Prognosis, Prophylaxis and Treatment of the Postoperative Complications in Diabеtic Cataract Patients

Abstract


The concept of "metabolic syndrome" in ophthalmology can include the entire set of interrelated metabolic abnormalities predisposing to the development of vitreoretinal complications of type 2 diabetes and coronary heart disease (CHD). Based on the definition, the researches of local changes in markers of metabolic processes, particularly in complicated cataract, are relevant for the prediction of the results of surgical treatment. Such a method for detecting marker proteins in tear was introduced by us in clinical practice for the differential diagnosis of local changes in metabolism in complicated (cataract caused by changes of the lens in response to background disturbances of metabolism) and age-related cataract. The mechanism of development of complicated cataracts is similar to cataractogenesis with age-related cataracts, but in complicated cataract processes of change in the lens is more intensive and faster under the influence of a violation of the immunological balance, oxidative processes and biochemical changes that occur in the body and locally on a background of concomitant diseases and diseases of the eye.

At the present stage it is believed that one of the triggers is cataractogenesis depletion of the antioxidant capacity of the lens and the development of oxidative stress. This manifests itself in the early stages cataractogenesis fluctuations in the level of glutathione in the lens and the accumulation of free radical oxidation products. Following this, a reduction in the number of negative charges on the main protein of lens fiber - crystallin. This fact is interpreted as a violation of protein phosphorylation within the fibers of the lens due to discoordination cascade regulation systems due to their free radical damage. In turn, decrease the water solubility of proteins leads to the adsorption of proteins on the uncharged cell membranes, resulting in increasing lens violation regular stacking membranes. Light scattering by surfaces of folded membranes lens fiber is considered as the main cause of lens opacity with cataract.

We examined 136 patients with cataracts of various origins (272 eyes) aged 62 ± 3,2 years. Among those surveyed were women (74 people). All patients underwent detailed clinical, ophthalmological examination of the complex and as a result were divided into groups with a diagnosis of cataracts of

various origins. We have developed an algorithm for determining the prognosis of outcome of surgical intervention in the oxidative stress on the content of antioxidant enzymes tears justified selective choice of preparations of local and systemic antioxidant action to prevent and stabilize the clouding of the lens.

The greatest number of complications arise in the extraction of complicated cataract, because its development is already associated with the presence of an underlying disease (a disorder of metabolism, endocrine disorders), additional ocular pathology (uveitis syndrome Fuchs, secondary glaucoma), the influence of external factors. This kind of state characterized by the presence of pathological changes in the immune, circulatory system, metabolic disorders, entailing and cause various postoperative complications (hyphema, postoperative iridocyclitis, exudative inflammatory response (EVR), epithelial-endothelial corneal dystrophy, macular edema with the outcome in macular degeneration). It becomes apparent that the creation of methods of forecasting and prevention of post-operative complications, as well as specific algorithm scheme of preoperative preparation, at various kinds of complicated cataract, is an important and urgent problem of modern ophthalmology.


Mariya Aleksandrovna Kovalevskaya

Voronezh State Medical University named after N.N. Burdenko
 

Email: m.kovalevskaja@vsmaburdenko.ru
SPIN-code: 7085-6923
http://vrngmu.ru/academy/personnel/1012/

Russian Federation, 10, Studencheskaya Str. Voronezh, 394036, Russia

professor

Lilya Filina

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: fil-liliya@yandex.ru
SPIN-code: 4480-4221
http://vrngmu.ru/academy/personnel/3368/

Russian Federation, 10, Studencheskaya Str. Voronezh, 394036, Russia

docent

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