Как попасть сейчас на прием в глазную больницу? Проводятся ли операции по лазерной коррекции зрения? Куда идти с ячменем или травмой глаза? На эти и многие другие вопросы News.Ykt.Ru ответили врачи Якутской республиканской офтальмологической больницы.
Офтальмологическая больница на улице Свердлова, 15 возобновила работу еще 1 сентября. Каждый день врачи-офтальмологи принимают примерно по 60 пациентов, и это не считая тех, кто приходит повторно, рассказала старший регистратор Наталья Свищ.
Как попасть сейчас, во время пандемии, на прием в больницу? Нужно сначала пойти в свою поликлинику к офтальмологу. Если врач решит, что нужна помощь коллег, он отправит электронное направление в глазную больницу. В регистратуре его проверят, выберут дату и время приема и позвонят пациенту.
Чаще всего в больницу направляют больных с катарактой, глаукомой, отслоением сетчатки и другими заболеваниями.
«Мы принимаем пациентов точно по времени, как видите — очередей нет, — рассказала News.Ykt.Ru заведующая клинико-диагностическим отделением Валерия Аржакова. — Стараемся, чтобы пациенты по минимуму контактировали друг с другом».
Многие больные ждали открытия больницы еще с весны. Летом планового приема не было, работал только пункт неотложной помощи. «У меня катаракта. Весной должны были сделать операцию, но из-за пандемии я не успела попасть к врачам, — рассказала пациентка Гелия Корнилова. — Ждала полгода. Вчера мне позвонили из регистратуры, пригласили на прием. Нравится, что здесь работают грамотные врачи, много современной аппаратуры. Мы могли только мечтать о таком в советское время».
Каждый первичный пациент сначала идет в кабинет медсестры. Ему проводят проверку зрения, измеряют внутриглазное давление, проверяют поле зрения. Затем больного принимает один из шести врачей-офтальмологов клинико-диагностического отделения.
Как правило, люди проходят полное диагностическое обследование за один день. «Это очень удобно для пациентов. Им не нужно приходить в больницу несколько раз», — отмечает заведующая Валерия Аржакова.
Чем опасна глаукома и как ее выявить
Глаукома — одна из самых частых причин обращения якутян в офтальмологическую больницу. Эта прогрессирующая болезнь опасна тем, что она приводит к слепоте, если вовремя ее не выявить.
«В группе риска — люди старше 60 лет, те, кто страдает от близорукости или гипертонической болезни, пациенты с травмами глаза, а также те, кто не придерживается здорового образа жизни — курит и употребляет алкоголь. Также обследования после 45 лет нужно проходить людям, чьи родственники страдают от глаукомы», — рассказала врач-офтальмолог Евгения Никифорова. Она работает в офтальмологической больнице с 2011 года.
По словам врача, на первых двух стадиях у больных глаукомой нет симптомов. «Жалобы появляются только на третьей стадии, когда сужаются границы поля зрения. В таких случаях мы сразу готовим больных к операции, поскольку при третьей стадии велик риск потери зрения».
Чтобы вовремя выявить болезнь, пожилым людям нужно ежегодно проходить обследование у окулиста с осмотром глазного дна, исследованием поля зрения и измерением внутриглазного давления. «Диагностировать начальную стадию глаукомы достаточно сложно, поэтому при подозрении на глаукому врач в поликлинике направляет больного в нашу больницу на дополнительное обследование», — сказала Евгения Никифорова.
В Якутии распространена закрытоугольная форма глаукомы, объясняет врач. Болезнь протекает молниеносно: у больного возникает острый приступ глаукомы. Основные симптомы — резкая потеря зрения, сильные головные боли со стороны больного глаза.
В отличие от глаукомы катаракта — заболевание с намного более благоприятным исходом. При катаракте постепенно снижается зрение и мутнеет хрусталик глаза. В офтальмологической больнице проводят операции по замене мутного хрусталика на искусственный.
