Scleroplasty for myopia in children: pros and cons

Despite the rapid methodological and technological development of ophthalmology in recent decades, the problem of childhood myopia (myopia) still does not lose its severity and relevance. As a critical period, which accounts for the largest number of requests on this matter, some sources indicate the age interval from 5 to 12 years, others associate it with the beginning of pubertal processes and refer it to the stage of 8-15 years. However, most experts agree that the proportion of children with myopic refractive error is unacceptably high, and estimate the incidence at an average level of 35-40%.

These age intervals are especially dangerous because, against the background of rapid growth and incipient hormonal changes, myopia tends to rapidly progress, which, in turn, is fraught with the development of organic changes and severe complications in the visual system, up to complete loss of vision.

There are a number of methods for correcting myopic vision in childhood, ranging from optical to surgical. Scleroplasty surgery allows you to stop the progression of myopia without, however, restoring normal visual acuity. This limitation of the predicted result is one of the main, but not the only reason for the ambiguous attitude of specialists towards this technique; In general, scleroplasty in pediatric ophthalmic surgery is a controversial method.

How vision problems develop in a child with myopia

As you know, with myopia, focusing and distinguishing distant objects suffers. The maximum distance of clear vision is determined by the severity of refractive errors in the optical system of the eye; when this distance is exceeded, the image projected onto the retina becomes blurry and blurry. This phenomenon is due to the fact that the light flux, which normally should be refracted by the cornea and then by the lens, and concentrated precisely on the macular zone of the retina, is actually focused closer. In optical-geometric terms, there are several possible causes of incorrect refraction (for example, deformation of the lens or spasm of the accommodating muscles), however, in relation to childhood, the most common is considered to be an abnormally elongated shape of the eyeball due to its disproportionate growth. The main risk factors include genetic predisposition, weakness of scleral tissue, constant overload of the visual system due to improper organization of the child’s lifestyle, education and development.

Scleroplasty surgery in children

The main condition under which the question of scleroplasty is raised is the rapid increase in the degree of myopia; in this case, “rapid” is considered to be a deterioration in distance visual acuity at a rate of 1 diopter/year or more. Myopia, which is generally not as harmless as it seems to the population, with active progression and increasing asphericity of the eyeball (i.e., as it lengthens along the main optical axis), can provoke degenerative processes in the intraocular tissues. In particular, with impaired or insufficient nutrition of the retina (through the associated system of blood vessels), degeneration of light-sensitive tissue may begin, hemorrhages of various sizes and localization may occur, and in the most unfavorable scenarios, a tendency to detachment of the retina from the choroid may appear, which, in the absence of urgent response means inevitable and irreversible blindness.

The main goal of scleroplasty is to improve the mechanical characteristics of the eyeball by strengthening its collagen framework at the posterior pole of the eye. To do this, the minimum necessary surgical access is provided, through which so-called strips are inserted behind the eyeball (i.e. from the side of the retina and optic nerve). scleroplastic tissue. As it engrafts and is included in the blood supply, the scleroplastic material imparts additional rigidity to the posterior wall and thereby prevents further increase in the horizontal axis of the eyeball. Neovascularization (the appearance of new blood vessels supplying the implanted tissue) also contributes to the general stimulation of the hemodynamics of the eye.

Alloplant in ophthalmology

“Alloplant” is a trademark of materials used for allotransplantation, produced from cadaveric donor material. The production of biomaterial is carried out at the Alloplant All-Russian Center for Eye and Plastic Surgery, headed by Ernst Muldashev (Ufa).

According to the manufacturers, a feature of the materials they produce is the selective extraction of glycosaminoglycans used in the processing of donor tissue, which ensures the minimization of tissue incompatibility reactions during transplantation operations. At the same time, transplantation of specially selected materials stimulates their replacement with patient tissue of a similar structure in the process of local tissue regeneration. A simple transplant of donor material risks rejection and overgrowth of the transplant area without restoration of functionality with scar tissue.

According to doctors, it promotes the regeneration of any tissue, for example, the liver damaged by cirrhosis, even in an advanced stage. After transplantation, the liver fully restores its functionality.

Alloplant for scleroplasty is a biological material used to strengthen the sclera, which is necessary for progressive high myopia. Its advantages are good survival rate, minor reaction to the operation performed and a guaranteed sclero-strengthening effect.

Today, four types of Alloplant are produced for the needs of scleroplasty:

1. For fenestrated scleroplasty of rapidly progressing myopia. 2. For fenestrated scleroplasty of slowly progressive myopia. 3. For meridional scleroplasty (Pivovarov’s technique). 4. For scleroplasty (according to the Snyder-Thompson method).

Sclero-strengthening fillings are dispersed Alloplant biomaterial with the maximum preserved primary structure and biological properties inherent in solid alloplants. When replanted, it is able to be replaced by a densely formed connective tissue regenerate, which is fused to the recipient’s episclera, which allows stabilizing the myopic process. Sclero-strengthening fillings are injected and ensure the absence of local or systemic reactions, which guarantees high efficiency, safety and low-traumatic operation, making it possible to perform it on an outpatient basis.

The biomaterial is intended to stabilize slowly progressive myopia, when the annual progression gradient is up to –1.0 D with slowly progressive changes in the patient's fundus.

Alloplant for conjunctival plastic surgery is a biomaterial made in the form of a membrane. Its purpose is to replace defects in the conjunctiva of the apple of the eye, as well as the eyelids, except for the conjunctival fornix (within the cartilage). The advantage of this Alloplant is the ability to replace conjunctival defects of any size, as well as a favorable cosmetic and lasting clinical effect. In the area of ​​replacement, after 1-2 months, the formed conjunctiva no longer differs from neighboring tissues.

It is used in the surgery of symblepharons, tumors, pterygium, and other pathologies of the conjunctiva.

