The review covers different aspects of the impact of femtosecond laser-assisted cataract surgery on the state of the macular zone of the retina. Literature search has revealed inconsistency of the published data and indicated the need for a more detailed study of this problem.
Adequate drug-induced mydriasis is one of the main factors that determine minimum surgical trauma and high level of safety of ultrasound phacoemulsification (PE). A small pupil significantly increases the number of potential complications (mostly those that are due to disrupted integrity of the posterior lens capsule and Zinn's zonules) and also increases the length of intervention, effective phacoemulsification time, and, thus, surgical trauma. The risk of complications is even higher in small rigid pupils combined with lens subluxation, as it is seen in pseudoexfoliation syndrome in particular, which is a rather common condition in the elderly. Hence, a number of methods and tools aimed at prevention of possible PE complications have been proposed [1-6]. Hybrid PE incorporates both femtosecond (FS) laser and classic ultrasound technologies and allows to perform some complication-prone technical steps (namely, round anterior capsulorhexis and fragmentation of the lens nucleus) on a "closed" eyeball [7-9]. However, the said advantage of hybrid technology can as well be negated to some extent by poor preopera-tive pupil dilation. The problem is that femtosecond laser operating specifics preclude mechanical iris retraction, since it involves opening of the anterior chamber. Therefore , attempts are being made to optimize the femtosec-ond laser stage of PE so that it could be still performed in poor mydriasis (dilated pupil diameter of less than 5.5 mm), which is yet considered a relative contraindica-tion to this type of surgery [10-11]. The aim of the present study was to develop a differentiated approach to hybrid phacoemulsification technique in small pupils. Aim-to develop a differentiated approach to hybrid phacoemulsification (PE) in small pupils. Material and methods. Modified hybrid PE was performed in 119 patients (130 eyes) with conditionally small pupils (preoperative dilated pupil diameter of less than 5.5 mm). Results. A differentiated approach to hybrid PE has been developed and tested in patients with poor preoperative mydriasis. Conclusions. Small rigid pupils are considered a relative contraindication to hybrid PE. Developed modifications enable less surgical trauma with effective phacoemulsification time generally unchanged, while the latter is usually increased in standard PE in patients with poor preoperative pupil dilation.
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