Most patients are referred to the retina services for one of the following problems
Although Visual loss is the most common symptom due to retinal disease it may be due to many other problems also. However visual loss associated with other symptoms such as scotoma (a partial loss of vision or blind spot in an otherwise normal visual field), metamorphopsia (distortion of objects such as straight lines appearing crooked), floaters (black spots moving around in visual field), photopsia (flashes of light coloured or otherwise) or field loss (inability to see from one side)
Persons suffering from diabetes and hypertension need special care as they are more likely to suffer from retinal problems.
Diabetic Retinopathy is by far the most common retinal condition presenting to our hospital. Diabetics and hypertensives may suffer from Retinal oedema (swelling in the layers of the retina) or vitreous haemorrhage (bleeding into the gel like substance in front of the retina). If left untreated this may progress to retinal detachment and complete visual loss. Less commonly, such patients also have conditions affecting the optic nerve.
RamSudha eye hospital is armed with a range of diagnostic and therapeutic equipment to diagnose, monitor and treat retinal conditions.
The OPTIVUE OCT by Zeiss provides state of the art imaging of different layers of the retina. It enables the measurement of macular oedema, assessment of response to treatment and patient education. It is invaluable in diagnosing almost the entire range of retinal diseases. Best of all it is completely non-invasive as it uses only light to acquire images and has no harmful radiation and no lenses need to be placed on the eye. Thus it provides maximum utility with no discomfort to the patient as it can acquire images without even putting any drops to dilate the pupil.
An example of a print out of the OPTIVUE OCT. Every layer of the retina is visualized. The collection of fluid under the retina can easily be visualized. The reduction of fluid after injections is also seen on the picture to the right.
It is a top of the line fundus camera which is capable of taking crystal clear photographs of the retina and can be used for 7 field photography which is the gold standard for screening diabetic retinopathy.
Fundus Fluorescein Angiography is an important ancillary investigation performed with the Visucam 500. A dye is injected into a vein on the patients forearm and the flow of the dye through the blood vessels of the retina is imaged. It is useful in certain diseases such as choroiditis, optic neuritis, to detect smaller new vessels in diabetic retinopathy or retinal venous occlusion. Again this uses no damaging radiation as only visible light is used as a flash to obtain photographs. Although it is relatively safe some patients complain of nausea and vomiting. More serious side effects are fortunately extremely rare.
This is the most common laser used worldwide for photocoagulation: a process of producing controlled burns on the retina in order to reduce the risk of bleeding, to create a scar around weak areas of the retina or to gently treat leaky blood vessels. This procedure involves a lens being placed on the surface of the eye under local anaesthesia. Most patients complain of little or no pain during the procedure.
A patient who has undergone laser treatment for diabetic retinopathy; gentle burns have been placed on the macula and heavier burns in the periphery
Surgical Equipment
Vitrectomy is the procedure of removing the gel like substance in front of the retina. It is usually performed by making 3 incisions in the sclera(white part of the eye behind the cornea) behind the lens and cutting and aspirating the gel using an automated probe introduced through one of the incisions. The other 2 incisions are used for an illumination probe to provide light and an infusion line to maintain a flow of fluid into the eye. It may sometimes be the only step required but is commonly followed by other procedures done on the surface of the retina.
The Constellation Vitrectomy System by AlconTM, a world leader in ophthalmic instrumentation and machinery has created a revolution in vitrectomy surgery by expanding the scope of Micro Incision Vitrectomy Surgery. In this extremely small (25G or 27 G) incisions are made which are only 0.55mm in diameter or less. To put that in perspective it around the diameter than the smallest gradation of a common ruler. Incisions so small require no sutures as they are self-sealing. This also results in minimal post-operative pain and irritation. 23 Gauge, 2 Gauge and 27 Gauge instruments as well as traditional 20 Gauge instruments are available in RamSudha eye hospital. We prefer to use the 25 Gauge and 27 Gauge for all our surgeries to provide maximum post-operative comfort for our patients. We also have the full range of Alcon TM accessories such as the GrieshaberTM forceps for delicate procedures performed on the surface of the retina.
RamSudha eye hospital is also well stocked with a range of adjuncts such as tamponading agents like silicone oil, perfluoropropane gas, sulphur hexafluoride etc. to provide appropriate support to the retina
Retinal surgery is a relatively major surgery of the eye and is usually performed on an in-patient basis. You are likely to be admitted for 1-2 days. Many patients will require strict post-operative positioning for a few weeks after surgery. Additional restrictions like avoiding air travel or travel to high altitudes may apply. While cataract and refractive surgery are performed on an otherwise normal eye; retinal diseases may create some permanent changes in the structure and function of the retina. Visual recovery is likely to be slower and some visual defects may sometimes remain.
Macular edema and wet age related macular degeneration can be treated mainly by injecting certain drugs (Anti VEGFs) into the gel like substance inside the eye (vitreous). There are 3 commonly used Anti-VEGFs, Ranibizumab, Bevacizumab and Aflibercept. These drugs have been found to be highly effective for edema. They have to be given monthly until there is resolution of the disease.
These injections are given into the eye through extremely fine needles, much smaller than the needles used for routine injections into the arm. The pain is minimal and is well tolerated by most patients. Extremely small quantities are sufficient. The risk of adverse effects are extremely rare and are in fact less common than the risks associated with the commonly performed cataract surgery. The benefits are immense with a large majority of patients experiencing significant improvement in their vision
These injections are given into the eye through extremely fine needles, much smaller than the needles used for routine injections into the arm. The pain is minimal and is well tolerated by most patients. Extremely small quantities are sufficient. The risk of adverse effects are extremely rare and are in fact less common than the risks associated with the commonly performed cataract surgery. The benefits are immense with a large majority of patients experiencing significant improvement in their vision
RamSudha eye hospital is well equipped to perform every type of retinal surgery including that for epiretinal membranes, macular holes, vitreomacular traction, and retinal detachment. All surgeries are performed using the smallest possible instruments of either 25/ 27 gauge.
Membrane pulling on the retina
A patient before and after 27 G surgery for epiretinal membrane. Note the normalization of retinal contour
The retinal services of RamSudha eye hospital are available from 10am to 5pm Monday to Saturday. You can fix an appointment by calling