Vitreo Retinal Surgery

Vitreo Retinal Services offer comprehensive medical and surgical management of all Vitreo Retinal diseases with cutting edge technology and at an affordable cost. Common diseases like diabetic retinopathy, vascular blocks, age related macular degeneration and retinal detachment are seen in specialized clinics of retina. Close collaboration with key departments like endocrinology, nephrology, neonatology and intern al medicine helps the patient get appropriate, timely and personalized retinal as well as medical management services, the same day. The right mix of clinical services, clinical research, education and community services are provided by the vitreo retina services. Daily OPD and procedure facilities reduce the waiting time of patients from long distances.

Phone: 0484 – 2851099, 0484 - 6681099

Email: [email protected]

Procedures and Equipment

The frequently done procedures are OPD procedures and Surgical Retina procedures.

OPD Procedures

• Indirect Ophthalmoscopy- To have a detailed 3 dimensional view of the retina till the periphery. The patient is asked to lie down and with an indirect ophthalmoscope, we look at the periphery of the retina. Sometimes, it may be needed to press on the lids to see the extreme periphery. It is painless, but may cause slight discomfort as bright light is shone into the eyes. We use the Heine Indirect ophthalmoscpe from Germany for this purpose
• Contact and noncontact stereo biomicroscopy- This is done for a detailed 3 D examination of the macula and optic nerve and to look at the vitreo retinal interface. The 90 D lenses for noncontact biomicroscopy and the superquad and transequator are from VOLK.
• Digital fundus camera and imaging – We can take serial pictures to evaluate any subtle changes that may occur with time. A key for all diseases in which we may require observation. We use Zeiss FF 450 plus camera for this purpose.
• Fundus Fluorescein angiography- The corner stone of medical retinal diagnosis. Here a dye is injected into the veins of the hand and serial pictures are taken with the fundus camera. The patient will sit with the chin and forehead apposed against the machine. We use Zeiss FF 450 plus camera for this purpose.
• Optical coherence tomography- A revolution that has improved our understanding of all retinal diseases. This offers an anatomic diagnosis at tissue level and is also nicknamed, bloodless histopathology. This machine gives us anatomic details of the microscopic retina with a resolution of 7 microns. We use a Zeiss OCT 4 machine.
• Ultrasonography and ultrasound biomicroscopy- Standard care for retinal diagnosis in hazy media like cataract and vitreous hemorrhage. An ultrasound biomicroscopy offers view to the extreme periphery of the retina like pars plana and ora serrata as well as the anterior segment and angle structures. We use an Appaswamy machine for USG.
• Humphrey visual field examination- This method of examination is automated visual fields which can offer great help in the functional quantification of the defects in visual function caused by macular pathologies.
• Short wavelength automated perimetry- Blue on yellow perimetry can have more accuracy than white on white fields in the diagnosis of specific conditions.
• Green laser photocoagulation – We use 532 double frequency YAG laser to treat the retina using a Zeiss Visulas machine.
• Laser indirect Ophthalmoscopy- Is used when we want to laser the extreme periphery, ROP, recent post-operative cases etc.
• Photodynamic therapy- Special laser therapy for ARMD and CNVM.
• Visual evoked potentials- Electrophysiology will help us determine whether vision is there in infants, in cases with neurological illnesses etc.

Surgical Retina Procedures

• Scleral buckling surgery
• Pars plana vitrectomy
• Vitreo retinal surgeries for PVR and RD
• Diabetic vitrectomies
• Macular hole surgery
• Epiretinal membrane peeling
• Endophthalmitis vitrectomy
• Dropped nucleus and IOLs
• Retained intraocular foreign body removal
• Subretinal bleed removal
• Silicone oil removal
• Submacular surgery
• Intravitreal device insertion
• Intravitreal injections

1. What is macular degeneration?

In macular degeneration, the light-sensing cells of the macula malfunction and may over time cease to work. Macular degeneration occurs most often in people over 60 years old, in which case it is called Age Related Macular Degeneration (ARMD). Much less common are several hereditary forms of macular degeneration, which usually affect children or teen-agers. Collectively, they are called Juvenile Macular Degeneration. They include Best’s Disease, Stargardt’s Disease, Sorsby’s Disease and some others.

2. Who gets ARMD?

Macular Degeneration is the leading cause of new blindness in adults over the age of 60 in this country. The disease also causes less severe but significant reductions in the ability to see and perform everyday tasks. A study done by National Eye Institute showed that Macular Degeneration occurs in approximately one out of five people between the ages of 65 to 74. One of three people over age 75 in this country will suffer some visual impairment due to Macular Degeneration.

3. What are the types of ARMD?

The “dry” form of ARMD refers to the atrophic form which is characterized, in its late stages, by the degeneration (i.e. atrophy) of the retina in a region that includes the macula. “Dry” ARMD develops and progresses slowly over a period of 5-10 years or longer. Approximately 85% of the total ARMD patient population has this atrophic form. The less prevalent, “wet” type of ARMD is also referred to as neovascular or exudative ARMD. It is characterized by the ingrowth of new blood vessels from the choroid. “Wet” ARMD progresses much more rapidly, over a period of weeks or months, and usually results in legal blindness in the central portion of the visual field.

