Optimization of the Lens Nucleus Fragmentation during Phacoemulsification in Patients with Pseudoexfoliation Syndrome

Objective:Comparative analysis of the results of phacoemulsification (FEC) with the use of developed and classic technologies for fragmentation of the lens nucleus in patients with pseudoexfoliation syndrome (PES).Patients and methods.The proposed technology is gentle crushing of the lens nucleus in patients with PES, you can reduce the pressure on the fibers of the zonule, the probability of damage to the ligaments and posterior capsule of the lens based on the use of phacofragmentation original design. To determine the radius of curvature of the working part of the tool a morphometrical measurement of the curvature of the equatorial zone of the lens cores removed during extracapsular and intracapsular cataract extraction in patients with PEX subluxation of the lens was carried out. A comparative analysis of the operation and the results of surgical treatment of cataract in patients with PEX with the use of the proposed (n = 58) and standard (n = 56) technologies of the nucleus fragmentation in phacoemulsification was made. The following ultrasound parameters were estimated: the average capacity in % (AVEUS), the average values of the absolute time ultrasound (APT) and average values of effective (EPT) time of ultrasound, in seconds, during phacoemulsification; structural-morphological changes in the posterior epithelium of the cornea according to the endothelial microscopy; the frequency and nature of complications, the visual acuity.Results.Morphometry of the lens nuclei in patients with pseudoexfoliation syndrome allowed to determine the average radius of curvature of the nucleus equator, which is made up 2.89 ± 0.14 mm, according to the performance curve of the Gauss — 2.895– 3.530 mm. These data are taken into account when selecting the radius of curvature of the working part of phacofragmentation (the radius of curvature of 3.0 mm) used with FEC in patients with PES (Patent RU152761 from 25.05.2015). The proposed chopper due to the conformity of the working part curvature of the tool and the Equatorial zone of cataract kernel can reliably capture and grind it, thus eliminating excessive pressure on the ligaments of the crystalline lens in patients with PES. Developed technology contributes to significantly reduction of the energy performance of ultrasound: AVEUS — 2.64–10.00 %; APT — 3.38–14.00 %; EPT — on 3.76– 16.00 % by 6.76 % in patients with different of the lens nucleus density degree, decrease operative and postoperative complications twice, 1.5 times less cell loss back the corneal epithelium. Visual acuity without correction from the first days after surgery was higher than 0.5 (average of 0.70 ± 0.05) in all the patients and increased to an average of 0.91 ± 0.01 within 12 months in patients of the main and 0.85 ± 0.02 — control groups.Conclusion.The developed technology of fragmentation of the lens nucleus reduces the time of phacoemulsification, reduces the ultrasound load, causes a smaller loss of cells at the back of the corneal epithelium, reduces the possible complications of the iris and ciliary body, which increases the efficiency of surgical treatment of cataract in patients with PEX.

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Morphological features of hyperplastic prostate tissue in patients with chronic prostatitis

Experimental and Сlinical Urology ◽

10.29188/2222-8543-2020-13-4-82-88 ◽

2020 ◽

Vol 13 (4) ◽

pp. 82-88

Author(s):

I.A. Aboyan ◽

◽

A.N. Tolmachev ◽

S.I. Lemeshko ◽

◽

...

Keyword(s):

