Algorithmof help
Qualified ophthalmologists are receiving appointments in 38 offices, which are in all districts of the region. The offices for general reception of patients and the protection of vision for children work in the regional consultative polyclinic of the Grodno University Clinic.
With a number of pathologies and the need for inpatient treatment, patients are referred to the ophthalmological department, which is in the Lida district hospital.
Ophthalmic beds are allocated in the Slonim and Volkovysk CRH. The residents of Grodno are assisted by the eye microsurgery department of the second city hospital. And in fact, the entire city of Grodno and the region are treated in the eye microsurgery department of the university clinic, where the most modern methods of "eye repair" have been mastered. Hospitalization of patients in eye hospitals is carried out after a preliminary examination in accordance with the developed protocols.
The region is working on early detection of patients with glaucoma. Tonometry is performed in eye rooms, prevention departments, health centers of enterprises, SVU. For this, they are equipped with Maklakovtonometers. Over the past year, 89.1 percent of the population, starting from the age of 40, was actually protonometric. Everyone who has a suspicion of glaucoma is consulted at the glaucoma center of the regional polyclinic, where a detailed diagnosis is established, a plan of treatment and rehabilitation measures is drawn up with registration in a dispensary. Treatment, according to the decree of the Ministry of Health, is prescribed with the issuance of drugs.
In the children's clinics of the regional center, as well as in Lida, Volkovysk, Slonim and Ostrovets, there are specialized ophthalmological procedures. In the rest of the districts, ophthalmologists serve residents of all ages, starting from infancy. Inpatient care for children is provided in the eye microsurgery department of the university clinic, where children's beds are allocated for this. Last year, more than eighty percent of the department's young patients were treated with surgery. Children are sent to the republican center for the most complex pathologies that require treatment with modern equipment. Laser coagulation of the retina for retinopathy in premature infants is performed at the regional children's clinical hospital.
The chief freelance ophthalmologist of the Main Department of Healthcare, Head of the Eye Microsurgery Department of the Grodno University Clinic Sergey Logosh tells about the surgical possibilities of helping people not only to remain sighted for many years, but to clearly see the world in all its diversity.
Replacement lens
Cataract removal in the eye microsurgery department of the university clinic accounts for about half of the total volume of surgical interventions. Representatives of the older generation of Grodno ophthalmologists remember the times when they had to replace the lens, figuratively speaking, manually. When the cataract matured, the cornea was cut. Today, no one brings the disease to such an extent. And modern technologies are such that no cuts are needed. They were replaced by a puncture up to two millimeters. Ultrasound works if you figuratively imagine how a drill and a vacuum cleaner: the lens is crushed and sucked off, and an artificial one is put in its place. Our doctors can operate on virtually any cataract: age-related complicated, traumatic, by implanting artificial lenses of the most modern models. Including multifocal lenses that allow you to see well both far and close and without glasses.
It is important that such manipulations are performed under local anesthesia. After all, there are people who simply do not tolerate anesthesia. The operation itself takes only 7-8 minutes. Of course, all this is thanks to the hands of surgeons and modern technology. The clinic has three operating rooms and three modern phacoemulsifier devices.
Drops, laser, operation
The second most common ophthalmic problem is glaucoma. If not taken in time, it can lead to irreversible blindness. Usually, this defect can be suspected during examination by an outpatient ophthalmologist. First, the person will be offered to cope with the violation of intraocular pressure without surgery, using special drops. If they do not give an effect, laser treatment is applied. On the basis of the regional polyclinic of the GUK, there are glaucoma rooms where the disease is finally diagnosed, and laser surgery is a kind of intermediate stage of assistance that must be used when drug therapy no longer helps. And only if the laser and the drops do not work, surgery is performed.
