ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2020-1-13-19ophthalmology-1126Research ArticleОБЗОРЫREVIEWSФемтолазерные технологии и торические линзы в коррекции роговичного астигматизма у пациентов с астигматизмом. Обзор литературыFemtolaser Assisted Cataract Surgeryand Toric Lenses in Patients with Astigmatism. ReviewКуликоваИ. Л.KulikovaI. L.

Куликова Ирина Леонидовна доктор медицинских наук, зам. директора по лечебной работе

пр. Тракторостроителей, 10, Чебоксары, 428000

Kulikova Irina L. MD, deputy director for medical work

Traktorostroiteley Ave., 10, Cheboksary, 428000

ТимофееваН. С.TimofeevaN. S.

Тимофеева Нина Сергеевна врач-офтальмолог катарактального отделения

пр. Тракторостроителей, 10, Чебоксары, 428000

Timofeeva Nina S. Ophthalmologist

Traktorostroiteley Ave., 10, Cheboksary, 428000

Чебоксарский филиал ФГАУ «МНТК “Микрохирургия глаза” им. академика С.Н. Федорова» Министерства здравоохранения Российской ФедерацииРоссияCheboksary Branch of S. Fyodorov Eye Microsurgery Federal State InstitutionRussian Federation2020020420201711319Copyright © Куликова И.Л., Тимофеева Н.С., 20202020Куликова И.Л., Тимофеева Н.С.Kulikova I.L., Timofeeva N.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1126

Наличие сопутствующего роговичного астигматизма является наиболее частой причиной получения невысоких зрительных функций у пациентов при оперативном лечении катаракты. Имплантация торических интраокулярных линз является процедурой выбора при коррекции роговичного астигматизма от 1,0 дптр и более у пациентов с катарактой. Успешные результаты зависят от нескольких факторов, наиболее важные из которых: правильное и стабильное положение интраокулярной линзы (ИОЛ) в капсульном мешке, отсутствие остаточного астигматизма, выбор модели имплантированной ИОЛ с учетом материала и конструкции гаптических элементов линзы и др. Отклонение цилиндрического компонента на 10° снижает остроту зрения до 35 %. Повторное вмешательство с целью репозиции торической линзы, по данным литературы, варьирует от 0,65 до 9 % и проводится при ротации ИОЛ более 10°. Проведение фемтолазер-ассистированной факоэмульсификации катаракты позволяет частично автоматизировать хирургический процесс, сделав его более эффективным и безопасным, создавая теоретическое преимущество перед мануальной техникой проведения операции. На практике капсулорексис, сформированный фемтолазером, отличается правильной округлой формой с заданным диаметром и обеспечивает покрытие оптической части ИОЛ на протяжении 360°, что, по данным различных источников, способствует меньшей степени децентрации и наклона линзы в капсульном мешке и может рассматриваться как одна из причин получения более точного рефракционного результата и, как следствие, более высоких зрительных функций. В приведенном обзоре представлены результаты клинических исследований коррекции роговичного астигматизма при проведении стандартной и фемтолазер-ассистированной факоэмульсификации с имплантацией различных моделей торических ИОЛ: остроты зрения, ротационной стабильности, процента остаточного астигматизма, изменений волнового фронта. Исследователи продолжают обсуждать преимущества и недостатки современных технологий. Однако несомненной остается проблема повышения предсказуемости хирургического исхода с целью получения более высокого рефракционного результата как в раннем, так и в отдаленном послеоперационном периоде.

The presence of concomitant corneal astigmatism is the most common cause of low visual functions in patients with surgical treatment of cataracts. The implantation of toric intraocular lenses is procedure of choice in the correction of corneal astigmatism from 1.0 DPT and more in patients with cataracts. Successful results depend on several factors, the most important of which: the correct and stable position of the intraocular lens (IOL) in the capsule bag, the absence of residual astigmatism, the choice of the implanted IOL’s model, taking into account material and design of lens elements. Deviation of the cylindrical component by 10 degrees reduces visual acuity up to 35 %. Repeated intervention for the purpose of toric lens reposition, according to the literature, varies from 0,65 to 9 % and is carried out with the rotation of IOL more than 10°. Femtolaser-assisted phacoemulsification allows partially automate the surgical process, making it more efficient and safe, creating a theoretical advantage over manual techniques of surgery. In practice, the capsulorexis formed by the femtolaser is characterized by a regular rounded shape with a given diameter and provides a coating of optical part of IOL for 360°, which, according to various sources, contributes to a lesser degree of decentralization and tilt of the lens in the capsule bag and can be considered as one of the reasons for obtaining a more accurate refractive result and, as a consequence, higher visual functions. The review presents the results of clinical studies of corneal astigmatism correction during standard and femtolaser-assisted phacoemulsification with implantation of various models of toric IOLs: visual acuity, rotational stability, residual astigmatism percentage, wave front change. Researchers continue to discuss the advantages and disadvantages of modern technologies. However, the problem of increasing the predictability of the surgical outcome in order to obtain a higher refractive result both in the early and in the long-term postoperative period remains unquestionable.

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The authors declare that there are no conflicts of interest present.