О лазерной коррекции зрения: цена, требования и противопоказания
Врачи офтальмологической больницы проводят операции по лазерной коррекции зрения с 2012 года. В первые годы коррекцию делали бесплатно. Тогда ежегодно выполнялось около 600-700 операций. Сейчас улучшить зрение с помощью рефракционной хирургии можно только платно. Стоимость операции — 64 800 рублей. Как говорят офтальмологи, очереди практически нет, можно спокойно записаться по телефону на консультацию.
«В нашей больнице применяются две методики исправления зрения — фемтолазерная (Femto Lasik) и ФРК (фоторефракционная кератэктомия), — объясняет врач-офтальмолог клинико-диагностического отделения Туйаара Исаева. — ФРК требует дополнительно послеоперационного контроля, поэтому сейчас, во время пандемии, мы используем только Femto Lasik. Это самая современная методика лазерной коррекции зрения, которая проводится без использования дополнительных механических инструментов. Благодаря этому пациенты восстанавливаются в максимально короткие сроки. Уже назавтра после операции они могут приступить к работе».
На лазерную коррекцию зрения могут записаться якутяне от 18 до 45 лет. Но врачи советуют делать операцию после 22 лет. «Человеческий глаз может расти до 22 лет, из-за этого его рефракция (проще говоря, сколько диоптрий у человека зрение — от ред.) может быть нестабильна. Но мы рассматриваем каждый случай индивидуально. Обращается много выпускников школ, которые хотят поступить в вузы, где требуется идеальное зрение. Если у молодого человека нет противопоказаний, мы готовы провести операцию».
Среди основных противопоказаний к операции врачи называют тонкую роговицу, амблиопию («ленивый глаз»), воспалительные и другие заболевания.
Как попасть на консультацию, чтобы понять, могут ли вам сделать лазерную коррекцию зрения? Сначала нужно записаться по телефону. На прием необходимо прийти с результатом анализа на COVID-19. Во время осмотра пациенту проведут первичную диагностику и скажут, нет ли у него противопоказаний к операции.
Сама операция длится 10 минут. Пациент выписывается в тот же день и уже назавтра может пойти на работу.
Регистратура по общим вопросам и записи детей: 22-53-57, 500-707, 8(961)869-43-43. Регистратура по вопросам лазерной коррекции, а также платных услуг: 22-64-20, 8(914)271-54-08.
Один из самых частых вопросов у тех, кто хочет пойти на операцию: насколько долгим будет эффект, не испортится ли потом зрение? «Зрение после операции улучшается, но нет гарантий, что у человека всегда будет стопроцентное зрение. Он может испортить себе его, если будет сильно нагружать глаза или проводить много времени за компьютером. Также нужно учитывать естественные возрастные изменения», — пояснила Туйаара Исаева.
«К основным осложнениям после лазерной коррекции зрения относят кератиты, воспалительные процессы, помутнение роговицы. В нашей больнице за восемь лет после операций ни разу не было таких кардинальных осложнений», — говорит заведующая стационарным отделением, главный внештатный офтальмолог министерства здравоохранения Якутии Екатерина Захарова.
Стационар: 60% больных — из улусов
В республиканскую офтальмологическую больницу направляют пациентов со всей республики. Около 60% больных — из районов, 40% — из Якутска. В стационаре мы встретили нескольких пациентов — из Нерюнгринского района, Чурапчинского и Эвено-Бытантайского улусов. Всего в дневном стационаре было 18 пациентов, в общем — 25 (во вторник, 20 октября, — от ред.).
У офтальмологической больницы есть филиалы в Нюрбе, Нерюнгри, Сунтаре, Чульмане, Ленске, Верхнеколымске. Скоро появится еще один в Олекминске. Эти филиалы являются первичным звеном, на операции пациентов направляют в Якутск. В скором времени ситуация может измениться: операции начнут проводить также в филиале в Нерюнгри.
Пациенты лежат в палатах поодиночке, чтобы не контактировать друг с другом. В каждой палате есть отдельный туалет.
«Я из Эвено-Бытантайского улуса. В конце лета сходил к фельдшеру, она сказала, что у меня глаукома и нужно срочно ехать в Якутск. В сентябре сдавал анализы, сейчас вот прошла операция, жду выписку», — рассказал мужчина.
