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Based on our experience we feel that immediate reconstructive urethroplasty with using an external metallic frame ring realignment of post-traumatic posterior disruption is feasible, safe and effective. The major drawback of our study is small number of patients and lack of comparison with patients who were managed by delayed method and immediate urethroplasty without external metallic frame ring.
Conclusion
Immediate open reconstructive surgery realignment with external metallic frame ring posterior urethral disruption is a feasible, safe and effective treatment modality for management of these patients. Our suggested technique is optimal for the repair of posterior urethral injuries and may reduce the incidence of postoperative restricture and we believe that it will find a place in reconstructive surgery ofurethra.
References:
1. Barbagli G., Perovic S., Milanov N. O. Urethral Reconstructive Surgery. - Moscow, 2005.
2. Daniela E. A., Anthony R. M: What is the Best Technique for Urethroplasty?//] Urol. - 2008. - 54: 1031-1041.
3. Elliot D. S., Barret D. M. Long-term follow-up and evaluation of primary realignment of posterior urethral disruptions//] Urol. -1997. - 157: 814-816.
4. Herschorn S., Thijssen A., Radomski S. B. The value of immediate or early catheterization of the traumatized posterior urethra// ] Urol. - 1992. - 148: 1428-1431.
5. McAninchJack W. Urethral injuries//World ] Urol. - 1990. - 7: 184-188.
6. Kogan M. I. Advances in the treatment of diseases of the upper urinary tract and urethral stricture. Materials Plenum ROU. - Yekaterinburg, 2006. - P. 271-281.
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8. Milroy E., Allen A. Long-term results ofurolume urethral stent for recurrent urethral strictures// ] Urol. - 1996. - 155: 904-908.
9. Moudouni S. M., Patard ]. ]., Manunta A., Guiraud P., Lobel B., Guille F. Early endoscopic realignment of post-traumatic posterior urethral disruption//Urology. - 2001. - 57(4): 628-632.
10. Pankaj N. Maheshwari, Hemendra N. Shah. Immediate endoscopic management of complete iatrogenic anterior urethral injuries: A case series with long-term results//BMC Urology. - 2005. - 5: 13.
11. Rusakov V. I. Some considerations on the treatment of urethral stricture (based on 43 years of experience)//Bulletin of Hippocrates. - 1997. - 1: 83-86.
12. Sertcelik M. N., Bozkurt I. H., Yalcinkaya F., Zengin K. Long-term results of permanent urethral stent Memotherm implantation in the management of recurrent bulbar urethral stenosis//BJU Int. - 2011. - 108: 1839-1842.
13. Tilyakov A. B., Valiev E. Y., Akhmedov R. N. The management of the combinerd injuries ofpelvis and lower urinary tracts treatment// ] Orthop Trauma Surg Rel Res. - 2011. - 2(22): 58-62.
14. Tune M. H., Tefekli A. H., Kaplancan T., Esen T. Delayed repair of posttraumatic posterior urethral distraction injuries: long term results//Urology. - 2000. - 55(6): 837-841.
15. Yachia D. How do temporary urethral stents work in recurrent urethral strictures? In: Stenting the Urinary System. 2nd ed. Eds. D. Yachia & P. ]. Paterson. - London: Pub by Martin Dunitz, 2004. - P. 465-474.
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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]
Phacoemulsification of diabetic cataract with pseudoexfoliation syndrome
Abstract: It is carried out the analysis of intraoperative and postoperative course of diabetic cataract phacoemulsification combined with pseudoexfoliation syndrome, depending on the methodology used by phacoemulsification. Keywords: diabetic cataract, Pseudoexfoliation syndrome, phacoemulsification.
Relevance
Today significantly expanded the indications for phacoemulsification of diabetic cataract, in connection with the increased attention to the prognostically unfavorable situations in terms of occurrence of intraoperative and postoperative complications. Pseudoexfoliation syndrome — the age-associated pathology of the extracellular matrix, accompanied by excessive production and accumulation of abnormal extracellular material in various intraocular and extraocular tissues. These ultrasound biomicroscopy in
the preoperative examination of the patient adequately assess the degree of damage Zinn ligaments [2, 27-38]. This situation is exacerbated when combined with diabetic cataract, which has its own characteristics: localization of opacities in the posterior subcapsular layers, a sharp increase in the core, the rigidity of the front lens capsule, opacification posterior lens capsule and so on, as well as concomitant diabetic changes in the surrounding tissue: rubeosis of the iris, the presence of mooring in the vitreous humor, diabetic retinopathy, increased fragility of blood vessels eye, bleeding tendency
Phacoemulsification of diabetic cataract with pseudoexfoliation syndrome
and so on [1, 1-22; 3, 15-19; 6, 1041-1047]. Taking into account the initial state of this pathology is necessary to perform ophthalmic surgery phacoemulsification with minimal time ultrasound to reduce the negative impact of its (time absorbed tissues ultrasound) on the structure of the eye [4, 1-27; 5, 61-65]. The above mentioned features of diabetic cataract combined with pseudoexfoliation syndrome contribute to the development of intraoperative and postoperative complications during phacoemulsification.
Purpose: To analyze the perioperative phacoemulsification for diabetic cataract combined with pseudoexfoliation syndrome, depending on the methodology used by phacoemulsification.
Material and methods
The results of 86 patients with phacoemulsification complicated by diabetic cataract combined with pseudoexfoliation syndrome. Among patients 51 women, accounting for 59.3 %, men 35-40.7 %, the average age was 60.2 ± 1.0 years. Diabetes mellitus type I suffered 17 patients, II type — 69.
Age, sex, stage of the disease and other clinical parameters were identical to both groups.
