Макулярний набряк і особливості його перебігу після різних методик хірургічного лікування вікової катаракти

Abstract

Поява фемтосекундного лазера (ФСЛ) і використання його в хірургії катаракти зробило революцію в офтальмохірургії. Фемто-асистована хірургія катаракти потенційно більш безпечна для очних структур. Одним з найбільш поширених ускладнень у післяопераційному періоді після видалення катаракти є макулярний набряк. Тому, метою дослідження було вивчення частоти, характеру і особливостей перебігу макулярного набряку після різних методик хірургічного лікування вікової катаракти. В результаті досліджень виявлено, фемтосекундне видалення катаракти дозволяє зменшити частоту післяопераційних ускладнень. Виконання факоемульсифікації катаракти (ФЕК) з фемтосекундним супроводом дозволяє зменшити частоту макулярного набряку в 2 рази в терміні 1 і 3 місяці. В термін спостереження 6 місяців і 1 рік макулярний набряк не розвивався; Появление фемтосекундного лазера (ФСЛ) и использование его в хирургии катаракты сделало революцию в офтальмохирургии. Фемто-асистована хирургия катаракты потенциально более безопасна для глазных структур. Одним из наиболее распространенных осложнений в послеоперационном периоде после удаления катаракты является макулярный отек. Поэтому, целью исследования было изучение частоты, характера и особенностей течения макулярного отека после различных методик хирургического лечения возрастной катаракты. В результате исследований выявлено, фемтосекундное удаления катаракты позволяет уменьшить частоту послеоперационных осложнений. Выполнения факоэмульсификации катаракты (ФЭК) с фемтосекундним сопровождением позволяет уменьшить частоту макулярного отека в 2 раза в сроке 1 и 3 месяца. В срок наблюдения 6 месяцев и 1 год макулярный отек не развивался; The emergence of femtosecond laser (FSL) and its use in cataract surgery has made a revolution in ophthalmic surgery. Femto- cataract surgery potentially safer for ocular structures and especially the endothelium of the cornea by reducing the number of manipulations in the eye, ultrasonic energy that is consumed during the operation, volume of irrigation solution used during surgery and reducing the time invasive part of the surgery. One of the most common complications in the postoperative period after cataract surgery is macular edema. Therefore, the aim of the study was to investigate the frequency, nature and features of macular edema after various methods of surgical treatment of age-related cataracts. Under our observation there were 158 patients (158 eyes) with senile cataract (82 men and 73 women) aged 40-85 years, with the degree of density of the lens nucleus after Buratto I-III, who were divided into 2 groups. 1 group consisted of 83 patients (83 eyes) with senile cataract who underwent phacoemulsification with implantation of flexible aspheric IOL Natural AcrySof IQ (Alcon, USA). Second monitoring group comprised 75 patients (75 eyes) with senile cataract who underwent phacoemulsification with femtosecond support and flexible implantation of an aspheric IOL Natural AcrySof IQ (Alcon, USA). Patients in both groups were examined by analysis of the nature and frequency of operational, early and late postoperative complications as well as immediate and remote results of surgical treatment. All the patients were performed in dynamics: visual acuity testing, perimetry, pneumotonometry, biomicroscopy, ophthalmoscopy, gonioscopy, keratometry, ultrasonography, confocal microscopy, optical coherence tomography. During the examination of 83 patients (83 eyes) at 1 month after surgery by ophthalmoscopy in 5 eyes (6.0 percent) was determined by the lack of macular reflex, smoothed contours of the fovea. These patients were investigated morphometric parameters of the retina macular area using optical coherence tomography. In all cases there was a significant increase in the thickness foveolar plot to an average of 420 µm; the volume of the retina in the fovea – 14 mm3). These patients were performed sustenance the introduction of 1.0 ml betamethasone (betaspan). After 4 days the visual acuity in these 5 patients was increased to 1.0. 3 months after surgery in 5 eyes (6.0 percent) showed a significant increase in the thickness of foveolar zone to an average of 390 microns. 6 months after surgical treatment of patients of the 1st group at 10 eyes (12,0%), according to the OCT determined macular edema with retinal thickness in average of 418 µm. 1 year after the surgical treatment of ophthalmoscopy in 3 eyes (3.8 per cent) were visualized macular edema. The thickness of the retina according to the OCT in these eyes averaged 390±15,4 µm. During examination of the patients 2 groups 1 month after surgery in 2 eyes (2.7 percent) was determined macular edema with retinal thickness in average 420,0 microns. 3 months after surgical treatment in 2 eyes (2.7 percent) was determined macular edema with retinal thickness in microns in average 398,0. 3 months after surgical treatment in 2 eyes (2.7 percent) was determined macular edema with retinal thickness in microns in average 398,0. During the examination of patients 6 months after surgical treatment in 2 eyes (2.7 percent) was determined macular edema with retinal thickness on average of 415.3 microns. 1 year after operative treatment of macular edema is not detected The studies revealed femtosecond cataract surgery reduces the rate of postoperative complications. After performing FEC macular edema develops within 1, 3, 6 months and 1 year of follow-up in 6,0%, 6,0%, 12,0%, 3,8% of the cases, respectively. After the FEC with femtosekond support macular edema develops only in the period of 1 and 3 months and is 2.8%. Performing phacoemulsification of cataract with femtosekond support allows to reduce the frequency of macular edema in term 1 and 3 months. In the observation period of 6 months and 1 year macular edema did not develop.