Iol turned what to do. A method for assessing the position of an intraocular lens. Posterior chamber IOL suturing techniques

This is a rather serious complication, as it may be accompanied by loss of the vitreous body, migration of the lens masses posteriorly, and, less frequently, expulsive bleeding. With inappropriate treatment, long-term effects of vitreous loss include a retracted pupil, uveitis, vitreous opacities, wick syndrome, secondary glaucoma, posterior dislocation of the artificial lens, retinal detachment, and chronic cystic macular edema.

Signs of posterior capsule rupture

Sudden deepening of the anterior chamber and sudden dilation of the pupil. The failure of the core, the impossibility of pulling it to the tip of the probe. Possibility of vitreous aspiration. A ruptured capsule or vitreous body is clearly visible.

Tactics depends on the stage of the operation at which the rupture occurred, its size and the presence or absence of vitreous prolapse. The main rules include:

the introduction of viscoelastic for nuclear masses in order to bring them into the anterior chamber and prevent vitreous hernia; the introduction of a special tonsil behind the lens masses to close the defect in the capsule; removal of lens fragments by the introduction of viscoelastic or their removal using phaco; complete removal of the vitreous body from the anterior chamber and the incision area with a vitreotomy; The decision to implant an artificial lens should be made taking into account the following criteria:

If large amounts of lens masses have entered the vitreous cavity, an artificial lens should not be implanted, as it may interfere with fundus imaging and successful pars plana vitrectomy. The implantation of an artificial lens can be combined with vitrectomy.

With a small rupture of the posterior capsule, careful implantation of the SC-IOL into the capsular bag is possible.

With a large gap, and especially with intact anterior capsulorhexis, it is possible to fix the SC-IOL in the ciliary sulcus with the placement of the optical part in the capsular bag.

Insufficient capsule support may necessitate sulcular suturing of the IOL or implantation of a PC-IOL using a glide. However, PC-IOLs cause more complications, including bullous keratopathy, hyphema, iris folds, and pupillary irregularity.

Dislocation of lens fragments

Dislocation of lens fragments into the vitreous body after rupture of the zonular fibers or the posterior capsule is a rare but dangerous phenomenon, as it can lead to glaucoma, chronic uveitis, retinal detachment, and chronic racemose macular edema. These complications are more often associated with phaco than with EEC. Uveitis and glaucoma should be treated first, then the patient should be referred to a vitreoretinal surgeon for vitrectomy and lens fragment removal.

NB: There may be cases where it is impossible to achieve the correct position even for the PC-IOL. Then it is more reliable to refuse implantation and decide on the correction of aphakia with a contact lens or secondary implantation of an intraocular lens at a later date.

The timing of the operation is controversial. Some suggest removing residues within 1 week, since later removal affects the restoration of visual functions. Others recommend postponing surgery for 2-3 weeks and treating uveitis and elevated intraocular pressure. Hydration and softening of the lens masses during the treatment facilitates their removal with a vitreotome.

The surgical technique includes pars plana vitrectomy and removal of soft fragments with a vitreotomy. More dense fragments of the nucleus are connected by the introduction of viscous fluids (for example, perfluorocarbon) and further emulsification with a phragmatome in the center of the vitreous cavity or by removal through a corneal incision or scleral pocket. An alternative method for removing dense nuclear masses is their crushing followed by aspiration,

Dislocation of the SC-IOL into the vitreous cavity

Dislocation of the SC-IOL into the vitreous cavity is a rare and complex phenomenon, indicating improper implantation. Leaving the IOL can lead to vitreal hemorrhage, retinal detachment, uveitis, and chronic cystic macular edema. Treatment is vitrectomy with removal, repositioning, or replacement of the intraocular lens.

With adequate capsular support, repositioning of the same intraocular lens into the ciliary sulcus is possible. With inadequate capsular support, the following options are possible: removal of the intraocular lens and aphakia, removal of the intraocular lens and its replacement with a PC-IOL, scleral fixation of the same intraocular lens with a non-absorbable suture, implantation of an iris clip lens.

Hemorrhage into the suprachoroidal space

Hemorrhage into the suprachoroidal space may be the result of expulsive bleeding, sometimes accompanied by prolapse of the contents of the eyeball. This is a formidable but rare complication, unlikely with phacoemulsification. The source of hemorrhage is the rupture of long or short posterior ciliary arteries. Contributing factors include advanced age, glaucoma, anterior-posterior segment enlargement, cardiovascular disease, and vitreous loss, although the exact cause of the bleeding is not known.

Signs of suprachoroidal hemorrhage

Increasing grinding of the anterior chamber, increased intraocular pressure, iris prolapse. Leakage of the vitreous body, the disappearance of the reflex and the appearance of a dark tubercle in the pupil area. In acute cases, the entire contents of the eyeball may leak out through the incision area.

Immediate actions include closing the incision. Posterior sclerotomy, although recommended, can increase bleeding and lead to loss of the eye. After the operation, the patient is prescribed local and systemic steroids to stop intraocular inflammation.

Subsequent tactics

ultrasound is used to assess the severity of the changes that have occurred; the operation is indicated 7-14 days after the liquefaction of blood clots. Blood is drained, vitrectomy is performed with air/fluid exchange. Despite an unfavorable prognosis for vision, residual vision may be preserved in some cases.

Edema

Edema is usually reversible and is most often caused by the operation itself and trauma to the endothelium in contact with instruments and the intraocular lens. Patients with Fuchs endothelial dystrophy present an increased risk. Other causes of edema are the use of excessive power during phacoemulsification, complicated or prolonged surgery, and postoperative hypertension.

Iris prolapse

Iris prolapse is a rare complication of small incision surgery, but may occur with EEC.

Causes of iris prolapse

The incision during phacoemulsification is closer to the periphery. Moisture seepage through the incision. Poor suturing after EEK. Patient-related factors (cough or other tension).

Iris prolapse symptoms

On the surface of the eyeball in the area of the incision, the fallen out tissue of the iris is determined. The anterior chamber in the incision area may be shallow.

Complications: uneven scarring of the wound, severe astigmatism, epithelial ingrowth, chronic anterior uveitis, racemose macular edema, and endophthalmitis.

Treatment depends on the interval between surgery and the detection of prolapse. If the iris falls out during the first 2 days and there is no infection, its reposition with repeated suturing is indicated. If the prolapse occurred a long time ago, the area of the prolapsed iris is excised due to the high risk of infection.

Intraocular lens displacement

Displacement of the intraocular lens is rare, but can be accompanied by both optical defects and disorders of the structures of the eye. When the edge of the intraocular lens is shifted into the pupil area, patients are disturbed by visual aberrations, glare and monocular diplopia.

The displacement of the intraocular lens mainly occurs during surgery. It can be due to dialysis of the ligament of Zinn, rupture of the capsule, and can also occur after conventional phacoemulsification, when one haptic part is placed in the capsular bag, and the second in the ciliary sulcus. Postoperative causes are trauma, irritation of the eyeball and shrinkage of the capsule.

Treatment with miotics is beneficial with little displacement. Significant displacement of the intraocular lens may require its replacement.

Rheumatogenous retinal detachment

Rheumatogenous retinal detachment, although rare after EEC or phacoemulsification, may be associated with the following risk factors.

Before surgery

"Retinal" retinal degeneration or tears require prior treatment before cataract extraction or laser capsulotomy if ophthalmoscopy is possible (or as soon as it becomes possible). High myopia.

During the operation

Vitreous loss, especially if subsequent management was wrong, and the risk of detachment is about 7%. In the presence of myopia >6 diopters, the risk increases to 1.5%.

