Офтальмохирургия. 2014; : 14-20
КЛИНИЧЕСКИЙ АНАЛИЗ ОСЛОЖНЕНИЙ ФАКОЭМУЛЬСИФИКАЦИИ С ФЕМТОЛАЗЕРНЫМ СОПРОВОЖДЕНИЕМ И ОСОБЕННОСТИ ПРОВЕДЕНИЯ ФАКОЭМУЛЬСИФИКАЦИИ ПОСЛЕ ФЕМТОЭТАПА
https://doi.org/undefinedАннотация
Цель. Оценка осложнений, возникающих при проведении фемтолазерного этапа с последующей факоэмульсификацией катаракты, и выработка методов борьбы с ними.
Материал и методы. Операции выполнялись в период с октября2012 г. по август2014 г. В исследования включены 815 пациентов (1239 глаз). Фемтолазерный этап осуществлялся с использованием фемтолазерной установки Victus компании Valeant (США). Факоэмульсификация катаракты проводилась по стандартной бимануальной технологии на аппарате Stellaris компании Valeant (США)
Результаты. Осложнения, связанные с фемторазрезами: разгерметизация фемторазрезов во время перехода пациента из одной операционной в соседнюю – 0% случаев; во время факоэмульсификации катаракты: отслойка десцеметовой оболочки в области парацентезов – 2 (0,2%); в области основного разреза – 9 (0,7%), термический ожог в области основного разреза – 3 (0,2%, при плотности ядра 4+). В послеоперационном периоде: гипотония – 3 (0,2%, при комбинированном вмешательстве), измельчение или отсутствие передней камеры – 0%. В ходе фемтокапсулотомии: 1133 (91%) флотирующего фрагмента, 101 (8%) плотноприлежащего фрагмента с завершенной капсулотомией, радиальных разрывов капсулотомии – 0%. Наблюдалось 5 (0,4%) случаев капсулотомии с образованием мостиков, 3 (0,2%) – в результате подвывиха хрусталика в начале освоения методики. Потеря вакуума – 3 случая. Интраи послеоперационное ВГД показало безопасные значения флюктуации. Не отмечено ни одного случая реактивного миоза на фоне применения мидриатиков из группы блокаторов М-холинорецепторов. Внутрикапсульная блокада с разрывом задней стенки капсулы – 0%. Разрыв задней капсулы – 2 (0,2%), ОСО – 18 (1,5%), иридоциклит – 19 (1,5%), эндофтальмит – 0%, гифемы – 0%, дислокации ядра или фрагментов хрусталика в витреальную полость – 0%. Изменение толщины макулярной области сетчатки не показало значительного утолщения.
Заключение. 1. Важно применение НПВС-препаратов и отдельных групп мидриатиков уже за день до операции во избежание эффекта сужения зрачка в ответ на фемтолазерное воздействие. 2. Исключение слишком беспокойных пациентов с очень узкой глазной щелью, рекомендовано отменять фемтоэтап при мидриазе менее5 мм. 3. Осуществление профилактики формирования капсульного блока с помощью интраоперационного выпускания ретраи интрахрусталиковых пузырьков газа перед этапом гидродиссекции или его исключение.
Список литературы
1. Анисимова С.Ю., Анисимов С.И., Новак И.В. и др. Комбинированная непроникающая глубокая склерэктомия и факоэмульсификация с фемтосопровождением у больных с катарактой и глаукомой // Глаукома. – 2014. – № 3. – С. 63-68.
2. Alio J.l., Soria F., Abdou A.A. Femtosecond laser assisted cataract surgery followed by coaxial phacoemulsification or microincisional cataract surgery: differences and advantages // Curr. Opin. Ophthalmol. – 2014. – Vol. 25. – P. 81-88.
3. Bodnar Z., Clouser S., Mamalis N. Toxic anterior segment syndrome: Update on the most common causes // J. Cataract Refract. Surg. – 2012. – Vol. 38. – P. 19021910.
4. Brian G., Taylor H. Cataract blindness – challenges for the 21st century // Bull World Health Org. – 2001. – Vol. 79. – P. 249-256.
