Vol 94, No 4 (2013)

Aim. To study the influence of brain natriuretic peptide gene polymorphism (polymorphic locus Т-381С) on brain natriuretic peptide serum level and congestive heart failure onset risk and clinical features in patients with coronary heart disease. Methods. 412 patients with congestive heart failure were examined. Genotyping was performed by polymerase chain reaction. Brain natriuretic peptide N-terminal fragment level was assessed by ELISA. The control group included 211 healthy controls with no signs of cardiovascular pathology on examination. Results. In healthy people with C/C genotype the level of brain natriuretic peptide N-terminal fragment was significantly higher in comparison with people carrying T/T genotype. It was found that the T allele and T/T genotype of the T-381C natriuretic peptide gene polymorphic locus was associated with high risk, severity and unfavorable clinical course of congestive heart failure in patients with coronary heart disease. At the same time, the C allele and C/C genotype emerged as a protective factor regarding the risk, severity and clinical course of the disease. Conclusion. T/T genotype carriers of the of the T-381C natriuretic peptide gene polymorphic locus are a special subgroup associated with high risk of congestive heart failure onset and unfavorable clinical course. Therefore these patients with coronary heart disease should be considered as a group requiring an out-patient control and preventive measures targeted on congestive heart failure and premature mortality prevention.

Aim. To examine the interrelation between depression and anemia in HIV-positive patients. Methods. A cross-sectional study included 99 HIV-positive patients. Anemia was defined as hemoglobin concentration below 12 g/dL in women and 13 g/dL in men. Depressive symptoms were measured using the Beck Hopelessness Scale. Results. Anemia was registered in 30.3% of patients. In 54.5% of patients depression was detected (Beck Scale score ≥10). In patients with anemia the prevalence of depression was 76.7% including severe depression in 20% of patients. Mean Beck Scale score in anemia group was significantly higher compared to the group without anemia (17.57±12.90%, 95% confidence interval 13.5-20.5 and 10.06±8.07, 95% confidence interval 7.7-12.3, t=3.2, p=0.007 relevantly). Moderate reverse correlation between Beck scale scores and hemoglobin level was revealed ((r=-0.24, p=0.019). After stratification and adjusting for potential confounders, anemia was found to be associated with higher prevalence of depression in patients younger than 40 years old. The prevalence ratio for depression in patients with anemia, comparing to patients without anemia was 1.827 (95% confidence interval 1.28-2.61, λ2=8.85, p=0.0029) in this age group. Detected association did not depend on sex, family status, disease duration, CD4-level and treatment with antiretrovirals. Conclusion. Depressive symptoms are associated with anemia in HIV-patients younger than 40 years old.

Aim. To determine the features of cytokine profile in patients with local and generalized soft tissue infections. Methods. The treatment results of 2350 patients with soft tissues infections since 1998 to 2012 were analyzed. ELISA test was used to measure tumor necrosis factor alpha and interleukin-1 receptor antagonist levels in 300 randomly picked patients with local (75 patients, comparison group) and generalized (225 patients, main group) forms of soft tissue infections. Results. In patients with generalized infections, tumor necrosis factor alpha level was 1.5 times higher in patients with mild systemic inflammatory response, 3.5 times higher - in patients with moderate and 6.7 times higher in patients with severe systemic inflammatory response compared to healthy controls. Interleukin-1 receptor antagonist levels were also elevated and related to the degree of inflammatory response, thus, it was the highest (2 times higher compared to controls) in patients with moderate systemic inflammatory response, while in patients with mild and severe inflammation it was only 30-40% higher. The significant increase in tumor necrosis factor alpha level associated with normal interleukin-1 receptor antagonist level is characteristic for different forms of sepsis. At the same time, increase in interleukin-1 receptor antagonist level associated with minimal changes in tumor necrosis factor alpha level can be used as a diagnostic criteria for compensated inflammatory response I patients with local infections cytokine profile was normal. The severity of systemic inflammation and clinical course of generalized infection depended not only on the absolute increase of cytokine levels, but on pro-inflammatory (tumor necrosis factor alpha) and anti-inflammatory (interleukin-1 receptor antagonist) cytokine levels misbalance. Conclusion. Examining the serum cytokine levels allows to confirm the diagnosis of generalized infection on early stages and to differentiate between compensated and non-ompensated systemic inflammatory response.

