II Microsurgical Department


90, Pushkin Street, Ufa, 450008
II Microsurgical Department 
Phone number +7 (347) 272-11-17

Currently the 2nd microsurgical department is one of the largest clinical departments of the Institute designed for 60 beds. There are 4 doctors and all of them are PhDs in medical sciences. 


   
Cataract in 35% is accompanied by astigmatism. It is known that patients with uncorrected astigmatism have a lower vision. The use of toric IOL allows obtaining precise surgical results in patients with a high degree of astigmatism and achieving the best possible visual acuity.
Patient L. 1 month after surgery
Patient S. 1 month after surgery
Patient U., 22 years. Congenital cataract, innate corneal astigmatism, low degree amblyopia.
Vis 0,2 uncorr.

Patient U., 1 month after surgery. Distance vision 0,6 uncorr., near vision 0,7.
Secondary closed-angle glaucoma, incomplete complicated cataract. IOP 36 mm Hg
 
 
 IOP after the surgery 17 mm Hg  without antihypertensive drugs
  
Doctors of II microsurgical department treat patients with the most severe forms of secondary, so-called refractory glaucoma. The term "refractory glaucoma" combines varieties of glaucoma in which the traditional medical and surgical treatment does not lead to compensation of intraocular pressure. A special place in refractory glaucoma surgery take operations for improvement of the outflow of aqueous humor with the use of drainage and artificial implants.The purpose is long-term preservation of the newly formed outflow tract of aqueous humour. Currently there are more than 20 types of these devices, however, only a few of them are widely used.
We have the following drainage devices for improvement of aqueous humour outflow: 

  • Ahmed glaucoma valve (silicone), 
  • the Ex-Press shunt (medical steel), 
  • modification of drainage "Repegel" (polyoxypropylene), 
  • "Glautex" (composition of polylactic acid and polyethylene glycol ) 
  • xenoplast (collagen)
  •  
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 Ex-press shunt Ahmed valveXenoplast
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modifications of
 drainage Repegel  
 "Glautex" drainage
 “Glaucolight” system

                 
Patient S., 72 y.o. Ahmed valve in the eye with IOL, early operated glaucoma and complicated cataract,IOP on  discharge 16 mm Hg

Patient V., 65 y.o. Ahmed valve in the eye with IOL. IOP on discharge 12 mm Hg


  

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Patient K., 68 y.o. OCT  with Ahmed valve

Patient G., 70 y.o. Increase of  anterior chamber angle by 10 °, deepening of  anterior chamber by 1 mm after phaco with IOL implantation in the eye with a previously implanted Ahmed valve

 Ex-Press device is made of medical stainless steel. This is the same type of steel which is used for cardiac stents manufacturing. Despite its tiny size Ex-Press has a quite complex structure.
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Рисунок21.jpgРисунок19.jpgРисунок23.jpg
Рисунок17.jpg    Рисунок4.jpg


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глауколайт 2.jpgглауколайт 3.jpgглауколайт 4.jpgглауколайт 5.jpg

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rectangle
trapeze triangle

Cyclodestructive techniques are generally used in cases where surgery is contraindicated or has been carried out without effect; if the conjunctiva scarring of previously performed surgeries complicates the filtering glaucoma surgery. Besides, they can be carried out in patients with advanced glaucoma, if the narrow field of view is unnecessary risk for intraocular surgery.

 

The illustration shows the scheme of implantation of drainage "Repegel" 
in filtration zone during antiglaucomatous operation.

- Direct, when  ciliary body areas responsible for production of intraocular fluid are exposed to cold. 

The 2nd microsurgical department is one of the oldest in the Institute. Cataract and glaucoma department was established in 1932 as a result of reprofiling of the adult’s department in 1930s.  Doctors of department were the first in the Institute who performed intraocular  lens of Fedorov-Zakharov (1979)

The main work area is surgical treatment of patients with cataract and glaucoma. Every year more than 5 000 patients receive treatment here and over 4 500 surgeries of various complexity are performed. 

