Офтальмохирургия. 2018; : 6-12
Особенности диафрагмальной функции радужки при фемтосекундном лазерном сопровождении факоэмульсификации на фоне применения различных нестероидных противовоспалительных средств
https://doi.org/10.25276/0235-4160-2018-1-6-12Аннотация
Цель. На основе клинического исследования выявить оптимальный для профилактики интраоперационного миоза нестероидный противовоспалительный препарат, определить факторы, предрасполагающие к интраоперационному миозу при ФЛСФЭ.
Материал и методы. Проведено проспективное одноцентровое исследование в четырех группах пациентов. В I и II группах (35 и 30 глаз) проводили фемтолазерное сопровождение факоэмульсификации (ФЛСФЭ) на фоне применения препарата бромфенак 0,09% и индометацин 0,1% соответственно. В III и IV группах (28 и 34 глаз) проводили стандартную факоэмульсификацию (ФЭ) на фоне применения аналогичных препаратов. Площадь зрачка рассчитывали в программе Image J версии 2.0. Корреляционный анализ проводился путем объединения двух групп между интраоперационными показателями ФЛСФЭ и диаметром зрачка, зарегистрированным на 5 этапах ФЛСФЭ до ФЛС (диаметр зрачка на первом этапе фоторегистрации – I∅), непосредственно перед ФЭ (II∅), после введения вискоэластика (III∅), на этапе аспирации-ирригации хрусталиковых масс (IV∅), после завершения операции (V∅).
Результаты.В I группе у одного пациента было зарегистрировано клинически значимое сужение зрачка 2 степени (КЗСЗ 2) (посткапсулотомический край под радужкой). В группе II у 5 пациентовбыло зарегистрировано КЗСЗ 2 на различных этапах ФЛСФЭ, при этом минимальный диаметр зрачка составил 4,0 мм (один случай –
IV∅ и один –V∅).
Выявлены взаимосвязи II∅ с ВГД через 15 минут (r=-0,42; p<0,05), III∅ – с ВГД, зарегистрированным сразу после ФЛС и через 15 минут (r=-0,38; p<0,05; r=-0,35; p<0,05 соответственно), V∅ – с ВГД, зарегистрированным сразу после ФЛС и через 15 минут (r=-0,45; p<0,001; r=-0,43; p<0,001 соответственно). Выявлены слабые отрицательные корреляционные взаимосвязи сужения зрачка с возрастом пациента.
Заключение. Более стабильный интраоперационный мидриаз наблюдается при ФЛСФЭ на фоне предоперационного применения препарата бромфенак 0,09% по сравнению с препаратом индометацин 0,1%.
Выявлены группы риска, подверженные интраоперационному миозу после ФЛС, а именно лица старшей возрастной группы, лица с изначально узкими зрачками, у которых паттерн передней капсулотомии будет приближен к краю зрачка. Определенны факторы риска, которые являются триггером миоза – флюктуация ВГД в промежутке непосредственно после ФЛС и до 15 минут после операции.Список литературы
1. Малюгин Б.Э., Шпак А.А., Морозова Т.А. Хирургия катаракты: клинико-фармакологические подходы. – М.: Офтальмология, 2015. – 82 с.
2. Bergstrom S., Ryhage R., Samuelsson B., Sjovall J.
3. The structure of prostaglandin E F1 and F2 // Acta Chem Scand. – 1962. – Vol. 16. – P. 501-502.
4. Chen H., Lin H., Chen W. et al. Topical 0.1% bromfenac sodium for intraoperative miosis prevention and prostaglandin E2 inhibition in femtosecond laserassisted cataract surgery // J. Ocul. Pharmacol. Ther. – 2017. – Vol. 33, № 3. – P. 193-201.
5. Cole D.F., Unger W.G. Prostaglandins as mediators for the responses of the eye to trauma // Exp. Eye Res. – 1973. – Vol. 17. – P. 357-368.
6. Diakonis V.F., Kontadakis G.A., Anagnostopoulos A.G. et al. Effects of short-term preoperative topical ketorolac on pupil diameter in eyes undergoing femtosecond laser-assisted capsulotomy // J. Refract. Surg. – 2017. – Vol. 33. – P. 230-234.
7. Diakonis V.F., Yesilirmak N., Sayed-Ahmed I.O. et al. Effects of femtosecond laser-assisted cataract pretreatment on pupil diameter: a comparison between three laser platforms // J. Refract. Surg. – 2016. – Vol. 32. – P. 84-88.
8. Donnenfeld E.D., Whitaker J.S., Jackson M.A., Wittpenn J. Intracameral ketorolac and phenylephrine effect on intraoperative pupil diameter and postoperative pain in cataract surgery // J. Cataract Refract. Surg. – 2017. – Vol. 43, № 5. – P. 597-605.
9. Duffin R.M., Camras C.B., Gardner S.K., Pettit T.H. Inhibitors of surgically induced miosis // Ophthalmol. – 1982. – Vol. 89. – P. 966-979.