Aim. To compare structural changes revealed at autopsy with clinical data, allowing to clinically predict the pancreatic damage in patients with acute destructive pancreatitis. Methods. Case histories and post-mortem pancreatic tissue samples from 12 patients who died of acute destructive pancreatitis, were examined. Results. Autopsies revealed the similar frequency of pancreatic anterior and posterior surface damage. Three types of pancreatic damage were observed: (1) total or extensive necrosis - 5 cases; (2) pancreatic fatty degeneration - 3 cases; (3) inflammatory changes with local necrotic lesions - 4 cases. Pancreatic morphologic changes were matched with clinical data and results of laboratory and instrumental tests that were performed in the patients who died from pancreatitis. The most significant clinical and laboratory changes were seen in patients with extensive necrosis, while in patients with pancreatic fatty degeneration and local necrotic lesions clinical presentations and changes in laboratory and instrumental tests were not so severe. Conclusion. Macro- and microscopic changes in pancreas observed in patients with acute destructive pancreatitis can be characterized as total or extensive necrosis, pancreatic fatty degeneration and acute inflammation with local necrotic lesions; matching the clinical and morphologic data revealed the relation between the extent of the pancreatic damage and clinical severity of acute destructive pancreatitis.

Aim. To study the relationship between the clinical and neurosonographic indicators of the hypertensive syndrome and blood hemoglobin level in infants with perinatal disorders of the central nervous system. Methods. A total of 58 children with a diagnosis of «Perinatal hypoxic-ischemic brain damage in the form of hypertensive syndrome» were examined at the age of 12 months and younger. Clinical, neurological examination, neuroimaging, laboratory tests and statistical analysis were performed. Results. The majority of infants who had suffered a hypoxia during labor and had clinical and neurosonographic signs of intracranial hypertension also had different stages of blood hemoglobin level decrease. Comparing the neurosonography data and hemoglobin levels, it was found that children with anemia dominated among children with primary accumulation of cerebrospinal fluid in the interhemispheric fissure. Neurosonography revealed interhemispheric fissure widening in 30 (51.7%) of infants, ventricular system widening - in 28 (48.3%) of infants. The anemia rate was high in infants with interhemispheric fissure widening - in 19 (63.3%) out of 30 infants. Anemia was more frequent in the full-term infants with interhemispheric fissure widening - 4 (87.5%) out of 16 infants, whereas prematurely born infants with interhemispheric fissure widening had relevantly higher rate of normal hemoglobin level - 9 (64.3%) out of 14 infants. In 28 infants with ventriculomegaly 23 (82.1%) had widened anterior horns of the lateral ventricles. In 14 (59.3%) of infants with dilatation of the anterior horns of the lateral ventricles hemoglobin level was within the age-appropriate normal limits. Conclusion. Reduced hemoglobin level aggravates the symptoms of intracranial hypertension, and the continuing anemia leads to tissue edema, which leads to a rapid increase of degenerative changes in the brain, causing mental and physical retardation.

Aim. To investigate the health-related quality of life among the patients with hand-arm vibration syndrome in the Kabardino-Balkar Republic. Methods. The study included 198 patients aged 36-65 years. The health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire before and after recreation treatment. Patients were divided to 3 groups according to disease severity: hand-arm vibration syndrome stage 1 - 54 (27.3%) patients, stage 2 - 75 (37.9%) patients, stage 3 - 69 (34.8%) patients. Results. Marked decrease in all HRQoL parameters measured by SF-36 was observed at the baseline. After the recreation treatment there was a significant improvement in all HRQoL parameters in all groups (particularly on «vitality» and «emotional role functioning»). The most prominent improvement was observed in patients with early stages of hand-arm vibration syndrome. Conclusion. Patients with hand-arm vibration syndrome suffer from severe decrease of HRQoL. Recreation therapy improves the HRQoL, especially on early stages of hand-arm vibration syndrome.