After operation

Carrying out YAG-laser capsulotomy in the early stages (within a year after the operation).

Cystic retinal edema

Most often, it develops after a complicated operation, which was accompanied by a rupture of the posterior capsule and prolapse, and sometimes infringement of the vitreous body, although it can also be observed with a successfully performed operation. Usually appears 2-6 months after surgery.

general description
Cataract diagnostics
Conservative or medical treatment of cataracts
Cataract - surgical treatment
Modern eye microsurgery
Postoperative complications in cataract treatment
Recommendations for patients after cataract removal in the postoperative period

An operation to remove a clouded lens (cataract) performed by an experienced ophthalmic surgeon is, in principle, a simple, safe and quick operation, although, like any surgical intervention, it does not exclude the possibility of some complications.

Types of complications after surgery

All complications of surgical intervention during cataract removal can be divided into those that occurred during surgery or intraoperative and immediately postoperative.

In turn, postoperative complications, depending on the timing of occurrence, can be divided into early and late. Statistics show a small percentage of postoperative complications: no more than 1.5% of cases.

Early postoperative complications include:

Iridocyclitis, uevitis - inflammatory eye reactions; Rise in intraocular pressure; Hemorrhage in the anterior chamber; Retinal disinsertion; Dislocation or displacement of the artificial lens.

More about each complication

The response of the eye to surgical trauma is called the inflammatory reaction. Prevention of this complication is always started already at the final stages of the operation, for which broad-spectrum antibiotics and steroid drugs are administered under the conjunctiva of the eye.

In the normal course of the postoperative period, i.e. without complications, and against the background of anti-inflammatory therapy, after 2-3 days all the symptoms of the body's response to surgical intervention disappear: the function of the iris and the transparency of the cornea are completely restored, and since the picture of the fundus becomes clear, ophthalmoscopy becomes possible.

Hemorrhage into the anterior chamber is a rather rare complication and is associated with damage or trauma to the iris during surgery. In these cases, against the background of the treatment, the blood resolves, as a rule, in a few days, and otherwise, i.e., if conservative therapy is ineffective, the anterior chamber is washed and the lens is additionally fixed (if necessary).

Intraocular pressure

An increase in intraocular pressure in the postoperative period may occur due to: the development of a pupillary block, or clogging of the drainage system with special viscous preparations - highly elastic, used at all stages of the operation to protect the intraocular structures and, especially, the cornea of the eye, if they are not completely washed out of the eye .

In this case, when intraocular pressure rises, drops are prescribed, and this is usually enough. Exceptionally in rare cases, with an increase in intraocular pressure in the early postoperative period, an additional operation is performed - a puncture (puncture) of the anterior chamber and its thorough washing.

Retinal disinsertion

Retinal detachment occurs with the following predisposing factors:

myopia,
eye injury in the postoperative period, complications during surgery.

The treatment of such a complication is most often surgical: the sclera is sealed with a silicone sponge - vitrectomy. In case of retinal detachment on a small surface, restrictive laser coagulation of the retinal break is performed.

Violation of the position of the optical part of the artificial lens adversely affects the functions of the operated eye. Such displacements can be caused by incorrect fixation of the lens in the capsular bag or disproportion between the supporting elements of the lens and the size of the capsular bag.

With decentration or slight displacement of the lens, patients complain of discomfort in the operated eye, rapid fatigue after eye strain, and double vision often appears when looking into the distance.

As a rule, these complaints are intermittent and disappear after a short rest. But with a significant displacement of the IOL, more than 0.7 - 1 mm, there is constant double vision when looking into the distance and constant visual discomfort. Moreover, the sparing visual mode of operation does not give any effect. With such symptoms, repeated surgical intervention is required to correct the position of the optical part of the artificial lens.

Complete displacement of the IOL

Complete displacement of the IOL - dislocation of the lens either anteriorly, into the anterior chamber, or vice versa posteriorly, into the vitreous cavity. This complication is considered severe and here it is necessary to perform a vitrectomy - a surgical intervention, when an artificial lens is lifted from the fundus of the eye and re-fixed in the correct position.

When the lens is displaced anteriorly, the operation is simpler, it requires re-insertion of the IOL into the posterior chamber with its further suture fixation.

Late postoperative complications include:

Irwin-Gass syndrome (swelling of the central region of the retina);
Secondary cataract.

Swelling of the retinal area

Edema of the macular area of the retina is one of the complications during operations on the anterior segment of the eye. Most often, this complication develops after traditional extracapsular cataract extraction rather than after phacoemulsification and occurs within 4 to 12 weeks after the operation.

The risk of developing this complication increases if the patient has:

diabetes,
glaucoma,
inflammation of the vascular membrane of the eye,
eye injuries in the past, etc.

Causes of secondary cataract formation

A fairly common late complication during cataract surgery is secondary cataract. The reason for the formation of a secondary cataract is the migration from the growth zone, which is located in the equatorial region, to the central optical zone of opaque, irregularly shaped, structurally defective cells-balls of Adamyuk-Elschnig, from which a film or opacity is formed, which reduces visual acuity, sometimes very significantly.

The decrease in visual acuity, in addition, may be due to the process of fibrosis of the lens capsule, and the process is natural, occurring after a certain time after the operation. And these terms of secondary cataract formation vary from several months to several years.

Prevention and treatment of secondary cataract

To prevent the formation of such a complication as a secondary cataract, special techniques are used:

selection of IOLs of special designs, “polishing” of the lens capsule to remove cells (as completely as possible), etc.

The treatment for secondary cataracts is to perform a posterior capsulotomy. Carrying out this manipulation consists in creating a hole in the posterior capsule of the lens, which frees the central optical zone from clouding and allows light rays to freely penetrate into the eye, thereby increasing visual acuity, and significantly.

Capsulotomy is performed either with a laser or by mechanical removal of the film using surgical instruments. Capsulotomy with a laser is preferable, since there is no insertion of a surgical instrument into the eye, but this method also has a number of disadvantages, the main of which is the possibility of damage to the optical part of the artificial lens by laser radiation. In addition, there are a number of clear contraindications to this procedure.

Both laser and surgical capsulotomy are performed on an outpatient basis and allow the patient to restore high visual acuity in just a few minutes, provided that the neuroreceptor apparatus of the optic nerve and retina is preserved in the patient.

People who have had to deal with such an ophthalmic problem as clouding of the lens know that the only way to get rid of it is cataract surgery, that is, IOL implantation. In the US, more than 3 million such operations are performed per year, and 98% of them are successful. In principle, this operation is simple, fast and safe, but it does not exclude the development of complications. What complications after cataract surgery can appear and how to correct them, we will find out by reading this article.

All complications that accompany IOL implantation can be divided into those occurring directly during surgery or postoperative. Postoperative complications include:

rise in intraocular pressure; uevitis, iridocyclitis - inflammatory eye reactions; retinal detachment; hemorrhage in the anterior chamber; displacement of the artificial lens; secondary cataract.

Inflammatory eye reactions

Inflammatory responses almost always accompany cataract surgery. That is why, immediately after the completion of the intervention, steroid drugs or broad-spectrum antibiotics are injected under the conjunctiva of the patient's eye. In most cases, after about 2-3 days, the symptoms of the response completely disappear.

Hemorrhage into the anterior chamber

This is a fairly rare complication that is associated with trauma or damage to the iris during surgery. The blood usually resolves on its own within a few days. If this does not happen, doctors wash the anterior chamber, and, if necessary, additionally fix the lens of the eye.

