Retina and vitreous
Treatment for all retina diseases, including diabetic retinopathy, retinal detachment, macular degeneration, with Zeiss spectral domain oct and fluorescent angiograph etc. Operation room equipped with Zeiss operating microscopes, alcon Constellation vitrectomy system, Zeiss laser systems etc. Deals with diseases of the posterior segment of the eye which are mostly pathological. The department is well equipped with state of the art equipments like 3D ultrasonography, Ocular Coherence Tomography (OCT), Carl Zeiss visupac 450 digitised angiography system for fundus fluracine angiogram and ICG, for Zeiss green & diode lasers, Alcon Constellation vitrectomy system & Zeiss Lumera operating microscopes with Rasik Biom. Diseases like diabetic retinopathy, retinal detachments, age related macular degenerations & intraocular tumours can be treated here. All simple & complicated retinal surgeries can be done here.
The eye is like a camera with a lens in front & a film (retina) at the back. The retina converts the image falling in the eye into a signal that is sent to the brain. The central part of retina, called the macula is responsible for the central & clear vision & also for the fine vision such as reading, recognizing faces & distinguishing things.
The area surrounding the macula helps in mobility & in seeing from the corner of eye. The retina is connected to brain by optic nerve. Blood is supplied to retina& optic nerve by a central blood vessels & its branches that maintain health of these tissues. In front of retina is a cavity which is filled with gel like substance called vitreous & hence named vitreous cavity.
Diseases of retina, vitreous & optic nerve can cause serious visual problems. Fortunately, most of them can be diagnosed & treated with latest modalities.
The retinal blood vessels are like tubes, which bring blood in & out of eye. In diabetes, these vessels may leak causing retina to swell & if this swelling involves central area called macula, vision will be affected. This is known as Diabetic Macular Edema (DME).
In advanced diabetic retinopathy, fragile new blood vessels sprouts & may break causing bleeding in the eyeball & thus entire field of vision is blurred.
In early stages, vision remains good & the disease escape notice of serious situation it can lead to. Hence it is essential to have regular retinal examination.
CAN DIABETES AFFECT OTHER PARTS OF EYE?
Although retinal changes are the major problem, diabetes can cause
Rise in eye pressure(glaucoma)
Clouding of lens(cataract)
Weakness of optic nerve
Weakness of eye muscle-resulting double vision
HOW CAN DIABETIC RETINOPATHY BE MANAGED?
Best treatment option available for Diabetes Macular Edema is Intravitreal Anti – VEGF therapy. Sometimes few laser spots are also given.
I Anti VEGF therapy
These are drugs injected into the eye to prevent the growth of abnormal vessels & fluid leakage. The drug effect lasts for 1 month, hence repeated injections may be needed.
Different Anti VEGF injections include
Lucentis (Ranibizumab) FDA approved
II Focal/Grid macular laser
Laser beams are projected on leaking blood vessels, this reduce swelling in retina.
Either injected or implanted in the eye
Different drugs available include:-
Ozurdex(Dexamethasone)- effect can last upto 3 months
Iluvein(Flucinolone Acetonide)- effect can last upto 6 months
Both are biodegradable & it causes sustained release of steroid to suppress DME. But they should be closely monitoring for IOP.
In advanced diabetic retinopathy, abnormal blood vessels sprouts that requires extensive laser treatment (Pan retinal photocoagulation) involving 2000-3000 laser spots in 2 or more laser sessions. This is done to preserve the vision from further deterioration. Laser treatment seals the leaks, thereby preventing further vision loss. More severe problems with bleeding (vitreous haemorrhage) or retinal detachment requires surgery such as sclera buckling or vitrectomy or both.
RETINAL VEIN OCCLUSION (RVO)/EYESTROKE
It occurs when blood vessels draining blood from retina gets blocked. This is more common in patients with diabetes, high blood pressure or high cholesterol.
A retinal vein occlusion can cause retina to swell with fluid &blood causing decreased central & peripheral vision. At a later stage, new blood vessels may grow inside eye(neovascularisation) & cause pain as well as very high pressure inside the eye(Neovascular Glaucoma).
For macular edema developed from RVO can be treated with AntiVEGF therapies ( as explained in diabetic macular edema). Laser treatment can help to reduce the leak or cause the new blood vessels to disappear.
AGE RELATED MACULAR DEGENERATION (AMD)
As a part of aging, some people develop changes in macula with loss of central reading vision. Most people develop Dry type ARMD which causes gradual central loss of vision as well as distorted images. The more severe or wet type causes macula to swell with fluid &blood due to abnormal blood vessels growing underneath.
Dry AMD is treated with supportive management with anti oxidants while for wet AMD aggressive management is needed with multiple injections of Anti VEGF to delay visual loss.
While off central, wet AMD patients benefit from thermal laser treatment (Photo dynamic therapy) which reduces the activity of the disease .
Latest treatment modality available for AMD is Intraocular Miniature telescope (IMT).This intraocular device improves the central vision in affected eye & fellow eye is used for peripheral vision & navigation.
CENTRAL SEROUS RETINOPATHY (CSR)
CSR consists of one or more areas of fluid collection in macula. It causes reduction & distortion of central vision, central dark area, abnormal color vision & a temporary far-sightedness.
A large majority of cases resolve their own, usually within 3 months laser photocoagulation is sometimes needed for persistant lesions & in those patients who require early visual rehabilitation.
The retina lines the eyeball just like wallpaper lines the wall. When retinal tear develops, retina is pulled away from the supportive tissues & the liquid that normally fills the central porton of the eye (the vitreous) leak beneath the tear, lifting the retina away from eyewall. Patient usually experience sudden appearance of floaters, flashes of light & sudden decrease in vision.
Retinal breaks usually occurs in high myopes or in case of trauma or after eye surgery.
Retinal detachment if left untreated can cause blindness. Repair of retinal detachment involves removing the central gel portion of eye(vitrectomy) & reattaching the detached retina via sclera buckling,band buckling, endolaser or cryotherapy or even filling the eye with silicon oil or gas.
It is a small break in the eyes most sensitive tissue for vision called macula. It affects the central fine vision & near vision along with distortion of images.OCT scan is a good tool for the diagnosis & prognosis of macular hole assessment.
Treatment involves macular hole repair along with vitrectomy and injection of air/gas to put pressure on the edges of the hole allowing it to heal. Hence patient is advised face down position for 3-7 days so that gas rises & pushes retina back into place.
RETINOPATHY OF PREMATURITY
It is an eye disease that happens in premature babies. The retina is not fully developed in premature babies as a result abnormal blood vessels grow inside the ye and can cause internal bleeding & even retinal detachment. This condition is called Retinopathy of Prematurity. It results in low vision & even blindness in early childhood.
Do all babies need ROP screening?
Babies with a birth weight less than 1700g or those born in under 35weeks of pregnancy are most likely to have ROP. Preterm babies who have had problems after birth such as lack of oxygen, infection, blood transfusion, breathing trouble etc are also vulnerable to develop ROP.
When & how to screen ROP?
The retinal examination should be completed before day-30 of life of a premature baby, usually 2-3 weeks after birth. A trained ophthalmologist can detect ROP by scanning the entire retina after dilatation of pupil & then gauge the state of retinal maturity.
Treatment of ROP
ROP is treated with laser rays or freezing methods (cryopexy).These treatment helps to stop further growth of abnormal blood vessels & thus prevent vision loss. In advanced stages, buckling procedures with vitrectomy is done. A regular follow up of the child is necessary.