Best Retina Tretments In Pune
Eye Clinic And Laser Centre in Pune
Dr. Amit Motwani,
Retina Treatments In Viman Nagar Pune
Retinal diseases vary widely, but most of them cause visual symptoms. Retinal diseases can affect any part of your retina, a thin layer of tissue on the inside back wall of your eye.
The retina contains millions of light-sensitive cells (rods and cones) and other nerve cells that receive and organize visual information. Your retina sends this information to your brain through your optic nerve, enabling you to see.
Treatment is available for some retinal diseases. Depending on your condition, treatment goals may be to stop or slow the disease and preserve, improve or restore your vision. Untreated, some retinal diseases can cause severe vision loss or blindness.
The retina contains millions of light-sensitive cells (rods and cones) and other nerve cells that receive and organize visual information. Your retina sends this information to your brain through your optic nerve, enabling you to see.
Treatment is available for some retinal diseases. Depending on your condition, treatment goals may be to stop or slow the disease and preserve, improve or restore your vision. Untreated, some retinal diseases can cause severe vision loss or blindness.
Types
Common retinal diseases and conditions include:
Common retinal diseases and conditions include:
Retinal tear
A retinal tear occurs when the clear, gel-like substance in the center of your eye (vitreous) shrinks and tugs on the thin layer of tissue lining the back of your eye (retina) with enough traction to cause a break in the tissue. It’s often accompanied by the sudden onset of symptoms such as floaters and flashing lights.
Retinal detachment
A retinal detachment is defined by the presence of fluid under the retina. This usually occurs when fluid passes through a retinal tear, causing the retina to lift away from the underlying tissue layers.
Diabetic retinopathy.
If you have diabetes, the tiny blood vessels (capillaries) in the back of your eye can deteriorate and leak fluid into and under the retina. This causes the retina to swell, which may blur or distort your vision. Or you may develop new, abnormal capillaries that break and bleed. This also worsens your vision.
Epiretinal membrane
Epiretinal membrane is a delicate tissue-like scar or membrane that looks like crinkled cellophane lying on top of the retina. This membrane pulls up on the retina, which distorts your vision. Objects may appear blurred or crooked.
Macular hole
A macular hole is a small defect in the center of the retina at the back of your eye (macula). The hole may develop from abnormal traction between the retina and the vitreous, or it may follow an injury to the eye.
Macular degeneration.
. In macular degeneration, the center of your retina begins to deteriorate. This causes symptoms such as blurred central vision or a blind spot in the center of the visual field. There are two types — wet macular degeneration and dry macular degeneration. Many people will first have the dry form, which can progress to the wet form in one or both eyes.
Retinitis pigmentosa.
Retinitis pigmentosa is an inherited degenerative disease. It slowly affects the retina and causes loss of night and side vision.
Symptoms
Many retinal diseases share some common signs and symptoms. These may include:
• Seeing floating specks or cobwebs
• Blurred or distorted (straight lines look wavy) vision
• Defects in the side vision
• Lost vision
You may need to try looking with each eye alone to notice these.
When to see a doctor
It’s important to pay attention to any changes in your vision and find care quickly. Seek immediate medical attention if you suddenly have floaters, flashes or reduced vision. These are warning signs of potentially serious retinal disease.
Risk factors
Risk factors for retinal diseases might include:
• Aging
• Smoking
• Being obese
• Having diabetes or other diseases
• Eye trauma
• A family history of retinal diseases
• Blurred or distorted (straight lines look wavy) vision
• Defects in the side vision
• Lost vision
You may need to try looking with each eye alone to notice these.
When to see a doctor
It’s important to pay attention to any changes in your vision and find care quickly. Seek immediate medical attention if you suddenly have floaters, flashes or reduced vision. These are warning signs of potentially serious retinal disease.
Risk factors
Risk factors for retinal diseases might include:
• Aging
• Smoking
• Being obese
• Having diabetes or other diseases
• Eye trauma
• A family history of retinal diseases
Visualization in Vitrectomy
In addition to stains and dyes, light filters are enabling more effective intraoperative views.
Vitreoretinal surgery is evolving with the times. New methods of tackling retinal surgical pathology are developing. These developments have been helped by newer, finer, and faster instrumentation and improvements in internal tamponading agents and visualization of the pathology.
In the event that, on the off chance that one feels that there is a problem in the eye, they should instantly counsel an eye specialist for further examination. On the off chance that it is a retinal disease, getting the right treatment will increase the chances of regaining or retaining your vision, and limit further loss. During the normal eye check-ups or consulting with our doctors, we distinguish different problems of the eye and suggest solutions accordingly. During the initial phases of the retinal difficulties, generally, a few safety measures and a set of essential medicines and eye drops are suggested for the treatment.
