helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2023-16-3-127-135helmholtzeyeinstitute-1310Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR OPHTHALMOLOGY PRACTITIONERSФакторы риска, диагностика и лечение расплавления роговицы после факоэмульсификации катарактыRisk factors, diagnostics and treatment of corneal melting after cataract phacoemulsificationhttps://orcid.org/0000-0002-7472-4883СветозарскийС. Н.SvetozarskiyS. N.

Сергей Николаевич Светозарский - канд. мед. наук, врач-офтальмолог, ассистент кафедры глазных болезней

Нижневолжская наб., д. 2, Нижний Новгород, 603001

пл. Минина и Пожарского, д. 10/1, Нижний Новгород, 603005

Sergey N. Svetozarskiy - Cand. of Med. Sci., ophthalmologist, assistant of chair of eye diseases

2, Nizhnevolzhskaya Emb., Nizhny Novgorod, 603001

10/1, Minin and Pozharsky Square, Nizhny Novgorod, 603005

svetozarskij@rambler.ruАндреевА. Н.AndreevA. N.

Андрей Николаевич Андреев - заведующий офтальмологическим отделением

Нижневолжская наб., д. 2, Нижний Новгород, 603001

Andrey N. Andreev -— head of ophthalmology department

2, Nizhnevolzhskaya Emb., Nizhny Novgorod, 603001

ШвайкинА. В.ShvaikinA. V.

Александр Владимирович Швайкин - врач-офтальмолог

Нижневолжская наб., д. 2, Нижний Новгород, 603001

Alexander V. Shvaikin - ophthalmologist

2, Nizhnevolzhskaya Emb., Nizhny Novgorod, 603001

СметанкинИ. Г.SmetankinI. G.

Игорь Глебович Сметанкин - д-р мед. наук, доцент, врач-офтальмолог, заведующий кафедрой глазных болезней

Нижневолжская наб., д. 2, Нижний Новгород, 603001

пл. Минина и Пожарского, д. 10/1, Нижний Новгород, 603005

Igor G. Smetankin - Dr. of Med. Sci., assistant professor, head of chair of eye diseases

2, Nizhnevolzhskaya Emb., Nizhny Novgorod, 603001

10/1, Minin and Pozharsky Square, Nizhny Novgorod, 603005

ФБУЗ «Приволжский окружной медицинский центр» Федерального медико-биологического агентства; ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава РоссииРоссияVolga District Medical Center, Federal Medical and Biological Agency; Volga District Medical UniversityRussian FederationФБУЗ «Приволжский окружной медицинский центр» Федерального медико-биологического агентстваРоссияVolga District Medical Center, Federal Medical and Biological AgencyRussian Federation202312102023163127135Copyright © Светозарский С.Н., Андреев А.Н., Швайкин А.В., Сметанкин И.Г., 20232023Светозарский С.Н., Андреев А.Н., Швайкин А.В., Сметанкин И.Г.Svetozarskiy S.N., Andreev A.N., Shvaikin A.V., Smetankin I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/1310

Воспалительные осложнения факоэмульсификации катаракты (ФЭК) относятся к числу неотложных состояний, потенциально угрожающих потерей зрения. Расплавление роговицы является редко встречающимся, но клинически значимым состоянием, предшествующим перфорации роговицы. Основными факторами риска его развития являются применение нестероидных противовоспалительных средств (НПВС), тяжелые формы синдрома сухого глаза (ССГ) и ревматические заболевания у пациента. В работе представлен обзор литературы и анализ длительного (5 лет) клинического наблюдения расплавления роговицы после ФЭК у пациентки с тяжелой формой ССГ, не диагностированной до операции. Обсуждаются возможности и ограничения различных методов лечения расплавления роговицы на стадиях персистирующего эпителиального дефекта и язвы роговицы. Рассматривается механизм развития заболевания и его связи с патогенезом ССГ, а также роль местного применения НПВС как триггера инициации и прогрессирования процесса расплавления роговицы.

Inflammatory complications of cataract phacoemulsification are among the most urgent and potentially vision-threatening conditions. Corneal melting is a rare but clinically significant condition preceding corneal perforation. The main risk factors are the use of nonsteroidal anti-inflammatory drugs (NSAIDs), severe dry eye disease and rheumatic diseases. The paper presents a literature review and offers an analysis of a clinical case of corneal melting after cataract phacoemulsification in a female patient with severe dry eye disease, which was undiagnosed before surgery. The follow-up period was 5 years. The possibilities and limitations of multiple methods of corneal melting treatment at the stages of persistent epithelial defect and corneal ulcer are discussed. The mechanism of disease development and its link with the pathogenesis of dry eye disease and the role of topical NSAIDs as a trigger for the initiation and progression of corneal melting are considered.

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The authors declare that there are no conflicts of interest present.