Rise in intraocular pressure

This complication may appear due to clogging of the drainage system with highly elastic viscous preparations that are used during surgery to protect the cornea of the eye and other intraocular structures. Usually, instillation of drops that reduce intraocular pressure solves this problem. In exceptional cases, it becomes necessary to puncture the anterior chamber and thoroughly wash it.

Retinal detachment

Such a complication is considered severe, and it occurs in case of eye injury after surgery. In addition, retinal detachment is most common in people with myopia. In this case, ophthalmologists most often decide on an operation, which consists in sealing the sclera - vitrectomy. In the case of a small area of detachment, restrictive laser coagulation of the rupture of the eye retina can be performed. Among other things, retinal detachment leads to another problem, namely lens displacement. Patients at the same time begin to complain of rapid eye fatigue, pain, as well as double vision that appears when looking into the distance. The symptoms are intermittent and usually disappear after a short rest. When there is a significant displacement (1 mm or more), the patient feels constant visual discomfort. This problem requires re-intervention.

Full lens shift

Dislocation of the implanted lens is considered the most severe complication that requires unconditional surgical intervention. The operation consists in lifting the lens and then fixing it in the correct position.

Secondary cataract

Another complication after cataract surgery is the formation of a secondary cataract. It occurs due to the reproduction of the remaining epithelial cells from the damaged lens, which spread to the region of the posterior capsule. The patient at the same time feels a deterioration in vision. To correct such a problem, it is necessary to undergo a procedure of laser or surgical capsulotomy. Take care of your eyes!

Relevance

In cataract surgery, in some cases, a complication of the early or late postoperative period is the dislocation of the intraocular lens (IOL) and its partial or complete luxation into the vitreous body, which occurs when the lens capsule ruptures and the ligamentous capsular apparatus of the lens fails. This raises the question of the possibility of safe reposition and reliable fixation of the IOL.

Currently, there are various ways to reposition or replace dislocated IOLs: suturing to the iris, various options for suturing to the sclera under and without a scleral flap, replacing a posterior chamber IOL with an anterior chamber or IOL with iridopupillary fixation. Each of these methods has its own advantages and disadvantages.

Replacing a posterior chamber IOL with an anterior chamber one often leads to damage to the trabecular apparatus, sluggish inflammatory processes in the eye and, as a result, to secondary glaucoma, as well as to the development of corneal EED.

With pupillary fixation of the IOL, there are also significant drawbacks associated with a violation of the diaphragmatic function of the iris, there is a risk of developing pupillary block, iridocyclitis, and macular edema. With pupil dilation, complete or partial dislocation of the IOL into the anterior chamber with the development of EED or into the vitreous body is possible, which forces additional fixation of the IOL with sutures to the iris and limits pupillary function.

A number of scientific works are devoted to the reposition and fixation of the most physiological posterior chamber IOLs to the sclera in order to avoid further IOL dislocation into the vitreous body. In addition, such fixation of the IOL becomes the only alternative in complicated pseudophakia, when implantation of an anterior chamber or iris clip lens is contraindicated due to pronounced changes in the anterior segment of the eye (presence of anterior synechia, iridodialysis, partial or complete aniridia).

Various methods of reposition and intrascleral fixation of the IOL make it possible to obtain good fixation of the IOL, but are not always the method of choice, as they are associated with risks of complications such as hemophthalmos, ophthalmohypertension, and suture protrusion. Most of the proposed IOL repositioning methods involve the use of various viscoelastics during surgery, which increases the likelihood of ophthalmohypertension after surgery. In this regard, thorough washing out of the viscoelastic is required. However, its washout is associated with additional corneal injury and an increase in the development of EED, which is already initially increased in eyes with a similar pathology. The search for new methods of reposition, reliable fixation of the IOL and reduction of the risk of complications is topical.

Target

To improve the technique of reposition and reliable intrascleral fixation of the IOL without the use of viscoelastics.

Tasks:

1. To develop a technique for IOL reposition and fixation in various complicated clinical situations.

2. Evaluate the results of the developed surgical intervention.

Material and methods

The study included 67 patients (72 eyes) aged 52 to 89 years with dislocation of the posterior chamber IOL. The follow-up period is up to 10 years. Dislocation of the IOL with a rupture of the lens capsule - 29 eyes. Dislocation of the IOL together with the capsular bag - 43 eyes. All patients underwent surgeries according to the microinvasive technique developed by us without the use of viscoelastic. In 5 patients, a combined pathology was observed from the side of the posterior segment of the eye. The following types of IOLs were repositioned: Alcon Acrysof IQ Natural, Acrysof tripartite, Rayner aspheric, Akreos AO, Hanita lenses. To fix the IOL after its reposition, we used the sclerocorneal IOL fixation method developed by us, which allows reliable fixation of almost any type of the most commonly used IOLs. Visual acuity before surgery ranged from 0.01 to 0.7 with correction (mean 0.28±0.06). IOP - from 14 to 25 mm Hg.

Operation technique: first, 2 through punctures of the sclera and ciliary body with a 25 or 23G needle were made oppositely in one of the oblique meridians, 2.5 mm from the limbus. Above the puncture sites, 2 limbal corneal paracentesis were formed. And in the perpendicular oblique meridian, there are 2 more limbal paracentesis of the cornea. Through one scleral puncture, a needle with a thread in the form of a loop was passed with the back part forward over the IOL, without touching the IOL. Then the back of the needle was taken out through one of the corneal paracentesis. Then, a 25 or 23G guide needle was inserted exactly at the site of the same scleral puncture, which was used to center the IOL and which was inserted behind one haptic element of the IOL. The cutting part of the needle with the thread was passed through the guide needle and brought out. Then, a “noose” loop was formed outside, which was tightened on the IOL haptic element. Then the needle with the thread was injected exactly into the place of the scleral injection and passed intrasclerally and intracorneally through both lips of the paracentesis. The needle with the back side of the thread was removed from the paracentesis to the outside. An "anchor" knot was formed, the rest of the thread with a needle was cut off, and the knot was immersed in paracentesis. The same surgical actions were carried out on the opposition side. Since no incisions were made in the sclera and conjunctiva, after the operation, there were no stitches left on the eye that would need to be removed later.

results

Central stable fixation of the IOL was achieved in 69 cases. In 3 cases, IOL decentration up to 1.0 mm was observed, which did not affect the result of the operation. Re-fixation of the IOL was not required in any case. Visual functions in patients corresponded to the initial situation before IOL dislocation and the degree of preservation of the optic nerve and retinal layers. Visual acuity ranged from 0.2 to 1.0 with correction (mean 0.78±0.08). IOP after surgery was from 11 to 23 mm Hg. in 68 cases. In 4 cases, transient ophthalmohypertension up to 26 and 37 mm Hg was observed, stopped on drops for 1.5 months.

conclusions

1. The developed technique for repositioning posterior chamber IOLs is safe and allows achieving reliable fixation.

2. The sclerocorneal method of IOL fixation without the use of viscoelastic allows minimizing the risk of complications, in particular, reducing the likelihood of postoperative hypertension.

The most optimal option for implanting an intraocular lens (IOL) when performing phacoemulsification (PE) is in the capsular bag, which is due to the strength of fixation, the physiological position in a natural place for a refractive lens, which is the native lens. Modern surgical technologies allow for intracapsular implantation in the vast majority of cases.

