PRESENT AND FUTURE OF THE S. FYODOROV EYE MICROSURGERY STATE INSTITUTION



The Academician Svyatoslav N. Fyodorov was a prominent ophthalmic surgeon, scientist and public figure, this name is well known all over the world. The main result of his life is the creation of the “Eye Microsurgery” Research and Technology Complex that allows realizing the most daring plans in eye diseases treatment. Now days after the tragic death of the famous ophthalmologist in June 2002 there are a lot of people asking: what is the Clinic now, what is its life and which are its purposes?
     The S.N. Fyodorov Federal State Institution “Eye Microsurgery Complex” is a leading clinical and research ophthalmological center in Russia. Besides the Head Organization in Moscow, including the Research Experimental Production Plant, 11 affiliated branches (Clinics in the largest Russian cities) are integrated to it. The Head Organization realizes coordination of their activities. All the Branches of the Complex show the stability of work. The net of medico-diagnostic centers organized in the distant regions on the basis successfully develops bringing the rendering of the highly specialized aid to all the regions of the Russian Federation.

    The “Eye Microsurgery Complex” is situated in a picturesque district to the North of Moscow City and consists of several buildings which are: policlinics (the out-patients diagnostic building) for daily examinations of 1200 patients; stationary with 10 clinical departments for the main ocular pathologies treatment; Medical Center No. 2 with specialized department for foreign patients treatment and hospitalization, Experimental Technical Production Plant and others.
    The capacity of the S. Fyodorov “Eye Microsurgery Complex” with its Branches is 300 thousand patients treated and 700 thousand patients examined annually. Etionosologic structure of diseases is very multiform and reflects practically the entire ophthalmology. The biggest volume of diseases are the patients with cataract, refractive abnormalities, glaucoma, vitreal, retinal and optic nerve pathology, corneal diseases, various infectious, autoimmune, endocrinologic and oncologic diseases as well as consequences of ocular trauma.

