Eye Microsurgery Federal State Institution Research Articles

EFFICACY OF THE INDICATORS IN THE SYSTEM OF INTERNAL CONTROL AND MANAGEMENT OF THE QUALITY AND SAFETY OF MEDICAL ACTIVITY IN S. FYODOROV EYE MICROSURGERY FEDERAL STATE INSTITUTION

The purpose of the study was to evaluate the efficacy of quality indicators in the system of internal control and management of ophthalmic activities at S. Fyodorov Eye Microsurgery Federal State Institution (Institution). Material and methods. The values of quality indicators were determined and compared in dynamics over the last 5 years of the Institution (indicators of structure, indicators of technological processes, and indicators of results). The actual values of the indicators are calculated using statistical data of accounting principles on the structure, medical processes and results achieved. Target values were established on clinical recommendations results of best practices, based on the introduction of modern technologies in medicine. Results. Analysis of changes in the indicators of structure reflects a positive dynamics of realization of the potential of the Institution medical-industrial activity (over a 5 years period reduced staff turnover, increased the number of doctors and medical sisters having certification category). Indicators of medical technological processes demonstrate the stable increase of the technological level of the Institution (the proportion of implantation of toric multifocal intraocular lenses, microinvasive endovitreal interventions 25–27 G, femtosecond stages of corneal and cataract surgery were introduced). After the comparative analysis of target and actual indicators of the result, the dynamics of indicators over 5 years was evaluated and showed their growth. Conclusion. The effectiveness of quality control and safety of medical assistance in the Institution with the use of dynamic assessment system and analysis of indicators has been proven by the increase in the quantitative-qualitative indicators of health activity for the last 5 years.

ANALYSIS OF SELECTIVE LASER TRABECULOPLASTY EFFECTIVENESS

Purpose of the study was to investigate the effectiveness of selective laser trabeculoplasty (SLT) in various forms of glaucoma, in the initial, advanced and far-advanced stages of the disease. Material and methods . An analysis of the effectiveness of the treatment of 132 eyes (132 patients), who were examined and treated in the department of glaucoma diagnostics and treatment of Ekaterinburg Center of Eye Microsurgery Federal State Institution, has been performed from 2016 to 2018. The study included a group of patients with primary open-angle, pseudoexfoliation, pigment, and combined forms of glaucoma previously not operated. Laser iridotomy was previously performed in patients with pigmented and combined glaucoma. The efficacy of SLT was assessed by the level of intraocular pressure (IOP) before SLT, after three days, 1, 6 and 12 months, using the perimetric MD index and according to the need for repeated surgical interventions during the observation period. Results. By the end of the observation period after SLT in patients with initial glaucoma IOP decreased by 5.1 mm Hg (by 20.7 %), with advanced glaucoma – by 6.3 mm Hg (by 25.7 %), with far-advanced glaucoma – by 6.8 mm Hg (by 31 %) compared to baseline values. Analysis of SLT effectiveness depending on the form of the disease showed that 12 months after surgery IOP in patients with primary open-angle glaucoma decreased by 5.5 ± 1.32 mm Hg (23 %) compared with baseline figures, and in patients with combined glaucoma – by 5.5 ± 1, 5 mm Hg (22.8 %). In the follow-up period from 6 to 12 months after SLT, 88 % of patients with pseudoexfoliation glaucoma, 64 % of patients with pigmentary glaucoma and 34 % of patients with combined glaucoma underwent non-penetrating deep sclerectomy, 15 % of patients with primary open-angle glaucoma underwent repeated SLT. Conclusion. SLT is the safe and effective method of glaucoma treating. In all forms and stages of glaucoma, target IOP was obtained, as evidenced by stabilization of retinal sensitivity by automated perimetry, but the hypotensive effect after SLT in patients with pseudoexfoliation glaucoma and pigmentary glaucoma lasted less than 1 year.

Эндофтальмиты после катарактальной хирургии в Чебоксарском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

Эндофтальмиты после катарактальной хирургии в Чебоксарском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

Методология развития телемедицинских и информационных систем ФГАУ «МНТК «Микрохирургия глаза» им. акад. С. Н. Фёдорова» Минздрава России на примере Новосибирского филиала

The article summarizes the experience in the development of information technology and telemedicine at the Novosibirsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution within an improvement of the administrative-management, medical-diagnostic and scientific-educational activities. The article presents ways to improve their use in accordance with the approved decisions on the telemedicine development in the Russian Federation.

