Purpose. Analysis of the cataract surgery visual outcomes and advantages of intraocular lens Synthesis SIPY.Material and methods. We have operated 43 eyes with cataract (38 patients) using Synthesis SIPY lens. Non-corrected visual acuity was 0.13 ± 0.08, best corrected visual acuity (BCVA) was 0.36 ± 0.1.Results. Following 7 months, secondary cataract was not detected in any patient, what explain the actuality of square edge optical part on 360° of perimeter. The lens is inserted in cartridge in factory sterile conditions which exclude the contact between lens and environment, reduce the risk of incorrect inserting of the lens in cartridge following pinching by the cartridge flaps and, subsequently, the haptic tearing off. This complex “lens-cartridge” excludes the damage of haptics and optic parts, which can occur in using other IOLs during the removal of the lens from the vial and placing it in the groove of the cartridge. Position of cartridge in injector centralizes the cartridge tunnel for the Accuject Pro injector plunger, thereby reducing the risk of pinching the rubber tip of the IOL haptic plunger during implantation. The diameter of the cartridge tip allows the IOL to be implanted through a 1.6 mm tunnel. The uncorrected visual acuity after surgery was 0.6 ± 0.28. The best corrected visual acuity was 0.78 ± 0.24.Conclusions. The Synthesis SIPY lens has a number of advantages: factory installation of the lens into the cartridge and compatibility of the cartridge with the Accuject Pro injector prevent damage to the IOL; Implantation of the Synthesis SIPY lens is possible through the 1.6 mm corneal tunnel; high diopter ranges from -10.0D to + 40.0D allows for maximum visual results.
According to the results of various studies, in up to 50% cases after cataract phacoemulsification patients with glaucoma experience ophthalmic hypertension on the first day. This occurs due to the mechanical retention of aqueous humor in the anterior chamber. Temporary decrease in the function of the eye drainage system is explained by pigment particles, viscoelastic, erythrocytes, protein cells, product of postoperative inflammation and lens particles obstructing the trabecula. In the long-term period after phacoemulsification in glaucoma patients there is a decrease in the intraocular pressure in up to 74% of cases.A decrease in the density of endothelial cells in these patients occurs as a result of fluctuation of intraocular pressure, prolonged application of hypotensive drops, surgical intervention and presence of drainage devices after antiglaucoma surgery. This leads to the increase of inflammatory reaction of the cornea in the form of edema of up to 16.9% after cataract phacoemulsification.Phacoemulsification also provides a significant hypotensive effect (up to 34%) and is a preventive measure for an acute attack in patients with angle-closure glaucoma. However, the state of acute glaucoma attack leads to difficulties in phacoemulsification in the form of high intraocular pressure, corneal edema and small chamber. Cataract extraction under such circumstances causes an increase in postoperative corneal edema and eye inflammation of up to 22.85%.
The comorbidity of glaucoma and cataract occurs in up to 76 % of ophthalmic patients. The presence of glaucoma in these patients increases the risk of complications in cataract surgery by up to 51.6%. Small pupil occurs in 14 % of cases during cataract surgery, with frequency increasing with age, reaching 71% by the age of 80. Small pupil is a complicating factor in phacoemulsification in patients with glaucoma and can lead to undesirable visual outcomes. However, today the arsenal of ophthalmic surgeons has a number of iris retractors that dilate the pupil during the lens extraction, which makes the operation simpler. Weakness of the ligamentous apparatus of the lens occurs in one third of patients with glaucoma. Cataract surgery in these patients is accompanied by difficulties in performing classical capsulorhexis and a high risk of decentration or subluxation of the lens. Pupil rigidity, drug-induced miosis and ligamentous laxity require the use of iris retractors, capsular rings, and in some cases extracapsular fixation of the lens. Hemorrhagic complications of cataract surgery in patients with glaucoma manifest as hyphema and expulsive hemorrhages. Considering the specifics of ocular microcirculation, expulsive hemorrhage occurs during cataract surgery in 0.026–0.04 % of cases. The reason for this is the difference in pressure in the vascular bed and out-side of it. The higher the initial intraocular pressure during lens extraction, the higher the risk of hemorrhage. The conventional recommendation is maximum compensation of intraocular pressure before phacoemulsification.
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