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The Department of vitreoretinal and laser surgery

450092, Ufa, ul avrory, 14,

Today one of the priorities of the Institute is the development of vitreoretinal and laser surgery. Such emphasis is justified by the steady growth of retinal pathology among persons of able-bodied population. Retinal diseases represent a quite frequent pathology of the organ of vision, leading to serious complications, and as a result to loss of vision. In the Russian Federation diseases of the retina and the optic nerve occupy 5 place in the structure of ophthalmic pathology, at around 6%.
Pathology of the ocular fundus is multifaceted, including not only the defeat of the retina but also the vitreous body. As a result, in the offices of the vitreoretinal and laser surgery appear the whole direction that studies the development, guide the search for new methods of diagnosis and treatment of various diseases. The prospect and the level of the offices of this profile are based not only on the level of qualification of the surgeons and equipment used in the diagnosis and treatment of patients. An important component is the scientific potential of the Department. And if a clinical unit is the tactical basis of the functional activity of the Department, the scientific – strategic, defining the directions of further development of the unit. At the Institute a hierarchical structure based on the principles of symbiotic relationship divisions, including the division of vitreoretinal and laser surgery with clinical structure, the laser Department, which provides outpatient care for patients.


History

Within the historical aspect, it should be noted that the development of vitreoretinal surgery at the Institute began in 2006. when at the initiative and under the leadership of Director, Professor M. M. Bikbov: was created the scientific Department of vitreoretinal and laser surgery of the Ufa research Institute of eye diseases.
To date, the Department of vitreoretinal and laser surgery is one of the largest departments of the Institute. Science division addresses key challengesoptimization of treatment and diagnostic procedures for diseases of the vitreoretinal interface. The priority areas are diseases associated with lesions of the Central section of the retina: age-related macular degeneration, and diabetic occlusive lesions of the foveolar zone. Scientific substantiation of the solution of a problem is based on a logical gradual task, starting with a study of morphological and functional features of the affected area, the development and improvement of diagnostic approaches, suggestions, optimization of surgical treatment nosology.

Office


The Department of vitreoretinal and laser surgery is a highly skilled unit of the Ufa research Institute of eye diseases, which is equipped with the most modern equipment of leading foreign firms (operating microscopes, microsurgical systems, lasers), which allows to carry out surgery on a very high level. As part of the Department there are 8 professionals whose mission is to provide professional specialized eye care to patients.

The specialists possess the entire spectrum of surgical interventions on vitreous body and retina. Currently, the Department of vitreoretinal and laser surgery has eight employees. The specialists were trained in vitreoretinal surgery in the leading foreign clinics, in addition, they annually go reports at scientific-practical conferences, congresses, congresses in Russia and abroad.

The main focus of the Department of vitreoretinal and laser surgery is necessary to surgical and scientific activities. And if surgical removal of the cataract by phacoemulsification is considered the "pearl" of the eye surgery, and glaucoma surgery is sometimesthe routine operation, the crown of surgical skill is undoubtedly vitreoretinal surgery.

The versatility of the operational activities of the branch will determine scientific and practical areas of work, participation in international multicenter trials. To date, the Department of vitreoretinal and laser surgery holds a leading position in Russia to assist patients in carrying out antimonopolization intravitreal therapy. Annually the Department staff carries out more than 2,000 surgical interventions with the use of blockers of angiogenesis. Similar high surgical activity is provided by the electronic document, developed by the Department staff.

 

                                                   Scientific activities


The Department staff conducts scientific research to develop methods for rapid treatment and diagnosis, thereby increasing the efficiency of treatment of patients with pathology of the retina, vitreous, eye injuries and their consequences. The development office, including drugs and their dosage forms, methods of surgical treatment of patients with pathology of the vitreous and retina, ophthalmic surgical instruments, confirmed by patents of the Russian Federation. Given the severity of the pathology encountered surgeons, often there is a need for combined surgical treatment, including a combined pathology and anterior segment of the eye. This fact determines the necessity of development of new methods of cataract surgery when damage to the ligamentsof the crystalline lens.