Организация работы и возможности повышения пропускной способности диагностического отделения Хабаровского филиала ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России

Организация работы и возможности повышения пропускной способности диагностического отделения Хабаровского филиала ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России

A DIFFERENTIATED APPROACH TO ENERGY PHACOFRAGMENTATION IN AGE-RELATED CATARACTS SURGERY

Aim. Analysis of complications arising in the process of fragmentation of the lens nucleus, by various methods the energy of the impact in the surgical treatment of age-related cataracts. Material and methods. The study included 550 patients (677 eyes) operated for cataract in the period from 2015 to 2017 in the Krasnodar branch of the S. Fedorov Eye Microsurgery Federal State Institution. According to the method of energy crushing of the lens nucleus, all patients were divided into 3 groups. For group 1 – ultrasound technology (bimanual phacoemulsification of cataract (FCE) was used; for group 2 – Nd: YAG-laser with a wavelength of 1,44 μm technology of laser cataract extraction (LCE) was used; group 3 – infrared femtosecond laser technology (femtosecond laser support phacoemulsification (FFCE) was used. Results. When using FFCE minimum percentage of complications in comparison with the FCE and LCE in cases of uncomplicated age-related cataracts was observed. In has been proved that in the presence of complicated cataracts, combined with a defect or weakness of the ligamentous apparatus of the lens, a pronounced syndrome, irido-ciliary dystrophy (IFIS-syndrome), bad expanding pupil; as well as in cataract with high degrees of density of nuclei, and in agitated patients, both FCE and LCЕ can be used. In our opinion LCE is preferable. Conclusion. Differentiated approach to the choice of the optimal method of phacofragmentation results in minimum intra – and postoperative complications, as well as better outcome for the patients.

Система управления эффективностью и качеством медицинской помощи в ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России

The system of management in efficiency and quality of medical care, developed at the S. Fyodorov Eye Microsurgery Federal State Institution, provides a constant growth of quantitative and qualitative indicators of the medical activities of the Institution that ensures for patients receive high-quality ophthalmic care services. The developed organizational and methodological principles of management in efficacy and a quality of medical care, methods of audit, a reasoned approach to the organization and remuneration of medical staff may be useful in the practice of health care facilities of ophthalmic profile and other specialized areas of medicine.

The S. Fyodorov Eye Microsurgery Federal State Institution – a national heritage

The S. Fyodorov Eye Microsurgery Federal State Institution – a national heritage

Роль лечебного контроля в повышении качества оказания медицинской помощи в Хабаровском филиале ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России

Purpose. Analysis of the quality of a medical ophthalmic care (QMOC), provided to patients at the Branch from 2010 to 2014. Material and methods . Evaluation of the QMOC was carried out on continuous selection of inpatients and outpatients for the period 2010-2014. Two basic components of clinical outcomes were assessed: the technology of treatment and functional results. The total quantity of the studied patients was 115394 persons. The assessment of quality in maintaining medical documentation was performed in the analysis of 106347 medical anamnesis and files of the patients who finished treatment at the Branch during 2010-2014. The patients’ satisfaction with QMOC was checked by an anonymous questionnaire using the assessment scale. Results. The maximum clinical outcome (10 or 12 points) was achieved in the treatment process in the vast majority of patients (98.8%). The deviation from a standard of clinical result of treatment took place in 1.2% of cases. The review and analysis of the causes of deviations of the clinical outcome of treatment from the standard allowed significantly to reduce the quantity of complications within the postoperative follow-up period – 1.7 times. A systematic analysis of completeness of diagnostic examination, adequately chosen treatment allowed to reduce the number of complications in the postoperative period in 2 times. Analysis of all types of defects in maintaining primary medical documentation allowed to decrease them during 2010-2014 in 1.5 times. Despite the available defects, in general the QMOC was always highly evaluated by all categories of respondents and was fluctuated from 98.8% to 100%. Conclusion. The system of an assessment of clinical result of treatment of patients applied at the Branch and developed at the S. Fyodorov Eye Microsurgery Federal State Institution allows to reveal effectively defects of diagnostic examination and disturbance of technology in the treatment. Its use, according to the analysis for the period 2010-2014, allowed to reduce the frequency intra- and post-operative complications twice.

