Ophthalmology ReportsOphthalmology Reports1998-71022412-5423Eco-Vector8401910.17816/OV84019Research ArticleWhy are patients with mature cataract admitted to hospital? Challenges for cataract surgeryIvachevEvgenii A.<p>Cand. Sci. (Med.), MD, Ophthalmologist, Head of Ophthalmology Department, Assistant of Department</p>eivachov1@yandex.ruhttps://orcid.org/0000-0001-5662-4195DenisovaIrina P.<p>Ophthalmologist</p>ipdenisova@gmail.comhttps://orcid.org/0000-0002-9911-0255AnisimovaElena V.<p>Ophthalmologist</p>makarova.elena1985@gmail.comhttps://orcid.org/0000-0002-5819-6494TanashMohammed A.<p>Cand. Sci. (Med.), MD, Ophthalmologist</p>dr.mohammedtanash@gmail.comhttps://orcid.org/0000-0002-3540-0683The departmental clinical hospital at the station Penza of JSC “Russian Railways”Penza State UniversityPeoples’ Friendship University of Russia (RUDN University)1512202114483902810202115022022Copyright © 2021, Ivachev E.A., Denisova I.P., Anisimova E.V., Tanash M.A.2021<p><strong><em>BACKGROUND:</em></strong> A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period.</p>
<p><strong><em>AIM:</em></strong> To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients.</p>
<p><strong><em>MATERIALS AND METHODS:</em></strong> 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts.</p>
<p><strong><em>RESULTS:</em></strong> 95.2% (<em>n</em> = 138) of patients did not seek ophthalmological attention, 4.8% (<em>n</em> = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was absence of an ophthalmologist in the outpatient polyclinic. The patients lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm 37.2%; pseudoexfoliation syndrome 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber 44.8%; lens subluxation 24.1%; atrophy of the pupillary margin 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 0.27, on Day 7 0.73 0.22, after 3 months 0.76 0.25.</p>
<p><strong><em>CONCLUSIONS:</em></strong> Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.</p>mature cataractcataract extractionphacoemulsificationintraocular lenscomplicated cataractзрелая катарактаэкстракция катарактыфакоэмульсификацияинтраокулярная линзаосложнённая катаракта[Branchevsky SL, Malyugin BE. Incidence of visual impairment due to cataract according to the RAAB study in Samara. Fyodorov Journal of Ophthalmic Surgery. 2013;(3):82–85. (In Russ.)][Evseeva AA, Antropov AYu. Gender differences of comorbid nervous and mental pathologies in patients with cataract. University proceedings. Volga Region. Medical sciences. 2015;36(4):31–39. (In Russ.)][Tomilova EV, Zagorulko AM, Shiryaev IV. Topical mydriatics in small-incision cataract extraction. Fyodorov Journal of Ophthalmic Surgery. 2014;(2):10–14. (In Russ.)][Orlova OM, Trubilin VN, Zhudenkov KV. Analysis of cataract progression in Russia based on the natural mortality data. Practical medicine. 2016;(2):70–73. (In Russ.)][Ioshin IE, Tolchinskaya AI. Surgical treatment of patients with bilateral cataracts. Fyodorov Journal of Ophthalmic Surgery. 2013;(2):10–15. (In Russ.)][Braziticos PD, Tsinopoulos IT, Papadopoulos NT, et al. Ultrasonographic classification and phacoemulsification of white senile cataracts. Ophthalmology. 1999;106(11):2178–2183. DOI: 10.1016/S0161-6420(99)90502-X][Pirogova ES, Fabrikantov OL, Nikolashin SI. Types of lens structure in intumescent cataract. Ophthalmology in Russia. 2018;15(2S): 153–159. (In Russ.) DOI: 10.18008/1816-5095-2018-2S-153-159][Fabrikantov OL, Nikolashin SI, Pirogova ES. Diagnostic value of modern methods of ocular anterior segment visualization in intumescent cataract. Ophthalmology in Russia. 2019;16(3):350–354. (In Russ.) DOI: 10.18008/1816-5095-2019-3-350-354][Yousef YoN, Yousef SN, Vvedenskiy AS, et al. Femtosecond laser-assisted facoemulsification of hypermature cataract. Ophthalmology in Russia. 2020;17(3S):592–596. (In Russ.) DOI: 10.18008/1816-5095-2020-3S-592-596][Ioshin IE, Khachatryan GT, Ozderbayeva AA. Analysis of Ozil IP technology results in phacoemulsification of high density cataract. Fyodorov Journal of Ophthalmic Surgery. 2011;(2):59–63. (In Russ.)][Loskutov IA, Korneeva AV, Lebedev PA. The use of new cohesive ophthalmic viscoelastic in cataract surgery. Ophthalmology Journal. 2019;12(4):51–56. (In Russ.) DOI: l0.17816/OV17539][Burhard D, Schultz T. Laser assisted cataract surgery in small pupils using mechanical dilatation devices. J Refract Surg. 2013;29(12):858–862. DOI: 10.3928/1081597X-20131115-06][Fabrikantov OL, Pirogova ES, Nikolashin SI. Technique for optimizing morganian cataract phacoemulsification. Ophthalmology in Russia. 2018;15(2S):160–165. (In Russ.) DOI: 10.18008/1816-5095-2018-2S-160-165][Shukhaev SV. Kombinirovannyi ul’trazvuk v khirurgicheskom lechenii plotnykh katarakt [dissertation]. Moscow, 2019. Available from: https://www.mntk.ru/files/upload/Dissertacia_Shukhaev.pdf. (In Russ.)]