For conjunctival plastic surgery, two types of Alloplants are available:

1. For total plastic surgery. 2. For partial plastic surgery.

Alloplant for keratoplasty is a material intended for replacing layer-by-layer corneal lesions in surgery for keratitis, cataracts, ulcers, and other pathologies of the cornea. It is easy to model according to the shape of the excised pathology focus, which makes it possible to preserve healthy areas of the cornea as much as possible. This Alloplant is a fundamentally new plastic material, clinically superior to the preserved or native cornea traditionally used for lamellar keratoplasty. The new Alloplant has a white color, which is replaced by transparent corneal tissue in 2 - 4 months. It is produced with a thickness of 100 or 200 microns.

Alloplant for keratoplasty is produced in two types:

1. For typical lamellar keratoplasty (rounded in shape, with a diameter of 5 - 10 mm). 2. For atypical layered keratoplasty (having a ring shape - for barrier keratoplasty, as well as an arbitrary shape - to replace various corneal lesions).

Alloplant for choroidal revascularization . In diseases of the retina and choroid, vascular disorders are quite common. One of the ways to restore blood circulation to the retina and choroid is choroidal revascularization surgery.

This biomaterial for choroidal revascularization is capable of inducing angiogenesis after transplantation. It is intended to stimulate a revascularizing effect during surgery for retinal pigmentary dystrophy, as well as secondary chorioretinal dystrophy or other vascular and dystrophic diseases of the retina. Alloplant is used with therapeutic retroscleroplasty or independently.

Alloplant for revascularization of the optic nerve . The material revascularizes the optic nerve, which is injected into the suprachoroidal space up to the region of the peripapillary choroid.

Its advantage over traditional suture materials is the special reliability of suture fixation. Sutures can be used in almost all areas of surgery, therefore they are made in different thicknesses and lengths.

The alloplant is mushroom-shaped, intended for sponge drainage in the suprachoroidal space. – a special biomaterial made from spongy tissue. Thanks to the patented “mushroom” shape, it promotes the redistribution of fluid from the suprachoroidal space to the sub-Tenon area. It stimulates the processes of ultracirculation, as well as drainage in the vitreous body, normalizes the tone of the posterior segment of the eye. This activates venous outflow, which eliminates retinal edema.

It is used in the surgery of primary angle-closure glaucoma, malignant glaucoma, and some forms of secondary glaucoma with an existing vitreal block.

Alloplant for supraciliary canalization is a material modeled in the form of spacers. Its elastic-elastic properties allow the use of two existing spacers to organize direct flow of anterior chamber fluid into the suprachoroidal space, with its free circulation.

It is used in the treatment of glaucoma (chronic primary open-angle, primary closed-angle, secondary burn, refractory, post-traumatic).

Alloplant for choroidal depression is the least traumatic method of obtaining stable contact between the choroid and the retina in the treatment of detachment of the latter using Alloplant biomaterial as a filling.

This material induces angiogenesis, which helps activate blood circulation in the previously detached retina.

Intended for depression of the choroid and is suitable for the treatment of various types of retinal detachment, including the macular zone, it can be used in combination with vitrectomy, as well as posterior autolymphosorption. The ribbon-like shape of the graft allows it to be inserted into the suprachoroidal space through a scleral incision and laid in the form of folds, which, as its density increases, gradually presses the choroid. The material has low antigenic properties, which determines its ability to gradually be replaced by richly vascularized tissues.

Alloplant for scleral indentation is a biological implant used for episcleral indentation in retinal detachment surgery. Its advantages are: elasticity, optimal density and good survival rate. Unlike polymer synthetic materials, it does not cause a reactive chronic inflammatory process of tissues.

Alloplant for scleral cerclage is a biomaterial that can improve the results of treatment of retinal detachment, especially its severe forms. The graft is a tape with high strength and elasticity. Its distinctive features: optimal thickness, as well as good engraftment.

Alloplant for strengthening existing cataracts during keratoprosthesis . The tissue of the cornea does not allow the keratoprosthesis to be pushed out of the eye during keratoprosthesis. Therefore, the outcome of the operation depends on the degree of strengthening of the cataract itself.

The biomaterial for strengthening cataracts used in keratoprosthetics is dense and durable, with good engraftment, which makes it possible to thicken the cataract. The alloplant is highly effective clinically and can replace autografts of the mucous membrane of the lip, cornea, and auricular cartilage.

A set of biomaterial that replaces scleral defects . This Alloplant is a specific transplant material that can be easily modeled according to the shape of the existing defect. It prevents the development of scleral staphylomas, helps restore the anatomy of the fibrous membrane and achieve a good cosmetic effect through plastic strengthening of thinned scleral tissue.

The set of Alloplants for replacing existing scleral defects contains:

1. Allotendinous threads. 2. Biomaterial for scleral plastic surgery for staphylomas. 3. Biomaterial for scleral plastic surgery for injuries or tumors.

It is possible to produce Alloplant for scleral plastic surgery for staphylomas, limited and extensive.

A set of biomaterial for the treatment of subatrophy . Alloplants for scleral bandage make it possible to create a framework of the sclera that will prevent its wrinkling and deformation and restore the shape and volume of the eyeball. They have pronounced scaffold properties, such as elasticity, rigidity, high strength, and also have sufficient thickness, good survival rate and gradual (at least a year) replacement with their own connective tissue, which forms a dense regenerate.

The alloplant intended for the anterior bandage is produced in the form of a broken ring. It is placed around the cornea, fixed to the episclera along the outer and inner diameters. The alloplant intended for the posterior bandage also has a ring shape. It is placed under the rectus muscles and the graft is fixed to the episclera. Eyeball bandage is carried out simultaneously with choroidal revascularization, as well as autolymphosorption or therapeutic retroscleroplasty.