Aim. To evaluate the complex therapy with the addition of metformin and orlistat in treatment of II-III functional class stable angina associated with metabolic syndrome. Methods. The study included 143 patients with stable angina at the age of 36 to 70 years (mean age 54.2±3.6). Of these, 59 patients (control group) received standard treatment (isosorbide 5-mononitrate 40 mg/day, amlodipine 5 mg/day, acetylsalicylic acid 100 mg/day, carvedilol 25 mg/day, atorvastatin 20 mg/day, eprosartan 600 mg/day), and 84 patients (study group) were additionally administered metformin 1000 mg/day and orlistat 360 mg/day. Clinical and laboratory examinations (serum glucose and lipid level measurements) as well as instrumental examinations (electrocardiography, Doppler echocardiography, 24-hour electrocardiography and blood pressure monitoring) were performed before the treatment, 3, 6 and 12 months after the treatment start. Results. After 12 months of treatment mean systolic blood pressure in patients of the main group reduced by 24.5%, diastolic - by 18.8%, fasting serum glucose level - by 14.3% compared to the baseline level. Cholesterol level reduced by 13.8%, triglycerides - by 14.7%, low density lipoproteins - by 14.0%, blood level of high density lipoproteins increased by 11.6%. Body weight index reduced by 10.3%. Conclusion. Adding of 1000 mg of metformin and 360 mg of orlistat daily decreased the fasting serum glucose level by 14.3%, body weight index by 10.3%, and reduced the number of angina episodes by 19.6%, of painless myocardial ischemia by 36.3%, as well as increased physical ability tolerance by 26.5%.

The review describes the modern approaches to open and endoscopic surgery, chemo- and radiotherapy in organ-saving treatment of invasive bladder cancer. Bladder cancer nowadays ranks the second among urological malignancies. Incidence of bladder cancer in Russia has increased by 58.6% over the past 10 years, with the share of invasive tumors reaching 30%. According to the European Association of Urology guidelines, the radical cystectomy with ureterocolonic diversion is the standard treatment of muscle-invasive bladder cancer. However, the extensive surgical trauma, comorbidities and exhaustion of patients, disability and social adaptation failure as well as the high mortality rate restrict the use of cystectomy. Thereby, taking into account the dynamic development of chemo- and radiotherapy allowing to reduce the recurrence rate, more and more experts are inclined to use organ-saving treatment of invasive bladder cancer. Organ-saving treatment has several advantages: it is less complicated and costly, preserves sexual function, decreases the risk of kidney damage and provides a good quality of life. Still, scanty publications are comparing results of cystectomy and organ-saving treatments of invasive bladder cancer, causing controversial opinions and highlighting the need for further studies.

Currently, ozone therapy is a method of treatment used in various fields of medicine, e.g., in treatment of neuropathies, liver diseases, as well as in cosmetology, surgery, traumatology, obstetrics, gynecology, urology, cardiology, pulmonology, gastroenterology, neurology, dentistry, otorhinolaryngology, ophthalmology. Recently, ozone therapy is increasingly used clinically as a complement to the classical treatment, which is contributed by the low cost and relative safety of the method. Ozone therapy as a modern and effective method of treatment continues to evolve, finding new areas of application, mechanisms of its action are being clarified, new techniques and new indications are offered. The main properties of ozone therapy are the stimulation of the antioxidant defense system, hypoxia reduction and metabolism activation, including carbohydrate and lipid metabolism, and improving blood circulation. Currently papers devoted to the application of ozone in ophthalmology in treatment of age-related macular degeneration, viral conjunctivitis and keratitis, corneal degenerations, purulent corneal ulcer, pigmentary retinal degeneration, optic neuritis and atrophy, degenerative changes of the choroid, high myopia, hemophthalmia, rhegmatogenous retinal detachment, diabetic retinopathy are known.

Aim. To provide the scientific rationale for medical and preventive measures improvement in Lyme disease endemic areas. Methods. Epidemiologic and biostatistical analysis of preventive measures holding in Lyme disease endemic areas was performed. Results. A decrease in mean longstanding prevalence of Lyme borreliosis by 31.5% was observed in the Udmurt Republic since 1999 to 2010. The tick-invaded area has increased by 25%, there was an increase in a borrelia-harboring ticks rate by 34.6%. The number of patients seeking medical aid because of the tick bites has increased by 25.4%, which can be attributed to increased social awareness. 62.5% of patients diagnosed with Lyme borreliosis were over 41 years old, the rate of unemployed patients was 61.1%. High prevalence of Lyme borreliosis in peasants living in highly endemic areas (southern part of the Udmurt Republic) related to low medical aid appealability due to tick bites and therefore untimely medical preventive measures, was registered. The prevalence of erythema migrans-free disease has increased 4.3 times. Among the Lyme borreliosis forms associated with erythema migrans, the 1.6 times increase in multiple erythema prevalence was observed, with increase by 24 times in the areas of high disease prevalence. The most severe disease course was observed in patients over 61 years old with erythema migrans-free disease. A single oral dose of doxycycline should be used for disease prevention in all patients seeking medical aid because of the tick bite. Conclusion. The offered preventive algorithm for Lyme disease allowed to prevent the disease development in 99.7% of all cases, the economical efficacy of doxycycline prophylaxis counted on 1 borrelia-harboring tick bite was estimated as 20 400 rubles.

