Vitreo-Retina Services

Retina forms the inside lining of the back of the eye. Its composed of light sensitive neurons. Retina processes the light emitted from the objects and transmits to the brain for us to get the perceptual awareness of the images. Retina mainly comprises of blood vessels and neurons. It’s highly oxygen sensitive. The central portion of retina is macula, where maximum vision is restored. Retinal damage results in permanent vision loss as it lacks power of regeneration.

Vitreous humour is a transparent, colourless, gelatinous mass that fills the space between lens and retina. Vitreous has firm jelly like consistency. Vitreous is attached to retina. As age advances vitreous shrinks and gets detached from retina. This is called PVD (posterior vitreous detachment).This may be associated with floaters.

Vitreous-Retina Services - Sunayana Eye Hospital

Diabetic Retinopathy

Diabetic Retinopathy is a disorder of the retina which affects most of the people with Diabetes Mellitus leading to visual disturbance, at times total blindness.

Diabetic Mellitus is a condition where the blood sugar levels are above the normal range due to absence or deficiency of insulin in our body.

There are two types:

Type 1 / IDDM ( Insulin Dependent Diabetic Mellitus)
Type 2 / NIDDM ( Non-insulin Dependent Diabetic Mellitus)

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+91 080-2244-2356

+91 080-2245-3473

Working Hours

MON-SAT	9:30 AM – 6:30 PM
SUNDAY	Holiday

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Diabetes Retinopathy is known to be more common in IDDM. It affects the small capillaries of the retina thereby damaging the nerve cells leading to a vision problem. The wall of the capillaries become weak and starts leaking plasma fluid and fat leading to retinal oedema. Ballooning of capillaries i.e. Aneurysms is a common feature. The part of retina deprived of blood supply starts developing new abnormal vessels which break frequently causing retinal and pre-retinal haemorrhages. If it happens in the central part of retina it is called Maculopathy which disturbs the vision to a greater extent.

Usually, Diabetes Mellitus does not affect the eye in the initial period (approx. 5-6 years) for the majority of the people. But, if the person is not careful in controlling his sugar levels, Diabetic Retinopathy can develop within a few years of onset of Diabetes Mellitus. After 10 years of Diabetes, in spite of good control, Diabetic retinopathy can still manifest in the majority of the individuals.

This is very important to know as one should always keep control of their diabetes from the time it is diagnosed.

Diabetic-maculopathy — Diabetic Maculopathy

There are four stages of Diabetic Retinopathy:

Non-proliferative Diabetic Retinopathy (NPDR)
Pre-proliferative Diabetic Retinopathy (PPDR)
Proliferative Diabetic Retinopathy (PDR)
Stage of complication

In non-proliferative and pre-proliferative Diabetic Retinopathy, small retinal haemorrhages (Dot & Blot) are commonly seen. Usually, vision is not affected. These are reversible changes.

The Diabetic individual should have regular follow-ups and Laser therapy is usually not required in these stages. But, if the central area of the Retina ( Macula) is affected by:

Fat collection
Fluid collection
Vascular blocks, etc.

Then laser therapy is indicated along with Anti-VEGF Intra-vitreal Injections.

At times, a test called FLUORESCEIN ANGIOGRAPHY is done to know the status of the central retina before Laser treatment.

In Proliferative Diabetic Retinopathy, new fragile, abnormal blood vessels start growing on the optic nerve head and the rest of the retina. Laser treatment and Intra-vitreal Anti-VEGF Injections should be done immediately or else sight-threatening problems arise.

In the stage of complications, sudden onset of blindness can occur due to:

Vitreous haemorrhages
Retinal haemorrhages
Traction retinal detachment
Venous and arteriolar occlusions.

Even in this stage, the surgical treatments like Vitrectomy, Membrane peeling, Endo laser, diathermy and other HI-Tech procedures are done. Complete visual recovery is difficult.

What are Anti VEGF Injections?

Vascular Endothelial Growth Factors [VEGF] are required for the development of normal blood vessels as well as the development of abnormal, fragile blood vessels in common retinal diseases. Anti VEGF drugs are used to prevent new blood vessels and also to shrink already grown abnormal blood vessels which cause retinal damage. Commonly used drugs are:

Accentrix [Ranibizumab]
Avastin [Bevacizumab]
Macugen [Pegaptanib]
Eylea [Aflibercept]

These agents are being used for many eye diseases like

Wet form of AMD.
Severe Diabetic Retinopathy.
Diabetic Macular Oedema.
Neo Vascular Glaucoma.
Vitreous Haemorrhage.
CRVO/BRVO [Blockages of Major Blood vessels of Retina].

These retinal diseases which were considered incurable or had poor results, with existing treatments are now being tackled with good results.

Points to be Remembered:

All diabetics should have a regular checkup and follow up to detect signs of Diabetic Retinopathy at an early stage.
ARGON or DIODE LASER TREATMENT is effective in stabilizing the vision and preventing further worsening of Diabetic Retinopathy.
All said and done, the visual loss that has occurred after the onset of Diabetic Retinopathy is difficult to be restored to normal with any of advanced treatment and hi-tech technologies.
Proper control of diabetes is very important by means of proper diet, exercise, regular usage of medicines and periodic eye checkups.

Apart from this, Diabetes can give rise to other eye problems like early Cataract formation, Optic neuritis and ocular nerve palsy resulting in double vision.

Retinal Detachment

Separation of light-sensitive layer of the retina from the pigmentary layer is termed as retinal detachment.

People at Risk:

Myopia (shortsightedness)
Patients with Diabetes
People having a history of eye injuries

Symptoms

Veil-like vision
Floaters in the vision
Seeing Flashes of light

1. Retinal Detachment Department-graphic — Retinal Detachment

2. Peripheferal-retinal-hole — Peripheral Retinal Hole Leading to Detachment

3. Retinal Detachment — Detailed look at Retinal Detachment

4. Vision-retinal-detachment — Vision in Retinal Detachment

Treatment offered at Sunayana:

Treatment should be done on an emergency basis.
Pneumo retinopexy in case of small breaks with local RD, by injecting expandable air bubble it can be reattached.
In total RD scleral buckling, cryopexy, internal procedures like vitrectomy, endo laser and silicon oil injection will be done.

Fundus Photo, FFA Unit (Vitreo Retina) Sunayana Eye Hospital — Fundus Photo, FFA Unit (Vitreo Retina)

IRIDEX Diode Green Laser (Vitreo Retina, Glaucoma) Sunayana Eye Hospital — IRIDEX Diode Green Laser

ZEISS Optical Coherence Tomography (Glaucoma, Vitreo Retina) Sunayana Eye Hospital — ZEISS Optical Coherence Tomography

Everything said and done, prevention is better than cure in these situations. Yearly checkup with dilatation is helpful in detecting the problem at an early stage.

What is ARMD?

It is a retinal disorder affecting the central area of the retina in aged people. (60-70)
It leads to distortion of vision, loss of central vision (central scotoma)
After cataract surgery, if vision is not improving even with a change of spectacles, ARMD has to be ruled out

Why it occurs?

The weakening of the central retinal cells
Reduction in the blood supply
Retinal cell damage by free oxygen radicals
For a 60-year-old person, retina behaves like a 90-year-old.

Diagnosing ARMD (Dry and Wet)

Visual Acuity Testing
Amsler Chart
FFA, ICG
OCT

Treatment

Anti-Oxidants
Lasers-TTT and PDT
Anti VEGF Injections

Sunayana Eye Hospital has advanced Vitreo Retina surgical facilities, offers the latest treatments for the above conditions by specialists of international standard.