Эффективность брахитерапии при ретинобластоме

Purpose. To assess the tumor control and complications of ruthenium 106 (Ru-106) and strontium 90 (Sr-90) plaques radiotherapy for retinoblastoma. Material and methods. The study included 60 children with retinoblastoma who were treated in the Ocular Oncology and Radiology Service at the S. Fyodorov Eye Microsurgery Federal State Institution with plague radiotherapy between 2006 and 2015. The mean patient age at the plaque treatment was 22 months (from 5 to 74 months). Prior this treatment the management of the retinoblastoma was carried out in one hundred tumors (92% of cases) and included various combinations of treatments such as systemic and/or local chemotherapy, external beam radiotherapy, laser coagulation, thermotherapy and cryotherapy. Five retinoblastomas (8%) were managed by plaque radiotherapy without any previous treatment. The Ru-106 plaques were used in 68.5% of cases (72 tumor foci) and the Sr-90 plaques – in 31.5% of cases (33 tumors). The mean doses to the tumor apex were 89 Gy for Ru-106 and 190 Gy for Sr-90 plaques, and to the tumor base were 348 Gy for Ru-106 and 757 Gy for Sr-90 plaques. Results. A complete tumor control was achieved in 87% of cases during a mean follow-up of 3.5 months. The failures after the plaque radiotherapy in 11% of cases were controlled with the thermotherapy and in 6% of cases with the repeated plaque radiotherapy. Radiation complications included nonproliferative retinopathy in 19% of cases, proliferative retinopathy – 4%, papillopathy – 11%, retinal detachment – 2%, vitreous hemorrhage – 18%, cataract – 3%, glaucoma and scleral necrosis – 0%. The mean follow-up period was 27 months (from 2 to 72 months). Conclusion. Plaque radiotherapy should be considered as an important and effective option for retinoblastoma, especially in resistant and recurrent tumors after a failure of other methods to achieve the tumor control. Complications such as radiation retinopathy and papillopathy, vitreous hemorrhage and retinal detachment should be anticipated, depending on the location, size of the tumor and previous treatment.

Results of surgical and radiation treatment of conjunctival melanoma

Objective – analysis of the results of surgical and conservative treatment of conjunctival melanoma (CM) on the basis of our own experience. Materials and methods. Retrospective analysis of 25 patients with CM treated with surgery and/or Sr-90-brachytherapy in Ocular Oncology Service of S.N. Fyodorov Eye Microsurgery Federal State Institution. Clinical and histological features and treatment outcomes were analyzed. Results. Patients mean age was 57.15 years (from 20 to 82). In 9 cases CM arose from acquired melanosis (primary — 8, secondary — 1). In 15 cases tumor involved limbus, in 14 — cornea, in 24 cases — bulbar conjunctiva, in 8 — fornices and in 7 — tarsal conjunctiva. Maximum tumor thickness was up to 28 mm. Ten patients were treated with excisional biopsy (including CO2 -laser or radiosurgery), 4 — with excisional biopsy with subsequent Sr-90-brachytherapy, 8 — with brachytherapy alone with mean irradiation dose 150 Gy to a depth of 1.5–3.0mm, in 1 patient orbital periosteal exenteration was fulfilled and in 2 patients extended enucleation was performed. Seven excised tumors were epithelioid cell, 5 — spindle cell, 5 — mixed cell type. The follow-up was from 3 to 114 months (mean 25 months). Local control was achieved in 21 cases, 1 recurrence was after surgery and 3 after irradiation, all the recurrences were in patients with acquired melanosis, 3 recurrences were successfully treated, one led to exenteration. No recurrences were diagnosed after surgery combined with brachytherapy. One patient had preauricular limph nodes metastasis. Two patients died because of metastasis. No complications were diagnosed after Sr-90-irradiation. Patients underwent extended enucleation are followed up 4 and 22 months with no features of recurrences. Conclusion. Excisional biopsy especially combining with Sr-90-brachytherapy is a well-tolerated and effective therapy. Larger groups of patient are required for further analysis.

Posterior chamber phakic intraocular lens sizing based on iris pigment layer measurements by anterior segment optical coherence tomography

To use anterior segment optical coherence tomography (AS-OCT) to evaluate the clinical effectiveness of Implantable Collamer Lens posterior chamber phakic intraocular lens (PC pIOL) sizing based on measurement of the distance from the iris pigment end to the iris pigment end. S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia. Evaluation of diagnostic test or technology. Stage 1 was a prospective study. The sulcus-to-sulcus (STS) distance was measured using ultrasound biomicroscopy (UBM) (Vumax 2), and the distance from iris pigment end to iris pigment end was assessed using a proposed AS-OCT algorithm. Part 2 used retrospective data from patients after implantation of a PC pIOL with the size selected according to AS-OCT (Visante) measurements of the distance from iris pigment end to iris pigment end. The PC pIOL vault was measured by AS-OCT, and adverse events were assessed. Stage 1 comprised 32 eyes of 32 myopic patients (mean age 28.4 years ± 6.3 [SD]; mean spherical equivalent [SE] -13.11 ± 4.28 diopters [D]). Stage 2 comprised 29 eyes of 16 patients (mean age 27.7 ± 4.7 years; mean SE -16.55 ± 3.65 D). The mean STS distance (12.35 ± 0.47 mm) was similar to the mean distance from iris pigment end to iris pigment end distance (examiner 1: 12.36 ± 0.51 mm; examiner 2: 12.37 ± 0.53 mm). The PC pIOL sized using the new AS-OCT algorithm had a mean vault of 0.53 ± 0.18 mm and did not produce adverse events during the 12-month follow-up. In 16 of 29 eyes, the PC pIOL vault was within an optimum interval (0.35 to 0.70 mm). The new measurement algorithm can be effectively used for PC pIOL sizing. No author has a financial or proprietary interest in any material or method mentioned.