Aim. Тo study the oral health among the poor citizens and the implementation of the program of preferential prosthetic dentistry in the Republic of Bashkortostan. Methods. The study involved 80 patients with prosthetic dentistry in the past who were asked to complete a survey questionnaire and underwent clinical examination. Statistical processing was performed using Microsoft Excel and Statistica 6.0 software. Results. Secondary partial adentia prevailed in poor, reaching 83.75%, with secondary complete adentia reaching 16.25%. The average age of patients was 63.4 years: female patients - 64.66 years, male patients - 67.25 years. 100% of patients had concomitant somatic diseases, with most of the patients having 2-3 comorbidities. Among concomitant conditions, musculoskeletal diseases were observed in 71% of cases, cardiovascular diseases - in 50% of cases, endocrine diseases - in 35% of cases. 86.25% of patients named financial strait as the main cause of a late visit to a dentist, the remaining 13.75% indicated a lack of time, poor health and unwillingness to care for themselves as the reason. Conclusion. Low-income patients need further support in preferential dentistry and oral health examination.

Aim. To list and review the combined treatment options in patients with locally advanced metastatic renal cell carcinoma with inoperable metastases to retroperitoneal lymph nodes based on the results of diagnosis and treatment of two patients. Methods. Patients underwent primary tumor resection with further immunotherapy in first case and further immunoradiotherapy in second case. Results. The results of locally advanced metastatic renal cell carcinoma successful treatment are presented. Patient U., aged 73 years was admitted to the oncology department with Karnofsky performance-status score of 50-60 points. The diagnosis of right kidney cancer was set up in 2008, but the patient has refused surgery. At the end of 2011 after general status worsening she was hospitalized for planned surgery. Upper and medium midline laparotomy was performed using the general anesthesia. Enlarged right kidney in retroperitoneum and a batch of paraaortic and paracaval metastatic lymph nodes 13-15 cm in diameter were found at revision, right kidney was substituted by tumor tissue with areas of normal kidney parenchyma at the upper kidney pole, the tumor diameter was 10 cm. Renal artery and vein were gradually separated out of lymph nodes batch with a lot of technical difficulties and stitched and tied up. The specimen was removed as a whole together with paranephric tissues. Post-surgical treatment was complicated by an endogenous intoxication. Immunotherapy with intramuscular oxodihydroacridinylacetate sodium 500 mg every 48 hours i/m could only be started in a month after the surgery. Nowadays the patient is alive and continuing the treatment with oxodihydroacridinylacetate sodium, that induced the clinical improvement and reduced the size of the rest of the affected lymph nodes. Patient K. aged 50 years was admitted by ambulance with the same diagnosis as the first patient, and was treated using the same principles with an addition of radiotherapy. The overall patient’s condition improved after the treatment, there was a reduction of low back pain intensity and reduction of paraaortic and paracaval metastatic lymph nodes aggregate on palpation. Conclusion. Primary tumor resection in presence of inoperable metastatic retroperitoneal lymph nodes with further immunotherapy and radiotherapy can lead to clinical improvement and increase of the patient’s life duration.

