The features of cataract surgery in a patient with Graves’ disease and endocrine ophthalmopathy
https://doi.org/10.14341/probl9431
Abstract
After the phacoemulsification technique was implemented in ophthalmic practice surgeries to replace the clouded lens have become routine for ophthalmologists. Today, over half a million phacoemulsification surgeries are annually conducted in Russia. Cataract combined with endocrine ophthalmopathy poses a significant challenge for an operating surgeon because of the unusual anatomical presentation of the orbit and the eyeball, as well as the elevated intraocular pressure caused by edema of the orbital tissues (i.e., retrobulbar tissue and extraocular muscles) rather than by primary glaucoma.
We analyze the features of surgical treatment of the cataract involving intraocular lens implantation in a patient with Graves’ disease and endocrine ophthalmopathy complicated by secondary ocular hypertension, optical neuropathy, and lagophthalmos.
After restoring the euthyroid state and reducing the severity of endocrine ophthalmopathy, phacoemulsification was performed in both eyes, with an interval of 2 months. Neither intra- nor postoperative complications of the patients’ organ of vision were observed. The maximum corrected visual acuity achieved on both eyes was 0.4–0.5 in the Snellen eye chart.
Supporting agencies: no
About the Authors
Dmitry V. LipatovEndocrinology research centre
Russian Federation
MD, PhD, Professor
Natalya Yu. Sviridenko
Endocrinology research centre
Russian Federation
MD, PhD, Professor
Elena G. Bessmertnaya
Endocrinology research centre
Russian Federation
MD, PhD
Anna A. Tolkacheva
Endocrinology research centre
Russian Federation
ophthalmologist
References
1. Межрегиональная ассоциация врачей-офтальмологов. Федеральные клинические рекомендации по оказанию офтальмологической помощи пациентам с возрастной катарактой. — Офтальмология. 2015. [Mezhregional’naya assotsiatsiya vrachey-oftal’mologov. Federal’nye klinicheskie rekomendatsii po okazaniyu oftal’mologicheskoy pomoshchi patsientam s vozrastnoy kataraktoy. Oftal’mologiya. 2015. (In Russ.)].
2. Липатов Д.В. Диабетическая глаукома. / Под ред. Дедова И.И., Шестаковой М.В. — М.: Медицинское информационное агентство; 2013. [Lipatov DV, Dedov II, Shestakova MV, editors. Diabeticheskaya glaukoma. Moscow: Meditsinskoe informatsionnoe agentstvo; 2013. (In Russ.)].
3. Липатов Д.В., Бессмертная Е.Г., Кузьмин А.Г., и др. Атлас по диабетической ретинопатии. Практическое руководство для врачей. / Под ред. Дедова И.И., Шестаковой М.В. — М.: Медицинское информационное агентство; 2017. [Lipatov DV, Bessmertnaya EG, Kuzmin AG, et al. Atlas po diabeticheskoy retinopatii. A practical guide for doctors. Moscow: Meditsinskoe informatsionnoe agentstvo; 2017. (In Russ.)].
4. Свириденко Н.Ю., Беловалова И.М., Шеремета М.С., и др. Болезнь Грейвса и эндокринная офтальмопатия. / Под ред. Дедова И.И., Мельниченко Г.А. — М.: МАИ-Принт; 2012. [Sviridenko NYu, Belovalova IM, Sheremeta MS, et al. Pod. red. Dedov II, Mel’nichenko GA. Bolezn’ Greyvsa i endokrinnaya oftal’mopatiya. Moscow: MAI-Print; 2012. (In Russ.)].
5. Бровкина А.Ф., Аубакирова А.С. Зрительные расстройства при оптической нейропатии у больных эндокринной офтальмопатией. / IX научно-практическая нейроофтальмологическая конференция «Актуальные вопросы нейроофтальмологии». Москва январь 26, 2007. [Brovkina AF, Aubakirova AS. Zritel’nye rasstroystva pri opticheskoy neyropatii u bol’nykh endokrinnoy oftal’mopatiey. In: proceedings of the 9th scientific and practical neurophthalmology conference «Aktual’nye voprosy neyrooftal’mologii». Moscow jan 26 2007. (In Russ.)].
6. European group on Graves O, Wiersinga WM, Perros P, et al. Clinical assessment of patients with graves’ orbitopathy: the European group on graves’ orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006;155(3):387-389. doi: 10.1530/eje.1.02230
7. Национальное руководство по эндокринологии. / Под ред. Дедова И.И., Мельниченко Г.А. — М.: ГЭОТАР-Медиа; 2016. [Dedov II, Mel’nichenko GA, editors. Natsional’noe rukovodstvo po endokrinologii. Moscow: GEOTAR-Media; 2016. (In Russ.)].
8. Mourits MP, Bijl H, Altea MA, et al. Outcome of orbital decompression for disfiguring proptosis in patients with graves’ orbitopathy using various surgical procedures. Br J Ophthalmol. 2009;93(11):1518-1523. doi: 10.1136/bjo.2008.149302
Supplementary files
|
|
1. Fig. 1. The appearance of the patient upon admission to hospital | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
2. Fig. 2. The appearance of the patient after pulse therapy with methylprednisolone. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(880KB)
|
Indexing metadata ▾ | |
|
|
3. Fig. 3. Right eye (side view). | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
4. Fig. 4. Left eye (side view). | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
5. Fig. 5. The moment of implantation of semi-rigid acry- LOVE IOL. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
6. Fig. 6. The imposition of a corneal suture at the end nii operations. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
7. Fig. 7. Implantation of the IOL “MIOL-HD” through special cartridge. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
8. Fig. 8. The end of the surgical intervention the second eye. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
Review
For citations:
Lipatov D.V., Sviridenko N.Yu., Bessmertnaya E.G., Tolkacheva A.A. The features of cataract surgery in a patient with Graves’ disease and endocrine ophthalmopathy. Problems of Endocrinology. 2018;64(4):226-230. https://doi.org/10.14341/probl9431
Views:
1945
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
.jpg){kind=logo}
