Problem of Acute ocular hypotonia in modern ophthalmosurgery

In the first two days after the operation with the aim to prevent general arterial expulsive haemorrhages under the control of general arterial pressure 2 times per day subconjunctival injections of 1% solution of Phenylephine Hydrochloride by 0,2 ml was made.

On the third day after the operation ophthalmoscopically and echographically сiliochoroidal detachment was found, more expressed into lower-outside quadrant of the eyeball. On the forth day after the operation sclerotomy on 5 hours was made in 5mm from lymbus. From suprachoroidal space about 0,4ml of transparent liquid of brown-yellow colour flowed out. There was no bleeding. The patient was discharged from the hospital on the 13^th day after the operation. Vision acuteness at discharge with correction: 0,1 (at admission 0,25), intraocular pressure measured by tonometer of Maklakov: 17 mm of m.c., vision field is not changed.

* * *

Proposed method of preventing of expulsive haemorrhages during intraocular operations unlike earlier known allows not only diminish negative showings of this complication, such as blood accumulation and sharp elevation of pressure into suprachoroidal space, but also effectively influence directly on injured vessel via intrachamberal injection of vasoconstrictive medicine and physical irritation of reflexogenic zones (ciliary body and episcleral vessels) and high hydrostatic pressure.

For all this mentioned influence is performed on the background of hydraulic compression of the eyeball at significantly less perfused pressure into ciliary vessels in comparison with those which exists in conditions of operational hypotonia of the eye and causes injury of one of them. Besides, hydraulic compression of the eyeball itself promotes termination of bleeding because it calls out expressed vasoconstrictive reaction of vessels of uveal tract and dosed decompression of the eye made after stoppage of bleeding promotes prevention of repeated bleeding.

CONCLUSION

At present, like last times, more widely spread intraocular operations (cataract extraction, antiglaucomatous, reconstructive and others,) as usual are held in conditions of acute hypotonia of the eyeball. However in spite of all delicacy of intervention, drop of ophthalmotonus itself may promote such serious complications as expulsive haemorrhages, phacoscotasmus, ciliochoroidal detachment and others. Practice shows that in conditions of acute hypotonia sensibility of intraocular tissues is sharply increased even to the very minimal trauma.

Content of current issues of the problem of acute hypotonia of the eye is an evidence of multiple unclear theoretical questions connected with peculiarities of reacting of intraocular tissues to decompression. Practically there were no attempts of complex investigations of condition of acute hypotonia of the eye at syndromal level. Multiple data of literature and also results of personal examinations make us study the problem of acute hypotonia of the eye and work out practical questions connected with it, to which the present monograph is dedicated.

Large part of the work is devoted to investigations of changes of hemodynamics and hydrostatic of the eye after drop of ophthalmotonus, and may be for the first time an attempt was taken to study indicated reactions “ in the pure state”, that is without influence of mechanical trauma on the eye tissues. In particular, reaction of the vessels of uveal tract and orbital artery to decompression and also dependence of arising impairments on speed of ophthalmotonus relieve were studied on the rabbits' eyes via non-invasive methods of rheoophthalmography and ophthalmodopplerography.

Also influence of preliminary short-term hydraulic compression on degree of changes in intraocular blood circulation was investigated.

Found regularities have widened conception of the character of pathologic changes arising in the vascular system of the eye in conditions of acute hypotonia and allowed work out optimal regimes of eye decompression in conformity with real conditions of making cavitary ophthalmologic operations.

Literature data and personal researches presented here describe interrelation between intraocular pressure and volume of humor lost during the eye decompression. Humor volumes are defined stipulating 1mm m.c. of intraocular pressure in dependence on general level of ophthalmotonus and sizes of the eyeball. Dynamics of changes in the eye volume resulting from “contraction” of fibrous capsule lost of hydraulic compression was also studied. Investigations made let us make quantitative evaluation of volumetric changes arising in the eye after drop of intraocular pressure.

We have also made an attempt to generalise data of studying of pathophysiological and topographic changes arising during cavitary operations and in early postoperative period.

In particular, results of investigations of changes in intraocular bloods circulation in all the main stages of intervention directly on the operated eye with the help of specially worked out method of intraoperational rheoophthalmography are contained in this work. Novelty of such investigations demanded series of technical problems to be solved and in particular creation of special sensor, means of eye immobilisation, screening of operational room and so on.

The results shown let us make a conclusion that at such stages of operation as opening of anterior chamber (eye decompression) and removal of the lens, sharp increase of volumetric speed of blood flow occurs; after coagulation of episcleral vessels, injection of Phenylephine Hydrochloride into anterior chamber, washing out of mass of the lens, recovery of ophthalmotonus, blood flow in the vessels of uvea decreases. On the whole changes in intraocular pressure at extracapsular method of lens removal are of more favourable character than at intracapsular.