The operation is necessary for subatrophy of the eyeball, regardless of the etiology of the disease and its stage.

An alloplant intended for eyelid plastic surgery is a biomaterial that creates a frame for the eyelids and holds it in its normal position. Alloplant combines the necessary density and optimal elastic-deformable properties, allowing you to give the eyelid a natural shape and position when performing various plastic surgeries. In addition, it can be used to restore the tarso-conjunctival zone of the eyelids, thanks to intensive epithelization of the surface of the biomaterial.

For eyelid surgery, Alloplant is produced in two types:

1. For total plastic surgery. 2. For partial plastic surgery.

Indispensable for various blepharoplasty operations (elimination of entropion, eversion, resection, etc.).

Alloplant for plastic surgery of the free edge of the eyelid is a material used to replace defects in the intermarginal space of the eyelid. The advantage of this graft is its ability to eliminate a tissue defect in single contact with the receiving bed, excellent engraftment, persistent clinical effect, and favorable cosmetic result.

Used in surgery for the consequences of trachoma, trauma (trichiasis, volvulus), burns, tumors, congenital anomalies of the free edge of the eyelids.

Alloplant for reproducing the musculoskeletal stump during enucleation of the eyeball . This biomaterial is implanted into the orbit to create a prosthetic stump, which is necessary after enucleation (removal) of the eyeball. The graft is perfectly modeled and takes root; it is not pushed out, which allows you to create a mobile, convex stump, which is ideal for the manufacture of an individual prosthesis.

A vasculogenesis stimulator is a dispersed biomaterial with technological processing that provides maximum concentration of biological factors that induce vasculogenesis processes.

The material is used for retrobulbar administration for complicated myopia, high degrees, abiotrophies, etc. In addition, it is used for local administration to other parts of the body.

Alloplant, used for sponge drainage in the treatment of glaucoma, is a biomaterial made from “sponge” (spongy biomaterial). Thanks to its microporous structure, Alloplant perfectly absorbs moisture in the anterior chamber, promoting its outflow into the area of ​​the suprachoroidal space, the posterior part of the eye. It is used in the surgery of primary chronic open-angle, refractory, congenital glaucoma, as well as some secondary glaucoma.

Alloplant, intended for intrascleral sponge drainage in the treatment of glaucoma, is a spongy material with a microporous structure. Its distinctive feature is the ability to intensively absorb moisture in the anterior chamber from the filtration zone, redirecting it to the area of ​​the suprachoroidal space between the layers of the sclera.

Indispensable in glaucoma surgery (primary and chronic open-angle, some secondary glaucoma).

Alloplant, intended for therapeutic retroscleroplasty , is a product of grinding biological tissues carefully selected in composition. Its purpose is to enter the space between Tenon's capsule and the sclera, in the posterior part of the eyeball. Due to the increase in the area of ​​contact with the tissue bed, the biomaterial for retroscleroplasty helps to intensify the physicochemical interaction, which creates especially favorable conditions for the release of bioactive compounds from the Alloplant matrix.

This Alloplant stimulates blood circulation in the sclera, retina and choroid, normalizes vascular permeability, activates the processes of resorption of pathological foci, and has a sclero-strengthening effect.

It is used independently for mild or moderate myopia, retinal abiotrophies, optic nerve atrophy, and lesions of the macular area. And also in combination with other surgical interventions: revascularization of the choroid or optic nerve, autolymphosorption.

In the medical department, everyone can undergo examination using the most modern diagnostic equipment, and based on the results, receive advice from a highly qualified specialist. The clinic is open seven days a week and operates daily from 9 a.m. to 9 p.m. Our specialists will help identify the cause of vision loss and provide competent treatment for identified pathologies.

You can make an appointment at the Moscow Eye Clinic by calling Moscow 8 (daily from 9:00 to 21:00) or using the online registration form.

Material for scleroplasty

Most parents are especially concerned about the nature and origin of scleroplastic tissue, in particular, whether it is an implant or a graft, i.e. synthetic material or donor material. In the classical version of the technique, as a rule, the corresponding tissues of large animals were used; after complex, several-stage processing, such material acquires the properties of replacement collagen, which is lacking in the myopic eye, which achieves strengthening of the posterior wall. However, in various modifications of scleroplastic surgery (see below), it is possible to use both donor and synthesized biocompatible materials.

Alloplant is the development of Russian scientists led by Ernst Muldashev. Alloplant is a unique biomaterial that stimulates affected tissues and organs to recover independently. A process of self-healing occurs due to tissue regeneration and increased growth of new healthy cells.

The scientific results obtained by the team of the All-Russian Center for Eye and Plastic Surgery and their practical implementation made it possible to develop the concept of regenerative surgery based on the Alloplant transplantation technology.

Many years of experience in experimental and clinical use is convincing evidence of their effect on the regeneration of various tissues and anatomical structures.

This promising direction opens up possibilities for the treatment of widespread autoimmune, hereditary and vascular diseases. When using various types of Alloplant biomaterials, it is possible to stimulate the regeneration of blood and lymphatic vessels, cornea, sclera, skin, conjunctiva, nerves, liver parenchyma, gastrointestinal mucosa, etc. Over the past two decades, Alloplant has been successfully used in the treatment of diabetic retinopathy, retinopathy of prematurity, retinitis pigmentosa, atrophy and neuritis of the optic nerve, uveitis, retinal vein thrombosis, cataracts, trauma, keratitis, myopia, tumors (extensive experience has been accumulated in alloplasty in the resection of basal cell carcinomas, neurofibromatosis), burns and birth defects. Alloplant is widely used in ophthalmology, plastic surgery, dentistry, thoracic surgery, neurosurgery, proctology, orthopedics, traumatology, liver surgery, gynecology, etc.