Еще один пациент стационара тоже приехал из Эвено-Бытантайского улуса. «У меня катаракта. Сегодня сделали операцию, завтра выписываюсь. Зрение стало лучше. Спасибо врачам», — говорит Иннокентий Васильев.
Сегодня из стационара выписывается пациентка из Нерюнгри. «Положили вчера с катарактой, сделали операцию. Все очень оперативно. Другое дело, что мне не смогли вовремя помочь в Нерюнгри. Я обращалась к нерюнгринским врачам еще в августе, просила направить в Якутск, но они так и не дали направление. Тогда я сама приехала в Якутск и пошла в Медцентр. Они подтвердили мои опасения, что операцию откладывать нельзя, сразу же направили в офтальмологическую больницу. К счастью, все обошлось», — рассказала Елена Анисимова.
В основном люди жалуются, что перед операцией им приходилось бегать сразу по нескольким разным клиникам и сдавать анализы. Главный врач офтальмологической больницы Иван Луцкан объясняет, что с 12 октября все предоперационные анализы можно сдать в больнице.
«Как только мы выявили эту проблему, сразу же начали решать ее, — говорит Иван Луцкан. — Во-первых, сократили до минимума количество требуемых анализов. Во-вторых, сделали так, чтобы пациенты могли сдавать все анализы, включая COVID-19, в нашей больнице. Мы заключили договор с Республиканской больницей №3, сейчас направляем анализы туда. Выделили процедурный кабинет, нашли медсестру — в общем, организовали весь процесс. Я всегда говорю коллегам: поставьте себя на место пациента, подумайте, через что ему пришлось пройти, чтобы попасть на операцию. Нужно максимально облегчить этот процесс. Записался, пришел на прием, если есть показания — сдал анализы и лег на операцию».
В больнице и подготовка, и сама операция занимают совсем немного времени. Пациенты приезжают, проходят в первый день обследование, а на следующий день идут в операционную. После операции они выписываются в тот же день или назавтра.
Заведующая стационаром: «Мы учимся работать и жить в новых условиях»
Всего в стационаре развернуто 105 коек, работают 12 офтальмологов.
Как объясняет заведующая стационарным отделением, главный внештатный офтальмолог Минздрава Якутии Екатерина Захарова, сейчас стационар работает в полном объеме и никому не отказывает в помощи. Хирурги оперируют больных с катарактой, глаукомой, отслоением сетчатки и другими заболеваниями.
Заведующая стационарным отделением, главный внештатный офтальмолог Минздрава Якутии Екатерина Захарова.
«Больница постоянно осваивает новые методики и технологии для оказания высокоспециализированной медицинской помощи, — говорит Екатерина Захарова. — Для этого у нас есть все необходимые расходные материалы и дорогостоящее оборудование. Например, наши хирурги удаляют катаракту методом факоэмульсификации (микрохирургический метод удаления катаракты — от ред.): выполняют разрез шириной всего два миллиметра. Это позволяет пациентам очень быстро восстанавливаться. Им не нужно долго находиться в стационаре, как было раньше».
Врачи больницы активно используют оптические когерентные томографы (нужны для получения двух- и трехмерных изображений сетчатки и диска зрительного нерва — от ред.). Они позволяют диагностировать заболевания сетчатки на ранних этапах, когда человеку еще можно сохранить зрение.
В этом году был внедрен хирургический метод с применением высокоочищенной плазмы — ICP. «Если объяснить простыми словами, плазма используется в качестве своеобразного клея при отслойке сетчатки. Эта методика лечения — одно из новых направлений в российской офтальмологии».
Кроме того, в 2020 году больница закупила новые аппараты, которые позволяют проводить операции больным с катарактой максимально щадящим образом и избежать отеков роговицы.
Говоря о пандемии, Екатерина Захарова отмечает, что COVID-19 не обошел больницу и некоторые сотрудники уже переболели коронавирусом. «Мы учимся работать и жить в новых условиях. Это, конечно, непросто. Тяжело даже просто ходить всю смену в средствах индивидуальной защиты. Но к этому нужно привыкнуть. Для нас важнее всего, чтобы не пострадали наши пациенты. Поэтому сейчас мы стараемся охватить как можно больше пациентов. Глаз — очень тонкая и нежная структура. Если вовремя не оказать помощь, человек может навсегда лишиться зрения».
