The presence of a balance between the production and outflow of intraocular fluid ensures stability of the level of intraocular pressure (IOP). To reduce IOP means to affect one of these variables. For many decades, transscleral technologies in the treatment of glaucoma were considered exclusively as traumatic cyclodestructive interventions that only affect the reduction of intraocular pressure (IOP). These methods have recently been considered as possible ways to influence uveoscleral outflow. This became possible due to the appearance of new lasers, the development of new modes of their operation, points of application in the projection of the pars plana of the ciliary body (for example, TRANS-scleral CFC in micro-pulse mode at λ = 810 µm and CFC using pulsed periodic laser radiation at λ = 1.56 µm). They have a gentler effect and, accordingly, cause fewer side effects and undesirable effects. This explains the increasing shift towards the use of transscleral technologies in the earlier stages of glaucoma, not only for end-stage painful glaucoma resistant to conventional treatment (so-called “last resort surgery”).
Cataract is the most common cause of blindness worldwide. The standard treatment for cataracts is phacoemulsification with implantation of an intraocular lens (IOL). Removing cataracts can significantly improve vision and the quality of life associated with vision. The review considers the necessary biometric studies before phacoemulsification of patients with macular pathology, the long-term effects of phacoemulsification in patients with various macular pathologies, the features of implantation of mono- and multifocal IOLs in such patients, as well as possible complications after phacoemulsification in patients with macular pathology. The importance of examination of the macula before phacoemulsification of cataract has been shown. A review of changes in different eye’s parts after phacoemulsification in patients with various pathologies: with the progression of myotic traction, with combined cataract and glaucoma, in patients with diabetes, with an epiretinal membrane, and the features of implantation of multifocal lenses and IOLs with UV protection are considered. Not only the postoperative condition is assessed, but also the changes between the preoperative and postoperative conditions. In addition, the review demonstrates the dynamic healing processes and changes in macular parameters (after different times — from several days to several years) in order to obtain a rational analysis result.
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.
Iatrogenic keratectasia is a corneal disease caused by refractive surgery, most frequently after laser in situ keratomileusis (LASIK) as a surgical correction of ametropia, and also after injuries, penetrating and lamellar keratoplasty. The following changes are noted in case of keratectasia after laser keratomileusis: an increase in keratometric indices in the central and lower parts of the cornea, a decrease in stromal thickness and a myopic shift in refraction, a progressive impairment of visual functions — a decrease in uncorrected visual acuity, monocular diplopia and an inability of spherocylindrical correction. A thin corneal bed or small residual stromal thickness, re-surgery LASIK in anamnesis, and also the initial preoperative features of the corneal topogram (Irregularity, asymmetric bow tie pattern) are considered to be the main risk factors of keratectasia after LASIK surgery.Methods. A patient with secondary keratectasia who had previously undergone LASIK and crosslinking was found to have progressive secondary keratectasia and decreased visual functions. An individual allograft was implanted (the form of a Landolt ring, 300 µm, at a depth of 290 µm) using the technology of bandage keratoplasty. Cutting transportat graft and tunnels for implantation were produced with the help of femtosecond laser. The data of visometry and keratotopography were evaluated.Results. As a result of the formation of the bandage, the functions of the eyes improved, and ectasia did not progress for 6 months. Visual acuity increased from 0.15 to 0.66, the average value of keratometry was 40.35 diopters, with the initial 44.8 diopters. The minimal corneal thickness remained at 440 µm.Conclusion. The proposed surgical technology BLOK allows to get an effective result in case of keratectasia after LASIK, which is manifested in improving visual functions, strengthening the cornea and normalizing its surface, as well as provides reduction of the further progression of keratectasia.
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