Pterygium Excision and Removal

Pterygium Excision is a procedure that improves vision through the removal of a pterygium, which are abnormal benign tissue that grow over the cornea.

DIABETIC VITRECTOMY

Diabetic retinopathy is one of the leading causes of visual loss in both the elderly and the working-age population. Danaei et al. recently reported in “The Lancet” that age-standardized adult diabetes prevalence has reached 9.8% in men and 9.2% in women. Approximately 24% of these patients are already diagnosed with different forms of diabetic retinopathy but 28% will remain undiagnosed until the onset of complications.

The prevalence of diabetic retinopathy grows proportionally to the duration of diabetes, so all the patients with type 1 diabetes and 60% of those with type 2 diabetes will be diagnosed with a form of diabetic retinopathy after 20 years of disease .

The diabetic retinopathy affects the retinal microvascularization, leading to progressive retinal ischemia, neovascularization and fibro- cellular proliferation. Many patients are referred to a retina specialist in late phases of diabetic retinopathy evolution, when severe complications like vitreous hemorrhage and tractional retinal detachment are already installed. On the other hand, 5% of the patients with diabetic retinopathy, appropriate ophthalmic care, and strict metabolic control still develop ocular complications requiring a surgical treatment.

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RETINOPATHY OF PREMATURITY SCREENING

Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels of the preterm infant. New recommendations for screening and treatment of ROP have been published in the past few years. Current evidence suggests that screening infants with gestational ages of 30 6/7 weeks or less (regardless of birth weight) and birth weights of 1250 g or less is a strategy with a very small likelihood that an unscreened baby would have treatable ROP. Individual centres may choose to extend birth weight screening criteria to 1500 g. Initial screening should be performed at 31 weeks’ postmenstrual age in infants with gestational ages of 26 6/7 weeks or less at birth, and at four weeks’ chronological age in infants with gestational ages of 27 weeks or more at birth by an ophthalmologist skilled in the detection of ROP. Follow-up examinations are conducted according to the ophthalmologist’s recommendation. Infants with high-risk prethreshold ROP and threshold ROP are referred for retinal ablative therapy. Developing processes for ROP screening, documenting results and communicating results to parents as well as health professionals involved in the infant’s care are important responsibilities for all nurseries providing care for preterm infants.

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INTRAVITREAL INJECTIONS

An intravitreal (pronounced in tra VIT re al) injection is a procedure to place a medication directly into the space in the back of the eye called the vitreous cavity, which is filled with a jelly-like fluid called the vitreous humor gel. The procedure is usually performed by a trained retina specialist in the office setting.

What are intravitreal injections used for? 

Intravitreal injections are used to administer medications to treat a variety of retinal conditions. Age-related macular degeneration (AMD), diabetic retinopathy and retinal vein occlusion are the most common conditions treated with intravitreal anti-VEGF drugs. Intravitreal steroids are used in some eyes with diabetic retinopathy, retinal vein occlusion and uveitis. The anti-VEGF drugs and steroids help to reduce fluid leakage associated with these disorders. Antibiotic, anti fungal and antiviral drugs are also used to treat patients with infections in the eye such as endophthalmitis and retinitis. In some cases an injection is used to insert a small gas bubble to aid repair of a retinal detachment.

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GLAUCOMA LASER TREATMENT

Selective Laser Trabeculoplasty, or SLT, is a form of laser surgery that is used to lower intraocular pressure in glaucoma.

It is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It can also be used as initial treatment in glaucoma. SLT has been in use for more than 25 years in the United States and around the world.

  1. Who is a candidate for SLT?
    Patients who have primary or secondary open-angle glaucoma (the drainage system in the front part of the eye is open) and are in need of lowering of their intraocular pressure (IOP) are eligible for the procedure. Your eye doctor will make the final determination if you are a candidate.
  2. How does it work?
    Laser energy is applied to the drainage tissue in the eye. This starts a chemical and biological change in the tissue that results in better drainage of fluid through the drain and out of the eye. This eventually results in lowering of IOP. It may take 1-3 months for the results to appear.
  3. Why is it called Selective?
    The type of laser used has minimal heat energy absorption because it is only taken up by selected pigmented tissue in the eye. Sometimes it is referred to as a “cold laser.” Because of this, the procedure produces less scar tissue and has minimal pain.
  4. What are the risks?
    One key aspect of SLT is a favorable side effect profile, even when compared with glaucoma medications. Post-operative inflammation is common but generally mild, and treated with observation or eye drops or an oral non-steroidal anti-inflammatory drug. There is an approximately 5% incidence of IOP elevation after laser, which can be managed by glaucoma medications and usually goes away after 24 hours.

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RETINAL DETACHMENT SURGERY

What is a Retinal Detachment?

