Surgical treatment of short-sightedness: the Myth or a reality - what is worse?
The problem of a wide spread of short-sightedness in the world has acquired in post-war decades a number of features and details concerning each region. First of all in a statistical sense and also treatment-and-prophylactic, And the shown picture is not clear: if we are familiar with the sensible approach to fight against the given disorder of sight in the advanced develop countries, in those areas which could be named as the "second" world or even generally accepted "third", the situation lays often in a spontaneous plane. Certainly, the status of the ophthalmologic help has practically everywhere stepped already over a stage of the primitiveness, however existing and principally more or less working modern techniques, tightly acquired by experts here or there, can bring every now and then harm not less than, let us suppose, revived for the same purposes "profile" shaman ritual.
Short-sightedness, in contrast to some other kinds of anomaly of a refraction and functional frustration of sight, is borne more difficult from positions of pure instinctive underlying reason: everyone without exception would like to see afar as more clear as possible. Therefore it is desirable to get rid of it as soon as possible and by all means. To read, write in glasses is still all right and when it is visible nothing in the distance without glasses... All this has led to extremely intensive search of ways as non-admission, and eradications of the given anomaly of refraction during approximately half a century. Very different ways; psychotherapeutic, pharmacotherapy, surgical... It has in turn given wide distribution of all kinds of handicraft healing. However actually very terrible threat can "harbor" at times the true doctor - ophthalmosurgeon armed besides a scalpel with the whole arsenal of techniques, proved, apparently, quite scientifically and firmly. This question merits detailed consideration.
The first techniques of surgical treatment of short-sightedness have been developed and approved in Japan since 1950 of the last century. Keratotomy was carried out - making special incisions on a cornea with the purpose of giving to it of the certain "minus" focal power and, hence, reduction of a degree of short-sightedness. Similar operations have been subsequently widely introduced in the USSR by the well-known Russian surgeon S.N.Fedorov. With development of medical lasers they turned to more modern methods, so-called Eximer-and Lasik-technologies which are carried out by means of change of thickness of the cornea in the assigned pattern. It is necessary to note that similar groups of techniques ground first of all cosmetic operations. That is they can be performed on an eye which short-sightedness is stable and does not progress within at least two years.
Generally speaking, operative correction of short-sightedness has clear borders of application. It is justified in case of significant distinction as vision of eyes/one eye is much weaker than the other one/ "steering" such eyes on application of corrective lenses creates a huge pressure at brain level. Operation can be shown and in case of expressed astigmatism - some kind of deformation, "abnormality" in a structure of a cornea.
Mentioned above, we repeat, "works" only there where any progression is absent. And what is to be done, when it takes place? Is it possible "to think up" such technique which would solve a problem in another case? Short-sightedness arises in fact mostly in childhood. It is preceded with a so-called "spasm of accommodation" that is infringement of ability of an eye to adequate refocusing on different distant subjects. The most complicated complex "starting" mechanism triggers - and short-sightedness starts to develop. It progresses then for years.
At first sight saving technique/surgical/ of sight stabilization by a stop of a progression/and a stop in literal sense/ has been created rather long time ago. It has received the name scleroplasty. Many our fellow citizens, basically children, are probably not by hearsay familiar with its consequences/we do not speak yet, why bitter / on their own experience.
As it has been said, development of short-sightedness represents very uneasy process. Among the reasons of its occurrence dominates excessive visual job at a short distance, a "bad" heredity, etc. At any case everyone says so. However the true source of the given pathology should be considered in a context of the general weakness of the organism provoked by patrimonial traumas, numerous borne viral respiratory infections, infringements on the part of the locomotor apparatus... And more: one if not the most important, underlying reason of such weakness and developments of short-sightedness is dysplasia a connective tissue. This term describes extensive enough group of the specific and genetically caused changes at a histologic level that is simplified speaking, conducts to loss of "quality of manufacturing" of all connective tissue of an organism. And where is it located in the organism? What is "made" of it? These are bones, cartilages, sinews, blood, and lymph.
The connective tissue supports the characteristic form of all viscera and their relative positioning. Perhaps, due to a connective tissue we look externally as it is peculiar to our biological species. The share of a connective tissue among other groups of the specialized tissues comes is equal approximately to 85 %. Sclera is built from the connective tissue, i.e. tunic which actually makes an eye similar to an eye. Its anterior region is transparent and known to us under the name of cornea. According to conception of physics an eye as the body filled with unsteady contents and contained in the flexible tunic, should theoretically aspire to accept spherical form. Will it manage to do this if this flexible tunic "does not hold"? Especially as relative change of norm of an eyeball alongside with accommodative function of a crystalline lens lays in a physiological basis of the visual act? 3 pairs of oculomotorius muscles and ciliary muscle surrounding a crystalline lens are engaged with it.
It is necessary to emphasize once again that the phenomena of displasia of a connective tissue are distributed to all organism without exception by virtue of infringement of structure of collagen /basic protein of its structure/. Why is a person not only short-sighted, he is also stooping and his viscera eventually can break localization/ nephroptosis, for example/ what, naturally, will not promote their full-value functioning.
The eye made by the nature with use of poor-quality materials at constant and significant stresses is deformed steadily; the eyeball is extended, being stretched. And - "so it remains". Most of all its posterior part suffers. As a consequence is infringement of function of a retina. And short-sightedness progresses... What to do?
Here on a stage an abstract ophthalmosurgeon with a knife in a hand appears. So who is he a savior or on the contrary, an embodiment of such gloomy but scientifically supported idea? And why?