    High functional results and advanced medical techniques determine the permanent influx of the patients not only from the territory of the former USSR, but also from foreign countries. And in 1986 at the “Eye Microsurgery Complex” the specialized department for the foreign patients’ eye treatment was created. Now this department is successfully realizing intensive international collaboration in the field of diagnostics and ocular diseases treatment. For instance, 2.816 patients from different countries received medical treatment during 2005.
     Surgery of cataract and aspects of intraocular correction takes traditionally one of the leading places in the subject-matters of the Institution. The technology of small incision is a dominant technique of cataract surgery. The ultrasound phacoemulsification is a modern method performed through a 2.5 mm self-sealing tunnel incision.
      At the “Eye Microsurgery Complex” a laser unit with a 1.44 mkm wavelength was elaborated providing an effective cataract of any hardness degree removal. A set of devices for laser cataract extraction includes: a Nd:YAG laser unit, an original aspiration irrigation device and a system of joint devices control. 8 543 laser cataract extraction operations were performed during 2005 in Moscow branch and 56 632 in other affiliated clinics of the Complex.
    At the Experimental Technical Production Plant of the “Eye Microsurgery Complex” a range of intraocular lenses is developed using flexible materials (silicone, hydrogel, collagen, polyurethanemetacrylate (FLEX)). The development of spheroprismatic IOLs is a considerable success in vision restoration in patients with age-related macular degeneration.
     The excimer laser technology of high myopia correction created at the “Eye Microsurgery Complex” is remarkable for the owing to a multifocal reprofiling of the cornea which enables to improve the far vision without disturbing the reading and near vision. Five generations of the «Profile» excimer laser ophthalmic unit has been developed here during recent 10 years. More than 27 000 laser refractive procedures have been performed in 2005 in the Complex.
     A problem of efficacy increase in glaucoma surgeries is studied for a long time. The doctors of the Clinic brought up an ischemic theory of open-angle glaucoma pathogenesis that substantiated an expediency of early surgical treatment of glaucoma and allowed to develop pathogenetically oriented glaucoma operations affecting several levels of retention.
      Non-penetrating character of the interventions allows to minimize 7-10 times the risk of complications. At the Clinic the excimer laser technology of non-penetrating deep sclerectomy with use of the device of our own original design (“AGAP”) is developed and widely used providing stabilization of the ophthalmic tonus level in average in 94.7 %.
     Vitreoretinal surgery is an important trend in medical work and scientific research. The essential achievement in this field is the development of our own perfluorcarbon liquid (PFCL) used for the short-term tamponade of the retina. The surgeons of the Clinic developed the methods for intraoperatively induced detachment of the posterior hyaloid in treatment of various forms of diabetic retinopathy and diseases of the central retinal area of various etiology; use of the endoscope in vitreal surgery in retinal detachment treatment complicated by anterior proliferative vitreoretinopathy. In 1997 the Eye Diabetes Center has been created at the Clinic with the task to render the highly specialized surgical aid to the patients suffering from diabetes mellitus of various ocular pathology. Totally nearly 11.000 vitreoretinal operations were performed in 2005 in all Branches of the Complex.
    Questions on restoration of the vision in patients with partial atrophy of the optic nerve take an important place among the problems facing the “Eye Microsurgery Complex”. On the basis of the experimental investigations it was proved that the impact of the alternating physical field on the optic nerve leads to the restoration of its function. A complex method including surgical, therapeutic and medical treatment was created.
    An extensive practical and scientific research work is implemented on the problems of the early diagnostics and treatment of the ophthalmic oncology patients. Depending on the size, character and degree of the tumor growing into the surrounding tissues are developed multiple adequate variants of iridocyclochoroidectomy presenting the effective system of the organ preserving operations in the uveal tract tumors in such cases when the other treatment methods are contraindicated.
    At the “Eye Microsurgery Complex” the problems of keratoprosthetics and keratoplasty are complexly studied. The developed methods allowed decreasing the rejection rate to 7.1 and increasing medico-social rehabilitation of the patients with severe earlier inoperable pathology to 76.4%. The Institute is the main elaborator of the complex of reconstructive operations in corneal transplantation including penetrating keratoplasty, re-keratoplasty, reconstruction of the anterior chamber, reconstruction of the anterior section of the eye, combination of penetrating keratoplasty with IOL implantation, simultaneous implementation of surgical interventions in the posterior section of the eye. Clear graft retention was gained in 96-100% in leukomas of the 1st category; from 71 to 86% in leukomas of the 2nd and 3rd categories. In leukomas of the 4th category clear graft makes 31% that is the highest result in the world ophthalmologic practice. The Eye Bank created at the Clinic being the largest in Europe contributes much to the keratoplasty success as well as the unique technology of immunologic testing of the donor material.
    The total number of operations performed in 2005 is 29 054 (in Moscow Branch), 165 231 - in other Branches of the “Eye Microsurgery Complex”. During 19 years of work (1986-2005) at the “Eye Microsurgery Clinic” (its Head organization in Moscow and in 11 regional Branches) over 4 million people were operated using the newest techniques. Over 14 million patients were examined and underwent medical treatment. Evaluating the level of surgical activity and introducing the newest technologies in the surgical practice the “Eye Microsurgery Complex” takes the leading place among all the ophthalmologic clinics of Russia.
    As for scientific research at the Clinic during recent years (2000-2005) 532 patents for inventions were received, 7 monographs and a Manual on eye diseases for the students of medical universities were published, 49 doctoral dissertations and 135 for the degree of candidate were defended that exceeds the average annual number of the defended theses of the previous period. More than 320 specialists from 30 countries of the world and 3 200 doctors from Russia studied at the post-graduate courses of the clinic. Within the mentioned period the doctors of the clinic participated in 245 national and 63 foreign ophthalmic Symposiums and Conferences. Every year in June ophthalmologists from Russia, ex-USSR and foreign countries take part in annual “Fyodorov Memorial Lectures”.
    The Complex maintains a leading position in the medico-surgical activity both in Moscow and in Russia as a whole. The surgeons of the “Eye Microsurgery Complex” perform over 30% of highly technological ophthalmic surgeries our country. During recent years the quantity of the examined and treated patients and children of the socially non-protected group significantly increased as well as the rate of operations of the highest category of complicacy (85%).

    On January 28, 2002 by the decree of the Government of the Russian Federation the IRTC our Clinic was renamed in memory of its founder. Now its name is “the academician S.N. Fyodorov Federal State Institution “Intersectoral Reseach and Technology Complex “Eye Microsurgery” of Roszdrav”. This is not only the name: this is our credo. Today the Clinic is forwards to moving the further horizons and achievements in the field of ophthalmology. “Eye Microsurgery Complex” is open for collaboration and experience exchanging. It has a colossal scientific, medical and organizational potential aimed at the benefit of the suffering patients that unites the numerous staff of the Institute and its Branches.