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Results and discussion
As a result of phacoemulsification by our method using ultrasound mode «Burst» depending on the lens density 2-6 times decreases the time used ultrasound reduced while the absorbed tissues ultrasound eyes, its negative impact on all the structures of the eyeball, especially endothelium and choroid. Thus, the time of ultrasound used depending on the density of the lens was as follows: group I in the main extent — 0 seconds, II degree — 0.1 seconds, III degree — 0.3 seconds, IV degree — 0.6 seconds, V extent — 0.8 seconds; a control group I extent — 0.2 seconds, II degree — 0.6 seconds, III degree — 1.1 seconds, IV degree — 1.6 seconds, V extent — 2.0 second.
According to the results of studies of patients with a core group ofvisual acuity on the first day after surgery was 0.49 ± 0.033, and in the control group 0.45 ± 0.043. Visual acuity at 10 days after
surgery in patients of the main group was at the level of 0.71 ± 0.032, while in the control 0.64 ± 0.039. Visual acuity after 1 month in the main group was 0.81 ± 0.033 vs. 0.71 ± 0.035 in the control group. By the end of the first year after surgery, visual acuity was 0.89 ± 0.032 and 0.79 ± 0.036, respectively.
Conclusions
Application of the method phacochop in this modification using ultrasound «Burst» mode and controlled crushing through «chopper» patients with complicated diabetic cataract combined with pseudoexfoliation syndrome significantly reduces the load on the ligaments of the lens tends to minimize complications during surgery, early and late postoperative period, allows you to get an early and complete visual rehabilitation, helps to ensure a high visual results of operations.
References:
1. Кувандыкова Д. Г. Оптимизация хирургической техники и профилактики интраоперационных осложнений факоэмульсифика-ции катаракты. Автореф. Дисс. ... канд. мед. наук. - Уфа, 2003.
2. Тахчиди Х. П., Узунян Д. Г., Егорова Э. В. Ультразвуковая биомикроскопия в диагностике патологии переднего сегмента глаза. -М.: Микрохирургия глаза, 2008.
3. Федоров С. Н. Прогнозирование функциональных результатов экстракции катаракты у больных сахарным диабетом//Оф-тальмохир. - 1992. - № 2.
4. Юсеф И. Ю. О новых возможностях усовершенствования современной факоэмульсификации при различных видах катаракт. Автореф. Дисс. ... канд. Мед. Наук. - М., 2003.
5. Altintas A. G. Comparison of corneal edema caused by cataract surgery with different phaco times in diabetic and non-diabetic patients/Mm. Ophthalmol. - 2006. - T. 38(1).
6. Cakrabarti A. Phacoemulsification in eyes with white cataract//J. Cataract Refract Surg. - 2000. - Т. 26(7).
Savranova Tatyana Nikolaevna, Republican Specialized Center of Eye Microsurgery, MD, Tashkent, Uzbekistan E-mail: tanya.eye@mail.ru
Clinical and functional results modified method of surgical treatment of neovascular glaucoma
Abstract: The analysis of the effectiveness of the proposed modified method of surgical treatment of neovascular glaucoma. Keywords: neovascular glaucoma, antiglaucomatous operation ksenokollagenovy drainage.
For decades worldwide glaucoma is a leading cause of irreversible blindness and becomes a social problem. The secondary neovascular glaucoma (NVG) is of particular severity, severe pain, high intraocular pressure, as well as rapid and complete loss of visual function [1, 162-193]. By the development of iris rubeosis and neovascular glaucoma may lead a number of both intraocular and systemic diseases. Among the intraocular diseases at the forefront diabetic retinopathy and retinal vascular occlusive disease (primarily thrombosis of the central retinal vein. In recent decades the tendency to quantitative growth and "rejuvenation" of the group of patients with vascular disease, leading to the emergence of neovascular glaucoma. Neovascular glaucoma is characterized by a poor prognosis and hard over due to fibrous degeneration of the newly created liquid outflow tract of the eye [2, 43-49]. Because byway pathogenesis of neovascular glaucoma treatment of this prognos-tically unfavorable disease remains a serious problem in ophthalmology [4, 357]. The low efficiency of drug treatment NVG and the relatively low success of current surgical treatment methods do develop new methods of treatment of the problem of NVG one of the most important in ophthalmology [3, 368-371]. The urgency of improving technology performance deep sclerectomy in NVG
prompted us to conduct research aimed at optimizing the treatment of patients with NVG.
