Diabetes and retina surgery

All vitrectomies are performed via small 1mm incisions  (23 and 25 gauge) under local anesthesia. Patients are discharged from the hospital 2 hours after the procedure. We are adimistering intraocular injections (anti-VEGF treatment): Avastin and Eylea.

Diabetes and the eye

Diabetes is the leading cause of blindness and poor vision of the working population in the world. The eye is, unfortunately, very often damaged  due to diabetes whereby no part of the eye is spared. Eyes of the people suffering from diabetes is more prone to the occurrence of various infections and degenerative processes, and the cataract also occurs early. The most important complication of diabetes on the eye is diabetic retinopathy.

What is diabetic retinopathy?

It is a complication of diabetes in which there is damage to the inner layer of the eye, which is made up of nerve cells, and is called the retina. The retina has a key role when it comes to the human vision because the light that enters the eye through the nerves of the retina is converted into an electrical impulse that travels to the brain through the optic nerve, which provides us with vision. Diabetes is microangiopathy, i.e. small vessel disease, and therefore the retina is particularly affected due to ts very small blood vessels.

What are the symptoms of diabetic retinopathy?

Impaired vision is the main sign of diabetic retinopathy. Impaired vision occurs for two reasons. The first is when the blood vessels in the center of the eye become permeable due to elevated blood sugar levels so there is edema or swelling in the center of the eye (yellow spot). This condition is called diabetic macular edema. The liquid that came out of the blood vessels damages the nerve cells that degenerate, leading to the weakening of central vision.

Another way in which diabetes weakens eyesight is when long-term diabetes leads to the blockage of blood vessels of the eye. In this case, the response of the eye to ischemia (malnutrition) is the development of neovascularization or degenerative blood vessels. This stage of diabetic retinopathy is called proliferative diabetic retinopathy. Newly formed blood vessels have a very unstable wall that often ruptures causing the bleeding in the eye or hemophtalmos. A person notices this as a rapid deterioration of vision or it feels like a fog has been lifted in front of the eye. If the condition is not treated, the connective tissue next to the vessels becomes enlarged and detaches the retina due to its contractile properties. This is a very dangerous condition and it is very challenging to treat.

What is the treatment for diabetic retinopathy?

Initially, the main treatment was laser treatment wherein we coagulated permeable blood vessels of the retina. Today, the standard treatment of macular edema and diabetic retinopathy are intravitreal injections of drugs from the anti-VEGF group of drugs. The injections are given after a local anesthesia by administering drops through the sclera and are completely painless. The treatment is carried out monthly over several months or years. With the help of these injections better results are achieved than after laser treatment because the laser damages the surrounding healthy tissue. The result is often vision improvement, not merely the stabilization of the existing vision. After improving the vision by injections, the treatment is supplemented by conventional laser treatment, which then permanently preserves the status quo. At our clinic, we have the most modern laser fotokoagulator Pascal, which is significantly less painful, and the process is several times shorter and is implemented in fewer sessions. 

Why is early detection and treatment of diabetic retinopathy important?

In advanced diabetic retinopathy newly formed veins and scars destroy healthy tissue of the retina by bleeding or clogging healthy circulation. Early treatment with injections and the laser destroys these newly formed blood vessels. Their development can also be prevented if you start timely treatment with injections and the laser.

What if diabetic retinopathy progressed?

If diabetic retinopathy progressed to a more advanced stage of proliferative diabetic retinopathy where the newly formed veins and scars pullulate and bleed in the eye and destroy and detach the retina, the only treatment is surgery. The operation is called vitrectomy, and it is completely painless for the patient. The procedure is performed under local anesthesia, after which a person can be discharged. Today, due to the progress of surgical technique and technology, these surgeries are performed as early as possible because they are minimally invasive and the visible result is better.

How to prevent the development of diabetic retinopathy?

It is necessary to do everything to prevent this severe complication. That is why every person suffering from diabetes needs regular checkups of the eyes at least once a year. The checkup shall include the dilation of the pupils and the examination of the fundus. This will not only consist of the test of vision, because changes may be present even though the patient does not notice visual loss.

Why „Sistina Ophthalmology“?