In the operating rooms there are 2 phaco machines «Legacy» (ALCON, USA), microscopes  Carl Zeiss OPMI Lumera T (Germany). Cataract surgery is performed by seamless ultrasound phacoemulsification with implantation of IOLs including multifocal, toric multifocal- toric, additional manufactured by RAYNER (United Kingdom), enVista (Bausch & Lomb), and others.

The latest achievement in intraocular lens improving  is to create a  multifocal toric IOLs, allowing to do without glasses for far as well as near vision and also to correct astigmatism.


The department implemented all modern pathogenetically oriented methods of surgery for glaucoma, such as sinus trabeculectomy, deep sclerectomy, iridocycloretraction, penetrating deep sclerectomy, combined operations for  glaucoma and cataracts, etc.

Nowadays perhaps the most common drainage device used in refractory glaucoma surgery is Ahmed glaucoma valve developed in 1993. It consists of tubes connected to the silicone valve enclosed in a polypropylene body-tank. The technology allows prevention of excessive filtering of aqueous humour via a valve in the early postoperative period and significant reduction of such complications as shallow anterior chamber syndrome.  

Ex-Press has been at world ophthalmic market for more than 10 years. It works for reduction of IOP by removing aqueous humour from anterior chamber to subscleral area. Currently for about 100 thousand devices has been implanted worldwide. 

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 While implanting Ex-press no tissue extraction is perfomed. Due to fewer traumas, less pronounced inflammatory response is achieved, healing and postoperative recovery goes faster, and therefore this type of glaucoma surgery may be considered as minimally invasive and preserving.

Ex-Press implantation technology «step by step": 

Russia has developed a bioresorbable drainage "Glautex" together with company Ltd. Haybitek and the Russian Chemical-Technological University n.a. D.I. Mendeleev. This drainage is a composite biomaterial based on polylactide, formed in a rectangular shape in a sleeve of a given size 2.5 * 5.5 * 0.15 mm, pore diameter 30-50 microns. It is intended to prevent the formation of drainage-conjunctival sclera, sclera, scleral adhesions and scarring on the edge of the scleral flap. Biologically inert and harmless to the eye tissue, undergoes gradual biodegradation for 6 months, does not cause allergic reactions.

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Recently such surgery as canaloplasty is introduced into practice.During this procedure the doctor makes a microscopic incision. Through the incision a microcatheter Glaucolight with an outer diameter of 150 microns and a blunt atraumatic tip (DORC, Netherlands) is introduced into drainage channels. Then, a microcatheter is removed and a special thread  is inserted, thus congestion of intraocular fluid is eliminated. Canaloplasty helps recovering drainage system of the eyes as intraocular pressure is reduced and becomes normal. Canaloplasty  is used to treat forms of open-angle glaucoma.

Surgery technique: 

Collagen Antiglaucomatous Drainage XENOPLAST

 Xenoplast is designed for being placed in the scleral bed in glaucoma surgeries. Drainage ihas a form of a narrow strip, it is porous, resilient, shapes and sizes may vary depending on the amount of surgery. Biologically compatible with eye tissues it is not resorbed and does not cause any allergic reactions.

Explant drainage “Repegel”

 This drainage is a joint development  of SPE “Reper-NN”, Nizhny Novgorod and Cheboksary Branch of FSBI «Interbranch scientific and technical complex «Eye microsurgery» n. a. acad. S.N. Fedorov» 

Types of drainage «Repegel»

Drainage "Repegel" due to its net structure allows the intraocular fluid to move freely from the filtration area to the vessels of the conjunctiva and choroid. ” Besides, it does not overgrow with rough capsule of connective tissue (capsule formed with time during the normal tubeless glaucoma surgery leads to decrease and sometimes to cancel the main goal of surgical treatment - the antihypertensive effect).

 Our department conducts cyclodestructive operations of two types:

- Indirect - without opening the eyeball;