4. How do you evaluate ARMD?

Clinical examination, coupled with fluorescein angiography, Optical coherence tomography and in some cases, indocyanine green angiography are the tests useful in finding out the type of ARMD0, its prognosis and outcome.

5. How do you evaluate ARMD? If you have drusen, does that mean you will eventually develop ARMD?

Not necessarily. Many individuals with some drusen do not go on to develop the visual symptoms of ARMD. From a clinical standpoint, drusen must attain a threshold in numbers, size, and shape for them to become a matter of concern to ophthalmologists.

6.What are the risk factors associated with ARMD?

The strongest risk factors are:

• The incidence of all forms of ARMD rises steeply with advancing age. In one large study, ARMD increased from approximately 4% of individuals at 43 to 54 years of age, to 23% in those 75 years or older.
• The presence of numerous and/or large drusen, accompanied by specific pigmentary changes in the macula, is considered to be diagnostic of early atrophic ARMD.
• The incidence of both “wet” and “dry” ARMD is strongly correlated a history of smoking, and the degree of risk is proportional to the amount of cigarette consumption.
• Genetic factors. Several studies have demonstrated a high rate of concordance in the development of ARMD among twins, particularly among identical twins. In family-based studies, the likelihood of developing ARMD is nearly 20 times higher if one or both parents have ARMD. It is highly likely that one or more gene alterations carried by the affected individual increase the susceptibility in his/her offspring.
• Current evidence for the following additional risk factors is either weak, conflicting, or unpersuasive: gender, social class, ethnicity, cardiovascular disease, high blood pressure, dietary fat intake, cholesterol levels, alcohol consumption, estrogen levels, light exposure, and circulating levels of vitamins, minerals, and anti-oxidants.

7. How does diet influence macular degeneration?

Several studies now indicate that diets rich in green leafy vegetables, such as spinach, chard and mustard greens, can reduce the risk of ARMD. These and other vegetables are rich in certain pigments known as carotenoids. Among these, lutein and zeaxanthin are two that are highly concentrated in the macula where they may have effects that protect RPE and/or retinal cells from injury caused by the formation of peroxides and other toxic by-products of the visual cycle . Lutein and zeaxanthin are now widely available as dietary supplements; however, their efficacy when consumed in this form has not been well studied.

8. Have vitamins and other nutritional supplements been shown to be effective as treatments for ARMD?

There have been at least five published trials that have tried to determine whether dietary supplements, such as vitamins A, C, E or zinc can arrest or prevent the development of ARMD. Thus far, the results from these small scale studies have not been encouraging. However, new data from a much larger study called the Age-Related Eye Disease Study (AREDS) indicates that dietary supplementation with 500 mg of vitamin C, 400 IU of vitamin E, 15 milligrams of beta-carotene and 80 milligrams of zinc (as zinc oxide) can reduce the risk of developing advanced ARMD by approximately 25%.

9. What are the Treatments for Macular Degeneration?

Earlier, there were no treatments for macular degeneration. About 15 to 20 years back, laser photocoagulation was used for the first time to treat ARMD. For the last 5 years, newer treatments, which are more effective, are coming up. The most commonly applied clinical approach to Age Related Macular Degeneration is one in which in some cases can slow the progression of the disease, but does not restore already lost vision. This is possible with special laser called Photodyanamic therapy. Newer therapeutic approaches include Photodynamic therapy along with intravitreal injections like Lucentis, Macugen or Avastin.

• Diabetic retinopathy clinic – Daily
• Paediatric retina clinic – Wednesday and Friday
• Surgical retina clinic – Thursday
• ARMD and macula clinic – Monday

Why see a Retina Specialist ?

• Diabetes more than 10 years
• Hypertensives more than 10 years
• Age over 60
• Chronic renal failure
• Vascular blocks
• Sudden dimness of vision
• Sudden visual field loss
• Flashes
• Floaters
• Ocular injuries
• Intraocular tumours
• Retinal detachments
• Age related macular degenerations
• ROP and failure to fix eyes on objects properly
• Collagen vascular disorders
• Systemic vasculitis
• Posterior uveitis
• Chronic CSR
• Cataract surgery complications
• Systemic diseases of vessels or nerves

Common Retinal Symptoms

• Sudden loss of vision
• Sudden loss of visual field
• Dimness of vision
• Central dark spot in front of the eye
• Flashes of light
• Black floats in front of eye
• Distortion of letters on reading
• Transient loss of vision
• Failure to improve vision after cataract surgery
• Difficulty to read
• Seeing things smaller
• Seeing things larger
• Diminished vision from childhood
• Night blindness
• Day blindness
• Photophobia
• Constriction of visual fields
• Trauma to the eye
• Severe pain in the eye
• White reflex in the eye