Comparative Analysis ◽

Surgical Treatment ◽

Chronic Prostatitis ◽

Inflammatory Process ◽

Morphological Changes ◽

Prostatic Hyperplasia ◽

Prostate Tissue ◽

Hyperplastic Tissue ◽

Laser Enucleation ◽

Transvesical Adenomectomy

Introduction. Benign prostatic hyperplasia (BPH) is a common disease wich is characterized by the proliferation of periurethral prostate glandular tissue. Infectious and inflammatory processes in the prostate play an important role in proliferation and hyperplasia, causing a significant deterioration in prostate metabolism and proliferation acceleration. This leads to progressive growth of the hyperplastic tissue in the prostate gland (PG). Тhe aim of study was to perform a comparative analysis of morphological changes in prostate hyperplastic tissue in patients with chronic prostatitis, who underwent various types of surgical treatment for BPH. Materials and methods. A comparative analysis of morphological changes in prostate tissue was performed, using a material from 276 patients with chronic prostatitis and BPH, who underwent various types of surgical treatment. The patients were divided into three groups: group I (n = 50) - patients who underwent surgical transvesical adenomectomy, group II (n = 76) - patients who underwent transurethral resection of the prostate (TURP) and group III (n = 150) - men who underwent holmium laser enucleation of the prostate. Fragments of the removed prostate tissue were fixed with neutral 10% formalin. The tissue samples were numerated automatically, using DIAPATH Donatello processor. Microscopic examination was carried out using a light microscope ZEISS «Axioskop 40» (eyepiece x 10, objectives x 5, x 10, x 20, x 40, 100). Results. Morphological features of resected prostate from patients with BPH and from patients with its combination with chronic bacterial inflammation were analyzed. The morphological picture varies from acute purulent inflammation to pronounced chronic lymphoplasmacytic inflammation around the acini. The features of morphological changes in the prostate after transvesical adenomectomy, TURP and laser enucleation were also studied. It was shown, that against the background of a chronic infectious and inflammatory process as well as a gross cicatricial process in the prostate, the organ anatomy, as well as the architectonics of vessels are disrupted, which can lead to a decrease in surgical treatment effectiveness. Discussion. In the majority of patients with BPH histological examination reveals a lymphoplasmacytic reaction of varying severity, which causes anatomical abnormalities and microcirculation deterioration. This condition significantly increases the risk of postoperative complications, requiring long-term conservative therapy and sometimes another surgical intervention. Conclusions. Against the background of a chronic infectious and inflammatory process, a gross cicatricial process in the prostate, its anatomy as well as vessel architectonics become disrupted, leading to a decrease in the effectiveness of surgical treatment. In the comparative study of morphological characteristics after various types of surgical procedures, it was revealed that the least significant changes were detected after laser enucleation of prostatic hyperplasia.

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Advantages of Femto-assistance in the surgical treatment of cataracts associated with glaucoma and pseudoexfoliation syndrome

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2018-5-28-30 ◽

2018 ◽

pp. 28-30

Author(s):

B.G. Jashi ◽

◽

S.V. Balalin ◽

Keyword(s):

Surgical Treatment ◽

Pseudoexfoliation Syndrome

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Postoperative endophthalmitis

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-185-187 ◽

2021 ◽

pp. 185-187

Author(s):

I.A. Frolychev ◽

◽

N.A. Pozdeyeva ◽

◽

...

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Silicone Oil ◽

Angiogenesis Inhibitor ◽

Cataract Extraction ◽

State Institution ◽

Federal State ◽

Postoperative Endophthalmitis ◽

Ophthalmic Surgery ◽

Corrected Visual Acuity

Surgical treatment of postoperative endophthalmitis is an urgent problem of ophthalmic surgery. Purpose.The aim of the study was to analyze the results of treatment of patients with postoperative endophthalmitis using perfluorodecalin and antibiotic solutions for vitreal cavity tamponade. Materials and methods. For the period 2016-2020, 35 patients (35 eyes) were operated in the Cheboksary branch of the S. Fyodorov Eye Microsurgery Federal State Institution. In 26 patients, this complication occurred after cataract extraction, in 7 after vitreoretinal operations, in 2 after intravitreal administration of an angiogenesis inhibitor. Visual acuity before treatment of endophthalmitis in 3 patients was to 0.02– 0.08, in 16 – counting of fingers in the face, in 13 – pr.l.certa, in 3-pr. l. incerta. All patients underwent vitrectomy with perfluorodecalin tamponade of the vitreal cavity for up to 14 days and intravitreal administration of vancomycin 1 mg and ceftazidime 2.25 mg at the end of the operation. On day 2-3, all patients underwent additional intravitreal administration of antibiotics, depending on the detected pathogen. Further, in 22 patients, the removal of perfluorodecalin and the remaining preretinal and peripherally located exudate was performed, in 13 patients - tamponade of the vitreal cavity with silicone oil. Results. As a result of the treatment according to the developed method, it was possible to preserve visual functions in 32 patients (91%) out of 35. At discharge, the corrected visual acuity was from 0.1 to 0.7 (0.28±0.2). After 6 months, the corrected visual acuity in 32 patients was from 0.1 to 0.9 (0.36±0.2). Visual acuity (above 0.3) was achieved in 26 cases (74.3%). Conclusion. Clinical results demonstrate the effectiveness of the developed method of surgical treatment of endophthalmitis. Key words: postoperative endophthalmitis, perfluorodecalin, intravitreal administration of vancomycin and ceftazidime.