Control of the production of Alloplant biomaterials The Russian Ministry of Health has approved the widespread clinical use of Alloplant transplant material (Registration Certificate No. 901 dated July 22, 1987). Alloplant is included in the General Classification of Biological Products and is approved for wide clinical use. Specification No. 42-2-537-93 (Ministry of Health of Russia, registration number 056/003230 dated May 17, 1993). The collection of donor cadaveric material is carried out in accordance with the Law of the Russian Federation “On Organ and Tissue Transplantation” No. 4181-1 of November 22, 1992.

Before entering production, biomaterial is subject to mandatory testing for AIDS, hepatitis B, hepatitis C and syphilis. In addition to these types of tests, we use the following types of control at various stages of production:

1. Morphological
2. Biomechanical
3. Macroscopic and microscopic
4. Polarizing-optical
5. Histochemical
6. Bacteriological

Developed technologies for processing and preserving biomaterials, methods for their control guarantee sterility, preservation of structure and plastic properties for 5 years. Store at room temperature.

Alloplant for acupuncture and intra-articular injection

A crushed alloproduct is made, which is administered through the finest needles (injections).

When the alloplant is introduced into biologically active points, the state of homeostasis and general regulatory mechanisms of metabolic processes are normalized, the protective functions of the body are increased, and regeneration processes are activated. In general, the body responds by increasing the production of its own stem cells, improving immunity, and resolving scar tissue. Unlike other medications, alloplant does not irritate the tissue at the injection site, so the procedure is almost painless.

Restoration of affected joint structures (arthrosis, arthritis, meniscosis, etc.), due to repeated activation of blood flow, restoration of the joint capsule with normalization of the production of intra-articular fluid (lubricating and nourishing the cartilaginous cover), restoration of the cartilage cover of the joint.

The introduction of these types of alloplants is carried out in the form of an independent method of treatment, or in complex therapy of organic diseases (visual, central nervous, respiratory, cardiovascular, musculoskeletal, digestive systems), functional disorders (metabolic processes in the liver, intestines, endocrine and nervous systems), immunodeficiency states of the body.

• After a course of injections, the condition of patients with cerebral palsy (cerebral palsy), as well as those who have suffered injuries to the central nervous system or suffer from diseases of the peripheral nervous system, significantly improves
• The method is successfully used to treat neurodermatitis, eczema, psoriasis, furunculosis, alopecia, trophic ulcers, bedsores, burns and other skin lesions.
• It has been noticed that acupuncture using alloplant helps the body recover faster from fractures and injuries of the musculoskeletal system, and heal from arthrosis and diseases of the spine.
• In addition, diseases of the respiratory organs and gastrointestinal tract (including chronic gastritis, stomach ulcers, chronic hepatitis) are cured this way.
• The use of the described method in complex therapy of eye diseases and chronic inflammatory diseases of the genital area, infertility and adhesions, periodontal disease, infectious and oncological diseases is also shown.
• Moreover, experts also note an exceptional cosmetic effect: scars, stretch marks and wrinkles disappear, and the aging process of the skin slows down.

The main advantages of alloplant

Alloplant makes it possible to treat diseases considered “hopeless”. It provokes the body to intensify the production of its own healthy cells, extinguishes inflammation, and stimulates the immune system.

• quickly relieves swelling and inflammation
• has a long-lasting therapeutic effect (dissolves in the body slowly, maintaining its healing effect for up to six months)
• does not cause allergic reactions and addiction, as well as side effects, like taking medications
• has a wide range of applications due to its universal healing effects at the cellular level: from cosmetology to the treatment of serious diseases. Among other things, the benefits of alloplant in the treatment of diseases of the joints and spine are undeniable.
• the procedure is practically painless (slight discomfort may only be felt at the injection site)
• does not leave scars

Alloplant treatment is carried out in a course. Depending on the disease and complexity.

Alloplant also has a beneficial effect on the functioning of the immune system. It not only increases local immunity, but also serves as a kind of immunomodulator. Alloplant is also used in aesthetic medicine. A unique biomaterial can treat baldness, eliminate scars, wrinkles, and sagging skin. Thanks to the alloplant, the natural aging process of the body slows down, and a colossal cosmetic effect occurs.

When reflexology and drug treatment methods are combined, the overall therapeutic effect is enhanced. Acupuncture in combination with an alloplant can give significant results, especially important in the treatment of serious diseases.

Operating principle

The drug is not rejected by the body and can remain in the tissues for a long time, gradually dissolving. There is an effect of long-term stimulation of bioactive points. Long-term exposure trains the organ to function normally. The drug carries information from a healthy cell about how to function “correctly”. The process of self-regulation starts, local immunity increases.

Alloplant injections are almost painless and do not cause scars or allergies.

Alloplant is approved by the Ministry of Health of the Russian Federation. Currently, biomaterials from the Alloplant series are supplied to more than 500 clinics in Russia and the CIS countries, as well as to a number of foreign medical institutions.

Types of operations

In the simplest version, small incisions are made in the eyeball, through which a composition of a fairly liquid consistency is injected with a syringe; The implanted material in this case can be either transformed donor tissue or specially developed synthetics. Soon after injection into the desired area, the composition hardens to the required degree. This intervention algorithm is called simplified scleroplasty.

Simple scleroplasty means the formation of a kind of bandage or reinforcing mesh from strips of scleroplastic material, which, as in the previous version, can also be either treated donor or artificial tissue (silicone or metal-plastic).

