The condition of the corneal nerve fibers after extracapsular cataract extraction
https://doi.org/10.25789/YMJ.2022.80.08
Abstract
The term "phacosurgery" combines various surgical technologies for the complete or partial removal of the lens. The last decades are characterized by an almost complete transition from extracapsular cataract extraction to the so-called. microinvasive phacosurgery, in particular, standard ultrasound and hybrid (femtolaser) phacoemulsification. Nevertheless, in a number of cases (for example, when the so-called brown cataract is combined with severe dystrophic changes in the cornea), extracapsular extraction, which involves the removal of the “whole” nucleus through a wide surgical incision in the limbal zone of the cornea, is still the method of choice for phacosurgery. The condition of the cornea after phacosurgery remains one of the criteria for the success of the intervention. In this case, as a rule, attention is focused on the "loss" of cells of the posterior epithelium and violations of the optical regularity of the cornea. Changes in corneal nerve fibers (CNF) have been studied to a lesser extent.
The aim of the study was to study the structural changes in CNF after extracapsular cataract extraction based on laser confocal microscopy.
The studies were conducted on the clinical material of 20 operations of extracapsular cataract extraction, which were performed on 20 patients aged 52 to 74 years. The condition of CNF was assessed before and after 7-10 days, 2-2.5 and 6 months after surgery, using the length and density of the main branches of CNF (in mm/mm2 and units/mm2, respectively) in the central zone of the cornea.
Regardless of the timing of follow-up, a decrease in the length and density of CNF was revealed with a moderate tendency to recovery by the 6th month after the intervention. Despite this, a statistically significant decrease in the average length of the main CNFs persisted during all periods of observation, and in density - for 2-2.5 months.
Factors that induce changes in CNF after various phacosurgery techniques include their intersection during the surgical incision and the energy impact on the cornea. When using microinvasive techniques, taking into account the minimization of the length of the incision, ultrasound and/ or laser radiation may be the dominant factor, and when using the extracapsular technique, the directly extended corneal incision, accompanied by the intersection of the CNF. In clinical practice, potential disturbances in the CNF structure after phacosurgery should be taken into account in situations accompanied by pronounced initial changes in CNF (condition after keratoplasty and excimer laser keratorefractive surgery, various types of systemic polyneuropathy)
About the Authors
S. E. Avetisov
I.M. Sechenov First Moscow State University
Russian Federation
Russian Federation
Avetisov Sergey E. – Prof. Acad. RAS, Scientific Director. Head. Department
Z. V. Surnina
Surnina Zoya V. – PhD in Medical Sciences, senior researcher
Russian Federation
Russian Federation
K. S. Avetisov
FBSSE Scientific Institute of Eye Diseases
Russian Federation
Russian Federation
Avetisov Konstantin M. – Head of Department
M. Ndari
I.M. Sechenov First Moscow State University
Russian Federation
Russian Federation
Ndari Mohamed – graduate student
S. Georgiev
Yakutsk Republican Ophthalmologic Clinical Hospital,
Russian Federation
Russian Federation
Georgiev Stefan – postgraduate student; ophthalmologist
I. P. Lutskan
Yakutsk Republican Ophthalmologic Clinical Hospital;
M.K. Ammosov North-Eastern Federal University
Russian Federation
Russian Federation
Lutskan Ivan P. – PhD, Doctor of the Yakutsk Republican Ophthalmologic Clinical Hospital, Associate Professor of the Medical Institute of M.K. Ammosov SVFU
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Review
For citations:
Avetisov S.E., Surnina Z.V., Avetisov K.S., Ndari M., Georgiev S., Lutskan I.P. The condition of the corneal nerve fibers after extracapsular cataract extraction. Yakut Medical Journal. 2022;(4):30-33. https://doi.org/10.25789/YMJ.2022.80.08
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