90, Pushkin str, Ufa, 450008
Microsurgery Department №2
Phone: +7 (347) 286-53-03
Microsurgery Department №2 is one of the oldest in the Institute. Department of cataract and glaucoma was established in 1932 as the result of conversion of adults offices existed in the 1930s . The doctors of the department were the first who performed the implantation of Fyodorov-Zakharov intraocular lenses (1979).
Currently, the Microsurgery Department №2 is one of the largest clinical departments of the Institute (with 60 beds). The Department employs 4 doctors, all of them are candidates of medical Sciences.
The main activity of the Department – surgical treatment of patients with cataract and glaucoma. Annually the Department receives for about 5000 patients, performs more than 4,500 operation of various degrees of complexity. Operating rooms are equipped with modern devices of domestic and foreign firms, it is allow to perform any kind of high-tech operations.
There are 2 phacoemulsifiers "Legacy" (ALCON, USA), Carl Zeiss microscopes OPMI Lumera T (Germany) in the operation room. Cataract extraction performed by the method of ultrasonic seamless phacoemulsification (FEC) with implantation of foldable artificial lens, including multifocal, multifocal-toric, toric, extra firm RAYNER (UK), enVista (Bausch&Lomb), etc.
Cataract is accompanied by astigmatism in 35% of cases. It is known that in patients with uncorrected visual astigmatism getting worse vision quality: broken color sense ability, appear glare (Buzard K. A., Shearing S. P., 1991). The use of toric IOL allows you to get precise surgical results in patients with astigmatism of high degree and to achieve the best possible visual acuity.
The Department use all of pathogenetically oriented modern methods of surgical interventions for glaucoma, such as: deep sclerectomy, iridocycloretraction, non-penetrating deep sclerectomy combined surgery in glaucoma and cataract etc.
On the basis of the Microsurgery Department №2 patients were treated with the most severe forms of secondary, so-called refractory glaucoma. The term "refractory glaucoma" unites these kinds of glaucoma, in which conventional medical and surgical treatment does not lead to compensation of intraocular pressure. A special place in the surgery of refractory glaucoma is occupied by surgical interventions, during which artificial drains and implants are used to improve the outflow of aqueous humor, the purpose of which is the long-term preservation of the newly formed outflow of intraocular fluid. Currently, more than 20 types of these devices are described, however, only a few of them are most widely used.
In our arsenal there are the following drainage devices to improve the outflow of intraocular fluid: Ahmed valve (material - silicone), the shunt Ex-Press (stainless steel), modification of drainage "Repegel" (material-polyoxypropylene), "Glowtex" (composition of polylactic acid and polyethylene glycol), ksenoplast (collagen).
The Ahmed valve the most common drainage device used in the surgery of refractory glaucoma for today, it was developed in 1993 and consisting of a tube connected with silicone valve, enclosed in polypropylene shell. The technology of the device allows through the valve to prevent excessive filtration of the aqeous in the early postoperative period and significantly reduce the frequency of such complications as syndrome of shallow anterior chamber.
Ex-Press exists on the global ophthalmic market for over 10 years. The principle of action – reduction of intraocular pressure by the discharge of intraocular fluid from the anterior chamber to subscleral space. At the moment 100 thousand devices were implanted by this method in the world.
Ex-Press device is made of medical stainless steel. This is the same steel which is used for the manufacture of stents. Ex-Press with its miniature size has a rather complicated structure, each element plays a role.
It is important to note that during the Ex-Press implantation no tissue is excised. Due to less trauma to the eye tissues - less pronounced inflammatory response, wound healing and postoperative recovery is faster, which means this type of glaucoma surgery can be considered minimally invasive and gentle.
The technique of implantation of the shunt Ex-Press "step by step":
Russia has developed a bioresorbable “Glowtex”drainag together with the HiBiTech company and Russian chemical–technological University named after D. I. Mendeleev. This drainage is a composite biomaterial based on polylactide, made in a rectangular shape in the form of colarette with sizes of 2.5^5,5^0.15 mm, pores diameter of 30-50 microns. Drainage is designed to prevent the formation of sclero–сonjunctival, sclero–scleral adhesions and scarring from the edge of the scleral flap. Biologically inert and safe to the eye tissues, undergoes gradual biodegradation within 6 months, does not cause allergic reactions.
Recently the practice introduced a new procedure called "Canaloplasty". In the process of carrying out this procedure, first the doctor makes a microscopic hole in the eye. Through it the Glaucolight microcatheter (DORC, the Netherlands), which has an outer diameter of 150 μm and a blunt atraumatic tip, is introduced into the system of drainage canals of the eye. Then, the microcatheter is removed, and a special thread is introduced into the canal, with the help of which it expands, and thus the congestion of the intraocular fluid is eliminated. With the help of canaloplasty, the drainage system of the eye is restored, as a result of which the intraocular pressure decreases and becomes normal. Canaloplasty with microcatheter is used in the treatment of open-angle glaucoma.
Drainage collagen antiglaucomatous KSENOPLAST
Ksenoplast is designed for placement in a scleral bed under antiglaumatous operations. The drainage is made in the form of narrow strips, has a porous structure, elastic, shapes and sizes can be designed depending on the extent of the surgery. Biologically compatible with eye tissues, is not absorbed, does not cause allergic reactions.
Explantodrenage "Repegel", the joint development of NPP REPER-NN, Nizhny Novgorod and Cheboksary branch of FGU MNTK "Eye Microsurgery".
Varieties of drainage", Repegel"
Drainage "Rapahel": due to its mesh structure it allows intraocular fluid to move freely from the filter zone to vessels of the conjunctiva, choroid, due to the biochemical structure of drainage "Repegel" is not cluttered coarse connective tissue capsule, which leads to a decrease, and sometimes eliminate the main goal of surgical treatment - anti-hypertensive effect.
Cyclodestructive techniques are usually used in cases where surgical treatment is contraindicated or has already been performed without effect, if the conjunctival scars from previously performed antiglaucoma operations make filtering interventions more difficult. In addition, they can be performed in patients with advanced glaucoma with such a narrow field of view that intraocular surgery presents an unjustified risk.
We perform two types of Cyclodestructive operations in our Department :
– indirect – without opening the eyeball, when cryotherapy is transconjunctival;
– direct, sections of the ciliary area are outcroped and the direct impact of cold on the area, responsible for the production of intraocular fluid