Complex scleroplasty involves excision of muscle fibers to provide the necessary access and insertion of scleroplastic strips. This technique requires a slightly larger volume of fixing materials. Many descriptions of scleroplasty emphasize that this technique has a minimal list of contraindications, but this is not entirely true. It would be more accurate to say that scleroplasty has no specific contraindications unique to this operation, since the list of possible restrictions, absolute or relative, in this case is almost universal for pediatric ophthalmic surgery. In particular, intervention is not performed under the age of eight years and/or in the presence of infectious and inflammatory processes, concomitant ophthalmopathology, contraindications to anesthesia, scar changes, thinning of the sclera.

Ernst Muldashev: "Alloplant" helps when the possibilities of conventional surgery have been exhausted"

We are visiting Professor Ernst Rifgatovich Muldashev, director of the All-Russian Center for Eye and Plastic Surgery of the Ministry of Health and Social Development of the Russian Federation, widely known for the development and active use of the unique biomaterial “Alloplant”.

– Ernst Rifgatovich, good afternoon! Please tell us about the creation of your Center, how it all began, what difficulties and thorns you had to go through?

– Our Center was created on the basis of the invention of Alloplant biomaterials. Alloplant is translated as: allos from Greek - “alien”, plant from English - “seedling”; it turns out to be “someone else’s seedling”. We produce alloplants from the tissues of deceased people, from cadaver tissues. These fabrics are processed using special technology. Each fabric has its own processing technology. And its essence lies in the impact on the matrix. Through chemical treatment, the matrix changes and the transplanted tissue fundamentally changes its properties. Firstly, it is not rejected. This is confirmed by more than one and a half million operations with Alloplant and not a single rejection. Secondly, it becomes a stimulator of the regeneration of its own tissues. In place of one Alloplant, figuratively speaking, blood vessels grow. In place of the other - lymphatic. In place of the third - bone, in place of the fourth - conjunctiva, fifth - sclera, and the like. By influencing glycosaminoglycans in different ways, we have achieved regeneration of a number of tissues, mainly in the treatment of eye pathologies. But now Alloplants are used in many areas of medicine, and they are used in 500 clinics in Russia. The invention of Alloplant made it possible to operate and help those patients who were previously considered hopeless. A striking example is optic nerve atrophy. Optic nerve atrophy is like a death sentence. And here, by performing an operation to revascularize the optic nerve, that is, by bringing Alloplant to the optic nerve, in place of which blood vessels grow, it is possible to improve the nutrition of the optic nerve and slow down the atrophy process.

– Does this have a direct relation to glaucoma?

– Of course, that’s why we operate on glaucoma in almost all cases, including operations on the optic nerve. Sometimes we perform a rather complex operation of revascularization of the optic nerve, but in almost all cases we introduce a dispersed form of Alloplant (powdered form) around the optic nerve, which stimulates the regeneration of blood vessels, improves metabolic processes, and the condition of the optic nerve in many cases improves, the patient feels it in form of improvement of visual functions. Glaucoma cannot be cured by lowering intraocular pressure alone. Glaucoma, as the great A.P. said. Nesterov, is a neuroopticopathy, that is, glaucoma is always accompanied by damage to the optic nerve. There is a known form of glaucoma with low pressure, when the glaucomatous process occurs, and the patient’s pressure is normal.

– When approaching the Center, a huge human eye is visible. What is this?

– The building was planned as a conference hall. This, by the way, is the world's largest model of an eye. We have already submitted documents to the Guinness World Records Committee. In addition to hosting conferences, this facility will be used for educational and therapeutic purposes. The use of modern technologies and equipment will allow us to project images of various pathological conditions of the retina onto the inner surface of the “Eye”. According to biologists, the rehabilitation of visually impaired children inside the “Eye” will be much more effective. We will let patients inside the huge eye and conduct rehabilitation classes. In my opinion, this will influence the subconscious, unknown to us and difficult to explain from the point of view of traditional medicine. Alas, there is much we still cannot explain. I'll give you one example. One patient had vision of 0.01, paracentral point field of view. And another patient had vision of 0.1. And this one with 0.01 vision was driving around like a blind patient with 0.1 vision, you see.

- Yes, it happens, an amazing case.

– These are amazing moments, some kind of influence of the subconscious that realizes this 0.01. We can't explain this yet. And this influence of the subconscious, I think, we can find some scientific criteria, scientific points, by placing people inside the “Eye”.

– But, evolutionarily, we have inherited many more receptors than we use. The brain is not used at 100%...

– Yes, and perhaps some serious science will emerge from this “Eye”, we do not exclude this possibility.

– Well, on the other hand, even temples were built for a reason, with a certain shape. When a person gets inside, I don’t know to what extent there is contact with higher powers, but a certain mental state arises immediately.

– After all, in churches, purification occurs, as we understand, in a certain sense. And this cleansing is also not entirely clear. Is it the form or what? And here this shape of the “Eye” turned out to be like the dome of a temple. People of the psychic type, there are quite a lot of them, say that there is strong energy here, that they feel good here. Even now, when the “Eye” has not been brought to its final form, everything has not yet been completely done, we began to test the visual acuity of our patients under normal conditions and when they are inside the “Eye”. It seems that while there are no such statistics yet, they provide higher visual acuity there.

– As for me, in this room I felt some improvement in my mood, to be honest. But, on the other hand, as an ophthalmologist, I have always dreamed of taking a virtual trip. I immediately found the disk, said that the eye was right, and imagined how it would all look. You recharge immediately, amazing acoustics. Well, in the end, the training component is also very important. Ernst Rifgatovich, let's talk in more detail about glaucoma, how is it treated in your center?