Aim. To analyze the effect of orthodontic devices in treating malocclusion in rural schoolchildren. Methods. The first group consisted of 25 schoolchildren aged 9-10 years with malocclusions treated with Frankel functional regulator, the second group consisted of 25 schoolchildren of the comparable age treated with function generating bite. Treatment results were assessed after 12 months of treatment in both groups. The treatment success was defined by calculation of the Pont’s and Korkhaus indices of dental arch dimensions. An adaptation to orthodontic devices was controlled monthly. Results. Schoolchildren treated with Frankel functional regulator abandoned treatment in 24% of cases (6 out of 25 cases), while treated with function generating bite - in 8% of cases (2 out of 25 cases). Dental arch expansion was registered in both groups. In patients treated with Frankel functional regulator the dental arch expansion reached 2.4-3 mm (mean value 2.7±0.3 mm), with function generating bite - 2.8-3.2 mm (mean value 3.0±0.2 mm). Conclusion. Function generating bite was the most rational malocclusion treatment in rural schoolchildren, its use was associated with lesser number of dropouts due to discomfort and allowed to achieve better results.

Aim. To study the systemic hemostatic activity of firstly synthesized 2-[3-methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt in vitro and in vivo. Methods. Experiments in vitro using the blood samples form healthy male donors, and in vivo on male rats by intraperitoneal injection of the equimolar concentrations of researched substances. The effect of the firstly synthesized xantine and etamsylate derivative on the platelet functional activity in vitro and in vivo was studied using a platelet aggregation laser analyzer «Biola 230 LA» (Russia). 20 mkg/ml of adenosinediphosphate and 5 mg/ml of collagen (produced by «Technologia-Standart» company, Russia) were used as an aggregation inducers. Aggregation was analyzed using the AGGR software. General aggregation parameters, maximal aggregation value, maximal aggregation speed, average size of platelet aggregates were analyzed. Experimental assessment of specific systemic hemostatic activity in vivo was made in accordance with the parenchymal hemorrhage model on mature male rats. Coagulation time and blood loss volume were registered. Results. 2-[3-Methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt showed a pro-aggregative effect both in vitro and in vivo. 2-[3-Methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt pro-aggregative effect which was observed both in vitro and in vivo increased the systemic hemostatic activity, exceeding the results of the control group and etamsylate group. Conclusion. The findings reveal potentially high systemic hemostatic activity of 2-[3-methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt and confirm the need for further studies of this compound and its equivalents in order to create highly effective selective hemostasis correctors on their basis.

Aim. To study the features of neuroendocrine regulation in cranial injury associated with diabetes mellitus. Methods. Experiments were carried out on 100 male white rats that were divided into the following groups: the first group (n=10) - control group consisted of 10 intact animals, the second group (n=40) - rats with simulated traumatic cranial injury, the third group (n=10) - rats with experimental diabetes mellitus, the fourth group (n=40) - rats with simulated traumatic cranial injury and experimental diabetes mellitus. Experimental diabetes mellitus was induced by a single streptozotocin solution intraperitoneal injection. Animals were withdrawn from the experiment at 3, 24 hours, 5 and 14 days after the traumatic cranial injury. The mathematical analysis of the cardiac rhythm variability was performed by ECG intervals data analysis. Corticosterone serum levels were measured using ELISA. Results. Based on a comprehensive ECG intervals data analysis, it was found that after experimental traumatic cranial injury the imbalance of autonomic nervous system with increased sympathetic autonomic nervous system function occurs, manifesting as a deregulation of cholinergic and adrenergic effects on sinoatrial node. In diabetes, an increase of the role of sympathetic effects on the sinus node functioning also occurred. Revealed autonomic nervous system deregulation after experimental traumatic cranial injury associated with experimental diabetes mellitus were associated with sympathetic autonomic nervous system over-function, parasympathetic autonomic nervous system exhausting and decreased recovery speed. There was a relevant increase in corticosterone serum concentration reaching its maximum 24 hours after traumatic cranial injury. Conclusion. A significant autonomic nervous system sympathetic shift and autonomic regulation intensifying characterizes the clinical course in traumatic cranial injury associated with diabetes mellitus, a positive correlation of corticosterone serum concentration and sympathetic autonomic nervous system over-function was revealed in animals with experimental traumatic cranial injury, particularly when associated with experimental diabetes mellitus.

