Surgical treatment of fundus diseases is one of the most technologically advanced area for S. Fyodorov Eye Microsurgery Federal State Institution.
Today, vitreoretinal surgery techniques and technologies are used to treat retinal detachment, proliferative diabetic retinopathy, inflammatory eye diseases, vitreo-retinal interface pathology etc. Modern vitreoretinal surgery can not only prevent blindness, but can actually restore vision.
All surgeries in S. Fyodorov Eye Microsurgery Institution are performed by highly qualified surgeons using state-of-the-art equipment. Modern vitreoretinal surgeries are microinvasive and performed through microscopic punctures with 25, 27 and 29-gauge instruments. The main goal of small gauge vitrectomy is to create less traumatic wounds, intraoperative surgical times and to reduce complications with this new technology.
Currently, the most commonly used vitrectomy systems include the Constellation (Alcon) and Enhanced Visual Acuity (EVA, DORC, Zuidland, the Netherlands). The Constellation vitrectomy system has a dual pneumatic vitreous cutter with increased cut rates up to 10,000 cpm, radiofrequency identification recognition technology to regulate light intensity based upon the probe gauge size, surgeon-controlled duty cycle, integrated laser, and torsional anterior segment phacoemulsification. The Constellation has capacity for 25, and 27 gauge instrumentation. The EVA vitrectomy system utilizes a two-dimensional vitreous cutter with a cut rate of up to 16,000 cpm, high flow infusion cannula, and instrumentation for 25, and 27 gauge vitrectomy. The advantage of larger gauge procedures is the decrease of postoperative infammation rate at the sclerotomy site and manipulations on periocular tissues, leading to more rapid recovery and decreased rate of surgical complications. Faster cut rates improve fluidics, reduce traction towards the retina. During surgical operations surgeons can vary the cut rate and duty cycle as needed for different steps of the procedure. With a high cut rate and a port-closed bias, shaving vitreous over detached retina is safer with significantly less risk of iatrogenic breaks. These advances have led to improved safety and efficacy of surgery.
In our Institution we use the most advanced surgical wide–angle viewing system (Topcon, Japan). Using these systems allows surgeons undoubtedly assess the fundus status and the area of retinal pathologies with the panoramic view. OCT-integrated microscopes are available from Carl Zeiss Meditec (Jena, Germany). Potential advantages of intraoperative OCT are the complete confirmation of epiretinal and internal limiting membrane removal and potentially better visualization and control of membrane peeling in some cases without using retinal dyes.
Recently, three-dimensional (3-D) viewing techniques for vitreoretinal surgery were introduced in S. Fyodorov Eye Microsurgery Institution an alternative to traditional viewing through microscope oculars. With 3-D viewing systems – the Ngenuity (Alcon), images from the microsurgical field are displayed on a flat screen via a 3-D camera. The microscope head must still be positioned properly, but visualization is independent of the oculars and requires the use of 3-D glasses for stereopsis. The single display allows multiple observers to view the 3-D surgical field. Through digital amplification of camera signals, lower illumination settings can be used, which can potentially reduce risks of phototoxicity to the patient’s eye. 3-D viewing also has the potential to improve ergonomics compared to conventional binocular microsurgery.
Thus, modern equipment and technologies allow surgeries to be performed as delicately and effectively as possible, thereby reducing postoperative risks.