But due to the initial weakness of the supporting apparatus of the capsular bag in some patients, intracapsular implantation in the postoperative period may be complicated by tearing of the Zinn ligament fibers with dislocation of not only the IOL, but also the entire complex "IOL - capsular bag" (KICM), or "IOL - intracapsular ring - capsular bag "(KIVKM), since the IOL itself is tightly wrapped in a lens capsule.

According to our data, the frequency of initial lens subluxation in patients before PE is at least 12%.

There are separate reports in the literature about spontaneous dislocation of CICM after PE. But at the same time, we found only single statements about the range of gradations of the degrees of its dislocation. This aspect, in our opinion, is extremely important for the surgeon, since it helps to comprehend and imagine the severity of the dislocation in a particular situation, as well as determine the choice of the most optimal method for its surgical correction.

According to the literature, the concept of the complex "IOL - capsular bag" or the complex "IOL - intracapsular ring - capsular bag" includes both the IOL itself and the capsular bag, and often the intracapsular ring contained in it. The relevance of a separate consideration of the problem of deployed KICM is due, in our opinion, to a number of reasons. First of all, the size of the entire complex is significantly increased in comparison with a separately deployed IOL. In addition, the frequent formation of fibrosis of the capsular bag can complicate the procedure for suturing and puncturing with a CICM needle, in contrast to suturing a dislocated IOL, when there are no obstacles for capturing and fixing its haptic element. It should also be noted that when suturing, piercing with a needle and repositioning CICM, the surgeon faces the problem of additional undesirable mechanical vibrations of the entire plane of the complex, creating a high risk of its luxation into the vitreal cavity and onto the fundus.

Surgical options for fixing the complex are also ambiguous. So, in some cases it is possible to hem it using all the structures included in the complex (haptic elements of the IOL, intracapsular ring). In other cases, when planning the fixation of IOL haptic elements in scleral pockets, the surgeon has to make additional efforts and surgical techniques to release them from the capsular bag and, if necessary, perform instrumental dissection of the fibrous posterior lens capsule.

Despite these concerns for surgeons, there is still no clinical classification of the severity of dislocation of the complex. The existing generally accepted clinical classification of the degrees of decentration, dislocation, subluxation and luxation of the IOL, created by Academician S.N. Fedorov and prof. E.V. Egorova, in our opinion, does not reflect situations with detachment and dislocation of the entire capsular bag with an intracapsular ring and IOL.

Meanwhile, the need for such a classification is long overdue, since it will, firstly, make it easier to understand the severity of the condition in each specific case, and secondly, to develop and use a certain sequence of surgical approaches to its elimination.

Target- to study the structure of topographic variants of CICM dislocations, distinguish them according to their severity and propose their conditional clinical classification.

Material and methods

40 eyes with KICM dislocation were taken by the continuous sampling method. 30 men, 10 women, age - from 63 to 88 years. The term after the implementation of the FEC is from 1 to 12 years. In the vast majority of cases (21 eyes) there was an immature stage of cataract, in 16 - mature, and in 3 - overripe. Age-related cataracts were noted in 7 eyes. In 33 eyes it was combined with various stages of pseudoexfoliative eye syndrome (PES). Despite this, PE was successful and in all 40 cases ended with intracapsular implantation of the posterior chamber IOL.

A set of factors was taken as a severity criterion: 1) the presence and degree of visual function decrease, 2) the risk of concomitant complications (keratopathy, IOP elevation, retinal complications - Irwin-Gass cystic maculopathy, vitreous hernia, retinal detachment), 3) the degree of difficulty in repositioning the complex , volume of intervention (in the anterior segment or the need for endovitreal intervention), 4) diastasis of the CICM edge from the ciliary processes according to ultrasonic biomicroscopy (UBM), localization of the dislocated CICM according to the B-scan, as well as the presence of concomitant retinal detachment, hemophthalmia.

Results and discussion

In this clinical group, we encountered various types of dislocations of the complex. Using our own criteria, we conditionally subdivided them according to severity.

I degree - subclinical dislocation of KICM - 4 eyes. They were characterized by high visual acuity (0.6-0.8), the presence of "glare", "halos" and "iridescence" in visual perception; visualization of the edge of capsulorhexis, which does not reach the optical zone, during biomicroscopic examination on a wide pupil. The displacement of the complex relative to the ciliary processes by 1.5–2.0 mm was determined by UBM. But, due to the asphericity of the IOL optics, visual acuity was almost the same as after PE. No complicating factors were identified; therefore, this group of patients was recommended only dynamic monitoring of the position of the complex, control of IOP (in 1–3 months).

II degree - clinically significant dislocation of the complex - 9 eyes. All these patients complained of decreased vision. The indicators of visometry were reduced relative to the initial ones by 0.1-0.2 and below. In the optical zone or below it, the edge of the IOL with a haptic element and a fibrous-modified capsular sac, torn fibers of the zinn ligament were visualized biomicroscopically. This dislocation of the complex entered the optical zone and, therefore, caused a decrease in visual functions. Considering the high risk of vitreous hernia and traction maculopathy, these patients underwent anterior vitrectomy with reposition and suturing of the complex to the iris in one case and replacement of CICM with IOL RSP-3 with suturing to the iris in 8 eyes. This degree of dislocation requires urgent surgical intervention in the anterior segment of the eye - in the next week. In terms of volume, it includes suturing the complex to the iris or replacing it with an IOL RSP-3; in case of vitreous prolapse, anterior vitrectomy.

III degree - dislocation of the complex in the anterior layers of the vitreum - 15 eyes. Complaints of patients on a significant decrease in vision. Moreover, with an aphakic correction of +8.5-+10 diopters, visual acuity increased significantly, up to 0.6-0.8. CICM was significantly displaced downward and was located in the anterior vitreous body (ST). With a wide pupil, only a small edge of the IOL haptic element or an intracapsular ring was visualized, uncomplicated or complicated herniation of the CT. The IOP level was within 23-25 mm Hg. The eyes were calm. Given the threat of complete dislocation of the CICM to the fundus, in these cases we performed a sclero-corneal tunnel incision of 4.5–5.0 mm, removed the complex with tweezers, performed anterior vitrectomy, and implanted an iridovitreal IOL RSP-3 with suturing to the iris.

IV degree - dislocation of the complex to the fundus - 12 eyes. These eyes were characterized by a sharp decrease in uncorrected visual acuity. In the lumen of the pupil in all eyes, both uncomplicated and complicated CT hernia were determined. B-scanning in 8 eyes revealed the dislocation of the complex into the deep layers of the CT, in 4 eyes it was adjacent to the surface of the retina (in one eye in the topographic zone of the macula, in 3 eyes in the equatorial zone). In one eye, a local traction retinal detachment was formed, caused by the contact of the CICM with its surface, in one eye, according to optical coherence tomography, cystic macular edema (retinal thickening, rounded intraretinal cysts) was detected. These cases required urgent endovitreal surgery, vitrectomy, removal of the complex, implantation of an iridovitreal IOL.

conclusions

1. Analysis of our own clinical material made it possible to identify a wide range of topographic gradations of the dislocation of the "IOL - capsular bag" complex.

2. A clinical classification has been proposed, which conditionally includes four degrees of severity of the dislocation of the "IOL - capsular bag" complex.

3. Each of the identified degrees of severity of dislocation of the IOL complex has characteristic clinical features, and its correction requires a certain amount of surgical approaches.

A patient came from a friendly clinic — when trying to perform a FEC + IOL on a glaucoma eye, a perforation of the back of the capsule occurred with dislocation of fragments of the nucleus and, subsequently, the IOL into the vitreous body. He was operated on the day before, corneal edema and IOP are growing - we must take it.