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Clinical analysis and efficacy of bimanual surgical treatment of retinal detachment in severe forms of proliferative diabetic retinopathy with preoperative preparation with anti-VEGF drugs in combination with the use of the Ngenuity ALCON 3D imaging system

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-195-198 ◽

2021 ◽

pp. 195-198

Author(s):

D.V. Chernykh ◽

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Surgical Treatment ◽

Retinal Detachment ◽

Postoperative Period ◽

3D Imaging ◽

Imaging System ◽

3D Visualization ◽

Preoperative Preparation ◽

Anti Vegf

The purpose of the study was to evaluate the effectiveness of bimanual surgery with anti-VEGF preparation of patients with severe forms of PDR complicated by traction retinal detachment, with intraoperative use of 3D visualization. Material and methods. Operated on 18 patients with a diagnosis of PDR complicated by traction retinal detachment. Of these, there were 7 patients with type 1 diabetes, type 2 diabetes. There were 5 men and 13 women. The average age was 58 + -2 years. All patients underwent a three-port vitrectomy, using an additional light source, with preoperative preparation with anti-VEGF drugs, using bimanual technique and 3D visualization, using air tamponade. Results and its discussion. As a result of the study, it was found that the visual acuity before the treatment was 0.03 [0.01; 0.1], and 4-6 months after the surgical treatment, 0.3 [0.15; 0.5]. The performed statistical analysis made it possible to establish a statistically significant increase in visual acuity 4-6 months after the treatment. (p = 0.001) Achieved complete anatomical retinal fit. With increased visual acuity. There were 5 complications in the postoperative period. Recurrent hemophthalmos was diagnosed in 3 people, which required repeated surgical intervention. In 2 patients in the postoperative period, DMO developed, which required IVI biodegradable dexamethasone implant. Conclusion. Bimanual, surgical treatment of traction retinal detachments, in severe forms of PDLP, with preoperative preparation with anti-VEGF drugs, and the use of the Ngenuity ALCON 3D imaging system, is one of the effective methods of treatment in this group of patients, and is aimed at reducing both intra and postoperative complications. Key words: рroliferative diabetic retinopathy, vitrectomy, 3D imaging, bimanual surgery, anti-VEGF drugs.

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Cytological substantiation of application of vacuum therapy in combustiology

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-6-44-49 ◽

2021 ◽

Vol 179 (6) ◽

pp. 44-49

Author(s):

S. B. Bogdanov ◽

D. N. Marchenko ◽

K. C. Pavlyk ◽

O. V. Gospirovish ◽

E. A. Artemova ◽

...

