Офтальмохирургия. 2016; : 70-77
Контрастирующие вещества для хромовитрэктомии
https://doi.org/10.25276/0235-4160-2016-2-70-77Аннотация
Одной из наиболее трудных задач для хирурга и одной из основных составляющих успеха хирургического лечения является безопасное удаление прозрачного, кажущегося бесструктурным стекловидного тела (СТ) и структур витреоретинального интерфейса (ВИ): полупрозрачной внутренней пограничной мембраны (ВПМ), эпиретинальных мембран в ходе субтотальной витрэктомии. С целью интраоперационной визуализации СТ, контрастирования его нативных структур и патологически измененных участков используют биологические и синтетические красители. Пиком развития направления интравитреального введения красителей явилось возникновение в 2000 г. нового хирургического подхода – хромовитрэктомии, суть которого заключается в интраоперационном введении красителей для контрастирования структур заднего сегмента глаза. Данная методика обеспечивает лучшую визуализацию СТ и ВИ во время операции, более тщательное удаление кортикальных слоев СТ, облегчает «пилинг» ВПМ и эпиретинальных мембран, снижая риск ятрогенного повреждения сетчатки. Однако агенты для контрастирования обладают рядом побочных эффектов, и, как результат, остается немало противоречий относительно потенциальной токсичности и безопасности использования данных веществ. Несмотря на большой накопленный в этой сфере опыт, ряд вопросов, связанных со свойствами интравитреальных красителей, с взаимодействием их с окружающими анатомическими структурами, побочными действиями данных веществ, остаются нерешенными до сих пор. В настоящей статье изложено современное состояние вопроса, экспериментальные и клинические результаты использования контрастирующих веществ, дана их физико-химическая характеристика с описанием свойств, показания к использованию, способы введения, возможные побочные действия на структуры ВИ.
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Fyodorov Journal of Ophthalmic Surgery. 2016; : 70-77
Vital dyes for chromovitrectomy
https://doi.org/10.25276/0235-4160-2016-2-70-77Abstract
One of the most difficult tasks for surgeons and one of the main components of success of surgical treatment is a safe removal of transparent vitreous body, and structures of the vitreoretinal interface (VI): translucent, internal limiting membrane (ILM), epiretinal membranes during subtotal vitrectomy. Biological and synthetic dyes are used for intra-operative visualization of vitreous body, highlighting its native structures and pathologically changed sites. The peak of development of the intravitreal injection of dyes was the appearance of a new surgical approach – chromovitrectomy, in 2000. Its essence consists in the injection of intraoperative dyes for contrast enhancement of structures of the posterior segment of the eye. This technique provides a better intra-operative visualization of vitreous body and the VI, a more thorough removal of the cortical vitreous layers, simplifies the peeling of ILM and epiretinal membranes, reducing the risk of iatrogenic damage to the retina. However, contrast agents have a number of side effects, and as a result, many discrepancies regarding the potential toxicity and safety of use of these substances remains. Despite the large accumulated in this field experience, a number of issues associated with the properties
of intravitreal dyes, their interaction with the surrounding anatomical structures, side effects of these substances remain unresolved until now. It should provide adequate color difference between the stained ILM/ERM and the normal retina. Other favorable characteristics are: rapid elimination from vitreous cavity, photochemical stability, solubility in balanced salt solution, absence of toxicity and an adequate light absorption profile. Also, numerous dyes have been applied in experimental settings with promising or devastating results. This article highlights the major clinical and experimental results of currently used novel vital dyes. The aim of this article is to present the current state-of-theart in regard to the application of vital dyes during vitreoretinal surgery to overview the current literature regarding the properties of dyes, techniques of application, indications, and complications in chromovitrectomy, the surgical recommendations to minimize the risk of toxic effects.
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