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0219U005304,
0114U001911
,
Peculiarity of cataract, glaucoma and other diseases surgical treatment depending on age-related changes and according to the morpho-functional, clinical and biochemical factors of development
Lutsenko Nina Stepanivna,
01-08-2019
State Institute "Zaporizhzhia Medical Academy of Postgraduate Education of Ministry of Health of Ukraine"
Improving the effectiveness of surgical treatment of the patients with cataract, glaucoma and other eye diseases by identification of age-dependent morphofunctional and biochemical factors of their development and elaboration the methods of prevention and treatment. A retrospective analysis of 562 patients after surgical treatment of glaucoma (52 patients) and cataracts (510 patients) was performed. Ocular manifestations of PES were detected in 196 patients; the frequency of occurrence was 21% under the age of 75 years and 57.1% in the age group over 75 years. Сomplications associated with capsular bag instability in the structure of intraoperative complications in patients with PES were observed in 10.5% of cases. It has been proved that the unsatisfactory condition of the filtering bleb after the glaucoma surgical treatment and intraocular pressure increase in the eyes with PES is accompanied by the presence of meibomian gland dysfunction in 92% of patients. An increase the signs of chronic inflammation in the presence of PES in comparison with the control group was established. The level of pro- and anti- inflammatory cytokines in anterior chamber fluid and blood serum was studied in 120 patients with cataracts, 41 patients with cataracts and glaucoma against the background of the PES and 45 patients of the control group. A local cytokine dysbalance has been established, namely an increase in the level of pro-inflammatory IL-6 ( 38% and 95% respectively) and IL-8 ( 7.5% and 40.1% respectively) in studied groups and decrease the level of anti-inflammatory IL - 10 and IL - 4 in the anterior chamber fluid. A high correlation was found between the increase in the level of pro-inflammatory cytokines and the state of the meibomian glands, which indicates the presence of chronic inflammation of the anterior surface of the eye in patients with PES. Surgical treatment of cataract was performed in 320 patients (400 eyes) with signs of PES. The observation groups were divided depending on the degree of PES, the density of the nucleus and the degree of weakness of the capsular bag. Intraoperative prophylactic measures have been developed that prevent the occurrence of a capsular block, both intraoperatively and in the postoperative period. A new method for the cataract surgical treatment with dense nucleus and rigid iris syndrome in the presence of PES was proposed. The effectiveness of the use of a capsular tension ring with scleral fixation in the presence of PES, is proved not only in cases of phacodenosis, but also in the presence of phacoiridodenesis. It is proved that the elimination of the mobility of the complex intraocular lens and the capsular bag by using the suture fixation of the modified capsular tension ring to the sclera during phacoemulsification of complicated cataracts is an effective mechanism for compensation of the intraocular pressure.
Ісакова Оксана Анатоліївна
Михальчик Тетяна Сергіївна
Рудичева Ольга Анатоліївна
2020-04-02
Updated: 2025-12-09
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