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Purpose. The aim is to estimate the content of pro- and anti-inflammatory cytokines (IL-1β, IL-8, IL-10, MCP-1, ICAM-1, VEGF) in tear of patients with advanced proliferative diabetic retinopathy and complicated primary cataract after phacoemulsification surgery and IOL implantation with vitreoretinal surgery accomplished at once in comparison with vitreoretinal surgery only. Material and methods. 34 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery (VRS) with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2nd step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2nd group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. On the 2nd day after the 1st step surgery and before surgical treatment the tear samples of the patients of both groups have been examined. Results. A concentration of the following cytokines: IL-8, MCP-1, ICAM-1 in the 2nd group was 2,5-5 times higher than in the 1st group. Conclusion. The research revealed that the patients with advanced PDR are accurately determined by the increased concentration of IL-8, MCP-1, ICAM-1 in tear after phacoemulsification surgery and IOL implantation with vitreoretinal surgery accomplished at once in comparison with vitreoretinal surgery only. Keywords: cytokines, diabetic retinopathy, cataract, vitreoretinal surgery.

Purpose. The aim is to conduct a comparative analysis of status of macular area of retina of patients with advanced proliferative diabetic retinopathy and complicated incipient cataract according to phacoemulsification surgery time frames: after vitreoretinal surgery only or after vitreoretinal surgery as an integral component. Material and methods: 26 cases of surgery treatment of patients with PDR and complicated primary cataract were analyzed. This patients were divided into two groups depending on the treatment tactics. Retinal thickness in the fovea was measured by optical coherence tomography before surgery and 1 and 3 months after phacoemulsification cataract. Results. Visual functions improved in 85.8% of cases in group 1, and in 66.7% in group 2. Conclusion. Outcomes of the preliminary studies suggest that the frequency of macular edema development after phacoemulsification surgery and IOL implantation with vitreoretinal surgery is recorded more often than when performing with phacoemulsification surgery and silicone oil removal simultaneously by the second stage. Key words: diabetic retinopathy, cataract, vitreoretinal surgery, macular edema.

Purpose. To compare and evaluate long-term results of two-stage surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated incipient cataract. Material and methods. 73 patients with advanced proliferative diabetic retinopathy and complicated incipient cataract performed by vitrectomy from 2016 to 2020 were analyzed. In the 1st group patients were subjected to a two-step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. Results. Visual functions improved in 88.8% of cases in group 1, and in 51.3% in group 2. Conclusion. Outcomes of the studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications. Key words: diabetic retinopathy, cataract, vitreoretinal surgery.

Vitreoretinal surgery (VRS) is the «gold standard» for surgical treatment of patients with proliferative diabetic retinopathy (PDR). However, the timing for the removal of primary cataract in this category of patients remains uncertain.To evaluate the effectiveness of multistage surgical treatment of patients with advanced PDR complicated with primary cataract.The study involved 94 cases of surgical treatment of patients with PDR and complicated primary cataract. These patients were divided into two groups depending on the treatment tactics. In the first group, patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade performed as the first step in their treatment followed by phacoemulsification, silicone oil removal, and IOL implantation, respectively, as the second step. In subgroup 1a - VRS was performed with standard pharmacological support. In subgroup 1b - intravitreal injection of angiogenesis inhibitors preceded VRS. In the second group, the first step was phacoemulsification performed simultaneously with vitreoretinal surgery with silicone oil tamponade; the second step consisted of removing silicone oil from the vitreous cavity. Subgroup 2a - surgical treatment was performed with standard pharmacological support (similar to subgroup 1a). Subgroup 2b - intravitreal injection of anti-VEGF drugs preceded VRS.Visual functions improved in 88.8% and 83.4% of cases in subgroups 1a and 1b, and in 51.3% and 66.7% in subgroups 2a and 2b, respectively.The study confirms the effectiveness of staged (multi-step) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated primary cataract. Conducting phacoemulsification sometime later along with silicone oil removal in PDR patients with preoperative intravitreal injection of angiogenesis inhibitors is a gentler approach for the anatomic structures of the eye during the first stage (VRS) and contributes to the reduction in the number of intraoperative and postoperative complications.«Золотым стандартом» хирургического лечения пациентов с далекозашедшей стадией пролиферативной диабетической ретинопатии (ПДР) является витреоретинальная хирургия (ВРХ). При этом вопрос о сроках удаления начальной катаракты у этой категории больных остается открытым до настоящего времени.Изучить эффективность многоэтапной витреальной хирургии у пациентов с далекозашедшей стадией ПДР и осложненной начальной катарактой.В исследование включены 94 пациента с ПДР и осложненной начальной катарактой, разделенных на две группы. 1-я группа: первый этап — ВРХ с силиконовой тампонадой, второй этап — факоэмульсификация катаракты (ФЭК) с имплантацией ИОЛ одновременно с плановым удалением силиконового масла (СМ). Подгруппа 1a — ВРХ проводилась со стандартным фармакологическим сопровождением. Подгруппа 1b — ВРХ с предварительным интравитреальным введением (ИВВ) ингибитора ангиогенеза. 2-я группа: первый этап — ФЭК с имплантацией ИОЛ одномоментно с ВРХ+силиконовая тампонада, второй этап — удаление СМ из витреальной полости. Подгруппа 2a — хирургическое лечение выполняли на фоне традиционной фармакотерапии (аналогично подгруппе 1a). Подгруппа 2b — перед ВРХ интравитреально вводили анти-VEGF-препарат.Улучшение зрительных функций в подгруппах 1a и 1b достигнуто в 88,8 и 83,4%, в подгруппах 2a и 2b— в 51,3 и 66,7% случаев соответственно.Результаты проведенного исследования подтверждают эффективность поэтапного хирургического лечения пациентов с далекозашедшей стадией ПДР и осложненной начальной катарактой. Выполнение ФЭК вторым этапом после ВРХ во время удаления СМ у пациентов с предварительным ИВВ ингибиторов ангиогенеза обеспечивает наиболее щадящий подход к хирургическому лечению этой категории больных, что позволяет улучшить анатомические и функциональные результаты ВРХ и способствует уменьшению числа интра- и послеоперационных осложнений.

