Особенности хирургии катаракты и послеоперационного периода у пациентов с глаукомой. Обзор литературы. (сообщение 1)
Abstract
Частота комбинации глаукомы и катаракты у офтальмологических пациентов достигает 76% случаев. Наличие у пациента глаукомы увеличивает риск осложнений в хирургии катаракты до 51,6% операций. Хирургия катаракты с узким зрачком встречается в 14% случаев и увеличивается с возрастом, достигая 71% к 80 годам. Узкий зрачок является осложняющим фактором процесса факоэмульсиифкации у пациентов с глаукомой, что приводит к нежелательным зрительным результатам. Однако, на сегодняшний день в арсенале офтальмохирургов имеется ряд ирисретракторов, которые дилатируют зрачок на время экстракции хрусталика, тем самым облегчая операцию. Слабость связочного аппарата хрусталика встречается у одной трети пациентов с глаукомой. Хирургия катаракты у данных больных сопровождается трудностями проведения классического капсулорексиса и высоким риском смещения или люксации хрусталика при её выполнении. Ригидность зрачка, медикаментозный миоз и слабость связочного аппарата требуют применения ирисретракторов, капсульных колец и, в некоторых случаях, внекапсульной фиксации хрусталика. Геморрагические осложнения хирургии катаракты у пациентов с глаукомой проявляются в виде гифемы и экспульсивного кровотечения. Учитывая особенность микроциркуляции глазного яблока, в 0,026-0,04% случаев во время хирургии катаракты возникает экспульсивное кровотечение. Причиной этого является разница давлений в сосудистом русле и вне его. Чем выше исходное внутриглазное давление при экстракции хрусталика, тем выше риск кровотечения. Рекомендацией исследователей является - максимальная компенсация внутриглазного давления перед факоэмульсификацией.
About the Author
Евгений ИвачёвRussian Federation
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