Important part of the monograph is devoted to discussion of topographic changes arising in the operated eye after drop of ophthalmotonus.

Literature data and personal researches convince that in condition of acute hypotonia deformation of the eyeball in projection of blepharons, oculomotor muscles and also in anterior-posterior direction often develops. In our opinion results of intraoperational echography allowed to register development of ciliochoroidal detachment 5 minutes after eye decompression in 23% of patients and lens deformation with increase of its anterior-posterior size just after drop of ophthalmotonus may also be interesting for the readers.

Comparative clinical analysis of two main methods of anaesthesia - local anaesthesia and general endotracheal narcosis on such criteria as degree of hemodynamic and topographic changes within intervention, character and frequency of operational complications, clinical peculiarities of early postoperative period was also presented by us. Investigations show that making operations under local anaesthesia is accompanied by more favourable reaction of the eye for decompression and lens removal in comparison with local anaesthesia; quantity of complications reduces, functional results become better. At the same time features of intervention under ETN are more expressed tendency to plethora of intraocular vessels and their weak sensibility to mechanical and physical irritators.

Basing on the results of experimental research we have worked out and approved method of controlled dosed decompression of the eye allowing to stimulate and to use personal mechanisms of adaptation of ocular tissues to drop of ophthalmotonus.

Appliance of three types of mentioned methods has shown their significant predominance in comparison with traditional way of operational intervention.

In chapter “General characteristic of deformation of ocular tissues in condition of its acute hypotonia” we have tried to give analysis of compound character of topographic changes arising in intraocular tissues after relieve of ophthalmotonus, and to show role of these changes into pathogenesis of more typical complications for cavitary ophthalmologic operations. Basing on the results of experimental and clinical investigations and also on literature data we have managed to propose to the reader classification of the main types of deformation of ocular tissues in condition of its acute hypotonia and to systematise methods of diagnostic and prophylaxis of deformation applied in modern ophthalmosurgery.

Analysing reasons of volume deformation of the eye influence of peculiarities of technique during making operation on the humor lost by the eye is considered. In particular, we have compared groups of patients operated on senile cataract using conventional method and patients whom during similar operation one of method of controlled dosed eye decompression was applied. Investigations have found true decrease in the volume of objective deformation of the second group of patients at an average by 39 mm3.

Important place we had given to questions of linear deformation of ocular tissues (that is arising of non-conformity between surfaces of conjugated tissues) not treated yet in ophthalmologic literature. Its role in origination of such complications as ciliochoroidal detachment, posterior detachment of the vitreous, intraocular haemorrhages, macular edema, postoperative retina detachment is considered.

Special place in the monograph is devoted to methods of prevention (based on the results of our investigations) of the most serious complication of acute hypotonia of the eye - expulsive haemorrhages. Pathogenetically oriented methods of influence directly on bleeding vessel with the usage of physical and pharmacological means are proposed.

* * *

On the whole, data of experimental and clinical researches of acute hypotonia of the eye which we managed to accumulate and analyse let us make a conclusion that traumatic decompression of the eye is accompanied by the whole complex of specific pathophysiological reactions which can be characterised as syndrome of acute ocular hypotonia (SAOH). The main showings of SAOH are: hyperemia of intraocular vessels; decrease in the volume of ocular cavity at the expense of membrane contraction and thickening of the choroid; deformation of the eyeball from the outside; removal of the vitreous to the front and changes of its volume; thickening of the lens; linear deformation of membranes; humor transsudation into intertissular spaces; ciliochoroidal detachment.

There is no doubt that mentioned impairments characterise significantly more difficult processes which take place in tissues and structures of the eye in condition of its acute hypotonia on neurophysiological, anatomohystological, biochemical and other levels only in general way.

Further investigations in this area will bring a lot of interesting findings which probably will significantly change our conceptions of true reasons of many operational and postoperational complications. It's evident that specific “posthypotonic syndrome” will demand attention and separate examination because even today we have many interesting data indicative of presence of compound pathophysiological reactions consequences of which (for example “secondary linear deformation”) are shown not only in early but also in late postoperative period.

Consideration of specific changes typical for SAOH in working out technologies of cavitary ophthalmologic operations will allow in our opinion reduce traumatism of intraocular tissues and certainly will lead to further progress in microsurgery.

Bibliographical list

1 Abramov V.G., Artamonov V.P. - Usage of cold in ophthalmosurgery - Uyaroslavl,1973.- Upper-Volga publish. house.-p.151.

2 Abramov V.G., Vakurin E.A.-Complications of trabeculectomy at initial open angle glaucoma./Ophthalmol. magazine-1976.-N6.-p.410-412.

3 Alexeev B.N.- Device for ultrasonic sensor for noncontact - dropwise echography in ophthalmology./Bullet. of ophthalmol.-1972.-N6.-p.70.