When checking for entry into the vitreal cavity with the end of the cannula in sclerotomy, there is a surprise - the choroid is not punctured due to high (hemorrhagic) CCO, the setting of the infusion line is impossible, and the blood in the suprachoroidal space is a fresh clot. The infusion was delivered through peracentesis in the PC, one of the sclerotomies was expanded, a small amount of hemorrhagic content was obtained from the suprachoroidal space.

After vitrectomy with OST induction and removal of small swelling fragments of the nucleus, the IOL was repositioned onto the capsular bag, most of the blood was left in the suprachoroidal space.

A patient came to us with a detachment of the capsular bag (with an IOL in it) and dislocation into the vitreous body in the left eye. He was operated on earlier (about 5 years ago) in another clinic, the details are unknown, except that he spent about 3-4 days in the hospital and was discharged with normal vision. That is, the posterior capsule, apparently, was intact and the operation took place without much stress on the endothelium. And now, for no apparent reason, the capsular bag has sunk.

The most interesting thing was that the right eye was practically blind at the same time - EED and, possibly, retinal detachment (this is unknown to science, EED was done in another clinic, and where the detachment came from is a mystery, the fields on this eye are quite decent). In addition, the left eye with aphakic correction sees 1.0.

My hands were shaking all the way out of the operating room. Vitrectomy, the lens descended on the macula, then nibbled the capsular bag, holding the lens in the air and holding the light guide and raised it in vacuum to the plane of the pupil, changed the light guide to collet tweezers, switched the microscope. I put the lens on the iris with tweezers. Since the technique of the phaco surgeon was unknown (you can see the old accesses, but you never know), so I decided to externalize the legs of the lens in paracentesis. I separated the posterior hyaloid without any problems. Since there is fragmentary data on detachment in the fellow eye, he examined the periphery with passion, did not find any gross changes, but LC did it anyway. Then he cut out the visors for 7 hours and for 1 hour, injected a needle under the bottom, brought the threads into the paracentesis, pulled out the legs through the paracentesis, tied the threads to them and stretched the lens behind the iris.

Corneal edema and descmetitis persisted for quite a long time, up to five days. But before discharge it was already more fun, vision up to 0.6, though with a sphere of +0.5D, I attribute this to the displacement of the IOL posteriorly during suture fixation.

A patient came to us from a friendly clinic. A month ago, I had a FEC + IOL in my left eye, it passed without any features, but on the 5th day uveitis occurred. At what, good uveitis with massive exudation into the vitreous. The patient himself is not very prosperous - partial atrophy of the optic nerve of toxic origin, vision in this eye at the time of discharge after lens replacement was about 0.2 with correction.

When hospitalized to us, the eye was practically calm, the anterior segment was without features, except for the absence of a posterior chamber IOL in the pupil lumen. There are dense floating opacities in the vitreous body, the fundus of the eye looks difficult and in general terms. On the B-scan, the retina is adjacent.

There are two interesting moments in the operating room: a defect in the posterior capsule in the lower quadrant (let me remind you, FEC is without features), an IOL in the vitreous body inside a clot of fibrous tissue behind the iris below. Of course, all this is removed, the IOL is returned to the anterior chamber, then to the lens capsule. But the most interesting was at the bottom. There was no BGM detachment, but despite the recommendations not to call it in case of intervention for endophthalmitis, I induced detachment of the posterior hyaloid (after all, not the peak of inflammation activity). On the retina itself, deposits were found in the form of rounded "heaps" of white dust. That is, it is gradually washed out during extrusion, it can be inflated with a “flute”. Somewhere in the literature (I don’t remember where, if anyone knows - tell me) I saw that these are colonies of bacteria.

In general, I washed everything, separated the BGM where I could (in one place behind the arcades it was quite dense, so I left it). By the time the patient was discharged, he saw 0.2, and after a couple of weeks - 0.3.

UDK 617.74.741-001.6

DISLOCATION OF THE LENS: REVIEW OF THE LITERATURE.

Bekmirova B.B., Frolov M.A.

FGBOUVPO "Russian University of Friendship of Peoples", Moscow Russia

Annotation: Based on the analysis of the literature review on lens dislocation, a number of diagnostic issues remain unresolved. Despite the developed various IOL options, there are controversial issues about the tactics of treating this pathology.

Key words: lens, dislocation, subluxation, glaucoma, IOL.

The pathology of the lens is one of the most important problems in ophthalmology, and cataract is one of the main causes of blindness. Among the pathological conditions of the lens, there are anomalies in its shape and size, violations of its transparency and position. Violations of the regulations lead to the most serious consequences. A large number of clinical variants of lens dislocation from minor dislocations to complete separation of the ciliary ridge is characterized by the nature of the disease, which can be congenital or acquired. Congenital dislocations are usually hereditary. The causes of which may be anomalies in the development of the ciliary band (defects, partial or complete aplasia), underdevelopment of the ciliary band. They can also be observed in hereditary diseases, such as: Marfan syndrome, Weil-Marchesani syndrome, homocystinuria, dominant spherophakia, etc. Acquired dislocations of the lens are divided into traumatic and spontaneous. There may be penetrating blunt injuries, wounds, concussions that occur as a result of exposure to objects that have a low speed of movement and a large area

The term "dislocation" of the lens covers all types of lens displacement: subluxation, dislocation into the vitreous body and into the anterior chamber. Less common are subconjunctival and

subchoroidal localizations. There is the concept of the so-called "alternating dislocation of the lens", when the lens can move from the anterior chamber to the vitreous body and vice versa. Another author calls it "migratory luxation of the lens".

Based on the analysis of the literature review, there are various classifications of different authors on this issue. In some cases, this is due to different surgical approaches, in others, the lack of a single tactic on the treatment of this pathology.

Of particular importance is the diagnosis of dislocation of the lens. Usually, lens displacement is diagnosed when the patient comes in with complaints of visual impairment, discomfort in the eye, or may be discovered by accident. The main objective symptoms of the lens are iridodonesis, phacodonesis, distance of the pupillary edge of the iris, uneven angle of the anterior chamber, change in the gap between the iris and the lens, displacement of the anterior-posterior axis of the lens. A more reliable sign is a hernia of the vitreous body and its presence in the anterior chamber. Traumatic dislocations are characterized by damage to the iris in the form of tears and ruptures of the pupillary edge, iridodialysis, complete or partial coloboma of the iris. Detection of iridodonesis is carried out with focal illumination, examining the iris with a binocular loupe. If a

the trembling of the iris when moving the eyes is doubtful, then the patient should be asked to look first at one point, then at another point on the forehead of the examiner. In cases where the transparency of the cornea and the moisture of the anterior chamber are impaired, "sonography with a water nozzle" can be used, the conclusion is drawn based on a comparison of echograms of a healthy and damaged eye. The distance of the lens echopic from the corneal one is taken into account. In case of subluxation or suspected dislocation of the lens, measurement of IOP is necessary. It is IOP in young people that can cause suspicion of subluxation, after which it is examined by biomicroscopy. However, IOP should be carefully measured so as not to increase the degree of subluxation. In addition to the usual ophthalmological examinations (visometry, perimetry, ophthalmoscopy, determination of binocular vision), specific electrophysiological studies (EPS) are also carried out, which require special equipment skills from the doctor. Computed tomography (CT), which allows obtaining high spatial and contrast resolution in a thin section of an eye disease associated with damage to the lens. With the advent of endoscopic methods in surgery, there are data on the use of intraoperative endoscopy to monitor the "supporting" apparatus of the lens, the supporting elements of the IOL during implantation in complicated cases.