The retina is the light-sensitive layer of nerve tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. A retinal detachment occurs when the retina becomes separated from the rest of the layers of the eye. This usually occurs after you develop a tear in the retina. The extent of permanent damage depends on how much of the retina becomes detached and whether or not the center of the retina (the macula) becomes detached. The macula is made up of special nerve cells that provide the sharp central vision needed for seeing fine detail (reading and driving etc.). If your macula has become detached, you have a poorer visual prognosis and you may not regain good enough vision to read or drive with that eye even after successful surgery.

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DIABETIC LASER TREATMENT

Laser photocoagulation is a proven effective treatment for preserving vision and reducing the risk of vision loss from diabetic retinopathy.  In national clinical trials of laser treatment for diabetic retinopathy conducted at multiple locations, laser photocoagulation reduced the risk of severe vision loss from diabetic retinopathy to less than 2% over a five-year period.

Two laser techniques are performed today, generally using an argon laser:

  • Scatter or panretinal photocoagulation generally requires 1,200-1,800 individual laser spots, usually spread over two or three sessions. In this technique the ophthalmologist avoids the macula, the central area of the retina that is responsible for our reading vision, color vision, and other tasks requiring sharp vision. Scatter laser photocoagulation is used to treat proliferative diabetic retinopathy, a major cause of severe vision loss from diabetes.
  • Focal laser surgery uses fewer spots and less intense laser power to treat diabetic macular edema. Using a technique called fluorescein angiography and other examination and photographic techniques, the ophthalmologist identifies areas that are leaking fluid into the macula area. These areas are then treated directly with a laser to prevent further leakage of fluid into the macula and to allow fluid that has already leaked to be reabsorbed.

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TREATMENT OF UVEITIS/ OCULAR INFLAMMATION

Uveitis is a broad term for many problems with your eye. What they have in common is eye inflammation and swelling that can destroy eye tissues. That destruction can lead to poor vision or blindness.The word “uveitis” is used because the swelling most often affects the part of your eye called the uvea.

Your eye is made of layers. The uvea is the middle layer.  It’s between the white part of your eye — called the sclera — and the inner layers of your eye.

Your uvea contains three important structures:

The iris. That’s the colored circle at the front of your eye.

The ciliary body. Its job is to help your lens focus and make the fluid that nourishes the inside of your eye.

The choroid. This is a group of blood vessels that give your retina the nutrients it needs.

Are There Different Types of Uveitis?

Yes. Which type you have depends on where the swelling is.

  • Anterior uveitis is the most common. It affects the front of your eye.
  • Intermediate uveitis affects your ciliary body.
  • Posterior uveitis affects the back of your eye.
  • If your entire uvea is inflamed, you have panuveitis.

Treatment

The first step may be eye drops that have medicine — usually a corticosteroid — to fight inflammation. You might get dilating eye drops to prevent scarring and cut eye twitches. If the drops don’t work, your doctor may add a pill or injection.

If an infection causes your uveitis, you’ll get other drugs, too. These infection fighters include antibiotics and antivirals.

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TREATMENT OF MACULAR DEGENERATION

Macular degeneration treatment breakthroughs inspire hope that someday we may see a cure to this disease.  Promising treatments, described below, depend upon the stage of disease progression.

The treatment for early dry AMD is generally nutritional therapy, with a healthy diet high in antioxidants to support the cells of the macula.

If AMD is further advanced but still dry, supplements are prescribed, to add higher quantities of certain vitamins and minerals which may increase healthy pigments and support cell structure.

There’s no cure, but treatment for age-related macular degeneration(AMD) may slow the disease and keep you from having a severe loss of vision. Talk to your us about the best way to manage your condition.

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GLAUCOMA SCREENING

Glaucoma is the most common optic neuropathy in the adulthood. Glaucoma is defined as an optic neuropathy associated in most cases with elevated intraocular pressure (although pressure may be within the normal range), with or without anatomic predisposing factors in the anterior chamber (open angle vs angle closure). The American Academy of Ophthalmology has defined Glaucoma as ” a multifactorial optic neuropathy with a characteristic acquired loss of optic nerve fibers” which is usually (but not necessarily) identified in visual field exam and retinal fiber OCT. This cluster of diseases is progressive without appropriate treatment, and unfortunately the damage is irreversible. Primary Open Angle Glaucoma is the most common form of this cluster of diseases.

There has been emphasis on glaucoma screening, since most of the times there is an insidious start of the disease (with no clear start point, POAG), and progression may be slow and unnoticed to the patient. In addition to that, there is a recognized stage of the disease in which patients are apparently in a pre-perimetric (before loss of the visual field is present) stage, bringing a challenge to the diagnosis and screening techniques.

The purpose of glaucoma screening tests is to detect those with early stage disease, so that these patients can be treated to reduce the risk of visual field loss.

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