4 Alexeev B.N.-Echographic diagnostic of detachment of ciliary body./ Bullet. of ophthalmol.-1973.-N4.-p.20-27.

5 Alexeev B.N.- Microsurgery of internal wall of Schlemm's canal in open-angle glaucoma. /Bullet. of ophthalmol.-1978-N4-p.14-20

6 Alexeev B.N., Pysetskaya S.F.-Reconstructive ophthalmology.-M., 1979.-p.88-90

7 Alexeev B.N., Pysetskaya S.F.- Hydro- and hemodynamics in ciliochoroidal detachments after antiglaucomatous operations/Ophthalmol. magazine -1983.-N6.-p.347-349.

8 Andreev L.A.- Works of physiological laboratory of academic Pavlov I.P.-Leningrad,1924,vol.1.-p.93-101.

9 Anin V.F., Filin V.A.- Mechanism of elongation of the eyeball in myopia./Ophthalmol. magazine-1975.N7.-p.510.

10 Astachov U.S.-Experimental studying of hemodynamics of the eye: Thesis of cand. of med. science.-L.,1969.

11 Atkinson W.S. Anesthesia in ophthalmology.-Springfield,1955.

12 Avetisov E.S., Ferfilfine I.L., Croosh I.I.-Rheological characteristics of sclera in myopia of high degree./Bullet.of ophthalmol.-1974.- N6.-p.43.

13 Axenfeld T. Wie sind das Infizieren und Komplikationen wahrend der Staroperationen zu vermeiden./Klin.mbl.Augenheilk,1925.-Bd.75 Sept.Oct.

14 Balazs E.A., Miller D., Stegmann R. Paper presented at the International Congress and first film Festival on Intraocular Implantation-Cannes,1979.

15 Balazs E.A., Healon: A guide to its use in ophthalmic surgery-1983.-p.5-27.

16 Balyasnikova I.V., Zykov N.I.-Ciliochoroidal detachment in blunt traumas of the eye./Theses of lectures of the 5th All-Union congress of ophthalmol.-M.,1979, vol.5.-p52-53.

17 Barkan H. CIT. accord. to: O'Brien C.S./ Arch. ophthal.-1935.-Vol.14.-p.542.

18 Bartnovskiy V.I.- Reaction of bloodcirculation of the eye in non-adequate anaesthesiological aid in children./Physiology and pathology of mechanisms of adaptation of visual organ.-1983, Vladivostok, vol.2.-p.23-25.

19 Bochkareova A.A., Nevednik L.M.-Hypotensive effect of oculocompression and condition of the vitreous./Ophthalmol. magazine - 1976.-N1.-p.37-39.

20 Bochkareova A.A., Zabobonina A.P.-Complications of cataract cryoextraction.-Rostov, 1985.-p.20,44.

21 Bradbery M.- Conception of haemato-encephalic barrier (transl. from English).-M., Medicine.-1983.-p.3-34.

22 Breslin C.W., Hershenfeld S.,Motolko M. Effect of retrobulbar anesthesia on ocular tension./Canad. T.Ophthalmol.-1983.-Vol.18;N5.-p.223-225.

23 Brown S.V.L., Tue J.G. Intraocular pressure after intracapsular cataract extraction./Ophthalm. Surg.-1984.-Vol.15;N5-p.389-393.

24 Bunin A.Y.- Hemodynamics of the eye and methods of its investigation.-M., Medicine.1971.

25 Burd E.M., Mac Rae S.M., Edelhauser H.F., Hyndiuk R.A.,Schultz R.O. The effects of sodium hyaluronate, chondroitin sulfate, and methylcellulose on the corneal endothelium and intraocular pressure./Am.T.Ophthalmol.-1983.-Vol.95;N3.-p.332.

26 Busse H., Kroll., Niermann W. Zur gezielten praoperativen Hypotonie bei der Kataraktextraktion./Klin.Mbl.Augenheilk,1982.-bd.181;N1.-p.20-24.

27 Cantor L.B., Katz L.J., Spaeth G.L. Complications of surgery in glaucoma./ Ophthalmology.-1985.-Vol.92,N9.-p.1266.

28 Chentsova O.B., Ryabtseva A.A., Gurov A.S.- Prognosticating of ocular hypertension after cataract extraction./Bullet. of ophthalmol.-1986,N2.-p.27.

29 Cherkunov B.F., Kolesnikova M.A.- Results of filtrating anguloplastic in glaucoma./Physiology and pathology of IOP.-M.,1985.-p.126.