– Yes, as for glaucoma, in our Center glaucoma is one of the main pathologies that we operate on. Most often, we receive patients who have already been operated on, with congenital glaucoma, with secondary glaucoma, with the so-called. "overgrown" operations. We were able to solve the problem of scarring of the filtration zone only by creating spongy Alloplants, the use of which prevents the development of scar processes in the area of ​​surgical intervention. We have been working on the creation of these Alloplants for about 10 years. We didn’t succeed right away, because we tried to technologically create an analogue of the trabecular apparatus. At the same time, it had to be not just an exact analogue, but also be denser so that it would not lose its structure in the postoperative period. And we managed to do it. We carried out experiments on animals for a long time, we did not dare to introduce it into the anterior chamber of the eye for the reason that it was risky, what if there was keratopathy, or whatever, there was such a risk. Then they began to operate on the “zero” eyes of volunteers. And now we perform sponge drainage operations every day. Often we immediately enter the suprachoroidal space through the same incision and implant the Alloplant for revascularization of the optic nerve. At the same time, we perform choroidal revascularization. And in this way, many patients who do not go for sinustrabeculectomies and other traditional operations manage to reduce intraocular pressure and preserve visual functions.

– What is the approximate volume of surgery per year?

– We perform somewhere between 8 and 10 thousand operations per year. On average we operate on 30-50 people every day.

– Your own production is quite well organized. Is everything produced here right in the Center?

- Yes.

– Do you use advanced technologies? Can you say a few words about this?

– Yes, we have a tissue bank. Thanks to which we have the opportunity to introduce our developments into clinical practice. Our tissue bank is equipped with modern equipment. For the first time, transplant modeling is carried out using laser technology. For this purpose, the installation was designed by our unique physicists from the nuclear center (Sarov). Modeling of transplants based on computer technology using a laser beam allows you to effectively create any volume and shape necessary for various operations without damaging the tissue structure.

– In terms of sterility of transplants, I think you use radiation?

– We had many problems with the sterilization of Alloplants, because until now we transported transplants for sterilization to the same Sarov and other cities of Russia, where there was such an opportunity.

-Have you ordered yours?

– Yes, with the sponsorship money that Roman Abramovich gave us, we built an accelerator here. Sarov scientists have built an accelerator that sterilizes with both electron and gamma rays, and in varying proportions by both methods, etc. But this is completely safe, because each type of Alloplant must have its own sterilization regime. For example, Alloplants, which contain more water (water with gamma radiation is the most dangerous, because it breaks down into OH- anions, which can give a tissue reaction), they were quite difficult to sterilize. Now all this is possible. Moreover, we are now producing a whole series of aqueous Alloplants, that is, Alloplant extracts are diluted in water, and this water can be drunk, it can be used in the form of eye drops, during electrophoresis.

– Ernst Rifgatovich, I noticed the good equipment of your Center. After all, in my opinion, it is not enough to come up with a new unique technology; it is important to have a base of evidence-based medicine and confirm the results. In just one office you have two Humphrey perimeters, amazing microscopes. Do you pay much attention to this?

– Of course, our equipment is very good. Almost now, if we take ophthalmology, we have absolutely everything: the best Doppler scanner, OST of the highest level, we have our own MRI. Tomograph with a program for diagnosing pathology of the optic nerve, optic canal, orbit and eyeball. This is, first of all, a question of descending optic nerve atrophy, which we operate on. In addition, I can say that our morphological unit is superbly equipped.

There are two electron microscopes, one raster, the other regular. Also, a laser microscope. When people from the department of anatomy and histology come to us and see the equipment for ocular morphology, they really envy us. I want to say a few warm words to the Russian Ministry of Health, because recently the supply of expensive equipment has been going very well; before it was harder. These deliveries are truly being fulfilled.

– The problem of material support in Russia is very relevant, of course.

– Now the Ministry of Health monitors the effectiveness of using this or that equipment. You can supply the whole of Russia with equipment, but it will not work. For us, of course, this is going well for the reason that we pay special attention to ensuring that each device works with maximum load, and is not just standing there for show. For example, a conventional optic nerve analyzer, which is designed by the company for diagnosing primary glaucoma. In fact, when we started using it, we did not immediately appreciate it.

– Do you mean that an experienced doctor can make a diagnosis without this?

- Yes. We set the task to modify the software part of this device. Now this analyzer calculates the percentage of damage to nerve fibers. When deciding whether to perform optic nerve revascularization surgery, which is risky in some sense, in this case it is very important to know the percentage of damage to the optic nerve fibers. After revascularization of the optic nerve using Alloplant or when dispersed Alloplants are introduced into the sub-Tenon's space, in these cases we can analyze the percentage of affected fibers before and after surgery. Studies have shown that many patients experience positive dynamics after surgery. What does this mean? Oddly enough, this indicates that regeneration is underway.

– But the regeneration of nervous tissue is very doubtful.

– Nervous tissue, it seems, cannot regenerate. We were surprised. But here it would seem. The now deceased famous neurologist D.M. lived in Moscow. Golubev. And his last words were: “But the nervous tissue still regenerates!” And so, in our morphological studies, we are increasingly finding evidence that nervous tissue and the retina can still regenerate.

“This is hope for a huge number of patients.

– Two doctoral dissertations were defended, one on retinitis pigmentosa, the other on retinal morphology, they just showed ultrastructural regeneration. That is, the number of melanosomes in the retinal pigment epithelium increases - this is already a sign of regeneration. There are other signs of ultrastructural regeneration. But we have now begun to find histological signs of regeneration. These are very serious experimental studies.

- On animals?

- Yes. Difficult experiments on the optic nerve. But these experiments provide pure morphological signs of regeneration of nervous tissue.

– That is, you create a model of secondary glaucoma, bring it to a certain stage, then study it?

- Yes Yes Yes. As the nerve fiber grows, growth flasks appear - this is a morphological sign; they are clearly visible with a certain color. And we are now coming to the conclusion that, in theory, we are seeing regeneration. Of course, in the future I would like to get good clinical results, but this work is not easy.

– Ernst Rifgatovich, thank you very much for the interesting conversation. I sincerely wish you good luck in both scientific research and clinical work!

