronic arthritis and severe ribbon-like corneal degeneration underwent standard intracapsular cataract cryoextraction with subsequent spectacle correction of aphakia. In other cases, ultrasound phacoemulsification with implantation of an intraocular lens (IOL) was used as a surgical aid. Regardless of the surgery technique and the cause of uveal cataract, a statistically significant decrease in the number of exacerbations per year (p<0.0001) and an increase in best corrected visual acuity (BCVA) were noted after its removal. In the long-term follow-up (2-24 months), 9 patients experienced persistent decompensation of the IOP level, which required various types of antiglaucoma surgery. Surgical treatment of uveal cataracts of various etiologies with adequate pre- and postoperative therapy provides an improvement in visual acuity and a reduction in the frequency of inflammation recurrence. Considering the high likelihood of IOP decompensation in the long-term postoperative period, IOP control should be given attention in such cases.

Optimization of Methods for the Selection of Multifocal Intraocular Correction in Eye-Lens Surgery

Purpose : to develop a methodology for the selection of patients for multifocal intraocular correction with an individual definition of the IOL type based on the data obtained from a preoperative questionnaire and a trial selection of multifocal contact lenses. Patients and methods . The study is based on the data obtained from an analysis of 1000 medical case reports and questionnaires of patients who have been recently operated in the LLC «Eye Clinik “Lege Artis”» because of cataracts and refractive changes. All patients underwent ultrasonic phacoemulsification according to the standard procedure on the Centurion apparatus. Monofocal IOLs from leading global manufacturers, such as M-plus, Comfort (Oculentis), Restor (Alcon) and the trifocal IOL manufactured by PanOptix (Alcon) were offered to patients for the implantation. In order to achieve this objective, questionnaires were developed with questions allowing to determine the psychological type of the patient before the surgery, the nature of his/her visual load and the requirements he/she has in relation to his/her vision. In order to simulate the conditions of multifocal intraocular correction, there were multifocal contact lenses Acuvue Moist selected for patients with varying degrees of ADD power. To assess the degree of patient satisfaction with the results of treatment performed by individual selection of multifocal IOLs, there was an anonymous postoperative survey conducted after 2 weeks and 2 months. Results. The analysis showed that the proportion of implantations of multifocal IOLs among all ultrasound phacoemulsification surgeries was 17 %. Of these, in 55 % of cases patients have chosen IOLs with a low degree of ADD power (Lentis Comfort), in 32 % — PanOptix and in 13 % — Lentis M-plus or Restor. The degree of patient satisfaction with the surgery and the vision obtained in 2 weeks after the surgery was 90 %, and after 2 months — 95 %. Cases with incomplete patient satisfaction with the surgery made (5 %) were noted mainly in the group with the implantation of bifocal IOLs and are associated with typical complaints about the appearance of light phenomena, mostly at night

Результаты факоэмульсификации с имплантацией ИОЛ у пациентов с эндотелиальной дистрофией роговицы Фукса

Purpose . To evaluate the results of treatment in patients with cataract and Fuchs endothelial corneal dystrophy (FECD) after phacoemulsification and IOL implantation. Material and methods . Ultrasound phacoemulsification with IOL implantation and further clinical-functional parameters follow-up was performed in 23 patients: 6 males (26.1%) and 17 females (73.9%), the mean age was 71.2±17.9 (from 54 to 88 years). Results . No intraoperative complications were registered. Transient corneal edema was observed in 17.4% (4 patients). In 8.7% of cases (2 patients) 3-6 months after the surgery persistent cornea edema was revealed, the visual acuity (VA) was 0.2 and those patients were treated with the Descemet’s membrane transplantation (DMEK). The best corrected visual acuity (BCVA) was high (0.8±0.11) within all follow-up periods. Mean values of corneal pachymetry was 582±32μm 6 months after the surgery. Endothelial cells loss was 19% – 1 month postoperatively, 22.4% – 6 months, 22.9% – 12 months, 24.9% 24 months later. Final endothelial cell density (ECD) 24 months postoperatively was 745±162 cells/mm2. Conclusions . The US phacoemulsification with hydrophobic IOL implantation is eventual, expedient and efficient for treatment of patients with cataract and early stage of FECD. Minimal US and hydrodynamic parameters settings are favorable to provide a better corneal endothelial protection.