30 Chouvin M.C. Anesthesie en Ophthalm.: Contribution a son etude.-Lion-1963-p.136.

31 Collin A. Dei Fexation des Augapfels in der Augenchirurgie./Ann.d'Ocul., 1925,Dec. Cit. accord. to: ROH.1926,p.673.

32 Collins E.T. Trans. Ophthalm.Soc.U.K.-1918.-Vol.38.-p.217-227.

33 Comberg T., Stoewer E. Die Erhohung des Augenbinnendrucks bei der Wirkung verschiedener Muskeln und deren klinische Bedeutung./Ztschr.F.A.-Bd.58,H1-2. Cit. accord. to: ROG.1926.-p.955.

34 Corydon L., Mackensen G. Progress in cataract surgery using microsurgical technique./Acta Ophthal.,1978.-Vol.56,N1-p.53-66.

35 Dashevskiy A.I.-False myopia. M., Medicine.-1973.

36 Dmitrovskaya I.P.-Clinical-experimental investigation of intraocular pressure, hydrodynamics and hemodynamics of the eye after penetrating injuries: Thesis of cand. of med. science.- M., 1971.

37 Doden W., Schaudigel O. Okulopression var intraokularen Eingriffen./Klin.Mbl. Augenheilk,1983.-Bd.182;N3-p.246-247.

38 Drews R.S. The present understanding of cystoid macular edema./Trans.Ophthalmol.Soc.V.K.-1985-Vol.104,N7.-p.744-747.

39 Duke-Elder W. Person's diseases of the eye.-London.-1954.

40 Dyban P.A.-Russian ophthalmologic magazine.-1927.vol. N6,N1.-p.21.

41 Egorov V.V.- Prognosticating and prophylaxis of prolapse of the vitreous in extraction of senile cataract./Bullet of ophthalmol.-1985.N6.-p.22-23.

42 Egorova E.V., Zubareva L.N., Nikitina G.P.- Collapse of the eyeball in removal of complicated traumatic cataracts./Bullet of ophthalmol.-1975.-N4.-p.47-49.

43 Ellis P.P. Retrobulbar Injections./Surv. Ophthal.-1974-Vol.18,N6.-p.427-430.

44 Elschnig A. Extraction of senilis cataract in capsula./Am.J.Ophthal.-1925.-Vol.8-p.300-305.

45 Ereomina A.I.-Etiology, clinic, treatment and prophylaxis of postoperative detachment of the vascular tract./Bullet of ophthalmol.-1966.-N3.-p.27-29.

46 Ermakova V.N.-Influence of some hypotensive means on prostoglandine ocular hypertension./Bullet of ophthalmol.-1981.-N1.-p.11-12.

47 Eroshevskiy T.I.-Primary glaucoma and complications after operation./ Ophthalmol. magazine.-1976.-N6.-p.403-407.

48 Eroshevskiy T.I., Cherkunov B.F., Malov V.M., Kolesnikova M.A., Basova L.I.- Implantation of posterochamber artificial lens in surgery of posttraumatic cataracts./Ophthalmol. magazine.-1983.-N8.-p.456-467.

49 Fechner P.U., Fechner M.U. Methylcellulose and lens implantation./Brit.Y.Ophthalmol.1983.-Vol.67,N4.p.259-263.

50 Feodorov S.N., Kolinko A.I.- Predoperational drop of intraocular pressure as a measure of prophylaxis of vitreous prolapse at intracapsular cataract extraction./Bullet. of ophthalmol.-1970,N4.-p.50-54.

51 Feodorov S.N., Egorova E.V., Strusova N.A.- Results of iridointracapsular fixation of intraocular lens after extracapsular cataract extraction./ Bullet. of ophthalmol.-1984. N2.-p.4-7.

52 Filatov V.P. 1924- Cit. accord. to Vurgaft Y.M.-Applanational tonometry.-Thesis of cand. of med. science.-M.,1985.-p.40.

53 Filatov V.P., Kalfa S.F.-Posterior sclerectomy as a method of prevention of choroid detachment./ Bullet. of ophthalmol.-1953,N5-p.13-17.

54 Flieringa. Cit. Accord. to Shmeleova V.V. Cataract.-M.,1981-p.139.

55 Forofonova T.I.-Fluorescentangiographic diagnostic of ischemic processes in pathology of IOP: Thesis of cand. of med. science-M.,1975.

56 Francois T., Ferbraeken M. Complication in 1000 conseсutive intracapsular cataract extraction./Ophthalmologica (Basel), 1980.-Vol.180,N3-p.121-128.

57 Friedenwald J.S. Contribution to the theory and practice of tonometry./ Amer.J.Ophthalm.-1937.-Vol.20.,N10-p.985-1010.