In this regard, we have the main purpose of scientific research has been formulated — to develop a modified method of surgical treatment of NVG with ksenokollagen drainage and to evaluate its effectiveness.
Material and methods
The results of surgery in 80 patients (80 eyes), neovascular glaucoma sufferers of them were males — 46 (57 %) of women — 34 (43 %). The average age of patients was 61 ± 1.9 years. Among the examined patients with NVG, according to the classification M. Shields [5, 269-286], II stage was recorded in 13 patients, accounting for 16 %, III stage — in 26 patients (33 %), IV stage — in 41 (51 %). Of patients, depending on the method used, the surgical treatment was allocated to two groups. The main group consisted of 40 patients (40 eyes) who underwent surgery for antiglaucomatous offered us the original procedure — with implantation of deep sclerectomy xenokollagen drainage (DSE with XDI) (patent number 04336 issued by the IAP State Patent Office of the Republic of Uzbekistan in 2011). Application of drainage Xeno-plast developed in the clinic Eye Centre East Insight, (Moscow) in
Clinical and functional results modified method of surgical treatment of neovascular glaucoma
patients with nonvascular glaucoma approved at a meeting of the National Ethics Committee of Ministry of Health of the Republic of Uzbekistan dated December 26, 2008. The control group consisted of 40 patients (40 eyes) who antiglaucomatous operations traditional deep sclerectomy (DSE) was held. Studies of patients carried out on the basis of informed consent in accordance with international ethical requirements (Helsinki, 1975). To ensure the prevention of operational and postoperative complications in patients revealed the presence of vascular, immunological, inflammatory and other bodily changes such as hypertension, atherosclerosis, diabetes, varicose veins, thrombophlebitis, blood disorders, vasculitis, uveitis, surgeries, acute disorders. Stroke, acute myocardial infarction, and others carried out by us of clinical and laboratory studies have allowed to determine that 38 % of patients from the general contingent suffer from diabetes, 23 % — hypertension, 9 % — coronary artery disease. In 30 % of patients with various other diseases have been identified, to link that we have not succeeded with the development of neovascular glaucoma.
Age, sex, stage of the disease and other clinical parameters were identical to both groups.
Mean follow-up after surgery was 12 months.
Eye diagnosis included a visometry, perimetry, tonometry, tonography, biomicroscopy, gonioscopy, ophthalmoscopy, A-, B-scan, ultrasound biomicroscopy, optical coherence tomography (iftrans-parent eye fluids).
In carrying out the scientific studies used clinical, mathematical, medical — statistical methods.
For the statistical analysis of the results of treatment of patients used the technique of selection of the data, which were recorded in a thematic map we developed examination of the patient with neo-vascular glaucoma.
Based on his own observations, and taking into account the experience of the literature we have identified indications and contraindications to the use of the method antiglaucomatous operations using xenokollagen drainage. The main criteria for the definition of the indications and contraindications for the DSE with XDIs were:
- The feasibility of the operation, due to the forecast in respect of visual function after surgery;
- The degree of risk, due to the severity of the initial state of the eye and diseases of the body;
- The technical capability of the operation — the availability of the necessary equipment, qualified surgeon and adequate anesthetic.
In determining indications for ICD operation with HSE took into account the risk of surgery related to the initial severity of the operated eyes and conditioning the severity of surgical complications, the technical feasibility of the operation, as well the forecast ofvisual function in the postoperative period. The surgeon conducting the operation with NVG must be highly qualified and ready to various complications. Patients with stage III and IV glaucoma for 2-3 days prior glaucoma surgery performed intraocular angiogenesis inhibitor.