If the diseases are at advanced stages or they are not being cured with the essential treatment, surgery is then suggested after inspecting the eye condition and understanding the patient’s problems. This is the time when an exceedingly experienced doctor would venture in and recognize what kind of surgical procedure is required and what will be the recovery time. Intravitreal injections involve injecting therapeutic agents (drugs/air/gases) inside the vitreous cavity throughparsplanaunder aseptic precautions
Vitreoretinal surgery is evolving with the times. New methods of tackling retinal surgical pathology are developing. These developments have been helped by newer, finer, and faster instrumentation and improvements in internal tamponading agents and visualization of the pathology.
In the event that, on the off chance that one feels that there is a problem in the eye, they should instantly counsel an eye specialist for further examination. On the off chance that it is a retinal disease, getting the right treatment will increase the chances of regaining or retaining your vision, and limit further loss. During the normal eye check-ups or consulting with our doctors, we distinguish different problems of the eye and suggest solutions accordingly. During the initial phases of the retinal difficulties, generally, a few safety measures and a set of essential medicines and eye drops are suggested for the treatment.
If the diseases are at advanced stages or they are not being cured with the essential treatment, surgery is then suggested after inspecting the eye condition and understanding the patient’s problems. This is the time when an exceedingly experienced doctor would venture in and recognize what kind of surgical procedure is required and what will be the recovery time. Intravitreal injections involve injecting therapeutic agents (drugs/air/gases) inside the vitreous cavity throughparsplanaunder aseptic precautions
What are the medical conditions associated with Retina?
There are four main types of disorders which are related to the retina:
Diabetic Retinopathy – It is one of the most common issues related to individuals having diabetes. In Diabetic Retinopathy illness, the high blood sugar levels cause harm to the vessels of the retina and damage it. In the advanced stages, it can prompt to blindness.
Diabetic Retinopathy – It is one of the most common issues related to individuals having diabetes. In Diabetic Retinopathy illness, the high blood sugar levels cause harm to the vessels of the retina and damage it. In the advanced stages, it can prompt to blindness.
Retinopathy Of Prematurity – ROP is principally caused because of the retinal vessels growing abnormally and affects prematurely born babies. It can likewise prompt retinal separation and visual deficiency.
Age-Related Macular Degeneration – The harm of macula can cause ARMD which can prompt a permanent vision loss.
Retinal Detachment – It is basically the detachment of the retina from the layer underneath. In the event that it isn’t dealt with properly, there is a chance for permanent vision loss.
Pars plana
Varies in anteroposterior diameter nasally 3mm wide and temporally 4.5mm wide. This variation is because of the posterior globe on temporal side curves posteriorly & laterally more than on the nasal side. Pars plana extend from pars plicata anteriorly to oraserrata (termination of the retina) posteriorly. Blood vessels in pars plana are radially oriented but circumferential incisions across these vessels cause no bleeding. Also, lens zonules insert into ciliary body avoiding pars plana
Thus, needle punctures 3.5 mm posterior to limbus enter globe through pars plana
Not damaging lens
Not puncturing the retina
Not tethering / damaging the vitreous base
Ciliary body, lens & retina attain adult size by 7years of age
Linear relation exists between the axial length of eye & pars plana during development
Hence in paediatric eyes site of injection varies taking into consideration small size of eye, anterior placement of pars plana& relatively greater size of crystalline lens.
Not damaging lens
Not puncturing the retina
Not tethering / damaging the vitreous base
Ciliary body, lens & retina attain adult size by 7years of age
Linear relation exists between the axial length of eye & pars plana during development
Hence in paediatric eyes site of injection varies taking into consideration small size of eye, anterior placement of pars plana& relatively greater size of crystalline lens.
Age |
Distance of injection from limbus |
1- 6 months |
1.5 mm |
6 mths—1year |
2 mm |
1—2yr |
2.5 mm |
2—6yr |
3 mm |
7 yr onwards |
4 mm phakic,
|
Distance of site of injection from limbus according to age
Therapeutic agent |
Indication |
Standard dosage |
|
Absolute |
Relative |
||
Triamcinolone Acetonide |
Refractory CSME, refractory pseudophakicCME, CRVO, BRVO. |
– |
2 mg in 0.05 ml / 4mg in 0.1ml |
Macugen
|
CNVM
|
Refractory CSME, PDR, NVG, CRVO, BRVO. |
0.3 mg in 90 µl |
Lucentis
|
CNVM
|
Refractory CSME, PDR, NVG, CRVO, BRVO. |
0.3 mg in 0.05 ml |
Avastin
|
CNVM
|
Refractory CSME, PDR, NVG, CRVO, BRVO. |
1.25 mg in 0.05 ml |
Vancomycin |
Endophthalmitis |
– |
1 mg 0.1ml |
Amikacin |
Endophthalmitis |
– |
0.4 mg 0.1ml |
Ceftazidime/cefazoline/cefotaxime |
Endophthalmitis |
– |
2.25 mg in 0.1ml |
Amphotericin B |
Endophthalmitis |
– |
5 mcg in 0.1ml |
Air |
Pneumatic retinopexy |
– |
0.5-0.8cc |
SF6 (100%) |
Pneumatic retinopexy |
– |
0.5 ml |
C3F8 (100%) |
Pneumatic retinopexy |
– |
0.3 ml |
retinopexy
CSME: clinical significant macular edema, CRVO: central retinal vein occlusion, BRVO: branch retinal vein occlusion, CNVM: choroidalneovascular membrane, AMD: age related macular degeneration, PDR: proliferative diabetic retinopathy, NVG: neovascular glaucoma.