58 Friedenwald J.S. Some problems in the calibration of tonometers./ Amer.J.Ophthalm.-1948.-Vol.31,N10-p.935-943.

59 Fucks E. Cit. accord. to: Chandler P.A., Maumenee A.E./Ibid.-1961.Vol.52.N5-pt.1-p.609-618.

60 Gass I.D.M. Management of vitreous loss after cataract extraction./Arch.Ophthal.-1970.-Vol.83,-p.319-323.

61 Gass I.D.M. Macular diseases.-Saint Louis.-1977.

62 Glomaud D., Viord P., Tissier M.H., Slamagne J.C. Etude experimental des variations de la pression du segment posterieur de loeil sous abesthesie generale./J.franc.ophthalmol.-1983-Vol.6,N5-p.507-513.

63 Gloor B. Gibt es schwere Komplikationtn der Okulopression/Klin.Mbl.Augenheilk.-1983.-Bd.182.N5.-p.431-433.

64 Gorban A.I.- The vitreous in clinical ophthalmology.- L.,1979.-p.197-198.

65 Goundorova R.A., Verigo E.N., Alexeeva I.B., Romashchenko A.D.- Healon in reconstructive ophthalmosurgery./Bullet. of ophthalmol.-1984.-N5-p.34-38.

66 Grehn F., Prost M. Function of retinal nerve fibres depends on perfusion pressure./Invest.Ophthalmol.-1983.-Vol.24,N3-p.347-353.

67 Guindon B., Harvey I., Peacocke. Factors modifying vitreous Pressure in Cataract Surgery./Canad.J.Ophthalmol.-1981-Vol.16,N2-p.73-75.

68 Haemmerli E. Die Fixation des Augenlides wahrend der Augapfelsoperation./R.M.F.A.,1925.-Bd74,Tan.-Feb. Cit. accord. to: POG.1926,-p.673.

69 Hargett H.P. Bulging Iris-Lens in Cataract Extraction./Ann.Ophthalm.1976.-Vol.8,N6.-p.749-751.

70 Hatminskiy U.F.- Sluice for surgery interventions in ocular cavity./ The III-d All-Union Congress of ophthalmol.-M.,1975.-p.290.

71 Hatminskiy U.F., Konopayev V.M.- Way of drop of intraocular pressure during surgery interventions./ Author's certificate of the USSR № 1366158 priority from July 5,1982.

72 Hatminskiy U.F., Melyanchenko N.B.- Reduction of complications of intraocular operations./ Traumas of organ of vision.-M.,1985.-p.13.

73 Hatminskiy U.F., Melyanchenko N.B.- New approach to making operations connected with opening of the eyeball./Thes. of rep. of the VI-th All-Union congress of ophthalmol.-M.,1985, vol.4.-p.127-128.

74 Hatminskiy U.F., Melyanchenko N.B.- Meaning of controlled decompression of the eye for prevention of dangerous consequences of opening of the eye./Scientific-technical progress and healthcare of Kuzbass-Kemerovo,1986.-p.193.

75 Hatminskiy U.F., Melyanchenko N.B.- Problem of acute hypotonia of the eye in cataract surgery./Thes. of rep. of intern. conference. Odessa,1987.-p131.

76 Hogan M.J., Alvarado J.A., Weddell J.E. Histology of the Human Eye.- Philadelphia-1971.-p.370.

77 Hudson A.C. Roy. London Ophth.Hosp.Rep.-1913-Vol.19,-p.301.

78 Ibadova S.I., Babigiayev M.A., Brickman S.I.- New type of protector in surgery of cornea at severe trauma./Plastic surgery at injuries of organ of vision.-Moscow-Telavi, 1986.-p.9-10.

79 Ivanov D.F., Nedelka A.F., Karpovich A.Y., Bezuglyi B.S., Kuchkova L.I.- Vasosection in basin of orbital artery as method of prophylaxis of intraocular haemorrhages in cataract extraction./ Ophthalmol. magazine-1985.-N5.-p.280-282.

80 Jaffe N. Complications of cataract surgery-Saint Louis-Toronto-London-1972.

81 Jalkh A.E., Avila M.P., trempe C.L., Schepens C.L. Diffuse choroidal thickening detected by ultrasonography in various ocular disorders./Retina-1983-Vol.3,N4,p.277-283.

82 Kallahan A.- Surgery of ocular diseases.- M.,1963.-p.228-257.

83 Kalpha S.F.1060.- Cyt. accordingly to Vurgaat Y.M.- Applanational tonometry: Thesis of cand. of med. science.-1985.-M.,-p.40.

84 Kartasheova E.A., Rosenfeld E.F., - Vitreous hernias and linear parameters of the eyeball./Bullet of ophthalmol.-1983.-N4.-p.43-45.

85 Kartasheova E.A., Serebryakova T.V., Plesko E.V., Tsybaneva E.V.- Choroid hemodynamics examined by method of M-scanning in patients with aphakia./Ophthalmol. magazine-1987.-N5.-p.286-287.

86 Karyagine V.F.- Prophylaxis of complications in cataract extraction: Abstract of thesis of cand. of med. science.-M.,1975.