24.05.2011

The conversation was conducted by S.Yu. Petrov, Candidate of Medical Sciences, Senior Researcher at the Scientific Research Institute of the Russian Academy of Medical Sciences Photo by the author

After operation

The restrictions associated with scleroplasty are usually minimal. So, after 10-14 days, the child can already resume sports and other types of physical activity; the forced pause in schooling does not exceed one and a half weeks; swimming in the pool is allowed after one postoperative month in the absence of any complications.

However, two restrictions must still be observed strictly and for quite a long time (up to one and a half to two years after the operation): intense visual loads are contraindicated, as well as physical strain (in particular, lifting even heavy weights that are quite feasible for a child). If scleroplasty is performed on a girl, questions are often asked about the possible impact of the surgery on the ability to perform reproductive functions - for example, there are concerns that natural childbirth will be contraindicated. In this regard, the prognosis is favorable: scleroplasty does not increase, but, on the contrary, reduces the likelihood that myopia will become a mandatory indication for cesarean section. Speaking about scleroplasty, it would be deontologically and ethically incorrect to omit the fact that this ophthalmic surgical technique is practiced only in the CIS countries; Experts from European countries do not consider its effectiveness to be sufficiently justified.

ALL-RUSSIAN CENTER FOR EYE AND PLASTIC SURGERY

On the pages of this site you can get acquainted with the scientific and medical center of federal significance, located in a picturesque corner of the city of Ufa. The basis for the creation of the Center was the development in Ufa of an innovative technology for tissue transplantation, protected by the Alloplant trademark. This is one of the rare cases when a fundamentally new treatment method has led to the opening of a federal scientific institution. The Center received All-Russian status in 1990. Since 1983, our team has been known as the Republican Laboratory of Tissue Conservation. The first Alloplant biomaterial transplantation operation was performed in 1973.

The All-Russian Center for Eye and Plastic Surgery today is a well-known scientific institute of regenerative surgery in the country and abroad. As is known, methods of regenerative surgery are being developed in various scientific and medical centers on the basis of cell, tissue and organ transplantation. Our institution creates and implements methods for the regenerative restoration of anatomical structures based on tissue transplantation. Donor tissues subjected to deep physical and chemical processing are commonly called biomaterials. Tissue transplantation fully meets the requirements of Russian and international legislation, is much cheaper than cellular technologies in terms of costs and can be implemented in both multidisciplinary and specialized medical institutions.

Our Center has all the necessary structural units in the field of transplantology from experimental development to clinical implementation.

It includes a scientific department of morphologists with laboratories of electron and laser microscopy, immunohistochemistry; a multidisciplinary tissue bank with a tissue conservation laboratory, a radiation sterilization unit for biomaterials and a laser modeling complex. The clinical divisions of the Center include specialized ophthalmic surgery departments, associated services of otorhinolaryngology and plastic surgery. Services for neurophysiological and psychological rehabilitation of patients are separated into a separate complex.

It is necessary to dwell separately on the systemic effect of transplants, first noticed by Academician V.P. Filatov and called biostimulation. Our studies have shown that Alloplant biomaterials, acting through the immune, nervous and endocrine systems, make it possible to rehabilitate patients with severe damage to the musculoskeletal system, peripheral and central nervous system, etc. For the clinical implementation of this area, a special department of biophysical methods of diagnosis and treatment “Aura” has been created.

All presented laboratories and departments form a single scientific, medical and production complex within the Center, within which the treatment and rehabilitation technologies created here are constantly being improved.

More detailed information about each service can be found on the corresponding pages of the site.

To quickly find the necessary sections of the site, use the Navigator - a visual menu. it is available on all pages of the site - just click on the Navigator icon.

An exceptional property of the Alloplant biomaterials we created was the ability to stimulate the regeneration of various tissues and anatomical structures. The development of the described biomaterials required solving a whole complex of scientific, organizational, technological and production problems. These include the technology of physical and chemical processing of donor tissues, which makes it possible to reduce the immunogenicity of the final biomaterial and achieve its decontamination while maintaining bioplastic properties. The technological equipment of our production was created through integration with the Russian Federal Nuclear Center (Sarov). Today we actively cooperate with this wonderful and highly respected scientific institution, constantly improving methods of selective radiation sterilization of biomaterials and their laser modeling. By creating biomaterials of various biochemical composition, spatial structure and biomechanical properties, the Center’s team solved many applied problems of regenerative medicine.

In particular, it was possible to achieve regeneration, both experimentally and in the clinic, of various types of epithelial cover, connective structures, blood and lymphatic vessels, peripheral nerves, optimize osteogenesis, etc.

As a result of many years of scientific and innovative activity of our Center, the technology of regenerative medicine based on Alloplant biomaterials was created and introduced into industrial and clinical practice.

Over 95 types of Alloplant biomaterials are used in clinical practice in more than 600 clinics in all regions of the Russian Federation and CIS countries.

The center cooperates widely with a number of scientific and medical institutions and universities in Russia, which ensures the introduction of biomaterials into various fields of medicine. One of the important activities of the team is training doctors in Alloplant transplantation technologies under postgraduate professional education programs.

With best wishes, Chief Scientific Consultant of the All-Russian Center for Eye and Plastic Surgery, Honored Doctor of the Russian Federation, Professor Ernst Muldashev

Possible complications

Undesirable side effects and complications with scleroplasty are quite common.

The main types include an individual allergic reaction to an implanted trans- or implant (the frequency of occurrence varies for different materials), as well as insufficient fixation of the artificial frame with its displacement anteriorly (swelling and swelling of the conjunctiva is observed). In the first case, the symptoms are relieved with standard antihistamines, in the second, corrective re-operation is required (the statistical risk of such a development is 1-2%).

