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What you need to know about scleroplasty
Progressive myopia is a dangerous pathology, sometimes leading to complete blindness. One of the most effective ways to stop further reduction of visual acuity is scleroplasty - a relatively simple microsurgical operation, which makes it possible to fix the deformed during the growth of the sclera and thereby eliminate the main cause of increasing myopia.
- Возможные осложнения и последствия операции 5 Possible complications and consequences of the operation
- Офтальмологи о преимуществах и недостатках метода 6 Ophthalmologists about the advantages and disadvantages of the method
- Отзывы пациентов о результатах процедуры 7 Patient Reviews on the Results of the Procedure
- О причинах и способах лечения прогрессирующей близорукости — видео 8 About the causes and methods of treatment of progressive myopia - video
What is the procedure?
Scleroplasty is a microsurgical operation aimed at strengthening the sclera - the outer ocular membrane. Surgical intervention is performed mainly to prevent progressive myopia (myopia) in children, but in some cases it is advisable for adults to do so. Scleroplasty per se does not eliminate myopia, its main task is to stabilize the existing level of visual acuity of the patient and eliminate the further progression of pathology.
The main feature of scleroplasty in children is the fact that in the period up to 16 years, there is an active growth and development of the organs of vision, changing the shape of the eyes, etc. view. Adult patients from 18 years and older, in which eye tissue is completely formed, are more often recommended the following operations:
- refractive keratotomy, in which the application of radial cuts is made on the cornea, which allows it to align and thus normalize the curvature of this natural lens;
- laser vision correction performed using various techniques: Lasik (Lasik), Surer Lasik, epithelial Lasik, Femto Lasik, photorefractive keratectomy.
It should be emphasized that these operations are not a direct alternative to scleroplasty, because with their help you can correct myopia, but you cannot stop its progression.
Today, there are several methods of scleroplasty, the most popular of which can be considered collagenoplasty and meridional scleroplasty. The essence of the first intervention is the introduction of a gel-like natural component (collagen) or an artificial (polymer) using a special syringe into the eyeball. The substance solidifies and further prevents the stretching of the cornea.
The second method consists in the introduction of reinforcing flaps on the sclera in specially made micro incisions, which will further prevent corneal deformity. Biomaterials, synthetic polymers, donor segments of the cornea or sclera, and the patient’s own tissues (autoplants) can be used as grafts. Over time, the flaps germinate with blood vessels and become an integral part of the eyeball.
In addition, a complex meridional scleroplasty can also be performed on the basis of transplants, the essence of which is that the strengthening flaps are installed in the form of a bandage covering the posterior surface of the eye, for which an oculomotor musculature is cut during the operation. After the transplants are installed, the surgical procedure is completed by fixing the dissected muscles in their places.
Indications and contraindications
The main indication for scleroplasty is the active progression of myopia (no less than one diopter per year), occurring as a result of changes in the size and shape of the eye, which just happens in childhood. The procedure is recommended when the level of myopia reaches 4-6 diopters. In addition, scleroplasty can also be performed with various dystrophic deformities of the retina.
As for contraindications, despite the prevalence of this type of surgical intervention, it may not be appointed to all. Scleroplasty is not recommended:
- children under five;
- patients with a number of ophthalmic diseases, such as, for example, scleral dystrophy;
- in the presence of inflammatory diseases and chronic infections;
- in case of intolerance to anesthesia;
- with psychosomatic disorders.
It is not prohibited to perform scleroplasty during pregnancy, however, it is much better to perform the procedure before the child’s planning or after birth, in order to avoid unnecessary stress for both the mother and the fetus.
How is the operation?
After the child has established a diagnosis of progressive myopia, scleroplasty is performed in a planned manner. Operations are preceded by necessary examinations, among which most often the following:
- clinical blood test;
- a blood test for Hepatitis B and C and for the Micro-Precipital Reaction (MOP);
- examination of specialized specialists - ENT and dentist;
- certificate of vaccination and epidemiological environment;
- the conclusion of a neurologist (for dispensary children).
For adult patients, in addition to tests and an electrocardiogram, fluorography results will be required. Depending on the requirements of the clinic where the manipulation will take place, the package of necessary documents and analyzes may vary.