Анализ эффективности глазных капель ОКУхил С у пациентов после ультразвуковой факоэмульсификации катаракты

Анализ эффективности глазных капель ОКУхил С у пациентов после ультразвуковой факоэмульсификации катаракты

The application of bilateral ultrasound phacoemulsification of cataract with IOL implantation in patients with severe somatic and psychiatric pathology

The application of bilateral ultrasound phacoemulsification of cataract with IOL implantation in patients with severe somatic and psychiatric pathology

Intraoperative outcomes and safety of femtosecond laser-assisted cataract surgery: Canadian perspective

ObjectiveTo report the intraoperative surgical outcomes and safety of femtosecond laser–assisted cataract surgery (FLACS) during surgeon learning curve and compare those outcomes with those of conventional phacoemulsification in a Canadian public hospital setting. DesignRetrospective chart review. ParticipantsFLACS and phacoemulsification patients at Brandon Regional Health Centre, Brandon, Manitoba, Canada. MethodsIntraoperative surgical outcomes and safety (rates of intraoperative complications and phacoemulsification parameters) were compared among 3 groups: the first consecutive 197 cases using femtosecond laser (FSL) pretreatment to ultrasound phacoemulsification in cataract surgery (group 1; early FLACS), the second consecutive 165 cases using FSL (group 2; later FLACS), and 80 consecutive conventional cataract surgery cases (group 3; conventional phaco). ResultsThere was a statistically significant difference for phacoemulsification parameters (actual phaco time [APT], effective phaco time [EPT], and ultrasound average) among the 3 groups (all p-values < 0.05). The mean phacoemulsification parameters (APT and EPT) for the early FLACS and the conventional phaco groups were significantly longer than those for the later FLACS group (p < 0.05). The mean FSL time for the early FLACS group was significantly longer than that for the later FLACS group. There was no statistical difference among the rates of intraoperative complications (suction breaks, capsular tags, FSL-induced miosis, posterior capsular tears, and anterior vitrectomy) for the 3 groups. ConclusionsDuring the learning curve, the intraoperative outcomes and safety of FLACS are comparable to the conventional phacoemulsification technique. After the learning curve, FLACS is significantly superior to conventional surgery in all measured phacoemulsification parameters.

Role of pterygopalatine blockade in the early rehabilitation program of children after congenital cataract surgery

Nowadays, the surgical treatment of congenital cataract is a small-incisions surgery (aspiration, in some cases ultrasound phacoemulsification). It corresponds to the Fast Track surgery principles, and as a quick recovery technology it requires optimization of pain control in the early postoperative period. &#x0D; Purpose. To estimate the efficiency of the pterygopalatine block as a component of an optimized Fast Track protocol in children after congenital cataract surgery.&#x0D; Materials and methods. 54 children operated for congenital cataract were included in the study. All patients were divided into 2 groups. In the first group (n = 26), a regional component of combined anesthesia on sevoflurane basis was carried out in combination with a pterygopalatine block; in the second group (n = 28), there was an implementation of a retrobulbar block. The efficiency of the methods was evaluated by a comparative analysis of hemodynamic parameters, the index of the vegetative system tension, the assessment of pain intensity by a verbal rating scale, as well as by the severity of ocular inflammatory reactions.&#x0D; Results. Obtained data show that the pterygopalatine ganglion block as a component of a combined anesthesia in congenital cataract surgery allows providing adequate anesthesia, creating prolonged pain control, reducing the inflammatory reaction in postoperative period during the first 24 hours.&#x0D; Conclusion. On the basis of our analysis, the possibility of a safe implementation of optimized (Fast-Track) protocol was proven.