The dissertation is dedicated to solving the current problem of modern ophthalmology - increasing the effectiveness of surgical treatment of cataracts in patients with type 2 diabetes mellitus based on the study of the features and mechanisms of the development of postoperative inflammatory complications and their relationship with the content of glucose and glycated hemoglobin in the blood, cytokines in the intraocular fluid, and as well as the development of a new method of their forecasting.
Diabetes mellitus (DM) is a chronic systemic disease that affects almost one in eight adults worldwide. According to data from the International Diabetes Federation, the prevalence of diabetes mellitus is steadily increasing worldwide and will reach more than 439 million people by 2030. This increase in the prevalence of DM is attributed to population growth, aging, urbanization, sedentary lifestyles, and obesity.
One of the most important problems affecting the quality of life of people with diabetes is blindness. More than 600,000 people among those suffering from DM lose their sight completely every year. Diabetic retinopathy (DR) is one of the leading causes of blindness among working-age adults. This has a significant impact on health-related quality of life and health care costs. Although there are medical and surgical interventions for proliferative DR, which carries a high risk of blindness if left untreated, irreversible vision loss often already occurs at this stage.
According to the statistics of the World Health Organization, 51% of all cases of blindness in the world are caused by clouding of the lens of various degrees. Cataract is the main cause of blindness worldwide, which is also one of the most common eye complications associated with DM. As the prevalence of diabetes has increased worldwide, the incidence of diabetic cataracts has also increased. Cataract ranks second among the causes of low vision in diabetes.
Currently, the "gold standard" of cataract surgery is phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Cataract phacoemulsification (PHACO) reduces the trauma of surgical treatment, promotes rapid socio-labor rehabilitation of patients and ensures stable high visual acuity. Cataract surgery is a common and safe procedure, but it can be associated with vision-threatening complications in diabetic patients, such as diabetic macular edema, postoperative macular edema, progression of diabetic retinopathy, opacification of the posterior capsule, inflammatory processes, etc. The introduction of microinvasive technologies made it possible to reduce the frequency of postoperative inflammatory complications in cataract surgery. According to the literature, the severity of the exudative-inflammatory reaction of the anterior segment of the eye in the early postoperative period has a direct correlation with the stage of diabetic retinopathy. It should be noted the role of immunological disorders in the pathogenesis of the inflammatory reaction that occurs in response to surgical trauma.
According to a number of researchers, when assessing the balance of cytokines, it is important not only to change the concentration of interleukins in biological fluids, but also the ratio of cytokines with pro- and anti-inflammatory activity, capable of stimulating the humoral or cellular link of the immune system, etc. Therefore, scientifically based development of effective prognostic, preventive and therapeutic methods that reduce the frequency of inflammatory complications is an urgent problem of modern ophthalmic surgery.