Operation technique
Preparation for surgery and treatment of traditional surgical field. The incision and the conjunctiva and Tenon's capsule held, departing from limb by 7 mm. to 7 mm. in any place convenient for surgery (free of scars from previous operations) segment of the eyeball. After coagulation of vessels from the surface layers of the sclera to 1/3 the thickness and cut out the basis for limb rectangular patch size 6 X 6 mm. Overlap 2 preliminary seam 8 (0) in the corners of the surface of the sclera of the valve without tightening. Makes 2 paracentesis of the cornea, through which the moisture is
released from the anterior chamber for dose reduction in intraocular pressure (IOP). Then, in order to avoid a sharp drop in IOP in the anterior chamber is entered viscoelastic. Under a cut surface flap incision is made through the X-shaped length of each beam to 6 mm in the deep layers of the sclera.
Triangle deeper layers of the sclera facing the limb is removed along with the scleral sinus, corneascleral trabeculae and corneal limbus part. Basal iridectomy is done. In exposing the ciliary body vertically stacked preformed xenokollagen drainage in the form of strips of 4 X 1 mm., which proximal end is introduced into the anterior chamber (or coloboma of the iris with pseudophakic), and the body and a distal portion thereof located under formed between the side flaps of the X-shaped incision of the sclera tunnel. On the top side scleral flaps superimposed nylon suture anchor 1 with 11.0 drainage stitching to prevent its displacement. The superficial scleral flap is laid in place, tied 2 pre-seam 8.0. conjunctival wound is sutured continuous suture 8.0. Buried disinfectant drops, eyes sealed with aseptic bandage.
Thus, the proposed method allows to reliably locate and fix drainage device rectangular and tubular shape in the tunnel between the deep layers of the sclera and the choroid at antiglaukomatous operations, leading to a free outflow of intraocular fluid from the anterior chamber into supraciliar in subtenon and subconjunctival space and is the prevention scarring in the area of operations and the achievement of a stable hypotensive effect.
The results of our many years of research lie in the fact that you have the clinical features of the course, taking into account the efficiency of NVG previous therapy. Average visual acuity before surgery was 0.1 ± 0.02. Observation of postoperative patients showed that visual acuity in the study group was significantly increased and amounted to an average of 0.2 ± 0.02 by the end of the observation period, whereas in the control group, we are watching its gradual decline 0.08 ± 0.01.
The average value of tonometry index measured 10 g. tonometer before surgery was 31.4 ± 0.1 mm. Hg. Such high figures IOP accompanied by severe pain in the eye, headaches and nausea and were stopped by conventional methods of antihypertensive therapy.
Initially, the high numbers of intraocular pressure in patients of the main group immediately after surgery greatly reduced, passing in persistent hypotension. In the control group by the end of 1 month after the operation normal IOP, and 6 months after surgery tonometry indicators point to a trend of increasing pressure. In 8 cases (20 %) the IOP in patients in the control group were normalized to the level of the upper limit of normal 25-26 mm. Hg. appointment of local antihypertensive drugs. In 10 % of cases due to the rise in IOP of relapse in patients in the control group required re-operation of our proposed method. eye hydrodynamics indicators point to a statistically significant reduction of the true intraocular pressure and intraocular liquid production in patients of the main group at 1 month after surgery, whereas in the control group found a slight increase in the production of intraocular fluid. After 6 months of operation control studies tonography rates in patients of the main group did not change, whereas the control group showed a decrease in the coefficient of outflow of intraocular fluid ease, despite the parallel decrease in the volume of production of intraocular fluid. This led to an increase in the coefficient of Becker compared to the norm, that is showing signs of glaucoma relapse.
In the study group we observed the expansion of the total field of view (213° ± 22.2° to 241.4° ± 21.1 ° on the sum of 8 meridians) and long-term (6 months), regarding this patient population stabilization achievements. In some cases, due to progression of
the underlying disease of the total boundaries of the field narrowed below baseline by the end of the observation period. In the control group 6 months total field of view narrowed (from 225.5° ± 22.8° to 169.0° ± 22.8°).