5. Chang J. S., Chen I.N., Chan W.M. et al. Initial evaluation of a femtosecond laser system in cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 29-36.
6. 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.
7. Conrad-Hengerer I., Hengerer F.H., Joachim S.C. et al. Femtosecond laser-assisted cataract surgery in intumescent cataracts // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 44-50.
8. Daya S.M., Nanavaty M.A., EspinosaLagana M.M. Translenticular hydrodissection, lens fragmentation, and influence on ultrasound power in femtosecond laser-assisted cataract surgery and refractive lens exchange // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 37-43.
9. Donaldson K.E., Braga-Mele R., Cabot F. et al. Femtosecond laser-assisted cataract surgery // J. Cataract Refract. Surg. – 2013. – Vol. 39. – P. 1753-1763.
10. Ecsedy M., Mihaltz K., Kovacs I. et al. Effect of femtosecond laser cataract surgery on the macula // J. Refract. Surg. – 2011. – Vol. 27. – P. 717-722.
11. Federica Gualdi Femtolaser cataract surgery. – 2014. – P. 50-67.
12. Gimbel H.V. The effect of treatment with topical nonsteroidal anti-inflammatory drugs with and without intraoperative epinephrine on the maintenance of mydriasis during cataract surgery // Ophthalmology. – 1989. – Vol. 96. – P. 585-588.
13. Hatch K.M., Talamo J.H. Laser-assisted cataract surgery: benefits and barriers // Curr. Opin. Ophthalmol. – 2014. – Vol. 25. – P. 54-61.
14. Hodge C., Bali S.J., Lawless M. et al. Femtosecond cataract surgery: A review of current literature and the experience from an initial installation // Saudi J. Ophthalmol. – 2012. – Vol. 26. – P. 73-78.
15. Kerr N.M., Abell F.G., Vote B.J., Toh T. Intraocular pressure during femtosecond laser pretreatment of cataract. // J. Cataract Refract. Surg. – 2013. – Vol. 39. – P. 339-342.
16. Lubahn J.G., Kankariya V.P., Yoo S.H. Grid pattern delivered to the cornea during femtosecond laser-assisted cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 496-497.
17. Matsuo T. Prostaglandins F2alpha and E2 in aqueous humor of patients with cataract surgery // J. Ocul. Pharmacol. Ther. – 2004. – Vol. 20. – P. 101-106.
18. Nagy Z.Z. New technology update: femtosecond laser in cataract surgery // Clin. Ophthalmol. – 2014. – Vol. 8. – P. 1157-1167.
19. Nagy Z.Z., Ecsedy M., Kovács I. et al. Macular morphology assessed by optical coherence tomography image segmentation after femtosecond laser-assisted and standard cataract surgery // J. Cataract Refract. Surg. – 2012. – Vol. 38. – P. 941-946.
20. Nagy Z.Z., Takacs A.I., Filkorn T. et al. Complications of femtosecond-assisted cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 20-28.
21. Nagy Z.Z., Takacs A. I., Filkorn T., Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery // J. Refract. Surg. – 2009. – Vol. 25. – P. 1053-1060.
22. Roberts T.V., Lawless M., Bali S.J. et al. Surgical outcomes and safety of femtosecond laser cataract surgery; a prospective study of 1500 consecutive cases // Ophthalmology. – 2013. – Vol. 120. – P. 227-233.
23. Roberts T.V., Sutton G., Lawless M.A. et al. Capsular block syndrome associated with femtosecond laser–assisted cataract surgery // J. Cataract Refract. Surg . – 2011. – Vol. 37. – P. 2068-2070.
24. Schultz T., Dick B. Suction loss during femtosecond laser-assisted cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 493-495.
25. Schultz T., Joachim S.C., Kuehn M., Dick B.H. Changes in prostaglandin levels in patients undergoing femtosecond laser-assisted cataract surgery // J. Refract. Surg. – 2013. – Vol. 29. – P. 742-747.
26. Tomalla M. Femtosecond laser – Principles and application in ophthalmology. – Bremen: Uni-Med, 2010. – P. 29.
27. Trikha S., Turnbull A.M.J., Morris R.J. et al. The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn? // Eye. – 2013. – Vol. 27. – P. 461-473.