A special advantage of our clinic in relation to the treatment of diabetic retinopathy is the fact that we have doctors who deal exclusively with the treatment of this disease. The diagnosis and treatment can be done on the same day. Our diagnostic devices are modern and provide an accurate diagnosis and treatment planning. Pascal laser and 23 and 25 g vitrectomy allow painless and minimally invasive treatment, recovery is faster and there is no delay nor waiting for surgery.

Age-related degeneration of the yellow spot or macula

The macula or the yellow spot is a central part of the retina that enables central vision, reading and distinguishing fine details. Macular degeneration is a disease that usually occurs in older adults, usually over 50 years of age, and which results in the loss of vision in the center of the field of vision so that it hinders and prevents reading and facial recognition, although the remaining peripheral vision allows other daily activities. The risk factors, other than age, are family history, smoking and high blood pressure and high triglycerides. It occurs in two forms: “dry” and “wet”.

What is dry, and what is wet macular degeneration?

The dry form of macular degeneration is reflected in the changes whereby there is a deterioration of cells in the retina responsible for vision. The dry form progresses more slowly than the wet form of macular degeneration, but also eventually leads to irreversible reduction of visual acuity. The most severe form of dry degeneration leads to a complete thinning of the parts of the retina, which is called geographic atrophy as it resembles a geographical map of areas where the parts of the tissue responsible for vision are missing. Unfortunately, currently there is no effective treatment for dry macular degeneration, but it is extremely important to take a combination of vitamins and high doses of the antioxidant lutein and omega acids that exist in finished dosage forms and provenly slow the progression of dry AMD, as well as its transition into the wet form. 

In the wet form of age-related macular degeneration with the deterioration of the macula tissue, there is also bleeding and the accumulation of fluid from abnormal blood vessels under the macula. If the condition is not treated, it leads to scarring over several weeks or months and results in permanent and irreversible damage to the photoreceptors of the yellow spot, after which there is a rapid loss of visual acuity.  

What are the symptoms of wet macular degeneration?

The occurrence of the weakening of central vision, difficulty reading, the emergence of a centrally located shadows or loss of the section of the image in the center, distorted lines (e.g. when solving crossword puzzles in the newspaper), a difficulty in distinguishing colors and a slow recovery of vision when moving from a bright room to the dark room are the most common symptoms of wet macular degeneration. 

How is wet macular degeneration diagnosed?  

An experienced ophthalmologist can identify bleeding and swelling in the macula based on the mere dilation of the pupils and macula examination. A confirmation of the diagnosis is obtained during the same examination on the OCT device. Sometimes an additional confirmation is obtained by performing fluorescein angiography.  

What is the treatment for wet macular degeneration? 

Although wet degeneration, compared to the dry, causes a rapid loss of vision, there are very effective drugs called anti-VEGF (Endotheilal anti-Vascular Growth Factor) which reduce the bleeding and leakage of fluid under the macula and improve vision. The drugs must be administered by injection into the eye. The injections are given in the eye under local anesthesia and are not painful. After outpatient application, the patient is discharged immediately. The treatment lasts from several months to several years and requires repeated injections at intervals of one month. On the market there are currently Avastin (bevacizumab), Lucentis (ranibizumab) and Eylea (aflibercept), and Fovista (anti-PDGF – Anti Platelet Derived Factor) is at the clinical stage of testing.

Why are early detection and prevention of this disease important?

For the elderly patients, preventive eye examination is very important, whereby by a simple dilation of the pupil, the condition of the macula can be determined. Initial changes related to wet degeneration can be treated successfully with these injections, but the patient may not notice them immediately.  

Why „Sistina Ophthalmology“?

We have extensive experience in treating these diseases because we started the treatment with injections in 2005, just a few months after the treatment was discovered in the United States. We use all globally available drugs. The treatment with injections is an outpatient treatment and the whole procedure takes about 15 minutes. The treatment is planned individually because our state of the art OCT device enables the detection of the most subtle changes. We are currently participating in the implementation of an American study for testing Fovista, a new smart drug for wet macular degeneration, and are certified by the US regulatory authorities confirming that we meet the highest level of diagnostic and technological standard for the testing of new drugs for retinal diseases.

What is retinal detachment?

