Konovalova K.I., Shishkin M.M.
Pirogov National Medical and Surgical Center, Moscow
Purpose. To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients.
Material and methods. 187 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into four groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the 3rd group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with gas tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and the IOL implantation. In the 4th group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with gas tamponade.
Results: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along on PDR patients with complicated primary cataract.
Conclusions: This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.
Keywords: diabetic retinopathy, cataract, vitreoretinal surgery.
1. Kalinin M.E., Fajzrahmanov R.R., Shishkin M.M. i dr. Morfologicheskie parametry perednego otdela glaza pri neovaskuljarnoj glaukome posle vitreoretinal’nyh vmeshatel’stv // Rossijskij obshhenacional’nyj oftal’mologicheskij forum. 2022. T. 1. S. 255-257. (In Russ.)
2. Кarpov G.O., Fajzrahmanov R.R., Pavlovskij O.A. Sravnitel’nyj analiz korrekcii afakii pri vitreoretinal’noj patologii // Saratovskij nauchno-medicinskij zhurnal. 2021. T. 17. № 2. S. 304-307. (In Russ.)
3. Lipatov DV, Aleksandrova VK, Atarshchikov DS, et al. Current report from Russian Diabetic Retinopathy Register. Diabetes mellitus. 2014;17(1):4-7. (In Russ.) doi: https://doi.org/10.14341/dm201414-7.
4. Fajzrahmanov R.R., Kalinin M.E., Shishkin M.M. et.al. Sovremennyj vzgljad na ispol’zovanie gonioassocirovannoj trabekulotomii // Oftal’mohirurgija. 2021. № 3. S. 77-82. (In Russ.)
5. Chehonin E.S., Fajzrahmanov R.R., Suhanova A.V. et. al. Anti-VEGF preparaty v lechenii diabeticheskoj retinopatii // Vestnik oftal’mologii. 2021. T. 137. № 4. S. 136-142. (In Russ.)
6. Shestakova MV, Vikulova OK, Zheleznyakova AV, et al. Diabetes epidemiology in Russia: what has changed over the decade? Ther Arch. 2019;91(10):4–13. (In Russ.)
7. Juldasheva N.M. Proliferativnaja diabeticheskaja retinopatija: novye aspekty patogeneza, obosnovanie sistemy shhadjashhei vitreoretinal’noi hirurgii i kompleksnoi farmakoterapii: Avtoref. dis. ... d-ra med. nauk. — M., 2014. (In Russ.)
8. Chung TY, Chung H, Lee JH. Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes. J Cataract Refract Surg. 2002;28:2001–5. doi:10.1016/s0886-3350(02)01354-8.
9. Efron N. Grading scales for contact lens complications. Appendix A. In: Contact Lens Complications. 2nd ed. Oxford: Butterworth-Heinemann; 2004. P. 239-243.
10. Hogan MH, Kimura SJ, Thygeson P. Signs and symptoms of uveitis: I. Anterior uveitis. Am J Ophthalmol. 1959;47:155.
11. IDF Diabetes Atlas, 10th Edition. Brussels: International Diabetes Federation; 2021. Available from: https://www.diabetesatlas.org.
12. Jin-woo Kwon, Donghyun Jee, Tae Yoon La. Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy. Medicine (Baltimore). 2017;96(10):e6263. doi:10.1097/md.0000000000006263.
13. Liao N, Li C, Jiang H, et al. Neovascular glaucoma: a retrospective review from a tertiary center in China. BMC Ophthalmol. 2016;16:14. doi:10.1186/s12886-016-0190-8.
14. Rivas-Aguino P, Garcia-Amaris RA, Berrocal MH, Sanchez JG, Rivas A, Arevalo JF. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation for the management of cataract and proliferative diabetic retinopathy: comparison of a combined versus two-step surgical approach. Arch. Soc. Esp. Oftalmol. 2009;84(1):31-38. doi: 10.4321/s0365-66912009000100005.
15. Senn P, Schipper I, Perren B. Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure. Ophthalmic Surg Lasers. 1995;26:420–8.