Ultrasound biomicroscopy structures responsible for the drainage function of the eyes, carried out after antiglaucomatous surgery showed significantly higher values of the parameters indicators of filter pads and intrascleral cavity height, area and volume, in the study group compared with the control group. On 2 (5 %) eyes of the control group patients filtration cushion completely isn't. In other cases researches parameters in patients of the control group was lower than in patients of the main group. In 2 eyes (5 %) in the control group revealed blockade anterior chamber iris root angle. At the same time it was combined with the disappearance of the filter pad.
Thus, a comparative assessment of the immediate and long-term results in the treatment of NVG, revealed the lack of effectiveness of the immediate outcomes and low efficiency deep sclerectomy in long-term period, in comparison with deep sclerectomy implantation xenokollagen drainage. Implementation of the developed modified surgery with implantation xenokollagen drainage at NVG will ensure the long-term normalization of intraocular pressure, the stabilization ofvisual function and decrease the intensity of antihy-pertensive therapy.
Conclusion
The use of a modified method of surgical treatment of neovas-cular glaucoma helps reduce the number of postoperative complications, not only provides a stable hypotensive effect, but also increase visual function in most patients.
References:
1. Wand M. Neovascular glaucoma. Ed. by R. Riteh, M. B. Shilds. - StLouis: C. V. Mosby Co., 2002.
2. Shmireva V. F. Causes of long-term decrease of glaucoma surgery hypotensive effect and possibilities of its enhancement//Glaucoma. -2010. - 2: 43-49. (In Russ.).
3. Madsen P. H. Rubeosis of the iris and haemorrhagic glaucoma in patients with proliferative diabetic retinopathy//Br J Ophthalmol. - 2001. - 55.
4. Nesterov A. P. Glaukoma. - Moscow: MIA, 2008. - 357 p. (In Russ.).
5. Shields M. B. Textbook of glaucoma. - Baltimore, 1997.
Rakhimova Gulnara Nishanovna, D. M., Head of the Department «Endocrinology», Tashkent Institute of Post-graduate Medical Education, Head of Science Department of «<Child endocrinology», Republic Specialized Scientific Research Center of Endocrinology of the Ministry of Healthcare of the Republic of Uzbekistan,
Uzbekistan, Tashkent E-mail: diabetgulnora@hotmail.com Sadykova Akida Sattarovna, D. M. at Science Department of «<Child Endocrinology», Republic Specialized Scientific Research Center of Endocrinology of the Ministry of Healthcare of the Republic of Uzbekistan
E-mail: akidahon@yandex.ru
Study of interrelation of I/D polymorphism in ace gene with a stage of chronic kidney disease in children and teenagers of Uzbek population with D1 according to guidelines K/DOQI (2012)
Abstract: The aim of the research was the evaluation of the functional condition of kidneys and the study of interrelation of I/D polymorphism in ACE gene with a stage of chronic kidney disease in children and teenagers of Uzbek population with D1 according to new guidelines K/DOQI (2012). 120 children and teenagers with type 1 diabetes, 53 (44.2 %) males and 67 (55.8 %) females, were examined. The average age of the patients was 13.8 ± 2.7 years old (Me 15.0; IQR 13.0-16.0). The stages of the chronic kidney disease were classified in accordance with guidelines K/DOQI (2012). In the course of work, it was revealed that the use of new classification K/DOQI (2012) for children and teenagers with D1of Uzbek population allows detecting the decrease in kidney function at earlier stages: 61.9 % of children and teenagers with D1 showed GFR 80.6 ± 7.5 ml/min/1.73m 2 at the stage of normal albuminuria, which corresponds to stage II of CKD and 16.7 % had GFR 45.1 ± 9.5 ml/min/1.73m 2, which corresponds to stage III of CKD. Also, 28.6 % of children and teenagers at MAU stage showed stage II of CKD and 75.0 % showed stage III of KCD respectively. Frequency distribution of ACE genotypes in children and teenagers with D1 was characterized by significant correlation of DD genotype interrelated with the severity of KCD of GFR reduction, which confirms the influence of genetic factors in KCD development. I/D polymorphism in ACE gene is a molecular-genetic marker of disposition to CKD D1 in children and teenagers of Uzbek population.
Keywords: diabetes, children and teenagers, CKD, polymorphism in ACE gene.