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The complexity of the pathology of the vitreous body and the retina, the different surgical methods of treatment defined the main scientific direction of the staff of the Department of vitreoretinal and laser surgery:
- optimization of surgical treatment of the Central region of the retina based on morphological features of the development of macular pathology in patients with age-related macular degeneration.
- the system of complex rehabilitation of patients in the development of macular edema on the background of venous occlusion of the retina.
- systematic approach of diagnostics and therapy of pathology of the macular area of the retina on the background of diabetic retinopathy.
the rationale for intravitreal pharmacotherapy in the differential approach to the diagnosis of retinal pathology in patients with vascular disorders on the basis of correlation analysis of morphological and functional changes.
- comprehensive assessment of the parameters of the macular zone in the choice of tactics of surgical treatment of patients with vitreomacular traction syndrome of different Genesis.
To this end, a study of various surgical techniques in the treatment ofthe macular zone on the background of age-related macular degeneration, diabetic and venous occlusive diseases.

Monographs


Bikbov M. M., Faizrakhmanov R. R., Yarmuhamedova A. L. Age-related macular degeneration.- Moscow: April, 2013.- 196: Il.

The monograph is devoted to questions of pathogenesis, diagnostics and treatment of age-related macular degeneration. Described in detail the modern concept of disease, are considered major risk factors, are collected the latest information about the methods, diagnostics of morphological and functional features of the disease, and also presents various methods of treatment of the wet form of age-related macular degeneration.

Bikbov M. M., Surkova V. K., Serezhin I. N., Altynbaev U. R.
Vitreoretinal surgery in diseases and injuries of the eye.- Ufa, GU "Ufa research Institute of eye diseases" an RB, GUP RB "Ufa polygraphic plant", 2008.- 182 p., Fig.


This book introduces the ophthalmologists with the latest developments in reconstructive surgery of the vitreous and retina. The monograph presents own experience of the sparing vitreoretinal surgery for rhegmatogenous retinal detachment, proliferative diabetic retinopathy, eye injuries and their consequences. Considered the theoretical and practical experience of many foreign and domestic scientists on the described problem.

Annually the Department staff produces more than100 publications in leading international and Russian magazines , methodological recommendations, monographs. With the aim of improving the professional skills of ophthalmologists and other regions by employees of the Department of vitreoretinal and laser surgery is conducted on the job training, certification cycles for retinal pathology and vitreous.
The annual and direct participation of employees in conferences, forums, congresses in Russia and foreign countries demonstrate the high scientific potential of the Department. Main scientific achievements of the employees reported and discussed at scientific-practical conference with international participation "Modern technologies in cataract and refractive surgery-2011" (Moscow, 2011); scientific - practical conference "Modern technologies in vitreoretinal pathology treatment" (Moscow, 2012, 2013, 2014); scientific - practical conference on ophthalmology with international participation "East-West" (Ufa, 2012, 2013, 2014); XXI all-Russian scientific – practical conference with international participation "New technologies of eye microsurgery" (Orenburg, 2012); conference of ophthalmologists "New methods of treatment of pathology of the macular region" (Surgut, 2012); ophthalmology Congress with international participation, dedicated to the 80th anniversary of the Kazakh research Institute of eye diseases "Innovative technologies in daily ophthalmic practice" (Almaty, Kazakhstan, 2013); the scientific-practical conference "Possibilities of high-tech care for patients with severe vitreoretinal pathology in the conditions of a multiprofile hospital" (Moscow, 2013); XXX Congress of the ESCRS | European Society of Cataract & Refractive Surgeons (Milan, Italy, 2012); XXXI Congress of the ESCRS | European Society of Cataract & Refractive Surgeons (Amsterdam, Holland, 2013); EURETINA | European Society of Retina Specialists (Hamburg, Germany, 2013); EURETINA | European Society of Retina Specialists (London, England, 2014), XXXII Congress of the ESCRS | European Society of Cataract & Refractive Surgeons (London, England, 2014).

Surgical operation

Vitreoretinal interventionthe present stage involves the removal of the vitreous (vitrectomy), mobilization of the retina by freeing it from scar tissue by using various auxiliary tools (collet tweezers, scissors, retinopathies), short-term and / or long-term tamponade of the retina liquid performancesee compounds, silicone oils, gases, and performing laser coagulation.

