ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2023-2-239-244ophthalmology-2102Research ArticleОФТАЛЬМОХИРУРГИЯOPHTHALMOSURGERYВозможности применения вискоэластиков в витреоретинальной хирургииPossibilities of Applying Viscoelastics in Vitreoretinal SurgeryПетрачковД. В.PetrachkovD. V.

Петрачков Денис Валериевич - кандидат медицинских наук, заведующий отделом инновационных витреоретинальных технологий, старший научный сотрудник

ул. Россолимо, 11a, б, 119021, Москва, Российская Федерация

Petrachkov Denis V. - РhD, head of the Innovative vitreoretinal technologies department, senior researcher

Rossolimo str., 11A, B, Moscow, 119021, Russian Federation

СидамонидзеА. Л.SidamonidzeA. L.

Сидамонидзе Александр Леванович - кандидат медицинских наук, младший научный сотрудник отдела инновационных витреоретинальных технологий

ул. Россолимо, 11a, б, 119021, Москва, Российская Федерация

Sidamonidze Alexander L. - PhD, junior researcher

Rossolimo str., 11A, B, Moscow, 119021, Russian Federation

БарышевК. В.BaryshevK. V.

Барышев Константин Владимирович - аспирант отдела инновационных витреоретинальных технологий

ул. Россолимо, 11a, б, 119021, Москва, Российская Федерация

Baryshev Konstantin V. - postgraduate of the Innovative vitreoretinal technologies department

Rossolimo str., 11A, B, Moscow, 119021, Russian Federation

kosttt1995@gmail.comШабалинаК. Н.ShabalinaK. N.

Шабалина Ксения Николаевна - врач-офтальмолог

Ореховый бульвар, 28, Москва, 115682, Российская Федерация

Shabalina Ksenija N. - ophthalmologist

Orekhovy blvd, 28, Moscow, 115682, Russian Federation

ФГБНУ «Научно-исследовательский институт глазных болезней имени М.М. Краснова»РоссияM.M. Krasnov Research Institute of Eye DiseasesRussian FederationФГБУ «Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентства»РоссияFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyRussian Federation202330062023202239244Copyright © Петрачков Д.В., Сидамонидзе А.Л., Барышев К.В., Шабалина К.Н., 20232023Петрачков Д.В., Сидамонидзе А.Л., Барышев К.В., Шабалина К.Н.Petrachkov D.V., Sidamonidze A.L., Baryshev K.V., Shabalina K.N.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/2102

Вискоэластичные вещества (ВЭ) являются неотъемлемой составляющей современной офтальмохирургии. В настоящем обзоре кратко освещены основные характеристики, классификация ВЭ, области их применения, влияние на агрегацию тромбоцитов. В научной литературе уделено мало внимания применению ВЭ в хирургии заднего отрезка глаза, в связи с этим основной целью настоящего обзора явилось подробное изложение возможностей и перспектив использования ВЭ при различной патологии сетчатки и стекловидного тела. В витреоретинальной хирургии (ВРХ) наибольшее распространение получили когезивные ВЭ в связи с простотой их удаления из витреальной полости в сравнении с дисперсными ВЭ. Главным недостатком применения ВЭ является их влияние на офтальмотонус, что требует тщательного контроля, касающегося полноты удаления ВЭ из глаза при завершении операции. В обзоре рассмотрены вопросы применения ВЭ при макулярной патологии с целью механической и химической защиты сетчатки при работе с люксированным хрусталиком или введении красителей, оказывающих токсическое воздействие на ретинальную ткань. При хирургии макулярных отверстий ВЭ могут применять с целью стабилизации лоскута внутренней пограничной мембраны, а также для предотвращения субретинальной миграции ретинального красителя. Описаны возможности применения ВЭ в ВРХ в педиатрической практике с целью вискоделаминации ретролентальных стриктур во время выполнения витрэктомии в глазах с тракционной витреоретинопатией и сохранением нативного хрусталика. Отдельное внимание уделено использованию ВЭ при наиболее сложной хирургической патологии, требующей ВРХ — пролиферативной диабетической ретинопатии. Продемонстрированы их преимущества в аспектах сокращения времени вмешательства, что, в свою очередь, снижает риск развития интраоперационных осложнений. Применение методики вискодиссекции позволяет повысить безопасность хирургии во время наиболее травматичных этапов операции: отделения задней гиалоидной мембраны и в особенности при работе с пролиферативными фиброваскулярными мембранами. Появление способа окрашивания ВЭ открыло новые перспективы использования методики вискодиссекции и вискоделаминации.

Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.

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