Shilovskikh O.V., Safonova O.V.
PHACOEMULSIFICATION OF UVEAL CATARACT WITH SYNECHIOTOMY, POSTERIOR CAPSULORHEXIS, PARTIAL VITRECTOMY AND ORIGINAL METHOD OF IOL IMPLANTATION: REMOTE RESULTS ^{[№ 12 ' 2015]}
Cataract is a frequent complication of chronic uveitis. There are literary data concerning the results of surgery in this pathology. Lensectomy, extracapsular extraction, phacoemulsification with or without intraocular lens implantation as well as partial or subtotal vitrectomy have been described. Postoperatively, complications influencing visual outcome such as pupil occlusion, iris bombee, secondary cataract often develop. Working out new methods of surgery minimizing complications frequency is actual. The paper presents the experience of surgery in 111 eyes of 83 patients with uveal cataract. The operations were performed using authors' method including ultrasound cataract phacoemulsification with preliminary synechiotomy, posterior capsulorhexis, partial vitrectomy and intraocular lens implantation. Haptics of the intraocular lens were placed into the capsular bag and optic part was placed behind the posterior capsulorhexis. No intraoperative complications were observed. Visual acuity in 1–2 days after surgery was: above 0.5 — in 43.2 % of cases, 0.2–0.5 — in 34.2 %, below 0.2 — in 22.6 %. Most significant increase of visual acuity after the operation was observed in patients with preoperative visual acuity above 0.5 and below 0.2. Complications included local posterior synechiae without iris bombee in 2 eyes (1.8 %), increase of intraocular pressure — 7.2 %, uveitis recurrencies — 17 %, deposits on IOL — 11.4 %, pre-existing macular edema — 40 %, macular edema in 1 — 6 months after surgery — 5.4 %. Subtotal vitrectomy with epiretinal membrane removal was performed in 9 eyes (8.1 %). The developed method of uveal cataract surgery is safe, provides good anatomic results and a significant increase of visual acuity. Cases with low postoperative visual acuity are associated with pre-existing macular edema. Epiretinal membrane is a risk factor for cystoids macular edema progression after phacoemulsification of uveal cataract and is an indication for vitrectomy.