87 Katsnelson L.A.- Rheography of the eye.- M., Medicine, 1977.-p.48.

88 Kolinko A.I., Zelikson B.B.- Mechanism of formation of rheoophthalmogram and electroplethysmogram of the eye./Physiol. magazine of USSR named after Sechenov.-1977.-N7.-p.970-975.

89 Kondratenko U.N.- Concerning pre- and postoperative treatment in cataract surgery./Bullet. of ophthalmol.-1985.-N5.-p.17-18.

90 Koretskaya U.M., Mogerenkov V.P., Ryabova A.A.- Postoperative hypertensive syndrome./Questions of pathogenesis and treatment of glaucoma.-M.,1981.-p.99-101.

91 Kovalenko M.D., Kravtsova G.M.- Concerning cupping of hypertension complications within operation of cataract extraction./ Ophthalmol. magazine-1983.-N7.-p.434-435.

92 Kovalevskiy E.I.- Ocular diseases.-M., Medicine.-1980.-p.41.

93 Kovalevskiy E.I., Ruzmetov M.S.- Local hemo- and hydrodynamics of the eye after ocular operations on children in monoanesthesia with Ketalarum./Bullet. of ophthalmol.-1982.-N4.-C.43-45.

94 Kozlov V.I.-New method of studying of tensility and elasticity of ocular membranes in changes of ophthalmotonus./Bullet. of ophthalmol.-1967.-N2.-p.5-8.

95 Krasnov M.M., Bocharov V.E.- Cataract phacoemulsification./Bullet of ophthalmol.-1975.-N3.-p.41-46.

96 Krasnov M.M.- Local caffeinotherapy of detachment of vascular tract./Bullet of ophthalmol.-1980.- N 2.-p.62-63.

97 Krasnov M.M.- Glaucoma microsurgery.-M., Medicine.1980.-p.9-91,99,176.

98 Krey H., Tacobi K.W., Wizemann A Intraokulare Lensenimplantatiouam hypototen Bulbus./Klin.Mbl.Augenheilk.1982.-Bd.180,N3.-p.239-241.

99 Krol D.S., Sheludchenko V.M.- Peculiarities of hemodynamics of anterior part of the eye in experimental contusion./Ophthalmol. magazine.- 1985.-N2.-p.112-115.

100 Krylova L.D.- Changes in hydrodynamics after extra- and intracapsular cataract extraction./Ophthalmol. magazine.-1985.-N4.-p.217-219.

101 Kulgynskaya G.I.- Comparative evaluation of extracapsule extraction and cryoextraction of senile cataract: Thesis of cand. of med. science.- Rostov-na-Donu, 1972.

102 Lazarenko V.I., Chanchikov G.F., Kornilovskiy I.M., Gaydabura V.G.- Influence of moderate local hypothermia on hemo- and hydrodynamic showings of healthy eyes./Ophthalmol. magazine-1976.-N6.-p.419-422.

103 Lazarenko V.I., Kornilovskiy I.M.-Test for evaluation of functional condition of ocular vessels./Ophthalmol. magazine.-1978.-N8.-p.598-600.

104 Linnik L.F., Grygoryants T.N., Leykina S.A., Bezpalchiy A.N.- Concerning the question of expulsive haemorrhages./Clinical aspects of pathogenesis and treatment of glaucoma: Collected scientific articles of MNII MG.-M.,1984.-p.118-123.

105 Littlewood K.R., Constable I.J. Vitreous haemorrhage after cataract extraction./Brit. J.Ophthalmol.-1985-Vol.69,N12-p.911-914.

106 Lysenko T.A., Bakurskaya V.Y., Zaharova V.G.-Peculiarities of course and outcome of operation of crioextraction of senile cataract in different age-groups./ Ophthalmol. magazine-1984.-N1.-p.33-35.

107 Machehin V.A., Belyanin A.F.- Transciliary lensectomy of traumatic cataracts./Ophthalmosurgery: collected scientific works-Kooybyshev,KMI,1983-p.12-13.

108 Mac Donnell P.J., Maumenee A.E., Stark W.J., Hutchins G.M. The Honan intraocular pressure reducer./ Arch. Ophthalmol.-1985-Vol.103,N3.-p.422-425.

109 Mac Rae S.M., Edelhauser H.F., Hyndiuk R.A., Burd E.M., Schultz R.O. The effects of sodium hyaluronate, chondroitin sulfate, and methylcellulose on the corneal endothelium and intraocular pressure./Amer. J.Ophthalm.-1983-Vol.95,N3-p.332.

110 Makeeva T.V., Nemenko F.P.- Concerning mechanism of development of detachment of ciliary body and choroid./Bullet of ophthalmol.1974.-N4.-p61-62.