Specialists of the Department are performed vitreoretinal intervention with opacities of the vitreous body, diabetic retinopathy, proliferative vitreoretinopathy, Central retinal tears, complicated with rhegmatogenous and tractional detachments of the retina of various origins. The duration of surgery depends on the severity of the disease and, consequently, the volume of treatment and an average of 15 to 30 minutes. High speed of carrying out the most complex operations in ophthalmology is determined by high qualification of the surgeons and availability of modern equipment. The operation is performed under the supervision of experienced anaesthetists under local anesthesia or General anesthesia.

Multifunctional oftalmologicheskiy system Мillennium

Multifunctional oftalmologicheskiy the Stellaris PC system Мillennium

Multifunctional oftalmologicheskiy system Constellation Vision System

Today in the Department of vitreoretinal and laser surgery is performed entire spectrum of vitreoretinal interventions. Unlike similar structural units of ophthalmic surgeons profile between the missing demarcation on the types of surgery that allows each employee to acquire all thethe types of surgery. However, priority emphasis on the choice of the surgical nosology puts the surgeon himself. The most extensive priority groups of surgical treatment of vitreoretinal pathology profile include macular surgery, diabetic loss of the eyeball, retinal detachment of various Genesis. Overall, the Department is no commonality in the surgical approach to pathology of the retina and vitreous cavity, allowing such interventions as:

· Vitreoretinal surgery of retinal detachment.
· Vitreoretinal surgery of proliferative diabetic retinopathy.
· Endoscopic vitrectomy.
· Seamless microinvasive vitreoretinal surgery (25G, 27G).
· Cataract extraction techniques of phacoemulsification, lensectomy, aspiration with implantation of various IOL designs.
· Removal of foreign bodies of any location, regardless of their magnetic properties.
· Reconstructive surgery for trauma.
· Intravitreal injection of drugs.
· Macular surgery.

Feature of the surgical profile is the ability to carry out surgical treatment not only the pathology of the vitreoretinal interface, but also cataracts, which is often concomitant pathology. The Department performs surgery for complicated cataract on the background of injuries, threats of luxatio in the vitreal cavity. The possibility of such events requires the need to use high-tech equipment on the basis of a combination of operational activities of the front and rear segments of the eye.

Based on the General trend of development of modern ophthalmology, Department of vitreoretinal and laser surgery to minimize the treatment time for patients by high functional parameters in the postoperative period. Similar to the development of the surgical care patients requiring vitreoretinal intervention became possible thanks to high qualification of staff and use of modern ophthalmic technology. Armed with the staff of the division at the momentare multifunctional oftalmologicheskiy system Мillennium, Accurus, Stellaris PC, the Constellation Vision System based on high-tech combination of platform.

The close relationship of scientific and practical activities of the Department allows for unique operations, such as:
combined surgical treatment fibrovascular membrane low degree of activity in patients with age-related macular degeneration extraction method of fibrous tissue with partial restoration of the retinal pigment epithelium;
- the use of techniques for surgical treatment of a hidden neovascular membranes on the basis of the impact on supplmental zone liceja and choroidal neovascularization;
- tech intravenoso the introduction of drugs with application of endovitriol access venous occlusion of the retina.


   

Diagnostic measures

The Institute has all the necessary modern tools for the diagnosis of pathology of retina and vitreous, such as; optical coherence tomography (study of the state of the retina, especially the macula, and optic nerve), fluorescein angiography in the absence of contraindications on the part of other organs and systems using digital nemidreatic fundus camera (Visucam 500), morphometric assessment of the macular region using the developed software, investigation of visual fields, ultrasound. The use of optical coherence tomography is a new generation OST RetianScan— 3000 (Nidek) allows to significantly expandthe study Protocol and to increase the accuracy assessment of fundus structures through layer-by-layer volumetric studies of the internal structure of the retina. In this regard, the possibilities OST RetianScan are widely used in diagnosis and monitoring, especially of the pathology of the macular region of the retina and optic nerve, allowing us to obtain quantitative measurements of the thickness of the tissue.


Ophthalmoscopy

Ophthalmoscopy is the primary mandatory method of research in the pathology of the ocular fundus. Most relevant are methods with the use of highly aspherical diopter lenses 60, 78 and 90 diopters and different contact lenses, for example, three-mirror lens Goldman. Ophthalmoscopy reflects all the processes on the retina, and defines the relationship with the functional data.

It should be noted that changes in the retina do not always visualize the pathology of the outer layers of the retina. This is due to the fact that the technique is aimed at rendering only the surface of the retina in two-dimensional space.


