Prevention method of toric intraocular lens rotation after phacoemulsification of cataract using a standard capsule ring

At the same time, phacoemulsification of cataracts remains the most popular surgery. But the problem among phacosurgeons is the correction of existing corneal astigmatism. According to studies, about 30% of the world's population have corneal astigmatism with a strength of 0.75D and above, which leads to a decrease in visual acuity after phacoemulsification of cataracts in the absence of its correction.The most commonly used method to correct corneal astigmatism is the implantation of toric intraocular lenses (TIOL). The main condition for obtaining high visual acuity after TIOL implantation is the location of the astigmatic component of the artificial lens in accordance with the strong meridian of the cornea. The aim of this study was to evaluate the effectiveness of the proposed method of preventing the toric intraocular lens rotation after phacoemulsification of cataracts in the eyes with corneal astigmatism by implantation of a standart capsule ring.Material and methods. The article presents the results of a comprehensive examination of 43 patients (59 eyes) who underwent surgery by phacoemulsification of cataracts with implantation of toric IOL to correct concomitant corneal astigmatism. Corneal astigmatism according to keratometry ranged from 0.5D to 4.25D (average 1.96 ± 0.1 D). Patients were divided into 2 groups. The first group consisted of 26 patients (31 eyes). Patients in this group underwent phacoemulsification with toric IOL implantation according to standard techniques without the use of techniques that prevent rotation of the artificial lens in the postoperative period. The second group included 18 patients (28 eyes) who were operated on according to our proposed prevention method of TIOL rotation. As a result of the study, it was found that rotation of TIOL was detected 6 months after surgery in the I group without the use of developed method in 22 eyes (70.9%), in the II group, where the capsule ring was implanted, rotation occurred in 12 eyes (42.85%). In the II group in all cases, the deviation of the TIOL axis did not exceed 6 degrees. The proposed method of prevention of rotation of TIOL allows to increase the efficiency of phacoemulsification of cataracts.Conclusions. Developed a method of preventing the rotation of the toric intraocular lens using a standard capsule ring, which is implanted and located on top of the haptic support elements of the artificial lens can increase the efficiency of phacoemulsification of cataracts in the eyes with corneal astigmatism, contributes to the rotational stability of the toric lens and provides long-term results of visual functions, reduces the need for repeated surgery due to reposition of the rotated lens and can be recommended for implementation in the practice of ophthalmic surgeons.The use of implantation of a standard capsule ring according to the proposed in this study method prevents the rotation of the toric intraocular lens by more than 6 degrees in all cases, which does not significantly reduce visual acuity and does not require reposition of the artificial lens. This method of preventing rotation of the toric intraocular lens allows to achieve visual acuity of 0.7 and above in 85.6% of cases

Аналіз інтравітреального застосування антиVEGF-препаратів при захворюваннях очного дна, що супроводжуються ексудацією й неоваскуляризацією