Failure to comply with the most stringent restrictions prescribed by the doctor for the period of rehabilitation - in particular, systematic and long-term neglect of the ban on visual overload - can result in the development of astigmatism or strabismus.

Types of biomaterials used Alloplant

Alloplant for revascularization of the optic nerve

Optic nerve revascularization is used for optic nerve atrophy, as well as in combination with antiglaucomatous operations. The operation is aimed at activating blood supply and metabolic processes in the optic nerve and retina.

Alloplant for therapeutic retroscleroplasty

Therapeutic retroscleroplasty firstly improves blood circulation in the sclera, choroid and retina. Secondly, it normalizes vascular permeability. Thirdly, it stimulates the resorption of pathological foci and has a sclero-strengthening effect.

It can be used independently for mild and moderate myopia, retinal abiotrophies, optic nerve atrophies, and pathology of the macular region. And also in combination with other operations: choroidal revascularization and optic nerve revascularization.

Alloplant for choroidal revascularization

Diseases of the retina and choroid are often accompanied by vascular disorders. As a rule, one of the ways to improve blood circulation in the retina and choroid is choroidal revascularization surgery.

Alloplant can be used either independently or in combination with therapeutic retroscleroplasty to stimulate a revascularizing effect in the surgical treatment of vascular and dystrophic diseases of the retina.

Phagocytosis stimulator

Injection of a phagocytosis stimulator helps increase the permeability of blood vessels. As a rule, it is used for effective resorption of pathological elements in the eye (blood or exudate).

Vasculogenesis stimulator

The vasculogenesis stimulator is used for retrobulbar administration for high complicated myopia, abiotrophies, etc. As a rule, it is aimed at activating blood supply and metabolic processes in the optic nerve and retina.

Alloplant for scleroplasty

Alloplant for scleroplasty designed to strengthen the sclera in cases of high progressive myopia. Of course, the advantages of this alloplant are good engraftment, a weak reaction to the operation and a reliable sclero-strengthening effect.

Alloplant for conjunctival plastic surgery

Alloplant for conjunctival plastic surgery can be used in the surgical treatment of pterygium and other conjunctival pathologies.

This biomaterial has a number of advantages. Firstly, the possibility of replacing conjunctival defects of any size. Secondly, the convenience of surgical manipulation. Thirdly, good survivability. In conclusion, a lasting clinical and favorable cosmetic effect. Subsequently, at the site of Alloplant replacement, after 1-2 months, a conjunctiva is formed that does not differ from neighboring tissues.

Points for and against

The most compelling argument in favor of scleroplasty is the immediate and radical elimination of the risks described above associated with the rapid worsening of myopia. Some parents choose not to take risks by trying various longer-term treatment options and thereby missing out on time when retinal degeneration and detachment could still be prevented, i.e. keep the child's vision at an acceptable level.

However, the opposing judgments are also very justified: these are low assessments of the effectiveness of scleroplasty by Western experts, and the impossibility of improving visual acuity simultaneously with stopping the progression of myopia, and an unacceptably high, in modern times, percentage of complications, and most importantly - a large number of completely accessible, proven and well-functioning proven methods for correcting myopia that do not require invasive intervention (glasses, lenses, vitamin-antioxidant complexes, angioprotectors, all kinds of hardware techniques, eye gymnastics, etc.).

In general, the practical significance and frequency of use of scleroplasty is gradually decreasing, and with the advent of new alternative approaches to the correction of myopia, it will most likely be completely lost.

Our ophthalmology center does not perform scleroplastic operations for the reasons stated above, but offers children with progressive myopia to undergo an effective and safe course of treatment using devices.

Impingement syndrome

Impingement syndrome is pinching of the rotator cuff tendons. The disease occurs almost exclusively in people engaged in heavy physical labor. Tendons are constantly injured and gradually degenerate, leading to limited mobility or even disability. The main symptom is shoulder pain, which gets worse with exercise. Treatment begins with therapeutic and physiotherapeutic methods. If they are ineffective, proceed to surgery, acromioplasty and subarcomial decompression are used. As a rule, patients seek medical help over the age of 40, which reduces the effectiveness of treatment, since by that time irreversible anatomical changes in the periarticular ligaments have already occurred.

• 1st stage. In the tissues surrounding the shoulder joint, inflammation, swelling, and hemorrhages develop, but the tendons maintain their integrity;
• 2nd stage. Persistent chronic inflammation leads to scarring (fibrotic changes). The tendons may already be torn;
• 3rd stage. The shoulder joint is affected by osteophytes. There are large-scale degenerative changes in the soft tissues; a slight load on the shoulder joint can cause complete rupture of the tendons.

Pain is the most difficult manifestation of impingement syndrome. It lasts constantly and seriously reduces the quality of life. In the first years, pain appears only during physical activity, but over time it becomes more and more constant. For athletes, the typical age for the onset of impingement syndrome is 10-15 years lower than for people engaged in physical labor, but it all depends on the characteristics of the body and the application of load.

Treatment

If therapeutic methods of treatment have turned out to be ineffective for you and we are talking about surgical intervention, then you should contact our center, where the author’s and patented treatment method with the unique Alloplant biomaterial is used. Using this technique, more than ten thousand patients have already gotten rid of their illness, not only from Ufa, but also from Russia, and even countries near and far abroad.

One of the high-profile developments in the treatment of impingement syndrome is the unique biomaterial “Alloplant”.

Our medical center offers a unique, modern method of treating impingement syndrome using the unique ALLOPLANT biomaterial.

The effectiveness of treatment reaches more than 95% and, most importantly, the effect is long-lasting; the treatment is carried out by a doctor with 23 years of experience and using an original technique.

The doctor who will treat you has 4 patents, you can make sure by following the link https://ulfar.ru/specialisty/musin-ulfat-kamilovich/?patent