What is Retina ?
The retina is like the film in a camera. It is the seeing tissue of the eye. When the focused light hits the retina, a picture is created and sent to the brain through the optic nerve (the nerve of the eye), thus giving us vision.
Retina has two parts :
- Peripheral retina
- Central Macula
Macula being the central part is capable of producing sharp and clear image. This clear image enables us to read, write, and do all fine work.
Retinal diseases are first evaluated clinically at our Best eye hospital in Pune with Indirect Ophthalmoloscopy and Slit Lamp Biomicroscopy. Then, if needed, advanced tests are performed.
The advance tests conducted by our retina specialist in Pune include:
- Fundus Fluorescein Angiography : examination of the retinal blood vessels in detail.
- Optical Coherence Tomography : examination of the cross sectional structure of the retina.
Specialized treatment of retinal diseases includes:
- Green Laser Photo Coagulation
- Red Laser Photo Coagulation
- Retinal Cryopexy
- Pneumoretinopexy - Gas injection
- Scleral Buckle Surgery for Retinal Detachment
- Vitrectomy with injection of Gas / Silicone oil for complex Retinal
- Indirect Laser Ophthalmoscope delivery system for treatment of premature affected by Retinopathy of Prematurity.
Laser is a highly concentrated light that is beamed onto the retina to treat the desired area. It is a painless Out Patient procedure, lasting about 10-30 minutes that does not require admission. It may require more than one sitting to complete the treatment. In majority of cases, the aim of laser treatment is to try to prevent further loss of vision. It cannot regain the vision already lost due to retinal disease. After the laser treatment, the patient may require to undergo repeat Fluorescein Angiography under the safe pair of hands of our retina surgeon in Pune at a later date to monitor the response, and may require more laser if indicated.
Lasers are commonly used in the following conditions:
- DIABETIC RETINOPATHY
- ARMD (AGE RELATED MACULAR DEGENERATION)
- ROP (RETINOPATHY OF PREMATURITY)
- RETINAL DETACHMENT SURGERY
- VITRECTOMY SURGERY
- MACULAR HOLE SURGERY
It is one of the commonest problems affecting vision in people having chronic diabetes where blood sugar is not well controlled.
Diabetic retinopathy leads to swelling of the central part of the retina, resulting in blurring of reading vision. If neglected it forms abnormal blood vessels on the surface of the retina which subsequently either bleed in front of the retina or cause pull on the retina. This ultimately results in profound loss of vision. Hence, every diabetic patient should have a periodic examination of his eyes and retina in particular to diagnose this problem at early stage to prevent major vision threatening problems later.
When a person undergoes thorough evaluation and is found to have Diabetic Retinopathy he usually undergoes tests like FFA(Fundus Fluorescein Angiography),OCT(Optical Coherence Tomography)and Perimetry.Based on these tests,the decision is taken on whether to go for Laser Photocoagulation or Intravitreal injection of Anti VEGF.In case of Laser treatment,it may be enough to go for a limited treatment of a single sitting.But if the problem is more serious,it may require extensive treatment with three to four sittings.
In case one needs Anti VEGF injections, these injections are given on monthly basis till the problem is controlled. But even after the prescribed injections are over, periodic examination is needed keep a check on Retinopathy. At times, there may be a need for additional injections or Laser treatment. If it is a case of severe Retinopathy with bleeding in the eye or significant pull on the retina, then surgery is recommended in the form of Vitrectomy and intra operative Laser with injection of Gas or Silicone oil.
ARMD is a common cause of vision impairment in the elderly. It usually affects one after the age of 60.Commonly two types of problems are noted: Dry type and Wet type.
ARMD usually affects the central part of the retina, hence reading, writing, recognizing faces becomes difficult.
In the Dry type, progression of the problem is very gradual and presently no active treatment is available to halt the progression.
In the Wet type, the drop in vision is sudden due to swelling and bleeding at the centre of the retina. If left untreated, this problem can get serious.
If ARMD is suspected after examining the retina, tests such as FFA (Fundus Fluorescein Angiography), OCT (Optical Coherence Tomography) and sometimes ICG (Indo Cyanine Green) angiography are performed to confirm the diagnosis and decide the treatment strategy. Currently for Dry type, no active treatment is available to improve the condition. Antioxidant tablets are prescribed to delay the progression of this condition. For the Wet type, as the condition worsens rapidly, treatment in the form of Injection of AntiVEGF drug into the eye is advised. Usually a loading dose of three injections on a monthly basis is given followed by injections as and when required. These injections are given with sterile precautions and are almost painless. In fact, one can be back to routine within an hour.
Retinopathy of Prematurity is a condition that affects premature infants which, if left untreated, can lead to profound loss of vision. Premature babies born before 32 weeks of pregnancy, with a birth weight of 1500 grams or less, are at risk of developing this problem.These babies need screening of the eye by 30 days post birth, to be continued up to 60-90 days on periodic basis.
If ROP is noted, then a close follow up is needed. If the disease progresses further, then to control it Laser Photocoagulation is applied. This can be performed under the effect of anaesthetic drops without causing much discomfort to the baby.
Post Laser Photocoagulation, the baby is examined periodically till the disease process comes under control. Even after control, these babies are kept under observation till their first birthday.
Retinal Detachment is an ocular emergency. Mainstay of treatment is surgery. Surgery involves supporting the Retina from outside with a Silicone band, applying Cryo to the Retinal defects and draining the sub retinal fluid. The complete procedure is done under local anaesthesia. Following surgery eye is patched and individual can go home after resting for a period of one hour.
In conditions like Diabetic Retinopathy, hypertensive retinopathy our eye injury, bleeding can develop in the eye. Rarely the bleeding can clear spontaneously but if it persists surgery in the form of Vitrectomy may need to be performed at our clinic by eye specialist in Pune. During Vitrectomy Three 23/25 gauge instruments are introduced in the eye through the white part of the eye called sclera. The vitreous along with the admixtured blood is cut and sucked out of the eye. Once the bleeding is cleared the abnormal tissue is removed from the eye and the pull on the retina is relieved. Retina if detached is placed back to its normal position. SF6/C3F8 gas or Silicone oil is injected in the eye.
Post operatively the individual needs to position himself for a week to 10 days to get maximum benefit from the gas/oil. The gas gets absorbed on its own whereas the silicone oil needs to be removed surgically after three to six months.
Older individuals at times develop a peculiar problem called Macular Hole where by a defect develops in the centre of the retina leading to loss of central vision. This problem does not have any medical treatment and surgery in the form of Vitrectomy with Gas injection is needed to treat this problem. Following surgery a face down positioning is required for a period of a week to 10 days.
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