10. Grob S.R., Gonzalez-Gonzalez L.A., Daly M.K. Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions // Clin. Ophthalmol. – 2014. – Vol. 8. – P. 1281-1289.
11. Jha R., Sur V., Bhattacharjee A. et al. Intracameral use of nepafenac: safety and efficacy study // Curr. Eye Res. – 2017. – P. 1-9.
12. Jun J.H., Hwang K.Y., Chang S.D., Joo C.K. Pupilsize alterations induced by photodisruption during femtosecond laser–assisted cataract surgery // J.
13. Cataract Refract. Surg. – 2015. – Vol. 41. – P. 278-285.
14. Jun J.H., Yoo Y.S., Lim S.A., Joo C.K. Effects of topical ketorolac tromethamine 0.45% on intraoperative miosis and prostaglandin E 2 release during femtosecond laser–assisted cataract surgery // J. Cataract Refract. Surg. – 2017. – Vol. 43. – P. 492-497.
15. Kiss H.J., Takacs A.I., Kranitz K. et al. One-day use of preoperative topical nonsteroidal anti-inflammatory drug prevents intraoperative prostaglandin level elevation during femtosecond laser-assisted cataract surgery // Curr. Eye Res. – 2016. – Vol. 41. – P. 1064-1067.
16. Lindstrom R.L., Loden J.C., Walters T.R. et al. Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification // Clin. Ophthalmol. – 2014. – Vol. 8. – P. 1735-1744.
17. Osher R.H., Ahmed I.I.K., Demopulos G.A. OMS302 (phenylephrine and ketorolac injection) 1%/0.3% to maintain intraoperative pupil size and to prevent postoperative ocular pain in cataract surgery with intraocular lens replacement // Expert Rev. Ophthalmol. – 2015. – Vol. 10. – P. 91-103.
18. Peneva P.T. Non-steroidal anti-inflammatory drugs for topical ophthalmic administration: contemporary trends // Int. J. Pharm. Sci. – 2015. – Vol. 7. –P. 13-19.
19. Sawa M., Masuda K. Topical indomethacin in soft cataract aspiration // Jpn. J. Ophthalmol. – 1976. – Vol. 20. – P. 514-519.
20. Suan A.L.L., Hamzah J.C., Ken T.S., Mansurali V.N. Intracameral mydriatics versus topical mydriatics in pupil dilation for phacoemulsification cataract surgery // J. Cataract Refract. Surg. – 2017. – Vol. 43. – P. 1031-1035.
21. Waitzman M.B., King C.D. Prostaglandin influences on intraocular pressure and pupil size // Am. J. Physiol. – 1967. – Vol. 212. – P. 329-334.
22. Walters T.R., Goldberg D.F., Peace J.H. et al. Bromfenac ophthalmic solution 0.07% dosed once daily for cataract surgery: results of 2 randomized controlled trials // Ophthalmol. – 2014. – Vol. 121. – P. 25-33.
Fyodorov Journal of Ophthalmic Surgery. 2018; : 6-12
Iris diaphragm stability during femtosecond-laser assisted cataract surgery with various preoperative non-steroidal anti-inflammatory drugs instillations
https://doi.org/10.25276/0235-4160-2018-1-6-12Abstract
Purpose. To compare the efficacy of two different nonsteroidal anti- the conventional phacoemulsification (CPE) was performed using the inflammatory drugs for maintenance of intraoperative mydriasis and to same preoperative instillations. Pupil diameter was registered at 5 surgical define causative factors for laser-induced miosis. steps before FLACS (first pupil diameter – I∅), before phacoemulsification
Material and methods. The prospective single center investigation (II∅), after viscoinjection (III∅), at А/I of the lens cortex (IV∅), at the end included the groups I and II (35 and 30 eyes) where femtosecond laser- of the surgery (V∅). Pupil diameter was calculated in the Image J program assisted cataract surgery was carried out with bromfenac 0.09% and version 2.0. Correlation analysis was performed by uniting the groups I indomethacin 0.1% instillations. In the groups III and IV (28 and 34 eyes) and II between intraoperative parameters and pupil diameter.
Results. The second degree clinical significant miosis (CSM 2) (postcapsulotomy margin of the capsule was under the iris) was detected in one patient of the group I. In the group II – 5 patients had CSM 2 on the different steps of FLACS, the smallest diameter was 4.0 mm (one case – IV∅ and one –V∅).
There were correlations between II∅ with IOP measured after 15 minutes (r=-0.42, p<0.05), III∅ with IOP that was measured right after femtosecond laser procedure and 15 minutes later (r=-0.38, p<0.05; r=0.35, p<0.05 consecutively). V∅ correlated with IOP measured right after femtosecond laser step and IOP after 15 minutes (r=-0.45, p<0.001; r=0.43, p<0.001, respectively). Low negative correlations of intraoperative miosis were observed with age of the patients.
Conclusion. The maintenance of intraoperative mydriasis was more stable in case of bromfenac 0.09% preoperative instillations than using indomethacin 0.1%.