Technique
Informed consent clearly explaining what the treatment involves/what to expect/what the risks are 1-3
Equipment
Eyelid speculum, gloves, toothed microforceps, cotton buds, eye drape, callipers, povidone iodine, 0.5% proparacaine, 26 or 30 gauge needle, tuberculin syringe
Preparation & Administration:4-7
Pupil– dilated
Prepare periocular area with 10% iodine solution
Instill 5% povidone iodine drops (3 mins)
Instill topical 0.5% Proparacaine
Under aspetic precautions drape placed, speculum inserted
Patient is asked to look away from site of injection (superonasally)
Mark the injection site using the caliper (the entry site of the needle should be 3.0-3.5 mm from the limbus in aphakic/pseudophakic patients, and 3.5-4.0 mm in phakic patients).
Avoid the horizontal meridians of the globe; the inferotemporal quadrant is preferred
Using forceps to steady the eye, the needle is inserted perpendicular through sclera with the tip aimed towards the centre of the globe (to avoid any contact with the posterior lens)
One can even go 15 degrees tangential to the sclera for a few millimeters and then insert perpendicularly so as to create a small self-sealing tunnel. The conjunctiva can also be retracted before injection so that the scleral and conjuctival entry do not overlap after completing the injection.
Prepare periocular area with 10% iodine solution
Instill 5% povidone iodine drops (3 mins)
Instill topical 0.5% Proparacaine
Under aspetic precautions drape placed, speculum inserted
Patient is asked to look away from site of injection (superonasally)
Mark the injection site using the caliper (the entry site of the needle should be 3.0-3.5 mm from the limbus in aphakic/pseudophakic patients, and 3.5-4.0 mm in phakic patients).
Avoid the horizontal meridians of the globe; the inferotemporal quadrant is preferred
Using forceps to steady the eye, the needle is inserted perpendicular through sclera with the tip aimed towards the centre of the globe (to avoid any contact with the posterior lens)
One can even go 15 degrees tangential to the sclera for a few millimeters and then insert perpendicularly so as to create a small self-sealing tunnel. The conjunctiva can also be retracted before injection so that the scleral and conjuctival entry do not overlap after completing the injection.
Remove needle slowly and carefully
A sterile cotton-tipped applicator is used to prevent reflux and to steady the eye.
Check that the patient is able to see objects immediately after injection to ensure that the retinal artery is perfused
Check that the patient is able to see objects immediately after injection to ensure that the retinal artery is perfused
Post-procedure
Advise patient to administer antibiotic drops QDS for a minimum of 5 days postinjection.
They should be instructed to report immediately if any symptoms like eye pain or discomfort, increased redness or additional blurring of vision arise. Floaters are common and should be explained to patients (especially with triamcinolone acetonide)
Follow-up
________________________________________
24 hours after injection. In cases of triamcinolone injections patient is asked to follow-up after 2 wks for Intra ocular pressure (IOP) measurement.
In cases of anti-VEGF injections follow-up after 4 wks
They should be instructed to report immediately if any symptoms like eye pain or discomfort, increased redness or additional blurring of vision arise. Floaters are common and should be explained to patients (especially with triamcinolone acetonide)
Follow-up
________________________________________
24 hours after injection. In cases of triamcinolone injections patient is asked to follow-up after 2 wks for Intra ocular pressure (IOP) measurement.
In cases of anti-VEGF injections follow-up after 4 wks
Complications
________________________________________
1. Defined risks (should be included in every informed consent)
2. Infection (0.16%, 2-year incidence in over 10,000 injections)
3. Retinal detachment (0.15%, 2-year incidence in over 10,000 injections);
4. Lens trauma/acute cataract (0.07%, 2-year incidence in over 10,000 injections).
5. Sub-conjunctival / vitreous hemorrhage
6. Vitreous wick syndrome
7. Precipitated angle closure
8. Elevated IOP with perfusion compromise (CRAO: Paracentesis to be done immediately)
9. Wound leak and hypotony
10. Anaphylactic reaction to either the agent or peri-procedural materials.
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