There are a large number of surgical techniques, but they all boil down to the formation of a drainage channel through which excess intraocular fluid flows from the eye into the vascular bed. On the basis of the university clinic, both classical operations and all modern types of glaucoma surgery are performed, including the implantation of Ahmed drainage systems, which independently regulate eye pressure. Since 2016, we began antiglaucomatous operations with donor sclera transplantation. Thanks to this, a high "functional survival" of the organ of vision has been achieved. But even five years ago there were cases when, due to decompensated painful glaucoma, it was even necessary to remove the eyeball.
Today, ophthalmologists can replace not only the lens, but also other components of the organ of vision. And transplantology helps a lot in this: in the main clinic of the region, a transplant coordination department has been created and a tissue bank has been organized. If, a quarter of a century ago, for example, with progressive myopia, cartilage was taken from the ear and with its help the eyes were “repaired”, then modern scleroplasty is performed using donor material. A special cryochamber allows you to preserve donor material - at a temperature of minus 80, it can be stored for a long time. Thus, the cornea, sclera, and amniotic membrane are harvested.
Previously, patients who needed, say, a corneal transplant were sent to the capital. Now there is no such need. Grodno ophthalmologists have everything they need to "repair" the eye, which is especially important in case of injuries. Thanks to this, eye prostheses have become a thing of the past: over the past decade, Grodno ophthalmologists have never had to remove injured eyes. Moreover, the eyes restore not only aesthetically, but also functionally - they restore vision.
From the point of view of children
In the Department of Eye Microsurgery, some of the beds are reserved for children. Elective operations are performed for strabismus, as well as congenital cataracts and glaucoma, dacryocystitis. In the usual view, these problems are considered age-related. And yet there are children. Recently we operated on a child who is a month old. The local pediatrician drew attention to the redness and tearing of the eyes and referred for a consultation. They measured the intraocular pressure and were horrified. It became clear that the only way to save a child from blindness was to surgically lower the intraocular pressure. There are surgeons' patients with babies with inflammation of the lacrimal sac, neoplasms, but most often with injuries. One such five-year-old boy, for example, decided to remove the shell from a sausage with a knife, but hit himself in the eye. The most complicated operation with the "repair" of donor material of the cornea and sclera saved the eye and preserved the vision.
For progressive myopia, scleroplasty is used. And if earlier they pulled with this until a certain age, now, with a clearly exposed diagnosis, they operate at any age.
A matter of technology
One of the components of a successful high-tech ophthalmic surgery is the provision of the necessary operating and diagnostic equipment. Optical biometer, phacoemulsifier, vitreoretinal system, ophthalmic laser, ultrasound machine, operating microscope - modern equipment has significantly expanded the possibilities of eye surgery. At the same time, Grodno specialists try to introduce everything new that appears in world ophthalmology. For example, anti-VEGF therapy - injections into the eyeball for retinal pathology. It is used for diabetic retinopathy, age-related macular degeneration, retinal vein thrombosis.
Of course, in working with equipment, you always need the professionalism of a specialist. Starting from the outpatient ophthalmologist, who is the first to see a patient with problems. In order not to overlook these problems, and, if possible, to solve them as much as possible, in the region, on the basis of the department of the university clinic, training for advanced training is organized. Here, both polyclinic specialists and ophthalmological surgeons from regional hospitals learn from experience. A promising direction is one-day surgery and polyclinic diagnostic centers, the first of which is being created on the basis of the 7th Grodno polyclinic.
Personal stories
"Consider all the subtleties of the eye"
Ophthalmologist Svetlana Britko conducts a reception in the office for the protection of the eyes of children in the regional consultative polyclinic of the Grodno University Clinic. The word "protection" in the title is not accidental: there are many threats that can affect the ability to see the world in all its glory even in childhood. Dangerous strabismus, a violation of refraction, that is, images due to a change in the shape of the components, the so-called lazy eye, when the seemingly intact organ of vision does not work properly due to functional disorders. There may be congenital cataracts, drooping eyelids, opacities on the cornea. Most of these problems can be discerned by outpatient ophthalmologists. The specialized office of the main clinic is sent to clarify the diagnosis, and to resolve issues of surgical treatment. Fortunately, the technical capabilities to help the hostess of the office are good. There is optical coherence tomography, a modern fundus lens for examining the fundus and the eye cavity, autorefractometers, including a non-contact one, with the help of which refraction is determined, that is, the features of refraction of light rays in the optical system of the eye, even in a restless one-year-old baby.
