BACKGROUND: The «gold standart» for surgical treatment of patients with proliferative diabetic retinopathy (PDR is vitreoretinal surgery. However, the question of the timing of the removal of primary cataract in this category of patients remains open.AIM: To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patientsMETHODS: 67 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsifi tion surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsifi tion performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity.RESULTS: Visual functions improved in 88.6% of cases in group 1, and in 68.7% in group 2.CONCLUSIONS: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.
The paper describes a clinical case of a female patient with severe obstructive sleep apnea syndrome in the presence of congenital hemangioma of the face, soft palate, and tongue concurrent with paroxysmal atrial fibrillation and atrial flutter, paroxysmal supraventricular tachycardia, and sinoatrial block (maximally up to 3.9 sec). Continuous positive airway pressure therapy could reduce the number of paroxysms of atrial fibrillation and atrial flutter, supraventricular tachycardia and eliminate sinoatrial block.
VEGF) в слезной жидкости (СЖ) пациентов с далеко зашедшей стадией пролиферативной диабетической ретинопатии (ПДР) и осложненной начальной катарактой при одновременном выполнении факоэмульсификации катаракты (ФЭК) с имплантацией ИОЛ и витреоретинальной хирургией (ВРХ) в сравнении с просто ВРХ. Материал и методы. В исследование включены 34 пациента с ПДР и осложненной начальной катарактой, разделенных на две группы. В I группе первый этап -ВРХ с силиконовой тампонадой, второй этап -ФЭК c имплантацией ИОЛ одновременно с плановым удалением силиконового масла (СМ). Во II группе первый этап -ФЭК с имплантацией ИОЛ одномоментно с ВРХ + силиконовая тампонада. Второй этап -удаление СМ из витреальной полости. У пациентов обеих групп исследованы образцы СЖ до операции и на 2-е сутки после первого этапа хирургического лечения. Результаты. Во II группе по сравнению с I группой на 2-е сутки после первого этапа хирургического лечения повышены в 2,5-5 раз концентрации в СЖ IL-8, MCP-1, ICAM-1. Заключение. Повышение концентрации цитокинов IL-8, MCP-1 и ICAM-1 в СЖ после одновременного выполнения ФЭК с имплантацией ИОЛ и ВРХ в сравнении с просто ВРХ указывает на необходимость дальнейшего изучения роли воспалительного компонента в патогенезе развития послеоперационных осложнений у пациентов с далеко зашедшей стадией ПДР. Ключевые слова: цитокины; пролиферативная диабетическая ретинопатия; витреоретинальная хирургия; факоэмульсификация катаракты Конфликт интересов: отсутствует. Прозрачность финансовой деятельности: никто из авторов не имеет финансовой заинтересованности в представленных материалах или методах.
Aim. Undertake a comparative analysis of the results two-stage or simultaneously vitreoretinal surgery with phacoemulsification of PDR patients. Material and methods. 52 cases of surgery treatment of patients with PDR and complicated primary cataract were analyzed. These patients were divided into three groups. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with gas tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and the IOL implantation. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with gas tamponade. Results. Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along on PDR patients with complicated primary cataract. Conclusions. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications. Key words: diabetic retinopathy, cataract, vitreoretinal surgery.
Purpose. To compare and evaluate long-term results of two-stage surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated incipient cataract. Material and methods. 73 patients with advanced proliferative diabetic retinopathy and complicated incipient cataract performed by vitrectomy from 2016 to 2020 were analyzed. In the 1st group patients were subjected to a two-step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. Results. Visual functions improved in 88.8% of cases in group 1, and in 51.3% in group 2. Conclusion. Outcomes of the studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications. Key words: diabetic retinopathy, cataract, vitreoretinal surgery.
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