Порівняння впливу факоемульсифікації катаракти та фемтосекундного видалення змутнілого кришталика на морфологічні зміни сітківки

Abstract

Показано вплив вибору оперативного втручання екстракції катаракти на зміни морфології сіт¬ківки макулярної зони та шару нервових волокон. У обстеженні взяли участь 32 пацієнта (39 очей), що були розподілені на дві групи у залежності від обраного виду хірургічного лікування катаракти. В результаті до¬слідження виявлено вплив факоемульсифікації катаракти на структури центральної зони сітківки, що про¬являлися потовщенням та набряку останньої. Подібного впливу при фемтосекундному видаленні катаракти не виявлено; Показано влияние выбора оперативного вмешательства экстракции катаракты на изменения морфологии сетчатки макулярной зоны и слоя нервных волокон. В обследовании приняли участие 32 паци¬ента (39 глаз), которые были распределены на две группы в зависимости от выбранного вида хирургичес¬кого лечения катаракты. В результате исследования выявлено влияние факоэмульсификации катаракты на структуры центральной зоны сетчатки, что проявлялось утолщением и развитием отека последней. Подо¬бного влияния при фемтосекундном удалении катаракты не выявлено; The aim of our study was to investigate and compare changes in the morphology of the retina after cataract surgery with the femtosecond laser and phacoemulsification. The analysis of survey data changes in the retina in 32 patients (39 eyes) in age from 39 to 86 years old, which had cataracts II-IV degree of density. All patients were divided into two groups depending on the type of surgery. The first group included 11 patients (19 eyes), of which 4 patients (8 eyes) were identified naprelan signs of diabetic retinopathy. The second group consisted of 21 patients (21 eyes), 9 of whom had a complicated ocular history - the presence of diabetic retinopathy naprelan stage. Patients of the 1st group was conducted cataract surgery on phaco machine Centurion Vision System with the help of the LenSx femtosecond laser on the basis of «New Vision”, Kiev. The usual technique is phacoemulsification was performed in patients of group 2 on phaco machine Constellation Vision System which basis on the ophthalmological department, Poltava. Comparing the postoperative thickness of the retina in both groups of patients revealed that a significantly higher level of the morphology of the retina was in the second group of patients with cataract phacoemulsification (p<0,05). The difference of the average values of the macular region between the groups in the period of 1 month is 12 microns. The retinal thickness of macular region in the second group of patients statistically significantly increased by 29 microns 1 month after surgery. Morphological changes in the retina in patients of the 1st group is not identified, the growth rate of the retinal thickness was 6 microns, which is statistically and clinically not significant. The study revealed the influence of cataract phacoemulsification on the structure of the СЄП^І zone of the retina, which was manifested by thickening and swelling. Edema of the macular area was observed in 4 patients (19% of the total number of patients). Similar effects in femtosecond cataract surgery is not revealed. Removing the cataract using a femtosecond laser is modern and safer type of surgery, as evidenced by the lack of morphological changes in the macular area in the postoperative period. Operation phacoemulsification cataract causes thickening of the retina, especially in patients with existing co-morbidities, diabetic retinopathy. Effect of surgery on the condition of the nerve fibers were detected in any of the suggested methods of surgical treatment of cataracts. Statistically significant changes in the nerve fiber layer is not recorded in any of the groups in all periods of observation. Morphological changes in the form of atrophy or thickening of nerve fibers were not identified in any patient. The increase in the thickness of this decreased 1 month after surgery in patients of the 1st group was 6 microns, patients of the 2nd group and 4.6 microns, which is statistically significant. Another goal is to extend the research on these groups of patients and study the influence of the state on the hyaloid membrane and progress of macular edema area after cataract removal.