Nowadays,  new methods of treatment of choroidal neovascularization are being actively developed and introduced in exudative form of age-related macular degeneration (AMD), complicated myopia, diabetic retinopathy and post-thrombotic retinopathy. Medications that block vascular endothelial growth factor (VEGF), which is the main link in the pathogenesis of retinal neovascularization and hyperfiltration, have become widespread. It is known that damage of endothelial cells of retinal vessels occurs in consequence of oxidative stress that leads to the death of pericytes, hyperfiltration of plasma from the vascular bed, hemorrhages and retinal hypoxia. The intracellular concentration of specific protein that regulates the transcription of genes (HIF-1) increases in response to hypoxic damage in the cells of the retina, which leads to increased transcription of the VEGF gene, which acts directly on the epithelium providing regeneration, stimulating the proliferation and neovascularization.Considering this, anti-VEGF medications have found their application in the treatment of choroidal neovascularization in clinical practice. Today, two preparations that block VEGF: selective (pegaptanib) and non-selective (ranibizumab) are used mostly common.The purpose of this investigation was to study the effectiveness of anti-VEGF medications in patients with choroidal neovascularization of different genesis.The analysis presents the results of 50 patients (50 eyes) treatment with choroidal neovascularization on the background of various diseases of the retina. Pegaptanib ("Macugen") was used for the treatment of 35 patients (35 eyes), the rest (15 eyes) - ranibizumab ("Lucentis").According to fluorescein angiography the subretinal neovascular membrane was in the stage of activity in all eyes.The effectiveness of the treatment was assessed by visometry, ophthalmoscopy, optical coherence tomography and fluorescein angiography.Application of intravitreal injection of pegaptanib improves visual acuity in 66% of cases in patients with choroidal neovascularization and exudation, application of ranibizumab - in 60% of cases.According to optic coherence tomography reduction of the retina thickness after injection of pegaptanib into the vitreous body is achieved in 57%, after ranibizumab - in 47% of cases, the suppression of activity of subretinal neovascular membrane by results of fluorescein angiography - in 26% and 27% respectively.The application of both selective and non-selective anti-VEGF medications renders substantial positive effect in patients with choroidal neovascularization and exudation, and it is safe and promising direction in treatment of this group of patients.So, in most cases using of pegaptanib and ranibizumab promotes the improvement or stabilization of visual functions and regression of neovascularization and exudation in patients with choroidal neovascularization and exudation of different genesis. This method of treatment is safe, however, it requires further studying, particularly in patients after repeated using of the anti-VEGF medications.Представлены результаты лечения 50 пациентов (50 глаз) с хориоидальной неоваскуляризацией на фоне различных заболеваний сетчатки. Для лечения у 35 пациентов (35 глаз) использовали пегаптаниб («Макуген»), у остальных больных (15 глаз) – ранибизумаб («Луцентис»). У больных с хориоидальной неоваскуляризацией и экссудацией различного происхождения применение пегаптаниба в виде интравитреальной инъекции способствует улучшению остроты зрения в 66% случаев, при использовании ранибизумаба – в 60%. Уменьшение толщины сетчатки по данным оптической когерентной томографии после введения в стекловидное тело пегаптаниба достигается в 57%, а при применении ранибизумаба – в 47% случаев. Применение как селективных, так и неселективных антиVEGF-препаратов оказывает существенный позитивный эффект у пациентов с хориоидальной неоваскуляризацией и экссудацией, является безопасным и перспективным направлением лечения данной категории больных.Наведені результати лікування у 50 пацієнтів (50 очей) із хоріоїдальною неоваскуляризацією на тлі різних захворювань сітківки. Для лікування у 35 пацієнтів (35 очей) використовували пегаптаніб («Макуген»), у решти хворих (15 очей) – ранібізумаб («Луцентіс»). У хворих із хоріоїдальною неоваскуляризацією й ексудацією різного походження застосування пегаптаніба у вигляді інтравітреальної ін’єкції сприяє поліпшенню гостроти зору в 66% випадків, при використанні ранібізумаба – в 60%. Зменшення товщини сітківки за даними оптичної когерентної томографії після введення в склоподібне тіло пегаптаніба досягається в 57%, а при використанні ранібізумаба – в 47% випадків. Застосування як селективних, так і неселективних антиVEGF-препаратів має істотний позитивний ефект у пацієнтів із хоріоїдальною неоваскуляризацією й ексудацією, є безпечним і перспективним напрямком лікування цієї категорії хворих

Analysis of intravitreal using of anti vegf-medications for diseases of fundus accompanied by exudation and neovascularization

Nowadays, new methods of treatment of choroidal neovascularization are being actively developed and introduced in exudative form of age-related macular degeneration (AMD), complicated myopia, diabetic retinopathy and post-thrombotic retinopathy. Medications that block vascular endothelial growth factor (VEGF), which is the main link in the pathogenesis of retinal neovascularization and hyperfiltration, have become widespread. It is known that damage of endothelial cells of retinal vessels occurs in consequence of oxidative stress that leads to the death of pericytes, hyperfiltration of plasma from the vascular bed, hemorrhages and retinal hypoxia. The intracellular concentration of specific protein that regulates the transcription of genes (HIF-1) increases in response to hypoxic damage in the cells of the retina, which leads to increased transcription of the VEGF gene, which acts directly on the epithelium providing regeneration, stimulating the proliferation and neovascularization. Considering this, anti-VEGF medications have found their application in the treatment of choroidal neovascularization in clinical practice. Today, two preparations that block VEGF: selective (pegaptanib) and non-selective (ranibizumab) are used mostly common. The purpose of this investigation was to study the effectiveness of anti-VEGF medications in patients with choroidal neovascularization of different genesis. The analysis presents the results of 50 patients (50 eyes) treatment with choroidal neovascularization on the background of various diseases of the retina. Pegaptanib ("Macugen") was used for the treatment of 35 patients (35 eyes), the rest (15 eyes) - ranibizumab ("Lucentis"). According to fluorescein angiography the subretinal neovascular membrane was in the stage of activity in all eyes. The effectiveness of the treatment was assessed by visometry, ophthalmoscopy, optical coherence tomography and fluorescein angiography. Application of intravitreal injection of pegaptanib improves visual acuity in 66% of cases in patients with choroidal neovascularization and exudation, application of ranibizumab - in 60% of cases. According to optic coherence tomography reduction of the retina thickness after injection of pegaptanib into the vitreous body is achieved in 57%, after ranibizumab - in 47% of cases, the suppression of activity of subretinal neovascular membrane by results of fluorescein angiography - in 26% and 27% respectively. The application of both selective and non-selective anti-VEGF medications renders substantial positive effect in patients with choroidal neovascularization and exudation, and it is safe and promising direction in treatment of this group of patients. So, in most cases using of pegaptanib and ranibizumab promotes the improvement or stabilization of visual functions and regression of neovascularization and exudation in patients with choroidal neovascularization and exudation of different genesis. This method of treatment is safe, however, it requires further studying, particularly in patients after repeated using of the anti-VEGF medications