All patients underwent standard ophthalmic research. In order to assess ligament lesions lens Ultrasound biomicroscopy was performed. Distribution pseudoexfoliative syndrome by groups was as follows: in the main group of I degree — 24 eyes, II degree — 13 eyes, III degree — 5 eyes; a control group I degree — 29 eyes, II degree — 19 eyes, III degree — 8 eyes.
Eye diagnosis included a visometry, perimetry, tonometry, tonography, biomicroscopy, gonioscopy, ophthalmoscopy, A-, B-scan, ultrasound biomicroscopy, optical coherence tomography (iftrans-parent eye fluids), fluorescent retinal angiography (if indicated).
Studies of patients carried out on the basis of informed consent in accordance with international ethical requirements (Helsinki, 1975).
All patients underwent clinical examination, includes laboratory diagnostics, counseling therapist, endocrinologist, otolaryngologist, dentist, according to testimony consulted a cardiologist, neurologist.
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.
Patients were divided into two groups according to the technique of phacoemulsification: I group (basic) — 40 patients (42 eyes), operated by the "fakochop" on Nagahara our modification using ultrasound in "Burst" mode (patent number the IAP 04320 from 18.03.2011 "The method of cataract surgery by ultrasound phacoemulsification" State Patent Office of the Republic of Uzbekistan in 2011). Group II (control) — 46 patients (56 eyes), operated by phacofragmentation "crosswise" or 4 quadrants on Shepherd c ultrasound in the "linear" and "pulse". To carry out operations using the apparatus for phacoemulsification «SERIES 20000tm EVERESTtm LEGACY SYSTEM» company Alcon (USA) with an ultrasonic tip «NeoSoniX» model. The frequency of the ultrasonic oscillations of the tip is 29 ± 2 kHz. and a maximum power ultrasonic generator — 22 watts. All patients received standard preoperative preparation adopted in the joint-stock company "Republican Specialized Center of Eye Microsurgery" for patients with diabetic cataract.
Bimanual phaco ultrasound diabetic cataract with implantation of flexible intraocular lens was performed by the method of "fakochop" Nagahara on our modification using ultrasound in
"Burst An" mode. The corneal tunnel incision is made «Many» knives calibrated 2.55 mm. The optimal length of the tunnel to maintain the integrity of the anterior chamber during the ultrasound needle diameter of 0.9-1.5 mm. The most comfortable and optimal for all stages of the work is with the angle of the needle to 30°. Use high vacuum numbers 350-400 mm. Hg. aspiration flow — 28-30 ml/min. These parameters and technology allow "safe" to implant the lens on the ultrasonic tip to prevent falling off, repulsion, rotation of the lens nucleus, and perform controlled grinding using "chopper". In the production of the first ultrasonic fracture handle and pull back up so that the lens moves to the area of the section, the upper part is lifted somewhat upward, while its lower part is lowered in some depth capsular bag, the space between the capsulorhexis opening and lens nucleus. In this space is inserted «chopper», smooth movement plunges deeper into the nucleus, and then output back towards the tip. Just before reaching the ultrasonic tip, the hook moves to the left and down, and at the same time, the tip moves to the right and up — thus produced fragmenta-tion.The maneuver is continued until the fault does not affect the entire thickness of the core and does not extend to the equator. As a result of the wedge fractures formed material of the lens nucleus, which can be captured by introducing ultrasonic handpiece of the ultrasonic handpiece using ultrasound «Burst» mode. The introduction of the fragment should be performed until the middle of the thickness and length, as this will exclude the probability of a defective capture, and the ability to derive reliable in the plane of the pupil of the first track to the center for emulsification Capsulorhexis just above the capsular bag. Parameters: Ultrasound power — 60-85 % vacuum — 400 mm. Hg. aspiration flow — 28-30 ml/min. Removal of the first fragment is required, since this greatly facilitates the rotation of the core in the capsular bag, there is sufficient space for «chopper», greatly facilitates manipulation «chopper» and ultrasonic tip. After five or six subsequent fragmentation usually becomes possible to remove the core of any degree of hardness; Nevertheless, if very volumetric core and the outer layer is low or no nucleus, in which case it is recommended to form a greater number of small sized core segments.
After the phacoemulsification of the lens in the capsular bag of the corresponding flexible implanted intraocular lens from different manufacturers.
According to the ultrasound biomicroscopy, 5 eyes of the patients of the first (main) group and 4 eyes in the second (control) group was marked gap Zinn ligaments in one quadrant. In the eyes of 6 patients of the main group and 8 eyes in the control group was observed in 2 quadrants. In the eyes of 3 patients of the main group and 3 eyes in the control group was observed gap Zinn ligaments in 3 quadrants. In both groups, with pseudoexfoliation syndrome I degree mechanical devices for expanding the pupil were not applied at pseudoexfoliation syndrome II degree used Malyugin's ring, with pseudoexfoliation syndrome III degree iris retractors used to suspending the capsular bag and the implantation of intracapsular Malyugin's ring. It should be noted that when using the ring Malyugin's and iris retractors in patients of the control group in 5 cases mentioned touch the iris, and in 2 cases the anterior capsulorhexis touch ultrasound needle that was associated with the need to form a groove for dividing the core into 4 quadrants. At the same time, the use of our technology fakochop modifications in the basic group it possible to avoid these problems.
Subsequent steps were standard phacoemulsification with implantation of flexible intraocular lens in the capsular bag. Intraoperative and postoperative complications were not.
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.
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Savranova Tatyana Nikolaevna, Republican Specialized Center of Eye Microsurgery, MD, Tashkent, Uzbekistan E-mail: [email protected]
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
