ǂThe ǂInfluence of material and design of intraocular lens on the posterior capsule opacification development in patients who underwent cataract surgery by the phacoemulsificaton method

[D. Z. Todorović]

108 listova

SAŽETAK: Kristalno sočivo predstavlja deo dioptrijskog aparata oka. Osnovne fiziološke funkcije sočiva jesu refrakcija, apsorpcija ultravioletnog zračenja i akomodacija. Katarakta je najčešće oboljenje sočiva, a predstavlja i vodeći uzrok slepila u svetu. Opacifikacija zadnje kapsule sočiva ili sekundarna katarakta, najčešća je komplikacija uspešno izvedene operacije katarakte. Saznanje da je operacija katarakte najučestalija hirurška procedura u svetu daje ovom fenomenu još veći značaj. Opacifikacija zadnje kapsule sočiva nastaje migriranjem i proliferacijom rezidualnih epitelnih ćelija sočiva prema centralnom delu zadnje kapsule sočiva i osnovni je uzrok nezadovoljavajuće vidne oštrine nakon operacije katarakte. Poslednjih godina incidenca opacifikacije zadnje kapsule sočiva dosta je smanjena uvođenjem hirurgije malog reza – fakoemulzifikacijom, ali i unapređenjem materijala i dizajna intraokularnih sočiva. Cilj: Osnovni cilj istraživanja bio je utvrđivanje uticaja materijala i dizajna intraokularnog sočiva na učestalost pojave opacifikacije zadnje kapsule sočiva kod bolesnika kojima je operisana katarakta metodom fakoemulzifikacije sa implantacijom intraokularnog sočiva Materijal i metode: Istraživanje je sprovedeno kao klinička, prospektivna studija u trajanju od 2 godine. Prilikom operacije katarakte bolesnici su razvrstani u tri grupe u zavisnosti od implantiranog intraokularnog sočiva: akrilatno monokomponentno hidrofilno, akrilatno monokomponentno hidrofobno ili akrilatno trokomponentno hidrofobno intraokularno sočivo. Incidenca opacifikacije zadnje kapsule sočiva analizirana je programom „EPCO 2000“, standardnim softverskim programom za analizu opacifikacije. Digitalni snimci načinjeni su metodom retroiluminacije na biomikroskopu, u punoj midrijazi, prvog postoperativnog dana, 1, 6, 12, 18 i 24 meseca nakon operacije katarakte. Analiziran je i uticaj veličine kapsulorekse na razvoj opacifikacije zadnje kapsule sočiva, incidenca YAG laser kapsulotomije, glistening, najbolje korigovana vidna oštrina. Ispitivan je i uticaj operacije katarakte na promenu intraokularnog pritiska, keratometrije. Rezultati: Na kraju istraživanja najnižu vrednost opacifikacije zadnje kapsule sočiva zabeležili smo u grupi bolesnika sa implantiranim trokomponentnim hidrofobnim intraokularnim sočivom. Razlika između bolesnika sa monokomponentnim hidrofilnim i monokomponentnim hidrofobnim intraokularnim sočivom bila je statistički beznačajna. Dijametar kapsulorekse imao je uticaj na incidencu razvoja opacifikacije zadnje kapsule sočiva samo u grupama bolesnika sa implantiranim monokomponentnim intraokularnim sočivima. Najnižu incidencu YAG laser kapsulotomije zabeležili smo u grupi ispitanika sa implantiranim trokomponentnim hidrofobnim intraokularnim sočivom. Učestalost glistening-a bila je najniža kod bolesnika sa implantiranim monokomponentnim hidrofilnim intraokularnim sočivom. Najbolje korigovana postoperativna vidna oštrina u svim grupama zabeležena je mesec dana nakon operacije katarakte. Operacijom katarakte utvrdili smo statistički značajno sniženje intraokularnog pritiska, kao i promenu keratometrijskih parametara rožnjače.

ABSTRACT: The crystal lens is a part of the eye's diopter apparatus. The basic physiological functions of the lens are refraction, absorption of ultraviolet radiation and accommodation. Cataract is the most common lens disease, and it is the leading cause of blindness in the world. Posterior capsule opacification or secondary cataract is the most common complication of a successfully performed cataract surgery. The cognition that the cataract surgery is the most common surgical procedure worldwide gives this phenomenon even greater significance. Posterior capsule opacification occurs by migration and proliferation of residual lens epithelial cells toward the central part of the posterior lens capsule and it is the underlying cause of unsatisfactory visual acuity after cataract surgery. Over the last few years, the incidence of the posterior capsule opacification has been greatly reduced by the introduction of small incision surgery – phacoemulsification and by the improvement of the material and design of intraocular lenses as well. Aim: The main aim of the study was to determine the influence of intraocular lens material and design on the frequency of posterior capsule opacification in patients who underwent cataract surgery by phacoemulsification with intraocular lens implantation. Material and methods: The study was conducted as a clinical, prospective study lasting 2 years. During cataract surgery, patients were classified into three groups depending on the implanted intraocular lens: acrylic 1-piece hydrophilic, acrylic 1-piece hydrophobic or acrylic 3-piece hydrophobic intraocular lens. The incidence of posterior capsule opacification was analyzed by the "EPCO2000" program, a standard software program for opacification analysis. Digital images were made by the method of retroillumination on a biomicroscope, in full mydriasis, on the first postoperative day, 1,6,12,18 and 24 months after cataract surgery. The influence of capsulorhexis size on the development of posterior capsule opacification, the incidence of YAG laser capsulotomy, glistening, best corrected visual acuity were also analyzed. The influence of cataract surgery on the change of intraocular pressure, keratometry, was also examined. Results: At the end of the study, the lowest value of posterior capsule opacification was recorded in the group of patients with implanted 3-piece hydrophobic intraocular lens. The difference between patients with 1-piece hydrophilic and 1-piece hydrophobic intraocular lenses was statistically insignificant. The diameter of the capsulorhexis had an effect on the incidence of the posterior capsule opacification only in the groups of patients with implanted 1- piece intraocular lenses. The lowest incidence of YAG laser capsulotomy was recorded in the group of subjects with implanted 3-piece hydrophobic intraocular lens. The incidence of glistening was the lowest in patients with implanted 1-piece hydrophilic intraocular lenses. The best corrected postoperative visual acuity in all groups was observed one month after the cataract surgery. Based on a cataract surgery, we determined a statistically significant decrease of intraocular pressure, as well as a change in the keratometric parameters of the cornea.

fakoemulzifikacija, intraokularna sočiva, opacifikacija zadnje kapsule sočiva.

phacoemulsification, intraocular lenses, posterior capsule opacification

617.741-004.1-089(043.3)

Tekst