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Application of the injector at implantation IOL RSP-III during phacoemulsification of cataract through a small self-sealing incision
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Rozukulov Vahid Ubaydullaevich, Republican Specialized Center of Eye Microsurgery, MD, PhD, Deputy Director for Clinical Work, Tashkent, Uzbekistan E-mail: [email protected]
Application of the injector at implantation IOL RSP-III during phacoemulsification of cataract through a small self-sealing incision
Abstract: Implantation of intraocular lens RSP-III at using the injector at rupture of the posterior capsule during the performance of phacoemulsification cataract allows stable position intraocular lens in the early and relatively distant observation periods, high levels of visual acuity with minimum values of corneal astigmatism.
Keywords: phacoemulsification, posterior capsule rupture, implantation of intraocular lens RSP-III through the injector.
Relevance
"The gold standard" of cataract surgery is ultrasound phacoemulsification cataract through a small self-sealing tunnel incision with intracapsular fixation flexible intraocular lens (IOL) [9, 345]. Application of this technology allows to achieve the minimization of injury to the eye structures. The virtual absence of postoperative corneal astigmatism due to the implementation of small self-sealing corneal incision (2.5 mm.), allows to reach high functional results early after surgery. An important factor to achieve the desired result is the initial state structures of the eye. It is obvious that the dominant factor is the safety and strength of the ligaments of the lens unit. According to the literature it is known that at outpatient screening for the level of 5-15 % of patients with cataract are breach of its integrit. According to the classification of N. P. Pashtaev on this group of patients is dominated by the first degree lens subluxation [4, 25-28; 5, 82]. It should be noted that 20 % of patients violations ligament of the lens unit is intraoperative finding that ophthalmic already preparing a flexible implant posterior chamber intraocular lens, which represents a considerable risk and it is likely luxcation of intraocular lens into the vitreous body [1, 22-23; 9, 345]. Atypical for phacoemulsification cataract can significantly increase the risk of damage to the capsular bag, provoke loss of the vitreous body, which leads to the abandonment of posterior chamber implantation intraocular lens [4, 25-28; 6, 290-293; 7, 192-195; 8, 100-102]. An this situation, the implantation technique intracapsular rings is most commonly used. Intracapsular rings spreading the capsular bag and creates tension in the areas of defects Zinn ligaments. In spite of this, this method does not solve the problem of weak ligaments, because in the future lysis of ligaments progresses and increases the risk of dislocation of the complex "capsular bag — intraocular lens — intracapsular rings". All kinds of suturing an intraocular lens or a set of "capsular bag — intraocular lens" to the iris or sclera can lead to hemorrhagic complications.
It must be remembered that in 5-7 years possible eruption of yarn or its biodegradation in the long term, which significantly increases the risk of intraocular lens dislocation into the vitreous body. Equally important is the constant mechanical pressure of the intraocular lens haptics to the ciliary body and the iris, leading to chronic cyclites and impaired hydrodynamics eye [3, 27-29]. Using a variety of techniques or implants pupil anterior chamber intraocular lens model with a wide access (5.0-6.0 mm.) traumatic, increases the possibility of the development of intra- and postoperative complications (vitreous loss, expulsive hemorrhage, endophthalmitis, a high degree of post-operative astigmatism, development of epithelial — endo-telialnoy corneal dystrophy, cystic maculopathy), with consequent whole set of problems [2, 9-11]. The postoperative astigmatism is characterized by the fact that the shape and contours of the obj ect are distorted and become fuzzy and uneven, the eyes often hurt, blush, sometimes a burning sensation is felt in eyes. Increased load on the eyes (reading, computer work) can lead to impaired vision — can seeing double, it becomes difficult to determine the distance between the objects. In addition to fatigue the eye, astigmatism can cause constant headaches. Furthermore, during the execution ofphacoemulsi-fication 0.05-1.2 % of posterior capsule rupture occurs.
In view of the above, the development of methods of selecting an intraocular lens implantation during cataract phacoemulsification with intraoperative posterior capsule rupture emerged, and in the eyes of the weakness ofligament of the lens unit is relevant, because of its solution depends on improving the quality of functional rehabilitation of patients.
Objective: to study the possibility of implantation of intraocular lens RSP-III using the injector during cataract phacoemulsification through a small self-sealing incision.
Material and methods. The object of the study were the results of phacoemulsification of 16 patients (16 eyes) with complicated cataract, at intraoperative posterior lens capsule rupture.
Section 6. Medical science
Studies of patients carried out on the basis of informed consent in accordance with international ethical requirements (Helsinki, 1975).