Svetlana Leontievna admits that modern diagnostic equipment, as well as operating equipment, is expensive in ophthalmology, especially when working with children. Even parents, not to mention the child himself, are far from always able to say what is bothering him. And it is important for a doctor to establish a 100% diagnosis, because the eye is a very complex organ.
Of course, experience helps the doctor. Having decided on the direction from the university bench, Svetlana Britko, after receiving her diploma, worked in a regional hospital, where she dealt with the eyes of both adults and children.
Personal stories
"Seeing the world from birth"
Ophthalmologist Galina Polyakova successfully solves one of the ophthalmological problems today thanks to high-tech equipment in the regional children's hospital. This is a retinal disease, scientifically retinopathy, in children who, figuratively speaking, were in a hurry to be born.
Retinopathy is most often observed in newborns who were born at a gestational age of less than 30 weeks and weighing less than one and a half kilograms, says Galina Feliksovna. This mainly occurs in the fourth to fifth week of life.
Most of these children are in the specialized department of newborns and premature babies of the regional children's hospital. In fact, all of them are under the care of Galina Polyakova: she checks her eyesight and decides what to do in case of violations. In some cases, as the child grows, retinopathy goes away on its own, but it happens that you cannot do without the help of an ophthalmologist. Then laser coagulation of the retina is performed. By the way, some children are operated on when they are still in intensive care from birth.
Galina Feliksovna is armed with a binocular ophthalmoscope, a retinal camera that displays a multiply enlarged picture of the fundus on the screen, and a laser device for laser coagulation of the retina in retinopathy. If earlier for such a procedure 18 - 20 children were annually sent to the Republican Center "Mother and Child", then in recent years it has been performed directly in the hospital. In the past year, 32 operations were carried out.
It is not difficult to imagine what level of professionalism a doctor should have in order to perform such a delicate and very responsible job!
Fortunately, Galina Feliksovna is an experienced and highly professional ophthalmologist; she has gone through the "school" of the children's clinic and for the eighth year in the main children's clinic of the region.
Personal stories
"Ophthalmology approaches the patient"
Oleg Sachko, head of the ophthalmological department of the Lida central regional hospital, has not solved any eye problems for a quarter of a century. He visits the operating room almost every day, performs complex microsurgical interventions several times a week. Copes with both cataracts and glaucoma, provides emergency assistance for injuries and other injuries. In the first wave of coronavirus, hospital ophthalmologists with their entire staff retrained to fight infection. At the same time, emergency ophthalmology did not go anywhere, and Oleg Vyacheslavovich had to be torn “on two fronts”. But seeing how the specialist in eye care is in demand, in the second wave he was already left in the main place.
After my question about the most memorable of medical practice, Sachko thinks about it. Any surgical intervention on the eyes is a delicate and very responsible matter. As they say, I've seen everyone. For example, recently they brought a man under the arms after a balloon with foam exploded in his hands. He was in a panic, he believed that everything would be left without eyes. And the doctor removed the formed film with tweezers - and the patient is free! But, as Oleg Vyacheslavovich says, such a lucky one is one in a thousand. Basically, the damage to the eyes is severe, the interventions of microsurgeons are required complex.
The department has good diagnostic equipment. There is an ultrasound scan of the eye, autorefractometers, a non-contact tonometer. In the operating room there is a microscope. In special cases, it is possible to urgently send the patient to the main clinic of the region - fellow ophthalmologists are always in touch. In turn, there are nine polyclinic ophthalmologists in the district, including one in Berezovka, and two for children. Their concern is not to bring their eyes to the operating room. And if an operation is needed, then Sachko is always ready. People appreciate the fact that you can replace the lens for free, that you do not need to travel far from home, and at the same time the quality of care is at the level.