28. Yeoh R. Hydrorupture of the posterior capsule in femtosecond laser cataract surgery // J. Cataract Refract. Surg. – 2012. – Vol. 38. – P. 730.
Fyodorov Journal of Ophthalmic Surgery. 2014; : 14-20
CLINICAL ANALYSIS OF COMPLICATIONS AND SPECIAL FEATURES OF FEMTOSECOND LASER-ASSISTED CATARACT SURGERY
https://doi.org/undefinedAbstract
Purpose. To estimate the number and type of complications during the femtosecond laser assisted cataract surgery and to develop methods of decreasing them.
Material and methods. The operation was performed in the period from October 2012 to August 2014. The study included 815 patients (1239 eyes). The mean age was 69.1±6.1 years (M±m). The femtosecond laser assisted step was realized using the Victus femtolaser, Valeant Co. (USA). Cataract phacoemulsification was carried out by standard techniques by means of the Stellaris device of Valeant Company,USA.
Results. Complications associated with the femtosecond laser cuts: corneal femto cuts depressurization during the transition of the patient from one operating room to another – 0%, during phacoemulsification cataract surgery: detachment of Descemet’s membrane in the paracentesis – 2 (0.2%), in the main section – 9 (0.7%), thermal burns in the main section – 3 (with the nucleus density: grade 4+ cataract) (0.2%). Postoperative hypotension – 3 (0.2%) in the combined intervention with glaucoma surgery. Milling or absence of the anterior chamber of 0%. During the anterior capsulotomy 1133 (91%) a floating track, 101 (8%) clued fragment with a complete capsulotomy, radial gaps of capsulotomy 0%. 3 (0.2%) as a result of lens subluxation starting the technique mastering. There were 5 cases (0.4%) of capsulotomy forming 3 bridges (0.2%). Loss of vacuum occurred in 3 cases. Intraand postoperative IOP elevation was not significant. Capsular blockage – 0%. Posterior capsular tear – 2 (0.2%). Choroidal detachment – 18 (1.5%), iridocyclitis – 19 (1.5%). There was no case of endophthalmitis (0%), hyphema (0%), nuclear or lens fragments dislocation into vitreous cavity (0%). The macular area of the retina showed no significant thickening.
Conclusion. 1. It is important to use an NSAID drugs and individual mydriatics groups already one day before the surgery to prevent the narrowing of the pupil in response to the femtosecond laser impact. 2. Exclusion too restless patients with very narrow eyelid margin and deep-set eye. We also recommend to cancel the femtosecond laser step when mydriasis is less than 5mm. 3. Prevention of formation of capsular block syndrome using intra-operative release of gas bubbles before the hydrodissection or its exception.
References
1. Anisimova S.Yu., Anisimov S.I., Novak I.V. i dr. Kombinirovannaya nepronikayushchaya glubokaya sklerektomiya i fakoemul'sifikatsiya s femtosoprovozhdeniem u bol'nykh s kataraktoi i glaukomoi // Glaukoma. – 2014. – № 3. – S. 63-68.
2. Alio J.l., Soria F., Abdou A.A. Femtosecond laser assisted cataract surgery followed by coaxial phacoemulsification or microincisional cataract surgery: differences and advantages // Curr. Opin. Ophthalmol. – 2014. – Vol. 25. – P. 81-88.
3. Bodnar Z., Clouser S., Mamalis N. Toxic anterior segment syndrome: Update on the most common causes // J. Cataract Refract. Surg. – 2012. – Vol. 38. – P. 19021910.
4. Brian G., Taylor H. Cataract blindness – challenges for the 21st century // Bull World Health Org. – 2001. – Vol. 79. – P. 249-256.
5. Chang J. S., Chen I.N., Chan W.M. et al. Initial evaluation of a femtosecond laser system in cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 29-36.
6. 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.
7. Conrad-Hengerer I., Hengerer F.H., Joachim S.C. et al. Femtosecond laser-assisted cataract surgery in intumescent cataracts // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 44-50.
