Ernst Muldashev, world famous medical scholar, director of the All-Russian Center for Eye Surgery and Regeneration Medicine, was an organizer of four scientific expeditions to the Himalayas and Tibet. This book tells about the sensational results of these. Convert currency. Add to Basket. Book Description Izdatel'skii Dom "Neva", Condition: New.

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In North America, management of glaucoma includes observation, medical therapy, laser surgery, and ab-externa ocular surgery. This unique biomaterial has been documented in Russian literature not only to lower intraocular pressure IOP but also to have the potential to induce normal tissue regeneration allowing for restoration of normal eye physiology , decrease inflammatory response, prevent or minimize scarring, and stimulate regeneration of natural host tissues.

LH is a year-old native Russian woman who presented to our office for cataract surgery evaluation. Her ocular history was significant for glaucoma, cataract in both eyes OU [ocular unitas] , and age-related macular degeneration. The ocular surgical history was significant for Alloplant [1] Figure 1 sponge implants in the right eye OD [oculus dexter]. She is currently instilling Xalatan and Azopt in the left eye OS [oculus sinister].

She reported compliance with her ocular medications. Various Alloplant biomaterials for ophthalmic surgery. The right pupil was irregular and minimally reactive.

The left pupil was mid-dilated and nonreactive. Anterior segment examination of the right eye showed conjunctival scarring, an Alloplant sponge located deep in the angle at approximately the 4 o'clock position, and posterior synechiae.

Figure 2. Anterior segment photograph showing the Alloplant implant at approximately the 4 o'clock position. Note the conjunctival scarring in the same location black arrow. Posterior segment examination of the right eye was restricted because of a mature cataract. Optic nerve findings were consistent with glaucoma. Funduscopic findings were consistent with poorly controlled systemic hypertension.

Gonioscopy revealed narrow angle, few scattered peripheral anterior synechiae, and the Alloplant sponge in the inferonasal quadrant. Indentation gonioscopy for both eyes resulted in minimal angle widening. Before presenting to the Westfield Eye Clinic, the patient had had several Alloplant implantations in the right eye, for sponge cyclodialysis, optic nerve revascularization, choroidal revascularization, and retrobulbar retrosclerofilling, at the Russian Eye and Plastic Surgery Center in Ufa, Russia, on June 8, The patient tolerated the procedure well and had no postoperative complications based on the discharge notes sent to the authors.

Her final postoperative visual acuity was light perception; IOP in the right eye was 28 mm Hg. Figure 3. On Sept 28, , the patient had cataract surgery at the Westfield Eye Center for the right eye. She tolerated the procedure well and had no intraoperative complications. On postoperative day 1, she denied any pain or improvement in visual acuity.

Uncorrected visual acuity was light perception, and the pupil was mid-dilated. The intraocular lens was centered. Posterior segment examination of the right eye revealed a deep, pale cup.

Funduscopic examination of the eye was consistent for a central retinal vein occlusion without evidence of neovascularization of the disc or neovascularization elsewhere.

Figure 4. Ophthalmoscopic photograph of the right eye denoting a deep, pale cup, and signs strongly suggestive of central retinal vein occlusion and hypertensive retinopathy. The pressure in the right eye was lowered by paracentesis, and Alphagan was prescribed. Optic nerve analysis was performed at the 1-week postoperative evaluation; measurement of IOP at this time was 13 mm Hg-OD on Alphagan. Anterior chamber was quiet, and Alphagan was discontinued. The patient returned to the office 3 weeks later.

Examination at this time showed a quiet right eye with an IOP of 12 mm Hg. After this last visit, she returned to Russia to undergo further Alloplant surgery in her left eye. Figure 5 , Figure 6. Surgical intervention is warranted for glaucoma patients who are recalcitrant to medical intervention.

These 2 approaches are used symbiotically or separately to repair or restore function to damaged tissue. Despite advancements in technology and surgical techniques, traumatized tissue responds by forming scar tissue. Tissue transplantation of all types allo-, xeno-, or auto-graft or synergistic is a well-documented means of restoring organ function. Although allotransplantation is more successful in ophthalmic surgery, the rate of success for extraocular tissue allotransplantation is not as high.

Scar formation is the most likely byproduct of ocular medications and can result in tissue compression and contraction and is occasionally unaesthetic. In , a group of Russian physicians and scientists led by E. Muldashev developed a biomaterial, Alloplant , that had low or reduced antigenicity and was able to naturally stimulate tissue regeneration at the implanted site. Muldashev and colleagues report that this material can prevent scarring and regenerate natural host tissue.

However, to date, information about Alloplant in non-former Soviet States appears to be scant at best. Based on the data obtained from research on allografting with tendon, sclera, and fascia lata, Russian investigators noted a well-defined, intense immune reaction within the first 21 days following allograft implantation. With the aid of electron histochemical microscopy, Russian investigators discovered that the reduction in immune response was related to extraction of glycosaminoglycan molecules from the collagen fibers of the allograft.