Scleroplasty represents rather extensive sphere of techniques. But all over again we shall understand: what can the mentioned surgeon make with an eye?
The eye is anatomically combined with a number of the major structures. Being in the eye-socket formed by corresponding bones of a skull, it looks actually like an eyeball, fatty tissue, located behind it and carrying out amortization functions, fascia, muscles, blood vessels and a nerve.
At posterior pole of eyeball the surface of fatty tissue is covered with the special fascia/by the way, also consisting of a connective tissue/, having the name Tenon's fascia. It begins at a posterior pole of an eye, goes in the tunic surrounding an optic nerve and, covering an eyeball, reaches practically its equator. All this is morphologically as a matter of fact a bag also having the name Tenon's bursa. It suspends an eye in an eye-socket, keeping it in the certain position and not interfering thus movements in the planes set by the nature. Between Tenon's fascia and sclera is Tenon's space in which the loose tissue with a liquid is located, for greasing to reduce friction at movements of eyes. Oculomotorius muscles are closely combined with fascia. This entire "device" - the eyeball in Tenon's capsule together with muscles represents the ingenious invention of nature. That model of organ of vision that is peculiar to mammals and human being, is completely adapted to binocular vision, and, hence, absolutely objective perception of depth of space, relief, distances.
But we shall return to essence of scleroplastic operation. So, in one cases the special bandage is put in on the back, the thinnest site of sclera in a circumference of an outlet of an optic nerve. In other cases an equatorial zone is strengthened. Sometimes sclera is incised on half of its thickness, creating, thus, tunnels for the subsequent introduction here bands of strengthening tissues. There are besides other, techniques of introduction under Tenon's capsule in a posterior-external part of an eye of liquid polymers which becomes subsequently denser. Practice has revealed the most dangerous complication arising as a result of application of techniques - squeezing of an optic nerve by the stiffened polymer, rough infringement of its functioning with the subsequent atrophy and loss of sight.
Under other kinds of scleroplastic operations complications are rare at all. Inflammatory diseases of eyes, increase of intraocular pressure, detachment of retina, infringements of coordination of eye muscles functioning occur. In fact the essence of scleroplasty is at any price to not give an eyeball to be stretched, that is to remove mechanically "the basic condition" of short-sightedness progressing. If everything was so simply...
For some reason short-sightedness does not leave anywhere, the progression proceeds. Our abstract ophthalmosurgeon makes a helpless gesture: operation turned out to be inefficient. And he as the expert cannot do anything more. Then he counts the money laid out by you, hides them in a pocket and disappears.
There is a natural question: what is to be done? This is the question set to himself not only by the patient, but also the doctor understanding an inconsistency of an event.
We have not casually touched the phenomenon of displasia of connective tissue and, as its consequence, congenital weakness of sclera. Let us imagine a balloon filled with water. If it is compressed in any plane, trying to give the set form it will be certainly deformed in another one. Approximately in the same way artificially strengthened sclera will behave.
As usual, the first absurdity of scleroplasty has been realized abroad. In those advanced countries of the Western Europe that we recently visited on working trip, the problem is solved completely in another way. For example, German ophthalmologists have been shocked, having found out a present degree of distribution of scleroplastic operations in the CIS countries and in Ukraine, in particular. Only in Crimea scleroplasty is performed in Simferopol, and in Sevastopol - with high intensity. While the Western world has practically completely refused similar interventions, In our country they are performed almost stream-handling. Why? We have in fact not casually represented the hypothetical surgeon counting your hard-earned money. Plus "hospital" charges familiar to all: medicines, nutrition etc. So the further is silence.
Our advice - if someone from a circle of your familiar, your child will be recommend to perform scleroplastic operation, do not hurry. Think properly. The eye touched by a surgical knife always differs from an eye which the knife did not touch. Of course the range of the problems connected with sight, is extremely wide, and some from them are unequivocally solved by means of a scalpel. But never run to unnecessary extreme measures!
What is the alternative?
In many cases it is necessary to admit an idea on a role compensatory biological mechanisms that will help to stop a progression and to stabilize sight at any level, it is necessary to initiate and direct them according to modern conception of dasplasia of a connective tissue, about collagenoses and the complex treatment connected with them which actually gives quite good results. It is based on correction of nourishment, a putting in order element/chemical/ composition of an organism, on supporting flexible pharmacotherapy, and, at last, on optic-physiological hardware treatment which value is hardly started to estimate in our country. That is: having improved quality of a connective tissue of sclera and gradually, carefully, we accustom an eye to correct, from the point of view of physiology, visual work. The progression of short-sightedness is slowed down, disappears. Sight is stabilized for all life without application of a "miracle" scalpel. I want to pay attention of everyone, sight is stabilized, but short-sightedness remains. Then there comes a stage of fastening of the received result.
On similar principles the work of created by us in 1991 the Crimean Republic Center of vision rehabilitation is based. As all history of the Center possessed of very interesting and effective equipment shows that they justify themselves completely.
In conditions of the insurance medicine constructed on an industrial basis as it takes place in the world, anybody from experts will never go on application of disputable, inefficient techniques, like scleroplasty. In fact its unsuccessful outcome threatens to the surgeon with court and removal from professional occupation.
The model of the modern organization of the ophthalmologic help to children is for a long time embodied in the Center of vision rehabilitation. Therefore it is especially bitter to understand till now our "uniqueness", loneliness in the country aspiring to the civilized world community.
Leonid Konstantinovich Dembsky,
the doctor of medical sciences,
director of the Crimean Republic Center of vision rehabilitation
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