111 Maksimov V.U., Shulga L.V.- Prediction of prolapse of the vitreous and choice of method of cataract extraction./Ophthalmol. magazine-1986.-N7.-p419-421.

112 Malaev A.A.- Ring- sucker for maintenance of the form of the eyeball during some cavitary operations./Traumas of the eyes.- M.,1978.-p.197.

113 Markova T.L., Letemina I.M., Naumova S.A., Nepoyda L.I., Ivanova S.A.- Intraocular bloodcirculation and cataract surgery./Thesis of reports of scientific-practic. conference of ophthalmologists.-Tomsk,1976.-p.158-161.

114 Maumenee A.E., Schwartz M.F. Acute intraoperative choroidal effusion./Amer.J.Ophthalmol.1985-Vol.100,N1-p.147-154.

115 Mauriello J.A., Mac Lean I.W., Wright J.D. Loss of eyes after intraocular lens implantation: Aclinicopathologic study./Ophthalmology-1983-Vol.90,N4.-p.378-385.

116 May D.R., Freedland R.J., Charles S., Wang C. Ocular Hypothermia: Anterior chamber perfusion./ Brit. J. Ophthalmol.1983.-Vol.67,N12-p.808-813.

117 Melyanchenko N.B., Hatminskiy U.F.-Interrelation between speed of decompression of the eyeball and arising at this vasculomotor reactions in the vessels of uveal tract./Bullet of ophthalmol.-1988.-N5.-p.29-31.

118 Melyanchenko N.B. and co-authors.- Changes in hemodynamics in the vessels of ciliary tract during operation of cataract extraction in accordance with the data of rheoophthalmography./Bullet. of ophthalmol.-1988.-N6.-p.19-22.

119 Melyanchenko N.B.- Simplified method of non-contact dropwise echography of the eye./Bullet. of ophthalmol.-1987.-N3.-p.67-68.

120 Melyanchenko N.B.- Acute ocular hypotonia./ Monogragraph. InSEPZ.1996.156p.

121 Miller T.R., Morin T.D. Intraocular pressure after cataract extraction./ Amer. T. Ophthalmol., 1968.-Vol.66,N3.-p.523-528.

122 Nesterov A.P., Bunin A.Y., Katsnelson L.A.-Intraocular pressure.-M., Medicine,1974.

123 O'Brien C.S., Weih J.Arch.Ophthal.-1949-Vol.42.-p.606-619.

124 Pape L., Balazs E. The use of Sodium hyaluronate in human anterior segment surgery./ Ophthalmology-1980-Vol.87,N7.-p.669-705.

125 Pechereau A., Bodereau Z., Baikoff G. Effets de differentes methodes d'implantation intra-ocular sur la population endotheliale corneenne. Etude en microscopie speculaire./T.franc.Ophthalmol.-1982.-5,N2-p.115-120.

126 Pederson T.E., Gaasterlaud D.E., Mac. Lellan H.M. Experimental Ciliochoroidal Detachment. Effect on Intraocular Pressure and Aqueous Humor Flax./ Arch. Ophthal.-1979.-Vol.97,N3.-p.536-541.

127 Penkov M.A., Avrushchenko N.M.- Concerning hemorrhagic complications of operation of cataract cryoextraction./Ophthalmol. magazine-1974.N1.-p.28-33.

128 Pisetskaya S.F.-Dehydration therapy in cataract extraction./Bullet. of ophthalmol.-1985.N2.-p.25-26.

129 Podolsky M.M., Ritch R. Elevated intraocular pressure in the immediate postoperative period after cataract extraction./Ann. ophthalm., 1981.-Vol.3,N11.-p.1239-1240.

130 Pohjampelto P. Pulse-induced intraocular pressure variation and retrobulbar anaesthesia with and without adrehnaline./Acta.ophthal. (Kbh.),1979.-Vol.57.-p.136-144.

131 Polyakova L.Y.- Indications and prophylaxis of complications in cataract cryoextraction./ Cold application in ophthalmology: Collected scientific works-M.,1976.-p.29.

132 Posagennikov A.P.-Akinesia with Trimekainum./ Ophthalmol. magazine.1975.N4.-p.302-303.

133 Posagennikov A.P.- Role of vasculomotor reaction in surgery of senile cataract./Ophthalmol. magazine.1975,N8.-p.598-600.

134 Purcell T.K., Krachmer T.H., Doughman D.T., Bourne W.M. Expulsive haemorrhage in penetrating Keratoplasty./Ophthalmology,1982-Vol.89,N1-p.41-43.

135 Radda Th.M., Bardack H., Riss B. Acute ocular Hypotony: A Rare complication of temporal arteritis./Ophthalmologica-Basel-1981,181,3-148-152.