Keyword(s):

Comparative Analysis ◽

Surgical Treatment ◽

Cytological Study ◽

Scientific Research Institute ◽

Vacuum Therapy ◽

Cytological Analysis ◽

Burn Wound ◽

Burn Wounds ◽

Healing Wounds ◽

Clinic Hospital

The OBJECTIVE was to perform a comparative cytological analysis of the wound exudate in healing wounds during autodermoplasty on a granulating burn wound with and without vacuum therapy.METHODS AND MATERIALS. The article presents the results of the cytological study substantiated the use of vacuum therapy in combustiology. The comparative analysis was performed in 2 groups of patients. The first group consisted of patients with granulating burn wounds, who underwent surgical treatment with vacuum therapy. The second group consisted of patients who underwent surgical treatment without vacuum therapy. In both groups, the complex of surgical treatment included autodermoplasty on a granulating burn wound. All the patients were treated in the Burn Department of the «Scientific research institute – Ochapovsky regional clinic hospital № 1».RESULTS. The application of vacuum-associated dressings in the surgical treatment of patients in burn hospitals helps to reduce the time of graft retention in the plasty of granulating burn wound, decrease the number of dressings and the amount of dressing material, reduce the time of treatment of patients.CONCLUSION. The obtained cytological results allow us to justify the application of vacuum therapy in the surgical treatment of granulating burn wounds.

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CO2-lézerrel végzett mélysclerectomiával szerzett tapasztalatok

Orvosi Hetilap ◽

10.1556/650.2017.30754 ◽

2017 ◽

Vol 158 (18) ◽

pp. 701-705 ◽

Cited By ~ 2

Author(s):

Zoltán Sohajda ◽

Ildikó Káldi ◽

Magdolna Kiss ◽

Andrea Facskó

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Surgical Treatment ◽

Open Angle Glaucoma ◽

Medication Use ◽

Open Angle

Abstract: Introduction: CO2 laser- assisted sclerectomy surgery (CLASS) can be used for the surgical treatment of open-angle glaucoma. Aim: To introduce our results with CLASS. Method: We performed 21 CLASS operations using OT-134-IOPtiMate (IOPtima Ltd, Ramat-Gan, Israel). Patients were examined on the 1st day, and in the 1st, 3rd, 6th, 9th and 12th months postoperatively. We evaluated intraocular pressure (IOP), antiglaucomatous medication-use, visual acuity, complications. Results: Mean age was 65.6 yrs. Complete success (no hypotensive medication required to target IOP) was achieved in 61.1% (18 patients) at 6 months, whereas in 50% (10 patients) at 12 months. Qualified success (hypotensive medication required to target IOP) was achieved in 72.2% and in 70%, preoperative mean IOP was 29.2 ± 9.4 Hgmm, which falled to 17.7 ± 4.9 Hgmm and 17.3 ± 4.3 Hgmm, respectively. Antiglaucomatous medication use falled significantly from 2.90 ± 0.83 to 2.05 ± 1.46. Apart from 1 macroperforation, no serious complication occurred. Conclusions: With CLASS it is possible to effectively lower intraocular pressure in open-angle glaucoma. Orv Hetil. 2017; 158(18): 701–705.

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Surgical Treatment of Persistent Fetal Vasculature and Visual Rehabilitation: One-Year Followup

Case Reports in Medicine ◽

10.1155/2012/687081 ◽

2012 ◽

Vol 2012 ◽

pp. 1-2

Author(s):

N. Kozeis ◽

K. T. Tsaousis ◽

D. Gidaris

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Hand Movement ◽

Good Prognosis ◽

Posterior Chamber ◽

Visual Rehabilitation ◽

Postoperative Course ◽

Persistent Fetal Vasculature ◽

One Year ◽

The One

We present the management and postoperative course of a persistent fetal vasculature (PFV) case. A four-year-old girl visited the Eye Department of Hippokration, General Hospital of Thessaloniki due to reduced visual acuity of her left eye. She was diagnosed with PFV and underwent surgery (lensectomy, capsulorhexis of the posterior capsule, insertion of an intraocular lens in the posterior chamber, and posterior vitrectomy) in order to dissect the PFV. Along with the postoperative medical care, she underwent intensive treatment for amblyopia. The postoperative course was uncomplicated, and the visual acuity of her left eye improved from hand movement to 20/25 with proper correction. Patients with unilateral PFV and gradually deteriorating visual acuity could be good candidates for a combined surgical procedure, as the one described above, with a good prognosis.

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