The original method of localization of the lens was proposed by the author. The patient's pupil is dilated with short-acting mydriatics using synergists. After expansion, the patient is placed in a face down position for 1520 minutes. Position control is carried out with the help of a concave mirror, which has the property of magnifying objects. Illumination is performed with a direct or reverse ophthalmoscope. When the lens moves into the anterior chamber, the radiance of the equator is determined against the background of a dark pupil; when the dislocated IOL exits, haptic elements become visible. Miosis is performed in the face down position.

Of particular importance in the diagnosis is the early detection of symptoms of dislocations and subluxations.

lens, which gives the right to carry out targeted, diagnostic and modern therapeutic measures.

Treatment of patients with dislocation of the lens remains one of the most pressing issues in ophthalmology today. Severe clinical manifestations of the disease, as well as unsatisfactory treatment of this pathology creates a big problem. The main method of treatment of dislocation of the lens remains the surgical method. Currently, there are many different approaches to the treatment of dislocated lenses. Complications that can be distinguished: secondary glaucoma, pronounced destructive changes or liquefaction in the vitreous body, firosa with subsequent fusion of the lens with the retina or ciliary body, iridocyclitis, retinal detachment, proliferative retinitis and retinal degeneration. The most common complication is secondary glaucoma. According to the authors, the frequency of occurrence with subluxations is 22-64%, and with dislocations in 52-76% of cases.

Many authors consider removing the lens from the vitreous body only in the presence of glaucoma, and only in the case when conservative treatment does not help. Not always a displaced lens after removal in secondary glaucoma leads to normalization of IOP, in such cases it is better to perform an antiglaucoma operation. According to some data, carried out by the author on the basis of his work performed 188 operations for dislocated lenses, he comes to the conclusion that in the presence of glaucoma, it is first necessary to perform anti-glaucoma fistulizing operations, and only then the extraction of the lens, regardless of the degree of clouding. An individual approach was proposed by another author to the tactics of treating patients with phacotopic glacoma, proposing to take into account the condition of the second eye, the degree of displacement and clouding of the lens. If the lens was deployed on a single eye, it is preferable to perform fistulizing operations. If there is a slight subluxation, but at the same time uniform vision is preserved, it is recommended to use miotics. If there are significant displacements, especially with clouding of the lens, its removal is considered to be indicated.

Due to the complexity of the operation for the removal of dislocated lenses, there are various recommendations and modifications of surgical interventions. The main purpose of removing the lens dislocated into the vitreous body is to transfer it from the back to the front.

A special Dixon I needle (1953) was proposed that fixes the lens when the patient's position changes, in which the lens changes localization, moving into the anterior chamber (sitting or lying face down), and removing it in the usual position, or in the prone position. This method is, in fact, the main one in the treatment of this pathology.

During the operation, a special cataract chair was proposed, which, when moved, puts the patient's head in a horizontal position, and Stricker's mesh. But it is not always possible to transfer the lens to the anterior chamber, so it has to be removed from the vitreous body. The lens was removed with tweezers, a diathermy needle, a cataract loop, Breinin's erisi-faq, Weber's loop. Mechanical aspiration of the vitreous body followed by cryoextraction, extracapsular (also phacoemulsification) extraction. Using a system of two soldered cannulas, the lens was moved to the pupil area and removed with a cryoetractor.

Translation is possible with the help of a discission needle, irrigation with a stream of saline or Ringer-Locke, injection of sodium hyaluronate solution behind the subluxated lens. To remove the lens from the vitreous body, an instrument was proposed that includes a device for fixing the lens in the form of a stainless steel loop with special outgrowths - loops, which is inserted through the flat part of the ciliary body

The method of electrodiaphakia is known (R. Gess, 1977), fixation and removal of the lens with cyanoacrylate glue (M. Gilebou, 1972). In many cases, the lens was fixed with a discission needle or spatula and removed with a loop or cryo-extractor.

The most frequently performed operations were: Elliot, Langrange - Golta in Filatov's modification.

The described methods are time-consuming and laborious in execution. They are designed to move the lens from the back to the front of the eyeball, which is possible only if there is a movable lens and a liquid vitreous body. All methods of removal and fixation of the lens cause injury to the eye and are accompanied by damage and loss of a large amount of the vitreous body during the operation.

The development of vitreous surgery has caused a more active attitude towards the removal of the lens from the vitreous body (lensectomy). The approach to the lens became possible through a small incision in the flat part of the ciliary body. Partial vitrectomy allows the lens to be freed from vitreous cords and, if possible, brought into the anterior chamber. The advantage of this method is the simultaneous conduct of closed vitrectomy in case of vitreal pathology, the presence of vitreous hernia, intravitreal hemorrhages. Approach through the flat part of the ciliary body with posterior luxation allows destroying the capsule and the cortex of the lens and performing aspiration. To perform a lensectomy when removing the lens completely or partially displaced into the vitreous body, some ophthalmologists use the OsChute apparatus of various modifications and the Vitrectomy apparatus for vitrectomy. The use of closed vitrectomy through an incision in the flat part of the ciliary body is best done young. In severe age-related, metallic, and other types of cataracts, the removal of the lens from the vitreous body is indicated by a loop or cryoextractor or in combination with closed vitrectomy.

With complete medical and social rehabilitation of patients after removal of dislocated lenses, intraocular correction is necessary.

In modern cataract surgery, intraocular correction is the most optimal option. In this case, the least traumatic and most physiological method is the implantation of an intraocular lens into the capsular bag of the lens. Various methods of fixation and IOL models are used: anterior chamber, pupillary and posterior chamber.

The posterior chamber location of the IOL has undeniable advantages: no contact with the posterior corneal epithelium and tissues of the anterior chamber angle, preservation of pupil function and shape, for cosmetic purposes, the most physiological position, the absence of pseudophacodenesis, as well as obtaining images of the correct size on the retina.

In the 50s of the last century, independently of each other, E. Epstein (1959) and C. Binkhorst (1962) investigated the possibility of using the iris to fix the intraocular lens. E. Epstein used a lens that resembles a cufflink, and in 1953 implanted this development after intracapsular cataract extraction in 24 eyes. Later, he abandoned his development, proposed a lens, which was called the "Maltese cross". This was a flat pupillary lens, first one-piece, and then with two solid (which was behind the iris) and two loop-shaped (which was in front of the iris) supporting elements. The author implanted 40 such lenses. A more modern model of this IOL is the flat Copeland lens used in the USA. This lens is much thinner than the original Epstein "Maltese cross" lens, has 4 one-piece parts and resembles an airplane propeller in shape.

At the same time, C. Binkhorst in 1957 developed an iris - clip - lens, which was applied on August 11, 1958. The lens has 4 supramid arches: the optical part and the front arches are located in one plane, and the two rear arches are in the other plane. The entire optical part is located prepupillary.

In 1963, S.N. Fedorov et al. began to use iris - a clip-on lens. At the heart of its fastening is fixation in the pupil area. Three haptic elements in the form of arches are located behind the iris, the lens itself with anterior haptic elements in the form of antennas is in front of the iris. First of all, the dislocation of the supporting elements, sometimes the entire lens, into the anterior chamber or the vitreous body should be considered specific for ICL, which, according to various authors, occurs in about 5–13.6% of cases.

In 1967 R. Binkhorst replaced the biconvex optical part with a plano-convex one,

to optimize the conditions for the circulation of aqueous humor between the posterior and anterior chambers of the eye.