The detached glycosaminoglycans are extracted and placed in cell culture. This process demonstrated decreased allograft antigenicity by inhibiting lymphocyte migration and enhancing the ability to regenerate normal tissue in the surrounding area. The allograft with the controllable extraction of glycosaminoglycans from the collagen fibers was named Alloplant.

Studies between native allograft and Alloplant using donor sclera showed that the immunologic response, the presence of lymphocytes and neutrophils, and edema and necrosis were much more prevalent in the group transplanted with allograft than in those transplanted with Alloplant.

The humoral response and B-cell sensitization showed a slight antigenicity to Alloplant , whereas marked immune responses to native allografts were observed. Histologic examination in the early postoperative period revealed a rather marked inflammatory reaction to native allografting, whereas the Alloplant showed low macrophage and fibroblastic infiltration and minimal edema.

Muldashev and colleagues reported that the proliferation of fibroblasts was similar for both native allograft and Alloplant in the early postoperative period. Scar tissue formed around the allograft implantation; however, implantation of the Alloplant biomaterial was characterized by gradual resorption with ingrowth of native, newly formed connective tissue fascicles and gradual formation of scleralike tissue in the place of the Alloplant , without the formation of scar tissue.

Every type of Alloplant contains free glycosaminoglycans; however, Alloplant exists in different forms that have various chemical properties that are suited for specific surgical approaches. Alloplant biomaterial that is rich in hyaluronic acid will result in the surrounding tissue being replaced by dense connective tissue; conversely, Alloplant biomaterial with a low concentration of hyaluronic acid stimulates regeneration of loose connective tissue.

The former is useful for repairing tarsal plate and periosteum while the latter is more suitable for restoring adipose tissue replacement of the orbital fat.

Alloplant biomaterial with a high heparan sulfate content will induce epithelialization that may be used to restore the epithelium of conjunctiva and skin.

Alloplant biomaterial with a high concentration of keratan sulfate will stimulate formation of transparent corneal material as in the case of lamellar keratoplasty. Finally, Alloplant biomaterial rich in chondroitin sulfate will stimulate growth of vessel-rich loose tissue. The ability to stimulate blood vessel growth can be very important for various aspects of retinal surgery. Finally, an aqueous form of Alloplant is being investigated for vitreous body replacement.

The benefit of using Alloplant to treat glaucoma is 2-fold: tissue regeneration and better fluid outflow. Through placement of Alloplant in the anterior chamber angle, its ability to restore normal tissue function enabled restoration of normal trabecular meshwork function ie, to increase drainage of aqueous fluid.

A review of the patient's preoperative chart provided by Dr. Muldashev showed that the patient's IOP ranged between 30 to 41 mm Hg. Three months after surgery, her IOP is 12 mm Hg and she is not receiving topical antiglaucoma medication. Her IOP remained in the low teens even after cataract surgery.

Since cyclodialysis was first suggested by L. Heine in , various methods have been used to include auto-, allo, and xenografts to preserve the outflow tract. Based on the biochemistry of Alloplant , the authors believed the mechanism of the cyclodialysis sponge was that it decreased inflammation and thus decreased the incidence of closure of the outflow tract. The combination of trabecular meshwork regeneration and maintenance of an unobstructed uveoscleral outflow tract make a compelling concept for lowering IOP.

Glaucoma remains the leading cause of preventable blindness worldwide. Despite advances in biotechnologies and multiple nationwide clinical research projects, the only treatable cause for primary glaucoma is lowering IOP.

Alloplant , as reported in Russian literature, has been shown to decrease IOP and allow the patient to be medication-free. Although this product is commonly used in Russia, it is not used in North America and relatively little is known about the biochemistry or physiologic response to Alloplant. We hope that this report will ignite further investigation into this novel material.

This is an original paper that has not been submitted to any other publications, nor has it been presented at any past meetings or accepted for presentation in any upcoming meetings. No ophthalmologist participating in this study has financial support or proprietary interests in any of the products included.

There were no public or private financial supports provided for this study. There were no conflicts of interest by any of the authors throughout the study period. The patient was informed that her case would be reported and provided consent. Any references to her name have been omitted from ancillary test results. Readers are encouraged to respond to the author at moc. Hon-Vu Q. Kenneth C.

National Center for Biotechnology Information , U. Journal List Medscape J Med v. Medscape J Med. Author information Copyright and License information Disclaimer. Disclosure: Hon-Vu Q. Duong, MD, has disclosed no relevant financial relationships in addition to his employment. Disclosure: Kenneth C. Westfield, MD, has disclosed no relevant financial relationships in addition to his employment.


ISBN 13: 9785765435229



E R Muldashev



Alloplant Implant: A Novel Biomaterial in the Management of Recalcitrant Glaucoma


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