For a better understanding of the principles of ophthalmoscopy is necessary to divide the Central area of the retina in several areas:
· foveola – zone of maximum accumulation of photoreceptor cells with a recess 300 µm whose main function is the Central vision;
· macula – radial area with a diameter of 1.5 mm;· paramacular area is the area located around the fovea, with a diameter of 2.5 – 3.0 mm;
· perimacular area almost reaches the inner arcades with a diameter of 6 mm.



Optical coherence tomography

One of the main tasks of any branch of medicine is the formulation of a correct, precise and, most importantly, timely diagnosis. In order to efficiently cope with this taskexperts are constantly improving their technology. The latest achievements of the late XX century in physics and the further development of computer technology has led to the creation of the method of optical coherence tomography (OCT or NOV – the abbreviation of the English. optical coherence tomography) without which it is difficult to imagine modern ophthalmology. The principle of operation optical coherence tomography is based on the use of optical radiation of near infrared wavelengths, i.e. a laser beam of low intensity.

In the division of vitreoretinal and laser surgery using optical coherence tomography, a new generation of OCT RetinaScan – 3000 (NIDEK) to significantly expand the study Protocol and to increase the accuracy assessment of fundus structures. OCT RetinaScan – 3000 can receive about 53 thousand linear scans in 1 second. Thus the resolution of the technique reaches 4 µm (1 µm = 0.001 mm).

OCT RetinaScan allows you to explore the layers surround the internal structure of the retina and to obtain unique information about the anatomy of the examined retinal structure. In this regard, the possibility of OCT RetinaScan is widely used in the diagnosis and monitoring of primarily pathology of the macular region of the retina and optic nerve. Oct is a digital method and allows to quantify the thickness of the tissue.


Due to the high scanning speed and high-resolution images of OCT RetinaScan – 3000 allows you to more clearly diagnose subtle changes in the structure of the retina and to detect pathology at the earliest stage of its development. Such a high spatial resolution of OCT providesthe ability to study tissue at the cellular level, objectively evaluate the slightest changes in the optical architecture of tissue structures and effectively monitor the status of the tissue studied in the dynamics.

Main technical specifications of OCT RetinaScan – 3000 (NIDEK):
· A method of obtaining images: optical coherence tomography
· The method of imaging of the fundus: scanning laser ophthalmoscopy
· Wavelength: 880 nm
· Scan speed: 53000 A-scans/sec
· The number of individual layers: 6
· Image of the fundus: SLO 785нм, 40°x30°
· The time of receipt of images 1.6 sec
· Field of view: 40°x30°
· Minimum pupil diameter: 2.5 mm
· Size: 380*524*515 mm

      
Fluorescein angiography

Angiography of the retinal vessels before introduction into ophthalmic practice optical coherence tomography is the "gold standard" diagnosis of pathology of the retina. Currently used in difficult cases, at impossibility of visualization of the vascular pathology of an eye bottom.

Currently, the study uses two types of angiographic systems:

· digital fundus camera with halogen light source, xenon flash (1 image per second) with the exciting (465-490 nm blue-green spectrum) light filter, absorbing (520-530 nm green-yellow filter) filter for the angiography with fluorescein and an infrared barrier filter for indocyanine green angiography;
· scanning laser Ophthalmoscope that allows high-speed shooting (12-30 images insecond). As a light source uses a monochromatic laser. Also, PSS can be equipped with systems for the multifocal ERG, microperimetry, determining the point of fixation;

Scanning laser Ophthalmoscope can be used in the following modes:
· fluorescent angiography - 488 nm;
· angiography using indocin green – 790 nm;
· beskrajno reflection of 488 nm;
· infrared reflection – 820 nm.

In the division of vitreoretinal and laser surgery is used nemidreatic digital fundus camera for fundus photography (VISUCAM 500) and angiography fundus fluorescein and indocyanine, including through a narrow pupil. For visualization of the fundus system is used observations in infrared light. The fundus camera provides images of the fundus without pupil dilation, with its diameter of 3.3 mm. the Camera is additionally equipped with features for determining the density of macular pigment and registration of autofluorescence.

