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Retinal detachment or break are complex pathologies that can be eliminated only by surgery. The operations are complex, high-tech. Last Friday, on the basis of the eye microsurgery clinic of the StSMU (Stavropol State Medical University), a vitreoretinal surgeon’s school was held with a demonstration master class, which was attended by specialists in this field of medicine from Moscow, Samara and the North Caucasus.
StSMU is the core of the North Caucasus Medical Cluster. Stavropol became the first city where a visiting meeting of the School of Vitreoretinal Surgeon took place. A workshop of this format with “live surgery” was held on the basis of the StSMU eye microsurgery clinic thanks to the active support of the rector of the university, Professor Vladimir Koshel, and the Foundation for Research and Treatment of Retinal Diseases (Moscow).
Many patients are not yet familiar with the term “vitreoretinal surgery” and similar names for specialized hospital departments. This area, by the way, the most difficult in ophthalmic surgery, has begun to develop in recent years. Therefore, as the organizer of the school, Tatiana Avanesova, told us, a fund was specially established to train vitreoretinal surgeons, improve their qualifications, promote this high-tech treatment with demonstration master classes. The leading surgeons of the country in this area were invited to share their experience — Dmitry Shkvorchenko, deputy chief physician of S. Fedorov MNTK (National Medical Research Center) (Moscow), Denis Petrachkov, head of the department of vitreoretinal surgery at the regional ophthalmological hospital (Samara).
“The need for this school is huge,” says Salautdin Gadjiev, director of the eye microsurgery clinic of the StSMU.” Previously, little was done on the problems of retinal pathologies because there was no appropriate diagnostic equipment. Now, when medical technology is being updated, there are optical coherence tomographs, which allow to carry out layer-by-layer examination of eye tissue and diagnostics of diseases, modern approaches are also used in treatment. Classes in such a school are an opportunity for doctors to share the “secrets” of surgical techniques, their own clinical experience with an analysis of specific cases of patient management. Ultimately — to improve the method of treatment. The retina is a very thin nerve tissue. On average, its thickness is 0.4 mm, it consists of 11 layers, and each performs its own function. With their edema, some kind of injury, inflammation of the vascular layer, a detachment or tear of the retina may occur. If treatment is not started on time, a person may lose their eyesight. At school, doctors discuss the pros and cons of existing technologies. There is a lively discussion.”
The discussion of the practical aspects of medical practice aroused great interest among the school members. So the time planned for this was not even enough. The practical part had to be postponed for two hours. And the author of these lines had to patiently wait for the start of the master class (I really wanted to see what surgery is in the range of tenths of a micron).
During the break we asked the doctors to share their impressions.
Emma Khadikova, head of the ophthalmology department of the Beslan multidisciplinary medical center in North Ossetia, for example, said that their department is just starting to perform such operations on the retina, so she was interested in everything.
“At regular conferences, the nuances in the work that surgeons face in their practice are not discussed,” says E. Khadikova. “And here is a lively discussion. Different techniques for the same disease. There are no small things here. Even the indications for the operation are important — in which cases it is necessary to operate, and in which — to abstain. Now we are sending patients to Krasnodar and Moscow. Soon we will perform such operations at our clinic. This is the top class of vitreoretinal surgery. The operations are complex. These are fractions of microns when the retinal
layer is pinched off and removed. Almost at the cellular level. Previously, we did not identify these pathologies, did not know what they were associated with. It was believed that the problem is age-related — a person begins to see poorly, but what is the reason was unknown. Now that we have good optics, we can make a specific diagnosis.”
Colleagues from Dagestan, despite the available practical experience in this area, had a lot to learn from recognized authorities in the field of vitreoretinal surgery. Doctor Aligaji Abdulaev, for instance, was interested in whether it is possible to operate on patients in the late stages of retinal pathology, the subtleties of the operation for macular ruptures. For myself, for the first time, I learned that the retina can be… filled. If earlier an internal limiting membrane was used for this, now the retinal defect is closed with platelet concentrate, the patients’ own blood. And this technique helps to reliably “glue” the gap, as well as to avoid postoperative complications.
School participants had a unique opportunity to observe the most complex retinal surgeries in real time. And the patients — residents of the Stavropol Territory — receive high-tech assistance from the country’s leading ophthalmic surgeons. One of them, for example, had had a cataract operation. A few months ago the man noticed: vision began to deteriorate. When examined, they found a detachment with a rupture of the macular (central) area of the retina. Last Friday, he underwent surgery at the eye microsurgery clinic. And the surgeon was not just anyone, but a recognized authority on vitreoretinal surgery, Dmitry Olegovich Shkvorchenko. The author of these lines had a chance to see a demonstration master class of “live surgery”.
From the camera of the operating microscope, the operation was broadcast on the monitor. In parallel, the doctor gave his comments, as the stages were completed, and explained the subtleties.
I suddenly saw how the eye tissue of the operated patient coloured… blue. It was the doctor showing other doctors the original method of layer-by-layer staining of the membrane and removal of fibrous tissue. Then Dmitry Olegovich injected the contents of the syringe. The picture on the screen changed — a drop, magnified many times by a microscope, looked like a little white ball changing in size. This was the main moment of the operation, for the sake of which all preliminary preparation was carried out — “gluing” the rupture of the central (macular) zone of the retina with plasma. All in all, it took no more than thirty minutes. The patient’s operating field was closed with a plaster. He got up …and left.
At this time, two more patients were preparing for the operation. And the doctors were waiting for two more master classes of filigree techniques for performing high-tech interventions of vitreoretinal surgery.