On the appointed day, the patient enters the clinic for surgery. The procedure takes place in young children under general anesthesia, and for adolescents and adults under local anesthesia, which, unfortunately, cannot completely relieve patients of pain, it is important to know. The operation on both eyes usually takes no more than half an hour.
Depending on the individual indicators and type of surgery, the patient either leaves the hospital several hours after the procedure, or is in the hospital for 7–10 days. Daily eyes are instilled with disinfectants and anti-inflammatory drugs. Within a few days after surgery, the patient feels sick, however, by the time of discharge from the clinic, his condition is almost completely normal. After 5–7 days after scleroplasty, sutures are removed under local anesthesia.
For successful rehabilitation after discharge from the clinic for some time it is recommended to observe a number of restrictions:
- one and a half to two weeks you can not read, write, work at the computer;
- month can not play sports and go to the pool;
- for 2-3 weeks it is recommended to wear glasses with light filters to protect the eyes from ultraviolet radiation, especially in the summer;
- at least a year to avoid serious physical exertion.
As already noted, scleroplasty stops a decrease in visual acuity, but does not return it to normal. To achieve a complete vision, it is necessary to additionally carry out laser correction, one of the conditions of which is the final formation of the eye. Thus, even if scleroplasty was performed in childhood or adolescence, the procedure can be planned only after 16-18 years and only with the stability of myopia, that is, when it does not progress.
Possible complications and consequences of the operation
As you know, any surgical operation carries with it certain risks of complications. Among the negative effects of scleroplasty should be mentioned as follows:
- allergy to anesthesia;
- allergic reaction to the graft;
- rejection of synthetic and donor material implanted in the eye;
- displacement of the implanted flap, which must be eliminated by repeated operation.
At the same time, with a successful scleroplasty, the patient can subsequently lead a normal full-fledged lifestyle - to play sports, use contact lenses, etc. Natural childbirth is not contraindicated in women.
Ophthalmologists about the advantages and disadvantages of the method
Among the main advantages of scleroplasty are the following:
- the operation is low-impact and is performed within 20–30 minutes;
- in many cases, does not require the use of general anesthesia;
- short hospitalization and rapid rehabilitation;
- according to indications, the procedure can be carried out on an outpatient basis;
- high chance of stopping the progression of myopia, although, unfortunately, not one hundred percent.
As disadvantages, we can mention the probability of postoperative complications and in some cases the absence of the result of the intervention, that is, after some time, the progression of myopia resumes.
As for the opinion of ophthalmologists, they are far from unanimous in evaluating scleroplasty. Some experts recognize the fact of the imperfection of modern methods of treatment of progressive myopia, but at the same time they believe that using scleroplasty it is quite possible to achieve the desired effect. Moreover, the growing myopia, if it is not stopped in time, can lead to a complete loss of vision. Proponents of this technique tend to consider the operation one of the safest in ophthalmology.
However, there are other opinions on this issue.
So, in the process of scientific and experimental work on the problem of myopia I have for a long time conducted research on the effectiveness of sclero strengthening operations of residents of Moscow and the Moscow region. Operations were performed on the territory of the specified region in clinics of the Research Institute of Eye Diseases and in medical institutions of the Ministry of Health. The observation period is from one to five years. The number of patients with myopia - 1430 people. Dynamics of observation: a year after the scleroplastic operations, the relative stabilization of the myopic process was observed in 582 cases, after 5 years - in 487 cases, which amounted to 34.05% (taking into account, of course, self-stabilization). Thus, the total efficiency of scleroplastic operations - in the long-term period (observation period - up to 5 years) was 34.05%. It is noted that scleroplastic operations ultimately not only do not stop, but do not slow down the progression in the postoperative period. At the same time, the gradient of progression both before and after surgery remained the same.
