The dissertation is devoted to the problem of improving the efficiency of treatment of patients with primary glaucoma in combination with cataracts by optimizing a two stage (surgical and laser) treatment method, studying the features of the cytokine profile of the intraocular fluid, and on the basis of this development of a new method of prevention of postoperative complications. In modern ophthalmosurgery, a large number of methods of combined operations with primary glaucoma in combination with cataracts are known. However, it is their number and indicates the unresolved issue. There is a need for a thorough analysis of existing operations, the development of optimal surgical techniques for surgical intervention, which would combine the advantages of modern cataract removal technologies with the most effective and safe hypotensive interventions. Under supervision were 175 patients (197 eyes) with the primary open angle glaucoma in combination with cataracts. Scientific novelty of the results. The scientific knowledge on the cytokine profile of the intraocular fluid in patients with primary glaucoma and cataract is supplemented. The TNF-alfa level ranged from 1.11 pg / ml to 140.55 pg / ml and amounted to 24.61 ± 5.43 pg / ml; BFGF ranged from 1.0 pcg / ml to 12.54 pcg / ml and amounted to 3.33 0.44 pg / ml and did not depend on gender, age, stage of glaucoma, and baseline IOP. A direct correlation is established between TNF-alfa and bFGF levels. For the first time, it was found that at the level of TNF-alfa in the intraocular fluid 36.36 pg / ml, the frequency and duration of inflammatory complications after stage I and at 50.11 pg / ml, after stage II of 2-step treatment, is significantly increased. It has been established that at bFGF level in the intraocular fluid 3.1 pg / ml and above, scarring develops in the structures of the anterior chamber angle of the eye after stage I, and at a level of 6.03 pg / ml and above - after the II stage of the two-stage treatment and as a consequence - Increase in IOP. The practical significance of the results. The two-stage method of treatment of patients with primary glaucoma and cataracts has been developed and implemented in practice, which allowed in the immediate observation periods to expand or maintain at the preoperative level viewpoints margin in 90% of cases, in the long term - 80%; Normalize intraocular pressure in 95% of cases in the immediate and 79% of cases - in the long term of observation. The optimal timing of the II stage (selective laser trabeculoplasty) after I (phacoemulsification) was developed and implemented in practice. It was established that the implementation of stage II in 4-5 weeks after the first allowed to reduce the frequency of inflammatory complications by 50.03% in the early postoperative period and their duration - by 2.1 days. A new method of preventing postoperative complications with the use of the aminodihydroftazaldehyde sodium was developed and implemented in clinical practice, which allowed to reduce the frequency of inflammatory complications after the implementation of stages I and II on 68.87% and 48.16% respectively, transient hypertension after stage I - on 55.6% and syndrome of pain after the second stage - on 49.4%, as well as increase the number of patients with normalized Intraocular pressure after 3 months by 8.5%, after 1 year by 18.9% and 1.5 years later by 20.6% after 2-step treatment, respectively. The use of aminodihydroftazaldehyde sodium in the complex of preoperative preparation and postoperative treatment allowed to increase the number of patients with visual acuity of 0,7-1,0 and 36,1% on 44,62% with enlarged or preserved margins of vision in 1 and 1,5 Year, respectively, after two-stage treatment.