MM. Krasnov (1968) proposed a number of modifications of extrapupillary lenses. Their supporting elements are attached to the iris in front or behind outside the pupillary area. The disadvantage of lens modification by the author is the complex implantation technique, the large weight of the IOL, which is distributed only over 2-3 fixation points. The close location of the supporting elements to the peripheral part of the cornea does not exclude the possibility of traumatizing the endothelium during eye movement, iridodonesis, and decentration of the pupil.

J. Worst (1969) began to sutured the IOL to the iris, first by one arch, and later by the equatorial zone of the lens body. This led to the development of a lens with an enlarged body and 2 holes in the upper segment, designed to pass a monofilament prolon thread. Thus, the lens had no front support elements. This lens was first implanted on December 18, 1970 and was known as the medallion lens.

In 1971, J. Worst proposed various modifications of lenses - medallions such as "clover - leaf", "small - incision - lens", "circular - loop - lens", etc. In 1973, the author developed a model of a pincer grip lens or lens - claw (iris - claw lens) which can be seamlessly attached to the iris. The distal ends infringe the iris at two points; for this, slit-like slots are provided in the supporting part of the lens, which fix the iris.

In this regard, there was interest in the use of IOL (iris - lens, Iris Claw IOL),. This lens was originally proposed for fixation to the iris in the anterior chamber, but subsequently there were reports of an original method for fixing the iris lens in the posterior chamber [Kumar V., 2002, 2010; Dushin N.V., 2003; Frolov M.A., 2009; Isufai E., 2010]. However, the authors of the method do not have sufficient information about the possibilities of changing IOP, as well as data on the use of posterior chamber implantation in patients with POAG.

A fairly common way to fix the posterior chamber IOL, in the absence of a capsular bag, is to suture the optical part or haptic elements of the IOL to the iris. Peirce in 1976 was one of the first to apply suture fixation of the posterior chamber IOL to the posterior surface of the iris. In this case, the IOL was fixed with two prolene sutures to the middle periphery of the iris.

A method has been developed for suturing the posterior chamber IOL model using a safety girdle suture, which is removed when the lens is fixed with 2-3 sutures to the posterior surface of the iris.

According to Chu M.W. et all., (1992) when stitching to the iris, it is technically difficult to achieve good centering of the lens. With large iris defects, this becomes generally impossible. In addition to all this, fixation of the posterior chamber IOL to the iris increases the risk of angle-closure glaucoma, which is due to the anterior displacement of the periphery of the iris by the haptic elements of the sutured IOL.

Helal et al. (1996) described an improvement in the technique of transscleral fixation of the posterior chamber IOL. The essence of the improvement is the use of a straight needle (Ethicon, USA) with a 10-0 propylene thread (Prolene, USA), which was vertically inserted into the sclera 0.75 mm from the posterior surgical limbus under the lower flap and directed into the cavity 27 gauge needles, which is also, but under the upper flap.

Regillo et al. (1996) suggests creating scleral flaps at 3 and 9 o'clock and using a soft silicone lens for implantation through a small incision.

Omulecki et al. (1998) used a needle with thread ("Prolene" 9 - 0, USA), which was inserted through the base of the scleral flap into the retropupillary space 1 mm posterior to the radicular oscleral incision at 3 and 9 o'clock also. An increase in IOP was observed, in one patient out of three, which was normalized by antihypertensive therapy.

N.M. Sergienko and D.E. Zhaboedov (2000) implanted in the posterior chamber of the "gymnast" IOL (29 eyes) in patients with failure of the ligamentous-capsular apparatus of the lens (with

lack of capsule support). In almost all cases, IOL fixation was sutureless and was carried out at the root of the iris through 2 microcolobomas. In 3 cases, additional IOL fixation was performed with one suture to the iris. In all cases, stable position and good centering of the IOL were observed.

Anterior chamber IOL implantation became popular in the 1950s. When mainly intracapsular cataract extraction was performed. There were different types of lenses with rigid haptics (Ridley Choyse), with flexible haptics (StrampelH, Simcoe, Barraquer). S.N. Fedorov implanted an anterior chamber lens of the H. Dannheim type made of plastic, M.M. Krasnov used a front lens made of B. StrampelH glass. Anterior chamber IOLs were almost simultaneously proposed by R. Baron (1953), J. Barraquer (1954, 1956), H. Ridley (1957), W. Lieb (1957), T.G. Parry (1958), B. Strampelli (1958), H. Dannheim (1961) and a number of other authors. Due to the fact that most of the first anterior chamber IOLs had rigid support elements, they were difficult to center and therefore a favorable outcome of the operation was not observed. B. Strampelli (1958), approximately 5 years after implantation of anterior chamber lenses, observed endothelial-epithelial corneal dystrophy in almost 60% of cases.

Choyce D.P. (1959 - 1979) experimentally and clinically tested, and recommended for clinical use, a model of his own design Mark VIII and IX. This model has dramatically reduced the percentage of postoperative complications, the design features are the presence of thin 4 legs that ensure a stable position of the lens in the anterior chamber.

To replace rigid anterior chamber lenses, lenses should be considered elastic support elements. Which were proposed by V.Ya.Bedilo (1975), M.M. Krasnov, M.L. Dali (1978), V.V. Nedospasov (1980), T.I. Eroshevsky (1983), Choyce D.P. (1980), Kelman C., Shepard D. (1980), Draeger J. (1989).

In recent years, anterior chamber IOLs have been used for implantation with reconstruction of the anterior eye with penetrating keratoplasty and IOL reimplantation.

There are isolated reports of the use of anterior chamber lenses for ligamentous defects.

The lens apparatus, while there are no clear indications for this type of correction, and changes in the hydrodynamics and gonioscopic picture of pseudophakic eyes in the long-term follow-up are not specified (Henning A. et al., 2001; Evereklioglu C. at all., 2003) .

In a historical context, IOLs with a pupillary fixation type have been an alternative to anterior chamber lenses. Pupillary IOL models are now practically not used in practice due to the large number of complications.

As a result of the review of the literature on the dislocation of the lens, it becomes clear about the unresolved, debatable issues regarding the optimal timing of the treatment of this pathology, the tactics of administration before and postoperative conditions of patients, and the treatment of patients with traumatic dislocations.

LITERATURE

1. Abbasov F.A. Results of implantation of anterior chamber intraocular lenses in traumatic cataracts in children / F.A. Abbasov / Oftalmol. magazine. - 2000. - No. 6. - S. 33 - 35.

2. Alekseev B.N. Intracapsular implantation of an artificial lens / BN Alekseev // Vestn. ophthalmol. 1976. No. 5. pp. 31 - 36.

3. Anisimov S.I. Computed tomography in the pathology of the lens // collection of scientific. stat. MNTK "Eye Microsurgery", -1988., - S. 157 - 160.

4. Belyaeva L.L., Wegner G.E., Dr. med. Sciences, Ko-teyansky E.O.// Ophthalmological journal. 1990 - No. 1.1-64.S.52.

5. Boyko A.V., Bykov V.P., Polyakova L.Ya. Indications for various methods of surgical treatment of patients with lens displacement // Oftalmol. Journal. - 1987. -№5. - S. 257 - 259.

6. Boyko A.V., Sinelshchikov I.V. The method of localization of lens displacement // Diagnosis and microsurgery of fragmental wounds of the eye - abstracts,

M., - 1991, - S. 87 - 89.

7. Venger G.E., Logai I.M. Extraction of dislocated traumatic cataracts with anterior vitrectomy and iridoplasty // Oftalm. Journal. -1977. - Number 3. - S. 170 - 174.