Patient reviews on the results of the procedure
In the 8–9th grade my eyesight began to deteriorate sharply, the doctors advised me to do scleroplasty. This simple operation is shown in cases where myopia increases with a speed of more than 1 diopter per year (I have dropped to -3). Immediately before the operation, local anesthesia is done, that is, the patient is conscious, sees everything, even helps microsurgeons — you have to look right and then left. The operation itself is almost painless, but the feeling is very unpleasant - they strongly press on the eyes. It takes a little time, after the operation you rest a couple of hours with your eyes closed, then you should avoid exertion. Immediately after the operation, there is discomfort in the eyes, it is painful to look at the light, the eyelids swell a little (although this is individual). These sensations completely disappear in a few days, and at the same time the ophthalmologist removes microwears from the eyes (completely painless). After the operation, visual impairment stopped, prescribed exercises, vitamins for the eyes and drops to relieve intraocular spasms. Now I have to choose whether to do a laser correction. I think, until I will, vision 2.5 and does not change, but the correction is still not such a harmless operation as scleroplasty.
I suffer with my eyes through my entire adult life, from the second grade. So, during the study it fell to -8! But in the 90s eye surgery caused great concern, especially in Tyumen. Already while working at school, the sight began to fall again to -13! In the regional eye clinic, they advised to do scleroplasty (done in 2003) to stop the progression of myopia. Before the operation, of course, you sign a contract that you will not have any claims to the doctors, in which case, and you have been told about the consequences (this is a surgical operation). It is performed under local anesthesia, drops in the eyes, then an injection (also in the eyes). Next, an incision is made in the cornea of the eye and some kind of gel is injected (I cannot say for sure, since I am not a doctor). Sensations such as if digging into your head, the pain is felt a little, but it is dull and pulling. It does not last long. First, one eye, and six months later - the other. You also move away quickly enough, only the eye becomes very edematous (such as if you hit the eye very strongly with your fist). For a week give sick leave. The first three days of daily dressings. A few days later, remove the stitches from the eyeball (by the way, it does not hurt at all). All this is experienced, the main thing is to stop the fall of myopia. The operation, I will say, was not a pleasant one for me, but it really helped, my vision after it improved by several diopters, of course, with the advantage of this operation I underwent a rather expensive injection course that supports my vision. The operation itself was free of charge, and it took me about 10–12 thousand to make the injections (it is advisable to put them every year). In general, if your doctors advise you to do it, then you have to do it. The main thing is to tune in positively. After two years, I still did a laser correction, I am very happy about it (now 100% vision).
Scleroplasty was recommended to me by an ophthalmologist back in 2002, when I had -2 or so. In my 12 years, I, accordingly, did not have the right to vote, and all my indignations and refusals were regarded as childish nonsense and fear (and there was something to be afraid of!), As a result, they did, of course ... I really regret that At that time I did not have not only the Internet, but even a computer, otherwise, reading about what scleroplasty is and what results it gives, I could persuade my parents to refuse it. And they were also afraid that I would remain “blind.” The ophthalmologist, who prescribed and performed the operation, said that it is desirable to perform it every six months or a year! Imagine: cut your eyes every year! The operation was done to me under general anesthesia (although it was said that if the cardiogram showed poor results, they would calmly do it under the local one). Before the operation, I was given a kind of “paralyzing” injection, I felt weak and my legs literally fell away. After the operation, I still had blindfolds for a day, and when they were removed, the light hurt my eyes, it was painful to concentrate on something concrete, bright, moving ... The stitches ached and pricked in the corners of the eyes. When my parents looked at my eyes - they were taken aback, they did not warn us about this: my eyes were completely filled with blood and while I looked into the eyes of people, they averted teary eyes from me. I could not read, write too - it was very painful for me to move my eyes. The stitches were removed after 2 weeks. The stitches for many years were sick of the weather and just like that, from a sudden movement, now I practically don’t notice this, but it happens, and this despite the fact that more than 10 years have passed! The ophthalmologist said that the stitches will hurt throughout life ... Effect: the vision after scleroplasty improved literally by 0.5 and remained so for about a year or two, and then it went down. Result: I am now 23 years old and have a vision of -4.5. I would not wish anyone to go through what I went through! It is better to wait for 18-25 years and go immediately to the laser!
About the causes and methods of treatment of progressive myopia - video
Scleroplasty is the solution by means of eye microsurgery of a very important problem - stopping the progression of myopia in children, a pathology that may in time lead to the fact that the child will practically lose sight. In order to make a decision on the operation, it is necessary to weigh the pros and cons and, of course, consult with highly qualified specialists whose opinion you trust.