8. Daya S.M., Nanavaty M.A., EspinosaLagana M.M. Translenticular hydrodissection, lens fragmentation, and influence on ultrasound power in femtosecond laser-assisted cataract surgery and refractive lens exchange // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 37-43.
9. Donaldson K.E., Braga-Mele R., Cabot F. et al. Femtosecond laser-assisted cataract surgery // J. Cataract Refract. Surg. – 2013. – Vol. 39. – P. 1753-1763.
10. Ecsedy M., Mihaltz K., Kovacs I. et al. Effect of femtosecond laser cataract surgery on the macula // J. Refract. Surg. – 2011. – Vol. 27. – P. 717-722.
11. Federica Gualdi Femtolaser cataract surgery. – 2014. – P. 50-67.
12. Gimbel H.V. The effect of treatment with topical nonsteroidal anti-inflammatory drugs with and without intraoperative epinephrine on the maintenance of mydriasis during cataract surgery // Ophthalmology. – 1989. – Vol. 96. – P. 585-588.
13. Hatch K.M., Talamo J.H. Laser-assisted cataract surgery: benefits and barriers // Curr. Opin. Ophthalmol. – 2014. – Vol. 25. – P. 54-61.
14. Hodge C., Bali S.J., Lawless M. et al. Femtosecond cataract surgery: A review of current literature and the experience from an initial installation // Saudi J. Ophthalmol. – 2012. – Vol. 26. – P. 73-78.
15. Kerr N.M., Abell F.G., Vote B.J., Toh T. Intraocular pressure during femtosecond laser pretreatment of cataract. // J. Cataract Refract. Surg. – 2013. – Vol. 39. – P. 339-342.
16. Lubahn J.G., Kankariya V.P., Yoo S.H. Grid pattern delivered to the cornea during femtosecond laser-assisted cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 496-497.
17. Matsuo T. Prostaglandins F2alpha and E2 in aqueous humor of patients with cataract surgery // J. Ocul. Pharmacol. Ther. – 2004. – Vol. 20. – P. 101-106.
18. Nagy Z.Z. New technology update: femtosecond laser in cataract surgery // Clin. Ophthalmol. – 2014. – Vol. 8. – P. 1157-1167.
19. Nagy Z.Z., Ecsedy M., Kovács I. et al. Macular morphology assessed by optical coherence tomography image segmentation after femtosecond laser-assisted and standard cataract surgery // J. Cataract Refract. Surg. – 2012. – Vol. 38. – P. 941-946.
20. Nagy Z.Z., Takacs A.I., Filkorn T. et al. Complications of femtosecond-assisted cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 20-28.
21. Nagy Z.Z., Takacs A. I., Filkorn T., Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery // J. Refract. Surg. – 2009. – Vol. 25. – P. 1053-1060.
22. Roberts T.V., Lawless M., Bali S.J. et al. Surgical outcomes and safety of femtosecond laser cataract surgery; a prospective study of 1500 consecutive cases // Ophthalmology. – 2013. – Vol. 120. – P. 227-233.
23. Roberts T.V., Sutton G., Lawless M.A. et al. Capsular block syndrome associated with femtosecond laser–assisted cataract surgery // J. Cataract Refract. Surg . – 2011. – Vol. 37. – P. 2068-2070.
24. Schultz T., Dick B. Suction loss during femtosecond laser-assisted cataract surgery // J. Cataract Refract. Surg. – 2014. – Vol. 40. – P. 493-495.
25. Schultz T., Joachim S.C., Kuehn M., Dick B.H. Changes in prostaglandin levels in patients undergoing femtosecond laser-assisted cataract surgery // J. Refract. Surg. – 2013. – Vol. 29. – P. 742-747.
26. Tomalla M. Femtosecond laser – Principles and application in ophthalmology. – Bremen: Uni-Med, 2010. – P. 29.
27. Trikha S., Turnbull A.M.J., Morris R.J. et al. The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn? // Eye. – 2013. – Vol. 27. – P. 461-473.
28. Yeoh R. Hydrorupture of the posterior capsule in femtosecond laser cataract surgery // J. Cataract Refract. Surg. – 2012. – Vol. 38. – P. 730.
