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Bulgarian Review of Ophthalmology

Predictive factors for the development of post-operative fibrinous exudation

Y. Zdravkov, E. Yankova, G. Tsvetkova, E. Marinova, A. Oscar, I. Tanev

Abstract

Introduction

Each surgical procedure in ophthalmology is a subject of debate about its applications, efficiency, risk factors, contraindications, etc. There is, however, an indiscriminate and persistent consensus that post-operative inflammation after each surgical intervention should be minimal. The incidence of inflammation in the anterior chamber after cataract surgery may reach 30%, varying in severity. The anterior chamber inflammatory response is significant due to the fact that it can lead to elevated intraocular pressure (IOP), corneal edema, endothelial damage, fibrinous exudation and membrane in the anterior chamber, posterior synechiae, cystoid macular edema, chronic anterior uveitis and others. Investigation and analysis of various factors influencing fibrinous pre-chamber exudation would pose new questions for discussion about the pre-, intra- and postoperative therapeutic algorithm.

Aim

To investigate and analyze various factors that might be in correlation relationship with the development of fibrinous reaction in the anterior chamber after phacoemulsification surgery. Let`s also present our clinical experience in the treatment of acute fibrinous exudation.

Material and methods

The design of the present clinical study is retrospective and observational, with tracked period 04.01- 15.12.2017. Criteria for inclusion in the study were standard phacoemulsification of the lens without intraoperative complications and implantation of IOL into the capsuler bag. The exclusion criteria taken into account for the purpose of differentiating the risk factors only for the phacoemulsification as a surgical method are executing the one-step combined surgical procedure (phacoemulsification with trabeculectomy, phacoemulsification with pars plan vitrectomy). The preoperative set of studies performed includes a thorough ophthalmologic exam, indirect ophthalmoscopy, Goldmann tonometry, keratometry and biometric ultrasonic A echography. To all 191 participants in the study, of which 67 men (35.1%) and 124 women (64.9%), with average age 􀂧 68 years, by planned order was assigned a phacoemulsification of the lens with implanted intraocular artificial lens (IOL). All operations were performed in the 3rd ward of the Ophthalmology Clinic, University Hospital `Aleksandrovska`, by one surgeon, according to the same methodology approved in the clinic.

Results

To all 191 patients (191 eyes) was accomplished phacoemulsification of the lens and implanted an IOL, according to a methodology approved in the ward without any complications. 78 (40.8%) of the participants had a hydrophobic, acrylic, aspheric implant, while the other group of 113 (59.2%) participants had a hydrophilic, acrylic, aspheric IOL. The patients with conventional monofocal (hydrophilic and hydrophobic) IOL were 162 (84.8%) and 29 (15.2%) were with implanted hydrophilic IOL with extended depth of focus. Fibrinous exudation in the anterior chamber during the early postoperative period was found in five patients (2.4%) of the studied cohort. After local therapy with anti-inflammatory drugs (corticosteroids), the fibrinous membrane in each of the five patients is completely absorbed. It was reported that the presence of diabetes mellitus (80% of the patients with exudation) as an accompanying disease and the implantation of monofocal hydrophilic IOL (for 100% of patients with exudation) were the factors with the highest predictive value for developing a pathological fibrinous reaction.

Conclusion

Senile cataract is among the main age-related eye diseases. Its frequency increases as the age advances. In the national and world scale, phacoemulsification is the most commonly performed surgical intervention in ophthalmology. The variety of intraocular artificial lenses nowadays is enormous, aiming to satisfy the ever-increasing demands and standards in ocular surgery. The rising incidence of diabetes mellitus poses new and important questions about which type of IOL are the most appropriate and recommended in patients with systemic accompanying diseases.


Keywords

phacoemulsification; IOL; exudation; diabetes mellitus

Full Text


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DOI: http://dx.doi.org/10.14748/bro.v0i1.4790

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About The Authors

Y. Zdravkov
Department of Ophthalmology, Medical University - Sofia, Ophthalmology Clinic, University Hospital `Aleksandrovska`
Bulgaria

E. Yankova
Department of Ophthalmology, Medical University - Sofia, Ophthalmology Clinic, University Hospital `Aleksandrovska`
Bulgaria

G. Tsvetkova
Department of Ophthalmology, Medical University - Sofia, Ophthalmology Clinic, University Hospital `Aleksandrovska`
Bulgaria

E. Marinova
Department of Ophthalmology, Medical University - Sofia, Ophthalmology Clinic, University Hospital `Aleksandrovska`
Bulgaria

A. Oscar
Department of Ophthalmology, Medical University - Sofia, Ophthalmology Clinic, University Hospital `Aleksandrovska`
Bulgaria

I. Tanev
Department of Ophthalmology, Medical University - Sofia, Ophthalmology Clinic, University Hospital `Aleksandrovska`
Bulgaria

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