Retinal detachment is a medical emergency that needs to be operated on as soon as possible, preferably within 24 hours. During retinal detachment, the retina breaks and a retinal hole is created. Aqueous humor enters through the retinal hole and detaches the retina from its base.

What are the symptoms of retinal detachment?

The patient sees the creation of dark curtains. When the detachment reaches the center of vision or macula, which can occur within 1-2 days, vision becomes very poor and the person can no longer read or recognize people. 

What is the treatment for retinal detachment?

Retinal detachment is treated by surgery called vitrectomy. As the retina feeds only when stuck to the fundus, each retinal detachment can result  in permanent retina damage. Therefore, the surgery should be performed  as soon as possible and postponing it results in the poorer functional. In Svjetlost, we can organize the surgery within 24 hours during weekdays or holidays. The procedure is performed under local anesthesia with sedation. This means the patient’s eye becomes numb. This method of surgery is completely painless. The surgery takes about an hour. After the surgery, the patient is discharged within 2 hours.

During vitrectomy, we enter the eye through 4 small incisions the size of 1 millimeter on the white part of the eye (sclera). During the surgery, we remove the vitreous which pulls on detached retina. The vitreous is later replaced by the normal aqueous humor produced by the eye and the eye functions normally. After removing the vitreous, retinal breaks are identified, retina reatached and retinal breaks sealed with laser..

What type of retinal tomponade is used after detachment surgery?

At the end of the suargery,  gas or silicone oil is placed in the eye to hold  retina in place until firmly aattached. In Svjetlost we generally use gas tamponade. The advantage of gas tamponade is that it dissapates from the eye within  2-6 weeks by itself, and no surgical removal is necesarry as with silicone oil. Retinal detachment diagnosed late are complicated with retinal scaring and folding. After membranes removal silicone oil is placed in the eye to unfold retina and provide longer acting tamponade. Silicone oil is removed from the eye within several months, but can remain in the eye for years if the eye was severely damaged. Sometimes, especially with severe retinal detachments, multiple procedures are necessary to achieve satisfactory results.

How long is the recovery and what about positioning?

After surgery, the eye is neither very red nor painful, and the recovery is quick. Eye drops and ointment should be applied during few weeks. No patching is necessary. Checkups are scheduled a day after the surgery, seven days after the surgery and 2-3 weeks after surgery. The patient needs to position himor herself cheek to pillow or face down for few days. In 10 days post uncomplicated retinal detachments repair, the patient can return to normal daily activities. During the entire recovery period, reading and  working on the laptop or watching TV with both eyes is  allowed. 

Why “Sistina Ophthalmology”?

In the case of retinal detachment, early detection and treatment is of a very essence, so contact us as soon possible so we can immediately organise your surgery and save the function of your vision, since delaying the surgery results in poorer  final outcome. We can schedule surgery within 24 hours. Surgery is done in local anesthesia and patient is discharged within 2 hours from the hospital.Mostly we end up with gass tamponade so no additional surgery is necesary. Even though the surgery is performed under local anesthesia, anesthesiologist is present to monitor blood pressure, heart rate, respiration, blood oxygen and blood sugar and may additionally intervene, as necessary.

Detailed eye examination

Refraction, visual acuity measurement, eye pressure measurement, evaluation of posterior segment – examination of anterior and posterior segment.
1.650,00

OCT

Оptical coherent topography on anterior segment or posterior segment.
1.900,00

Argon laser photocoagulation

Price is for one eye.
7.700,00

Administration of Avastin injection

Intrabulbar administration of Avastin. Price for one eye.
12.500,00

Administration of Avastin injection

Subconjunctival administration of Avastin. Price for one eye.
8.300,00

Administration of Eylea injection

41.200,00

Vitrectomy

Surgery for posterior segment. Price is for one eye. This surgery is covered by HIF only for Macedonian residents.
123.000,00

Vitrectomy via HIF

Surgery for posterior segment. Price is for one eye. This surgery is covered by HIF only for Macedonian residents.
6.000,00

Vitrectomy and cataract surgery

Surgery of posterior segment and cataract surgery with implantation of intraocular lens. The price is for one eye.
166.000,00

Prices are in MKD.