The patients who were older and had small pupils prior to the surgery showed a higher reduction of the pupil size. The risk factors for the intraoperative miosis were IOP spikes that occurred in the time period of 15 minutes after femtosecond laser procedure.
References
1. Malyugin B.E., Shpak A.A., Morozova T.A. Khirurgiya katarakty: kliniko-farmakologicheskie podkhody. – M.: Oftal'mologiya, 2015. – 82 s.
2. Bergstrom S., Ryhage R., Samuelsson B., Sjovall J.
3. The structure of prostaglandin E F1 and F2 // Acta Chem Scand. – 1962. – Vol. 16. – P. 501-502.
4. Chen H., Lin H., Chen W. et al. Topical 0.1% bromfenac sodium for intraoperative miosis prevention and prostaglandin E2 inhibition in femtosecond laserassisted cataract surgery // J. Ocul. Pharmacol. Ther. – 2017. – Vol. 33, № 3. – P. 193-201.
5. Cole D.F., Unger W.G. Prostaglandins as mediators for the responses of the eye to trauma // Exp. Eye Res. – 1973. – Vol. 17. – P. 357-368.
6. Diakonis V.F., Kontadakis G.A., Anagnostopoulos A.G. et al. Effects of short-term preoperative topical ketorolac on pupil diameter in eyes undergoing femtosecond laser-assisted capsulotomy // J. Refract. Surg. – 2017. – Vol. 33. – P. 230-234.
7. Diakonis V.F., Yesilirmak N., Sayed-Ahmed I.O. et al. Effects of femtosecond laser-assisted cataract pretreatment on pupil diameter: a comparison between three laser platforms // J. Refract. Surg. – 2016. – Vol. 32. – P. 84-88.
8. Donnenfeld E.D., Whitaker J.S., Jackson M.A., Wittpenn J. Intracameral ketorolac and phenylephrine effect on intraoperative pupil diameter and postoperative pain in cataract surgery // J. Cataract Refract. Surg. – 2017. – Vol. 43, № 5. – P. 597-605.
9. Duffin R.M., Camras C.B., Gardner S.K., Pettit T.H. Inhibitors of surgically induced miosis // Ophthalmol. – 1982. – Vol. 89. – P. 966-979.
10. Grob S.R., Gonzalez-Gonzalez L.A., Daly M.K. Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions // Clin. Ophthalmol. – 2014. – Vol. 8. – P. 1281-1289.
11. Jha R., Sur V., Bhattacharjee A. et al. Intracameral use of nepafenac: safety and efficacy study // Curr. Eye Res. – 2017. – P. 1-9.
12. Jun J.H., Hwang K.Y., Chang S.D., Joo C.K. Pupilsize alterations induced by photodisruption during femtosecond laser–assisted cataract surgery // J.
13. Cataract Refract. Surg. – 2015. – Vol. 41. – P. 278-285.
14. Jun J.H., Yoo Y.S., Lim S.A., Joo C.K. Effects of topical ketorolac tromethamine 0.45% on intraoperative miosis and prostaglandin E 2 release during femtosecond laser–assisted cataract surgery // J. Cataract Refract. Surg. – 2017. – Vol. 43. – P. 492-497.
15. Kiss H.J., Takacs A.I., Kranitz K. et al. One-day use of preoperative topical nonsteroidal anti-inflammatory drug prevents intraoperative prostaglandin level elevation during femtosecond laser-assisted cataract surgery // Curr. Eye Res. – 2016. – Vol. 41. – P. 1064-1067.
16. Lindstrom R.L., Loden J.C., Walters T.R. et al. Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification // Clin. Ophthalmol. – 2014. – Vol. 8. – P. 1735-1744.
17. Osher R.H., Ahmed I.I.K., Demopulos G.A. OMS302 (phenylephrine and ketorolac injection) 1%/0.3% to maintain intraoperative pupil size and to prevent postoperative ocular pain in cataract surgery with intraocular lens replacement // Expert Rev. Ophthalmol. – 2015. – Vol. 10. – P. 91-103.
18. Peneva P.T. Non-steroidal anti-inflammatory drugs for topical ophthalmic administration: contemporary trends // Int. J. Pharm. Sci. – 2015. – Vol. 7. –P. 13-19.
19. Sawa M., Masuda K. Topical indomethacin in soft cataract aspiration // Jpn. J. Ophthalmol. – 1976. – Vol. 20. – P. 514-519.
20. Suan A.L.L., Hamzah J.C., Ken T.S., Mansurali V.N. Intracameral mydriatics versus topical mydriatics in pupil dilation for phacoemulsification cataract surgery // J. Cataract Refract. Surg. – 2017. – Vol. 43. – P. 1031-1035.
21. Waitzman M.B., King C.D. Prostaglandin influences on intraocular pressure and pupil size // Am. J. Physiol. – 1967. – Vol. 212. – P. 329-334.
22. Walters T.R., Goldberg D.F., Peace J.H. et al. Bromfenac ophthalmic solution 0.07% dosed once daily for cataract surgery: results of 2 randomized controlled trials // Ophthalmol. – 2014. – Vol. 121. – P. 25-33.