The book deals with the main issues of fixing an intraocular lens with a complete loss of the lens support apparatus. This is the first illustrated guide to understanding the technology of trans-scleral IOL fixation. Special attention is paid to the technique of surgical treatment. The author's techniques and features of each stage of surgical treatment are considered.

To draw attention to characteristic features of the clinical manifestations of vitreopapillary traction syndrome (VPTS) in patients with proliferative diabetic retinopathy (PDR), to determine the role of the biomechanical factor in pathophysiology of this syndrome, and to evaluate the results of surgical treatment.The features of clinical manifestations of VPTS of 50 patients with PDR who were treated at the ophthalmology center of the National Medical and Surgical Center named after N.I. Pirogov in the period from 2014 to 2018 were analyzed retrospectively. The preoperative study included standard ophthalmological examination methods, as well as ultrasound B-scan, computer perimetry, optical coherence tomography (OCT), fluorescence angiography (FA) in the first two years of observation. The comparison group consisted of 45 patients with PDR without signs of VPTS, who were treated in the center during the same period of time.The obtained results suggest that the pathophysiology of VPTS in diabetes mellitus has distinctive features and is determined by the topography of the peripapillary zone, as well as choroidal vascularization of the optic nerve head; biomechanical factor plays an important role in the formation of a fibrovascular stem (FVS) in VPTS.The results indicate that patients with VPTS have a worse prognosis for achieving best corrected visual acuity (BCVA) after surgery than patients without signs of VPTS. Correct and timely diagnosis, early treatment by vitreoretinal surgery give a greater chance of achieving higher BCVA in the postoperative period in this category of patients.Акцентировать внимание на особенностях клинических проявлений витреопапиллярного тракционного синдрома (ВПТС) у пациентов с пролиферативной диабетической ретинопатией (ПДР), определить роль биомеханического фактора в патофизиологии данного синдрома и оценить результаты хирургического лечения.Ретроспективно проанализированы особенности клинических проявлений и течения ВПТС у 50 пациентов с ПДР, которые проходили лечение в Центре офтальмологии НМХЦ им. Н.И. Пирогова в период с 2014 по 2018 г. Предоперационное исследование включало стандартные офтальмологические методы, а также ультразвуковое B-сканирование, компьютерную периметрию, при наличии прозрачных оптических сред — оптическую когерентную томографию, флюоресцентную ангиографию в первые два года наблюдения. В качестве сравнения взяты результаты наблюдений за 45 пациентами с ПДР без признаков ВПТС, пролеченными в стационаре центра в тот же период.Полученные данные позволяют утверждать, что патофизиология ВПТС при сахарном диабете имеет отличительные особенности и определяется топографией препапиллярной зоны, а также хороидальной васкуляризацией диска зрительного нерва; важную роль в формировании фиброваскулярного стебля при ВПТС играет биомеханический фактор.Результаты исследования свидетельствуют, что у пациентов с ВПТС прогноз на достижение максимально корригируемой остроты зрения (МКОЗ) после хирургического вмешательства хуже, чем у пациентов без признаков ВПТС. Правильная и своевременная диагностика, раннее выполнение витреоретинальной хирургии дают больший шанс для получения более высокой МКОЗ в послеоперационном периоде у данной категории пациентов.