All patients underwent standard ophthalmic examination: autoceratorefractometers, visometry with and without correction, tonometry on Maklakov or pneumotonometry, perimetry, critical flicker fusion frequency, A-scan, B-scan, biomicroscopy, ophthalmoscopy. Status ligament of the lens unit and the degree of reduction of the support function Zinn ligaments were detected indirectly by biomicroscopy and objectively with ultrasound biomicroscopy study.
In carrying out the scientific studies used clinical, mathematical, statistical, and ultrasound biomicroscopy and medical-statistical methods.
Statistical analysis of data from clinical studies carried out by the method of variation statistics using Microsoft Excel software package, including the use of built-in statistical processing functions with the calculation of the arithmetic mean of the studied index (the M), SEM (m), relative values (frequency, %). Significant differences between the groups studied traits was performed using Student's t test with the calculation of error probability (p). Authentic considered differences in the probability of coincidence of at least p < 0.05.
Among 9 patients were female (56 %) and 7 men (44 %), mean age 73.2 ± 5.2 years. By steps of cataract: primary — in 1 eye, immature — 9, mature — 4, overripe — in 2 eyes.
Concomitant ocular pathology: Pseudoexfoliation syndrome II degree — 7 eyes, primary open-angle glaucoma II, III stages — 5 eyes, blunt trauma history — 2 eyes.
According to the ultrasound biomicroscopy 5 eyes marked gap Zinn ligaments in quadrant 1, 4 eyes marked in quadrants 2 and 1 eye was observed gap Zinn ligaments in 3 quadrants.
All patients received standard preoperative preparation, adopted in JSC "Republican Specialized Center ofEye Microsurgery" for patients with complicated cataract.
All patients FEC method "fakochop" Nagahara on our modification using ultrasound in a mode «Burst» (patent number 04320 dated 18.03.2011 the IAP "method of cataract surgery by ultrasound phacoemulsification", Intellectual Property Agency of the Republic of Uzbekistan) has been performed. To carry out operations using the apparatus for phacoemulsification «INFINITI Vision System» company Alcon (USA) with an ultrasonic tip "NeoSoniH" model, the frequency of the ultrasonic oscillations of the tip of 34-42 kHz. Phacoemulsification of cataract performed by corneal tunnel incision of 2.2 mm. with implantation intraocular lens RSP-III to break the back of the lens capsule. For the prevention of loss of the vitreous at rupture of the posterior capsule was used in all the eyes of cohesive viscoelastic «ProVisc» Alcon (USA).
We have developed a modified method of implantation model intraocular lens RSP-III on own method (a positive decision of the formal examination of the application on 29.04.2015, the number 20150015, published in the Official Gazette number 5 Intellectual Property Agency of the Republic of Uzbekistan). The technique is to implant of intraocular lens model RSP-III through corneal tunnel incision of 2.2 mm. (if necessary, followed by expansion to 2.5 mm.), via the injector into the anterior chamber when the FEC in the posterior capsule intact. Intraocular lens RSP-III centered, haptics are installed in the correct position, and sutured to the iris nylon thread 10-00, departing from its pupillary edge of about 1.5-2.0 mm. in the section of the projection (12 hours). After intraocular lens RSP-III implantation for the prevention of occurrence of pupillary block peripheral iridectomy was performed.
The validity and stability of the intraocular lens RSP-III is the main criterion. Secondary endpoints were: technical difficulties of performing cataract phacoemulsification technique, the presence of intra- and postoperative complications, visual acuity in the early and distant probation periods. Term follow-up of 6 months.
Results and discussion
Analysis of the results of our studies have shown that visual acuity on the first day after surgery was 0.4 ± 0.1, on 10th after surgery on visual acuity level was 0.5 ± 0.1. Visual acuity after 1 month was 0.6 ± 0.1. By the end of the first six months after surgery, visual acuity was 0.7 ± 0.1.
In all 16 eyes (100 %) was achieved the correct position of the intraocular lens in the early (1-3 days) and later periods (6 months) after surgery.
Intraocular pressure for 1-3 hours, and 14 eyes (88 %) were within normal limits, 2 eyes (12 %) had transient hypertension, which was cupped instillation of antihypertensive drugs and the use of diuretics for 3-5 days. The average value of the intraocular pressure (IOP) was normal in all the observation dates.
Since the implantation of intraocular lens RSP-III was performed using an injector, and did not require an extension of the section, postoperative astigmatism was within the physiological norm.
Conclusions:
1. Implantation of intraocular lens RSP-III using the injector with posterior capsule rupture during phacoemulsification cataract performing allows stable intraocular lens position in the early and relatively distant observation periods, high levels of visual acuity with minimum values of postoperative corneal astigmatism.
2. The need for a more long-term follow the provisions of the stability of the intraocular lens RSP-III after implantation by the method developed by us.
