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BACKGROUND: A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period. AIM: To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients. MATERIALS AND METHODS: 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts. RESULTS: 95.2% (n = 138) of patients did not seek ophthalmological attention, 4.8% (n = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was absence of an ophthalmologist in the outpatient polyclinic. The patients lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm 37.2%; pseudoexfoliation syndrome 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber 44.8%; lens subluxation 24.1%; atrophy of the pupillary margin 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 0.27, on Day 7 0.73 0.22, after 3 months 0.76 0.25. CONCLUSIONS: Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.
BACKGROUND: A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period. AIM: To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients. MATERIALS AND METHODS: 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts. RESULTS: 95.2% (n = 138) of patients did not seek ophthalmological attention, 4.8% (n = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was absence of an ophthalmologist in the outpatient polyclinic. The patients lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm 37.2%; pseudoexfoliation syndrome 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber 44.8%; lens subluxation 24.1%; atrophy of the pupillary margin 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 0.27, on Day 7 0.73 0.22, after 3 months 0.76 0.25. CONCLUSIONS: Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.
Purpose: to develop new approaches to Morgagnian cataract surgery by optimizing the phacoemulsification technique and reducing the risk of surgical complications.Material and methods. 22 patients (22 eyes) with hypermature Morgagnian cataract were divided into 2 groups. The main group I included 11 patients who underwent surgery according to the PEC technology using iridocapsular retractors, an intracapsular ring and the scaffold technique with the last nucleus fragment relocated into the anterior chamber. The comparison group II included 11 patients with PEC and IOL implantation using iridocapsular retractors and an intracapsular ring with no scaffold technique involved. In 7 patients of group I, the lens nucleus was considered “large” and in 4 patients, “small”. In 8 patients of group II, the lens nucleus was considered “large” and in 3 patients, “small”.Results. After 6 months, BCVA in group I was 0.60, whilst in group II it was 0.70. IOP in group I averaged 12.9 mm Hg, while in group II it averaged 17.90 mm Hg. The endothelial cell density (CD) in group I decreased by 241 cells and amounted to 2012.0 cells/mm2 , the endothelial cell loss was 10.70%, while in group II CD loss was greater. It dropped by 377 cells (15.60%) and amounted to 2039 cells/mm2 .Conclusions. The severity of involutional changes in the ligamentous apparatus of the lens in Morgagnian cataract was found to depend on the nucleus size. A working classification of Morganian cataract by the nucleus size has been proposed. The use of scaffold technique with the relocation of the last fragment into the anterior chamber made it possible to reduce the share of surgical complications to 18.18%. During phacoemulsification of Morgagnian cataract with small nuclei, surgical complications took place in both group I and II, which necessitates further improvement of the existing surgical technique of this type of pathology.
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