8. Wenger G.E. Peculiarities of intraocular correction in case of ruptures of the posterior lens capsule / G.E. Wenger, L.V. Wenger // Newer in ophthalmology: abstracts of the scientific and practical conference 3 days of the Academy V.P. Fshatova - Odessa, 2005. - S. 78

9. Gundorova R.A., Malaev A.A., Yuzhakov A.M. // Eye injury - M., 1986.-p. 342; 5.

10. Dancheva L.D. Treatment of secondary glaucoma caused by an incorrect position of the lens - L.D. Danchev // Ophthalmol. Journal. 1958. No. 2. S.210 -216.

11. Zolotarev A.V. Secondary implantation of an anterior chamber intraocular lens in reconstructive keratoplasty / A.V. Zolotarev., E.S. Mimodin // Eroshevsky Readings: abstract. report - Samara, 2002. - S. 230 - 232.

12. Ioshin I.E. Extracapsular IOL fixation in lens pathology in complicated situations. Diss. ... dr. honey. Sciences. - M., 1998. - S. 108 - 119.

13. Kasparov A.A. Simultaneous penetrating keratoplasty and secondary IOL implantation // A.A. Kasparov, I.N. Subbotina // Proceedings. report 1st Ros. Symp. in refractive surgery. - M., 1999. - S. 32.

14. Kobzeva V.I. To therapeutic tactics in case of lens displacement / V.I. Kobzeva, I.M. Drozdova // Vestn. ophthalmol. 1972. No. 2. pp. 45 - 46.

15. Krasnov M.M. Artificial lens attached to the iris outside the pupil (extracapsular model) / M.M. Krasnov // Bulletin oftalmol. - 1975. - No. 4. - S. 42 - 47.

16. Lebekhov P.I., Krugleev A.A., Rodzevich G.V. and others. Methods for fixing a subluxated lens (methodological recommendations) // L., -1987, - P. 15.

17. Logai I.M., Krasnovid T.A. Indications and choice of method for removing the lens during its dislocation // Tez. report V All-Russian Congress of ophthalmologists. - M., 1987. - S. 315 - 317.

18. Malyugin B.E. Current status and prospects for the development of cataract surgery and intraocular correction. Keynote speech / B. E. Malyugin // Proceedings. report VIII Congress of Ophthalmologists of Russia.

M., 2005. - S. 556 - 558.

19. Orozalieva M., Durdieva L.D. // Actual problems of ophthalmology. Sat. scientific work. Ufa; Gilem 1999 p.132.

20. Pashtaev N.P. Analysis of 151 implantation of anterior chamber IOLs // Comparative technologies of cataract surgery - 2006. Sat. scientific articles GU IRTC MG. - M., 2006. S. 199 - 203.

21. Prytkova N.A. On the issue of traumatic displacements of the lens: Abstract of the thesis. dis. .cand. honey. Sciences / N.A. Prytkova // M., 1969.

22. Savitskaya I.I. Dynamics of true and tonometric intraocular pressure in contusion dislocations and subluxations of the lens / I.I. Savitskaya // Vestn. ophthalmol. 1968. No. 2. pp. 23 - 25.

23. Sergienko N.M. IOL implantation in eyes without capsule support / N.M. Sergienko, D.E. Zhabo-edov // VII Congress of Russian Ophthalmologists. Moscow 16 May 19, 2000 Abstracts M., 2000. - 4.1. - p. 71

24. Sergienko N.M. Intraocular correction

Kyiv: Zdorov "I", 1990. - S. 128.

25. Skripnichenko Z.M. The current state of the issue of treatment of traumatic dislocations of the lens. // Ophthalmol. magazine -1977 -№3 -p. 163 - 170.

26. Fedorov S.N. Two cases of removing the lens from the vitreous body by changing the position of the head // Ophthalm. Journal. - 1962 - No. 5. - S. 311 - 312.

27. Fedorov S.N., Egorova E.V. Surgical treatment of traumatic cataracts with intraocular correction. - M.: Medicine, 1985. - S. 111 - 119.

28. Fedorov S.N., Zakharov V.D., Lazarenko L.F. and others. Surgical treatment of a subluxated and dislocated lens in the vitreous body (method. recommendations) // M., - 1990., - P. 21.

29. Frolov M.A., Kumar V., Isufay E., The use of Iris Claw and Artisan for the correction of aphakia in the absence of the ligamentous-capsular apparatus of the lens. Guidelines. M., 2008. S. 36.

30. Bartholomew R.S., Russel J. Striepers "s turning net for conduction an operation of lens dislocated into vitreous // Canada. J. Ophthalmol. - 1976 - V. 11. - No. 3. - P. 270 - 271.

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32. Binkhorst C.D. Use of papillary lens (iris - clip lens) in aphakia. First fifty implantacion / C.D. Binkhorst // Br. J. Ophthalmol. - 1962.V. 46. No. 6. - P. 184 - 192.

33. Boscher C., Lebuisson D.A., Lean J.S., Nguyen

Khoa J.L. Vitrectomy with endoscopy for management of retained lens fragments and / or posteriorly dislocated intraocular lens // Graefes - Arch - Clin - Exp - Ophthalmol., - 1998., - No. 2(236)., - PP. 115 - 136.

35. Chu M. W. Visual results and complication following posterior iris - fixed posterior chamber lenses at penetrating keratoplasty / M. W. Chu, R. L. Font, D.D. Koch // Ophthalmic. Surg. - 1992. - Vol. 23, no. 9. - P.608

36. Douvas N.J. Removal of luxated and subluxated lenses// Trans. amer. Acad. Ophthalmol. Otolaryng. -1969 - V. 4 - No. 74 - P. 100 - 106.

40. Kolasny J. Luxatio lentis alternaus / J. Kolancny // Klin. Mbl. Augenheilk. 1970 Vol. 156, no.6. P. 885-887.

43. Maumenee A.E. Intraocular lenses complications and complicated cases // Rehabilitation of patients with pathology of the organ of vision: Tez. Report Conf. - Odessa, 1986. - S. 195 - 197.

45. Regillo C.D., Tidwell J.A. A small - incision technique for suturing a posterior chamber intraocular lens // Ophthalmic - Surg. Lasers., - 1996, - Vol. 27, - N6, PP. 473 - 475.

48. Worst J.C. F. Iris - fixed lenses: evolution and application / J.C.F. Worst // A color Atlas of lens Implantation/ ed. by. S.P.B. Persival. -St. Louis: Mosby, 1991.

DISLOCATION OF THE LENS OF THE EYE: A REVIEW OF THE LITERATURE

Bekmirova B.B., Frolov M.A.

People's Friendship University of Russia, Moscow, Russia

Annotation: From the analysis reviews the literature on the lens dislocation, a number of issues remain unresolved regarding the diagnosis. Although in pharmaceutical industry various IOL options, there are disputes about the tactics of treatment of the pathology (disease) Key words: lens dislocation, subluxation, glaucoma, IOL.

1. Abbasov F.A. The results of implantation of anterior chamber intraocular lens in traumatic cataract in children / F.A. Abbasov / Oftal "mol. zhurnal. - 2000. - No. 6. - pp. 33 - 35. (in Russia)

2. Alekseev B.N. Intracapsular implantation of an artificial lens / B.N. Alekseev // Vestn. oftal "mol. 1976. No. 5. pp. 31 - 36. (in Russia)

3. Anisimov S.I. Computed tomography in the pathology of the lens // sbornik nauchn. stat. MNTK "Mikrohirurgija glaza", -1988., - pp. 157 - 160.

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