New functionality of the fundus camera VISUCAM 500 – determination of the density of macular pigment.
Macular pigment is a protector against damage to the retinal cells in the dry form of age-related macular degeneration.
In the modern world in developed economies there is a trend of increasing life expectancy and increasing number of older people in the population. In this regard, the increasing relevance and importance is the development of innovative technologies of diagnostics and treatment of diseases of the elderly, and medical information support this population.
Model fundus camera VISUCAM 500 series is equipped with a module for determining the density of macular pigment. This module allows you to evaluate the level of protection of retinal cells from the pathogenic factors leading to the development of age-related macular degeneration (AMD). The module also allows to represent in a three dimensional distribution of macular pigment in the Central area of the retina and evaluate changes in the dynamics of its density.

The facts of lifeoffice

The staff of the Department actively participate in scientific competitions. Work "Intraoperative protection of the corneal endothelium" became the winner of competition "the Best innovative project of the Republic of Bashkortostan - 2011" and the work "a New method of intravitreal access" took first place in the competition U. M. N. And.To. – 2012.

 
In 2015. An innovative project of scientists of the Ufa research Institute of eye diseases "Drainage for lacrimalis surgery" was published in the final Federal competition Startup Village-2015 and was awarded a grant from the SKOLKOVO Foundation, which emphasizes the recognition of scientific achievements in the international scientific arena.

Since July 2012 Institute on behalf of the pharmaceutical company "Novartis Pharma AG" (Basel, Switzerland), along with 12 krupneishie clinics in Europe and the United States, participates in multicentrum international study "LUMINOUS". The study aimed at studying the effectiveness of the ranibizumab for edema of the macular zone with different types of retinal pathology, and its result will be the definition of new directions and indications for treatment of diseases of the vitreomacular interface.
In accordance with the Protocol, all patients undergo a planned study with the use of the results in the international registry. For the entire period of project implementation the study surveyed more than 400 patients in different countries, 20% of which were registered in our Institute.
According to the international system Protocol "LUMINOUS", the Institute ranks 11th in the world according to the activity of research.
Research and development based on global trends in modern ophthalmology. Recognition of vitreoretinal surgeons confirmed the close interaction with foreign schools in vitreoretinal surgery. Every two years at the Institute together with the University of Mannheim Heidelberg (Germany), organizes international training courses on vitreoretinal surgery, age-related macular degeneration and ophthalmic manifestations diabetes with the participation of leading experts in the diagnosis andtreatment of retinal pathology. Close cooperation in training programs for ophthalmologists of Russia held jointly with Professor Ingrid Kreissig.








Major developments

Diagnostic software of fundus pathology

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In the division of vitreoretinal surgery created a program to calculate the parameters of eye fundus structures (Diagnostic software of fundus pathology No. 2012612047). The main feature of such software is the ability to reflect the dynamics of the process that allows us to estimate not only the likely prognosis of the disease with the results of objective evaluation, but the quality of medical care at any stage.

It does not require any additional hardware with high-tech morphometric features.

A method for modeling age-related macular degeneration in the experiment

The basis of the mechanism of formation of age-related macular degeneration are the main factors: lesion of the retinal pigment epithelium, Bruch's membrane and choroidal. The developed method is based on intraoperative damage foveolar zone is directed to cellular degradation of the retinal pigment epithelium, which determines the running processes of neovascularization and the development of neovascular membranes.

The way of modeling of experimental diabetic macular edema

The technical result when using the invention – the formation of diabetic macular edema for the assessment of pathological processes in the retina and the development of new methods of its treatment. The result of this model is the development of edema, aimed at a classic way. On histological level in the area of the photoreceptor layer of the cavity formed in the form of cysts, drusen. In 34% of them are United into one conglomerate, manifested by local retinal detachment. Changes in the neurosensory layer of the epithelium typical of diabetic macular edema. When using this model, CCT is not identified from the vitreous body, is what characterizes this diabetic edema as primary.

Conductor intravitreal injections

Whencertain eye diseases, intravitreal (TRS) of medicines is a specific method of treatment. These conditions include age-related macular degeneration of the retina, diabetic macular edema, macular lesions in the retinal vein thrombosis.


Conductor intravitreal injections are for the convenience of intravitreal injection of drugs, provides accurate positioning, the optimal direction and depth of intravitreal injections by fixing the eyelids and the eyeball without the use of additional surgical instruments. The use of the conductor reduces the time intravitreal injection of the drug.