PREDICTING INFLAMMATORY REACTION AFTER CATARACT PHACOEMULSIFICATION
Main Article Content
Abstract
Currently, phacoemulsification is the «gold» standard of cataract surgery. In a number of cases, post-surgical complications can develop in the form of an inflammatory reaction of varying degrees of severity. The purpose of the study was to develop a method for predicting the inflammatory reaction after phacoemulsification of cataract (PEC) by analyzing the clinical and immunological status of the patients.
Material and methods of investigation. The study included 318 patients (318 eyes) with age-related cataracts who underwent PEC. In a number of the patients (49 patients, 49 eyes) with age-related cataract 3 days before the surgery day and after the operation we performed a tear fluid intake. In the obtained samples of tears, the content of alpha2-macroglobulin (alpha2-MG), immunoglobulin G (IgG), albumin and lactoferrin was determined.
Results. All PEC operations were conducted according to the plan. In most operated patients, the post-surgical period proceeded smoothly, without an inflammatory response. Only in 19 patients (5.9 %) during the early post-surgical period we diagnosed an exudative reaction in the cavity of the eye. On the 1st day after the operation, the concentration of albumin in the tear fluid of the patients was sharply increased almost 2-fold, as well as the content of alpha2-macroglobulin.
Conclusion. A method for predicting the development of post-surgical intraocular inflammation has been elaborated:
1) We determine the concentration of alpha2-MG in the tear fluid of the eyes of the patients with cataract before surgery. If it is below 1.03 mg/l, then the probability of inflammation is low (because the sum of the remaining risk factors namely sex, age of the patients, the degree of cataract maturity, etc. does not exceed 20 scores), we perform the PEC operation in a planned manner.
2) If the sum of scores is higher than 20, the probability of inflammation is high. With a high risk of developing inflammation before surgery we perform intensive local and systemic anti-inflammatory therapy.
Keywords
Author Biographies
Анна Сергеевна Попова,
post-graduate student, the chair of ophthalmologyАлександр Леонидович Онищенко,
doctor of medical sciences, professor, deputy director for scientific workСергей Николаевич Филимонов,
Filimonov Sergey Nikolaevich
M.D., Ph.D., Professor. Chief.
Раиса Михайловна Зорина,
doctor of biological sciences, leading researcherАнна Егоровна Власенко,
candidate of technical sciences, senior lecturer, the chair of medical cybernetics and informaticsArticle Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
Brian G, Taylor H Cataract blindness – challenges for the 21 century. Bulletin of the World Health Organization. 2001; 79: 249-256
Fedorov SN, Egorova EV. Errors and complications in the implantation of the artificial lens. Moscow: MNTK, Eye Microsurgery Publ., 1992. 244 p. Russian (Федоров С.Н., Егорова Э.В. Ошибки и осложнения при имплантации искусственного хрусталика. М.: МНТК, Микрохирургия глаза, 1992. 244 с.)
Grinev AG. Postoperative inflammation in cataract surgery with intraocular correction. Herald of Ophthalmology. 2003; (2): 47-49. Russian (Гринев А.Г. Послеоперационное воспаление в хирургии катаракты с интраокулярной коррекцией //Вестник офтальмологии. 2003. № 2. C. 47-49)
Bocharov VE, Ivanov MN, Gantsovsky PI, Fedorov AA. Express method for predicting fibrotic iridocyclitis in the early postoperative period with pseudofakic. Herald of Ophthalmology. 2002; (2): 6-8 Russian (Бочаров В.Е., Иванов М.Н., Ганцовский П.И., Федоров А.А. Экспресс-метод прогнозирования фиброзного иридоциклита в раннем послеоперационном периоде при артифакии //Вестник офтальмологии. 2002. № 2. C. 6-8)
Pavlyuchenko VK, Mareeva TE. Possibilities of prediction and prevention of postoperative inflammatory complications with intraocular correction. Herald of Ophthalmology. 1989; (5): 27-30. Russian (Павлюченко В.К., Мареева Т.Е. Возможности прогнозирования и профилактики послеоперационных воспалительных осложнений при интраокулярной коррекции //Вестник офтальмологии. 1989. № 5. С. 27-30)
Zorina VN, Zorin NA. Protein components of innate immunity in protection from pathogenic invasion. Journal of Microbiology, Epidemiology, Immunology. 2013; (3): 111-117. Russian (Зорина В.Н., Зорин Н.А. Белковые компоненты врожденного иммунитета в защите от патогенной инвазии //Журнал микробиологии, эпидемиологии, иммунологии. 2013. № 3. C. 111-117)
Zorin NA, Zorina VN. Evolution of macroglobulin family proteins: from bacteria to primates. Journal of Evolutionary Biochemistry and Physiology. 2017; 53 (6): 389-397. Russian (Зорин Н.А., Зорина В.Н. Эволюция белков семейства макроглобулинов – от бактерий до приматов //Журнал эволюционной биохимии и физиологии. 2017. Т. 53, № 6. С. 389-397)
Petersen CM. Alpha 2-macroglobulin and pregnancy zone protein. Serum relation to immunology. Dan. Med. Bull. 1993; 40: 409-446
Greiff L, Andersson M, Erjefalt JS, Svensson C, Persson CG. Loss of size-selectivity at histamine-inducted exudation of plasma proteins in atopic nasal airways. Clin. Physiol. Funct. Imaging. 2002; 22(1): 28-31
Siddiqi N. Scoring maps for credit risk assessment. Development and implementation of intellectual methods of credit scoring. Moscow: Mann, Ivanov and Ferber Publ., 2013. 288 p. Russian (Сиддики Н. Скоринговые карты для оценки кредитных рисков. Разработка и внедрение интеллектуальных методов кредитного скоринга. М.: Манн, Иванов и Фербер, 2013. 288 с.)
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology. 1996; 49: 1373-1379
Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998; 280: 1690-1691
Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: Absolute risk reduction, relative risk reduction, and number needed to treat. Perspectives in Clinical Research. 2016; 7(1): 51-53. Doi:10.4103/2229-3485.173773
Zhu W, Zeng N, Wang N. Sensitivity, specificity, accuracy, associated confidence interval and ROC analysis with practical SAS® implementations. In: NESUG Proceedings: Health Care and Life Sciences, 14-17 November 2010. Baltimore, Maryland, 2010. P. 1-9