References:
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Study on the composition and concentrations of phosphoglycolipids in the skin of healthy subjects and patients with vitiligo
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8. Терещенко Ю. А., Кривко С. В., Сорокин Е. Л. и др. Спонтанная дислокация заднекамерных интраокулярных линз в позднем послеоперационном периоде: частота, причины, осложнения//Клиническая офтальмология. - 2010. - № 3. - С. 100-102.
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Saatov Botir Talatovich, Post-graduate student, Department of Dermatology, Republican Specialized Scientific-Practical Medical Center of Dermatology and Venereology, Uzbekistan Public Health Ministry
E-mail: [email protected]
Umerov Oibek Ilyasovich, Junior researcher, Laboratory of Metabolomics, Acad. O. A. Sadykov Institute of Bioorganic Chemistry, Uzbekistan Academy of Sciences
Study on the composition and concentrations of phosphoglycolipids in the skin of healthy subjects and patients with vitiligo
Abstract: Despite considerable progress recently attained in study on the human skin lipids there is still a number of problems in this area to be solved. As the achievements of our study, the findings on changes in concentrations of total phospholipids and their fractions as well as on cerebrosides in the human skin in vitiligo should be emphasized. Keywords: cerebrosides, fractions, lipids, phosphoglycolipids, skin, vitiligo.
Introduction
The skin is the largest and most visible organ of a human body. It is an outer cover of a human being, a border between the body and the environment. The skin is a live tissue with biochemical and physiological processes proceeding constantly and continuously [1, 11-16]. Human skin has a very complex structure set up ofvarious types of chemical substances. The skin protects a human organism resisting any chemical, physical and microbiological effects [1, 11-16; 2, 3-5]. The mammalian skin consists of definite types of cells bound by a mixture of lipids [2, 3-5].
Various lipids are present both in the skin and in the epidermis. Thus, the epidermis contains nearly equimolar ratios of cholesterol, ceramides and free fatty acids (FFA), the most significant elements to form a well-organized structure ofthe skin lipid domain [3, 824-834; 4, 10-13]. Quantitative or qualitative changes in lipid composition by sex, age, season, localization and many other factors are of high significance for permeability and dehydration of the skin, as well as for onset and progression of some skin disease [5, 88-91].
It should be noted that some limitations and problems hamper analytical studies on lipids of the skin. Lacking perfect spectrophotometry properties and being more hydrophobic than lipids of other tissues and organs, the lipids of skin is the complex object for analytic study [2, 3-5]. Lipid composition of the mammalian skin was examined quite sufficiently [4, 10-13; 6, 120-130; 7, 147-151; 8, 710-717]; however most studies aimed at determination of limited types of lipids. There is no information about wide spectrum of lipids in human skin, the data about phospholipids and complex skin lipids in pathology are scarce.
Extreme significance of elucidation of role of lipids in the mechanism of the human skin functioning in the normal conditions and in pathology taken into account, wide scale study on fraction composition of lipids from the skin is a crucial task for chemical and medical science. The work was initiated to comparatively study
composition and concentrations of phospholipids and glycolipids in the skin of healthy subjects and in the skin of patients with vitiligo.
Materials and methods
The skin bioptats from healthy subjects and of the depigmen-tated areas from patients with vitiligo were the objects of the study. In total 47 samples of skin were examined, 17 normal and 30 pathological among them. The procedures of extraction of total lipids from the skin and their purification of non-lipid additives was derived from the method of Folch [9, 497-509] with recommendations of Kates [10, 74] by means of chloroform: methanol mixture (2:1 w/w). The total lipid extract of skin thus obtained was used to determine total phospholipids and their fraction composition, as well as for estimation of cerebrosides.
Determination of phospholipids and their fractions
Quantitatively phospholipids and their fractions were assessed by the content of phosphorus determined after mineralization of lipid samples with subsequent colorimetric determination of inorganic phosphorus by reaction of Vaskovsky. SF-26 spectrophotometer (LOMO, the Russian Federation) was used to perform the procedure at 825 nm. [11, 129-141].
Fraction composition of phospholipids was studied by means of thin layer chromatography at KSK silica gel in the mixture of chloroform: methanol: acetic acid: water (16:4:1:14). When the solvent front was achieved, the 13 x 18cm. chromatographic plates were taken out of the chamber to be dried. Phospholipid fractions were developed in the iodine vapor. Each fraction thus obtained was scraped off, subjected to mineralization with perchloric acid in aluminum blocks at 200 °C. The method ofVaskovsky et al. [11, 129-141] was used to determine inorganic phosphorus thus obtained.
Cerebrosides
Cerebrosides from lipid extract of the skin were obtained by means of a general method for the preparation of cerebrosides by Uz-man [12, 149-155]. The procedure involves the extraction of total lipids from fresh tissue with a boiling mixture of chloroform-methanol