136 Reference-book on ophthalmology.1978,-M., Medicine.-p.299.

137 Remisov M.S., Shachov L.L., Yartsheva I.I.- Application of autohumor for restoration of anterior chamber after cataract extraction./Bullet. of ophthalmol.-1981,N2.-p.25-26.

138 Rich W.J., Radtke N.D., Cohan B.E. Early ocular hypertension after cataract extraction./Brit.J.Ophthalm.-1974-Vol.58,N8-p.725-731.

139 Rodinson Cyt. accord. to: Dyban P.A./Ross. Ophthalm. Magazine.-1927-N1-p.21.

140 Rodezhauzer J. Uveadurchlutung und Augeninnendruck, Beihefte./ Buech. Augenarzt-1963-Bd.42-p.1-98.

141 Rykov V.A.-Experimental hypotonia of the eye. Pathomorphology of drainage system./Ophthalmol. magazine.-1986,N3.-p.176-179.

142 Saharov Y.I.- General regularities of deformation of spherical membranes similar to the eyeball./Physiology and pathology of intraocular pressure: collected scientific works of II MOLGMI named after N.I.Pyrogov.-M.,1982.-p.12-15.

143 Sallman L. Central control of intraocular pressure:Glaucoma/Trans.art. of the first conf.-1955-p.81-122.

144 Samoylov A.Y.-Reactive hypertonia of the eye.-M.,1926.

145 Savinkov O.I.- Improving of informational capacity of the table for definition of changes in the ocular volume./Clinical aspects of pathogenesis and treatment of glaucoma: collected scientific articles of MNII MG.-M.,1984.-p.43-47.

146 Sergienko N.M., Kondratenko Y.N.-Investigation of pathogenesis of postoperative corneal astigmatism after cataract extraction./Ophthalmol. magazine.-1982,N3.-p.172-176.

147 Serov A.A.-Posterior sclerectomy in prophylaxis of CDD./Physiology and pathology of intraocular pressure: collected scientific works of II MOLGMI named after N.I.Pyrogov.-M.,1985.-p.53-56.

148 Shamsutdinova R.A.-Reactive syndrome in experiment and in clinic./Ophthalmol. magazine-1971,N6.-p.430-433.

149 Shmeleova V.V.-Cataract.-M.,1981.-p.101-141.

150 Sicelman G., Coleman D.J. Spontaneous Lens Rupture Following Pars plana Viterectomy./Ann.Ophthal.-1978-Vol.10, N1-p.65-74.

151 Solovjeova G.M., Savinkov O.I.- Technique of deep sclerectomy, some of its variations and peculiarities./ Clinical aspects of pathogenesis and treatment of glaucoma: collected scientific articles of MNII MG.-M.,1984.-p.67-72.

152 Sydorenko E.I.-Transitional hypertension of the eye after cataract extraction./Bullet. of ophthalmol.-1975,N3.-p.14-16.

153 Vagin B.I.- Calibration table of true ophthalmotonus for elastotonometer of Filatov-Kalf./Collected scientific articles of MNII MG.,1984.-p.35-39.

154 Verigo E.N., Gerchikov A.N., Fridman F.E.- Meaning of echographic diagnostic of posterior uveitis in rehabilitation of the patients with posttraumatic subatrophy of the eye./Bullet. of ophthalmol.-1987.-N1.-p.32-35.

155 Volkov V.V.- To pathogenesis and therapy of postoperative detachment of vascular tract./Bullet. of ophthalmol.-1973.N5.-p.31.

156 Volkov V.V.- Ocular vacuum-syndrome./ Bullet. of ophthalmol.-1978.-N5.-p.45-48.

157 William M., Bourne D.M., Thomas T., Liesegang M.D., Robert R., Waller D., Duane M., Ilstrup M.S. The effect sodium hyaluronate on endothelial cell damage during extracapsular cataract extraction and posterior chamber lens implantation. /Am.T.Ophthalmol.1984.-Vol.98.-p.759-762.

158 Yanko L. Prevention of vitreous loss in cataract extraction./Acta ophthal.-1974.-Vol.52,N5-p.724-728.

159 Zabobonina A.P.- Secondary maculodystrophia in aphakia. (Materials of the IVth congress of ophthalmologists of USSR.- Kiev, 1973.-vol.1.-p.263-265.

160 Zauberman H. Controlled retrobulbar anesthesia for ECCE and iol implantation./Ophthalmol. Surg.-1985-Vol.16, N9-p.560-562..

161 Zayko N.N., Mynts S.M.-Role of vasculomotor reaction in surgery of senile cataract./Ophthalmol. magazine.-1975.-N8.-p.598-600.

162 Zubareva L.N., Marchenkova T.E., Tolchinskaya A.I., - Actual questions of injuries and diseases of the eye.- Igevsk,1984.-p.95-96.

Melianchenko Nikolai

melanch@yandex.ru

mob.: +7-8916-3946253