Офтальмохирургия (Oct 2015)
SELECTING VOLUME OF RECONSTRUCTION OF ANTERIOR EYE SEGMENT USING ULTRASOUND BIOMICROSCOPY DURING KERATOPROSTHETICS IN PATIENTS WITH VASCULAR LEUKOMA OF THE DEGREES 4-5
Abstract
Purpose. To determine Ultrasound Biomicroscopy (UBM) capabilities for selecting volume of reconstruction of anterior eye segment (AES) during keratoprosthetics in patients with vascular leukoma of the degrees 4-5.Material and methods. We examined 54 patients (54 eyes) with vascularized burn leukoma of the degrees 4-5. All patients underwent different functional, electrophysiological and ultrasound diagnostic procedures including the UBM before and after surgery, especially in case of complications. The UBM was performed in a standard manner using the UBM-840 system (Humphrеy,USA). Examined: cornea, anterior chamber, angle of anterior chamber, iris, lens, ciliary body, intraocular implants (keratoprothesis, drainage, lens). According to the diagnostic data collected the classic method of keratoprosthesis of the Fyodorov-Zuev model were carried out in 20 patients and the transplantation of complex cornea-prosthesis with a simultaneous reconstruction of anterior chamber in 40 patients.Results. The UBM allowed us to assess topography characteristics of anterior eye segment in patients with the 4th-5th degree leukomas. These characteristics included scarring flattening of cornea (100%), non-uniform (63%) increase of thickness (90.7%) of leukoma, presence of pronounced peripheral iridocorneal adhesions (98.2%), with reduced central depth of anterior chamber (92.6%). We performed 193 surgeries in 54 patients based on our findings and 121 UBM examinations. These surgeries included reconstruction of anterior eye segment (glaucoma surgery with implantation of Ahmed glaucoma valve (59.3%)), iridoplastic (38.9%), cataract extraction (31.5%), lensectomy (18.5%), anterior vitrectomy (14.8%) and keratoprosthesis (classic method of keratoprosthesis with Fyodorov-Zuev model (37%) and transplantation of complex cornea-prosthesis (63%)). The UBM is capable of diagnosis of cornea valve defects, fistulas, which has partial passage under kerathprosthesis bearing plate, assess of patency and position of Ahmed glaucoma valves drainage as well. The UBM allowed to diagnose and to confirm the cornea aseptic necrosis with keratoprothesis protrusion in 22.2% of patients (12 patients, 3 of them had aqueous humor filtration) during the 2 year follow-up. In 1 case a dislocation of Ahmed glaucoma valves drainage was diagnosed. Our findings allowed us to select surgical approach to complications after keratoprosthetics and to retain prosthesises in the eyes in 9 out of 12 patients.Conclusion. The UBM allows to foresee a postoperative course for patients with vascularized burn leukoma of the 4th-5th degrees and to perform a dynamic monitoring of patient data after surgery.