Aim. To study of individual components of quality of life and the impact of various factors on quality of life in patients with choroidal melanoma after treatments. Methods. 122 patients (80 women, 42 men, mean age 59.89±11.95 years) were questioned. The first group included 48 patients who underwent an organ-sparing procedure (eye enucleation); the second group included 72 patients with choroidal melanoma who underwent an organ-saving procedure (brachytherapy, transpupillary thermotherapy, or combination of both methods). To investigate the quality of life, Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was used. Evaluation was carried out during the first three months after treatment, up to 1 year, 1 to 3 years, as well as 3 years or more after hospital discharge. Results. Quality of life parameters as the evaluation of the total well-being in patients following enucleation, and after brachytherapy, laser treatment and combinations of those at different terms after treatment, were defined. Total quality of life score in patients who underwent an organ-sparing procedure at the late terms after the surgery (more than 3 years) was significantly higher compared to patients who underwent an organ-saving procedure (FACT-G scores 78.79±14.28 and 67.93±13.92), with no significant differences in quality of life at earlier terms. Conclusion. An organ-saving treatment is associated with a significant total quality of life score reduction, and performing enucleation in patients with choroidal melanoma is characterized by significantly higher quality of life levels at long-term follow-up. The decline in the quality of life in patients with choroidal melanoma after enucleation is directly related to the visual acuity of the second eye.

Aim. To examine the systemic and local (corneal) free radical status in rabbits with experimental purulent corneal ulcers. Methods. The study was performed on the male chinchilla rabbits with an average weight of 3500±200 g 10 intact rabbits (10 eyes) served as controls. Staphylococcal purulent corneal ulcer was modeled on 40 animals (40 eyes) as described by N.A. Adamova (1999). The animals were euthanized at 3rd, 7th, 14th, and 21st day of the experiment. The concentration of malondialdehyde, protein-free thiols, as well as superoxide dismutase, glutathione peroxidase and glutathione-S-transferase activity were determined in cornea homogenate and erythrocyte lysate. The obtained data were processed by the one-factorial dispersive analysis (ANOVA), Newman-Keuls test. Results. In all animals the purulent ulcer occurred 12-24 hours after staphylococcus culture introduction. From day 1 to day 3 of the experiment, the clinical picture of a purulent ulcer corresponded to an infiltration stage. From day 3 to day 7 of the experiment, palpebral edema developed, the purulent discharge lasted out, and in some cases even intensified. From day 7 to day 21 of the experiment, corneal infiltration decreased both by area and intensity. In 11,1% scaring corneal opacity formation began. Experimental purulent corneal ulcer development was accompanied by lipid peroxidation activation both in cornea and in erythrocytes, shown by increased malondialdehyde concentration, decreased protein-free thiols level and antioxidant glutathione peroxidase, glutathione-S-transferase and superoxide dismutase enzymes activity. There was a strong direct relationship between the erythrocyte malondialdehyde level and corneal malondialdehyde concentration, and inverse relationship between erythrocyte malondialdehyde level and erythrocyte superoxide dismutase activity. Conclusion. The development of experimental staphylococcal corneal ulcers is accompanied by the development of local and systemic oxidative stress.

Aim. To describe the technique and to assess the results of phacoemulsification in eyes with extensive zonular defects of Zinn ligament fibers. Methods. Phacoemulsification was performed through a 2.2- mm corneal tunnel incision on adhesive viscoelastic bed. The lens was stabilized with a capsular tension ring. The operation was finished with intraocular implantation and its suturing to the iris. The study included 36 patients [42 eyes, 23 males (63.9%), 13 females (36.1%)] in whom phacoemulsification has been performed. Visual acuity before surgery ranged from 0.01 to 0.7 (mean 0.2±0.18). Intraocular pressure ranged from 15 to 25 mm Hg (mean 19.2±4.5 mm Hg). Corneal astigmatism value before surgery ranged from 0 to 2.25 D (mean 0.87±0.63 D). Results. Postoperatively the following complications were observed: an inflammatory reaction in 3 eyes (7.1%), inflammation of Descemet’s membrane in 3 (7.1%) cases, ocular hypertension in 9 (21.4%) eyes. All the complications were drug treated within 3-5 days. On the second day mean visual acuity was assessed as 0.56±0.12,1 month after surgery - 0.70±0.16,6 months after surgery - 0.75±0.21, and 1 year after surgery - 0.74±0.19. Corneal induced astigmatism 1 year after the surgery ranged from 0.0 to 1.5 D (mean 0.39±0.16 D). Conclusion. The presented technology of phacoemulsification is relatively safe, effective and provides a possibility to rehabilitate patients with cataract combined with extensive zonular defects of Zinn ligament fibers in minimal terms.