Хирурги: «Если ювелир совершит ошибку, то он просто испортит камень, а если ошибемся мы, то человек может потерять зрение»
В стационаре работают как начинающие, так и опытные врачи, добившиеся звания заслуженных. Один из самых опытных специалистов больницы — заслуженный врач Любовь Внукова. Она работает в Якутской офтальмологической больнице с 1984 года и проводит по 700-800 операций в год.
Операционная
«Для хирурга любая операция — большая ответственность, — говорит Любовь Внукова. — Самые непростые — операции шестой степени сложности. К ним относятся операции пациентам с заболеваниями стекловидного тела и сетчатки. Чтобы вы поняли, насколько это сложно, приведу лишь один факт: сетчатка глаза тоньше полумиллиметра. Оперировать на сетчатке — ювелирная работа. Причем если ювелир совершит ошибку, то он просто испортит камень, а если ошибемся мы, то человек может потерять зрение».
Любовь Евгеньевна считает, что для хирурга очень важно, чтобы пациент отнесся к врачу с доверием. «Всегда нужно говорить с пациентами, рассказывать им о прогнозе и возможных осложнениях. И если ты вызвала у пациента доверие, сложнее всего, конечно, оправдать его. Как видите, любую ступень нашей работы — от общения с пациентами, оформления бумаг и до операции — можно назвать сложной и ответственной».
Вместе с Любовью Внуковой работает врач-офтальмолог Елизавета Карпова. Она устроилась в больницу год назад. «Я выбрала офтальмологию во многом благодаря моему преподавателю в Мединституте — Тамаре Романовне. Глаз — очень красивый орган, при микроскопии он выглядит как отдельная планета. Позже я стала больше узнавать про микрохирургические операции, очень вдохновилась, узнав, как они проводятся, и тогда же решила стать офтальмологом. Люблю свою работу за общение с пациентами», — рассказала Елизавета.
В больнице также принимают детей
С 12 октября в больнице возобновился прием детей. «Мы разделили потоки взрослых и детей, — говорит Иван Луцкан. — Дети приходят после 13 часов. Они заходят в здание через отдельный вход, у них своя раздевалка».
Чаще всего в больницу приводят детей с астигматизмом, миопией (близорукостью) и амблиопией (синдром ленивого глаза). Медсестра детского приема Ольга Федорова с воодушевлением рассказывает о гордости больницы — кабинете аппаратного лечения. Здесь есть специальные аппараты для улучшения зрения у детей с близорукостью и «ленивым глазом».
«Дети ходят на занятия с большой радостью, — рассказала Ольга Федорова. — Аппараты новые, современные. Многие наши маленькие пациенты с нетерпением ждали, когда больница снова откроется».
Травмы, ожоги, конъюнктивит, ячмень: пункт неотложной помощи на улице Стадухина
С травмами и ожогами глаз нужно сразу ехать в пункт неотложной офтальмологической помощи на улице Стадухина, 84. Он работает круглосуточно. Здесь есть процедурная и операционный кабинет: неотложную помощь могут оказать прямо на месте.
«Чаще всего люди приходят с жалобами, что в глаз попало инородное тело. Летом травм намного больше. Обычно это травмы, полученные при сварке или во время строительных работ», — сказала регистратор Анастасия Дегтярева.
Каждый день в «неотложку» обращается до 90-100 человек. Принимают как детей, так и взрослых. В час дня, когда мы приехали в пункт, здесь уже успели помочь с утра 40 горожанам.
Многие обращаются в пункт из-за ячменя или острого конъюнктивита, увеита, кератита. Врачи и медсестры также оказывают им помощь.
В будущем больница будет расширять перечень услуг. Уже до конца года хирурги начнут проводить операции по блефаропластике. По словам главврача, стоимость операции будет ниже, чем в платных клиниках.
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Фото: Вадим Скрябин
Автор: Мария Алексеева
Источник: News.Ykt.Ru
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