Retinal diseases are: macular degeneration (wet and dry form), diabetic retinopathy, retinal detachment, retinal degeneration, macular edema, retinal venous occlusion and traction with the possibility of retinal detachment.
Diabetes is the leading cause of blindness and poor eyesight in the working age population worldwide. Diabetes can cause eye damage as a result of long-term elevated blood sugar levels. The blood vessels of the retina are damaged, there is bleeding of the retina, swelling and fatty deposits, especially in the center of clear vision, as well as the creation of new blood vessels due to which bleeding occurs inside the eye. This condition is called diabetic retinopathy.
In already developed diabetic retinopathy, newly formed blood vessels that have weak walls and are abnormal, destroy the healthy tissue of the retina by rupturing and bleeding or by preventing healthy circulation. Early treatment with injections and laser achieves the destruction of these newly formed blood vessels. At the same time, their development can be prevented if injections and laser are started on time.
Also, patients with this condition who have a diopter or cylinder are suitable for laser diopter correction in cases where diabetes has not made changes in the eye. The technology is so advanced that even in patients with diabetic retinopathy, we implant the latest intraocular lenses to remove their diopters.
Symptoms of diabetic retinopathy:
- Gradual deterioration of vision.
- Sudden loss of vision.
- Opiates floating in the field of vision (flies)
- Blurred vision;
- Eye pain or redness.
Macula or yellow spot is the middle part of the retina that allows us to see, read and distinguish fine details.
Macular degeneration is a disease that most commonly occurs in the elderly, usually over 50 years of age, and results in vision loss in the middle of the visual field making it difficult to read and recognize faces, although other peripheral vision allows for other daily activities.
Risk factors in addition to age are family history, smoking, high blood pressure and fat. This condition occurs in two forms: “dry” and “wet”.
The dry form of macular degeneration is characterized by changes that lead to the collapse of the retinal cells responsible for vision. The dry form progresses more slowly than the wet form of macular degeneration and over time leads to an irreversible decrease in visual acuity. The most severe form of dry macular degeneration leads to completely exposed parts of the border that look like a map. There is currently no effective treatment for dry macular degeneration, but there is a way to slow its progression with the help of vitamin complexes with a high concentration of the antioxidant lutein that have been shown to slow the progression of dry senile degeneration of the macula as well as its transition to the wet form.
The wet form of senile macular degeneration is characterised by the collapse of tissues in the macula leading to the growth of abnormal blood vessels, bleeding, and their leakage of fluid into the surrounding retinal tissues. The result is swelling and exudates that deplete the retinal layers leading to damage to nerve cells and photoreceptors.
- Common symptoms of wet macular degeneration:
- Impairment of central vision,
- Difficulty reading,
- Appearance of a shadow in the central part of the vision or loss of part of the image in the center,
- Distorted lines (e.g. when solving a crossword puzzle)
- Difficulties in distinguishing colors and
- Slow recovery of vision when switching from light to dark room
Macular edema occurs when fluid accumulates in the macula and causes swelling.
Macular edema can occur due to:
- macular degeneration;
- retinal venous occlusion;
- hereditary diseases such as retinosis or retinitis pigmentosa;
- inflammatory eye diseases such as uveitis;
- eye tumors;
- eye surgery – it is not common but can occur after a certain eye surgery;
- eye injuries.
Macular edema is usually asymptomatic and painless. However, the symptoms that may indicate that you have this condition are:
- Blurred or wavy-like central vision;
- Colors look paler or different;
- Difficulty reading.
If you notice any of these symptoms, you should see an ophthalmologist immediately. If not treated in time, there is a possibility of blindness.
The subspecialty examination is a detailed examination and consists of anterior segment examination, as well as diopter determination (new diopter, diopter change, hidden diopter examination) and examination of the posterior segment of the eye (fundus and optic nerve). This examination is done for all retinal diseases.
OCT is an optical coherence tomography – it examines the structure of the macula and the optic nerve to find out if there are any defects in that structure that are invisible when using a magnifying glass. In people over 60 years of age with diopters, this diagnosis is made due to the possibility of macular degeneration.
Visual field – this examination checks the central and lateral vision (peripheral vision). Perimetry serves to detect changes in vision, i.e. its weakening which may be caused by the disease.
Fluorescent angiography – performed as needed in macular degeneration.
Examination for people with diabetes covers examination of the anterior segment, determining the diopter (new diopter, changing the diopter, checking for hidden diopter), and checking the posterior segment of the eye (fundus and optic nerve) and examination of the posterior segment is done by examination with the so-called OCT or optical coherence tomography, which is also the most important examination in people with diabetes. This test scans the structure of the macula, the optic nerve to see if there are any defects in that structure, which are invisible when examined with a magnifying glass, as well as the condition of the blood vessels in the back segment of the eye.
All diagnostic tests are painless and are performed in collaboration with the patient.
- Laser photocoagulation
Laser photocoagulation takes place in an outpatient setting, with local anesthesia of the dilated pupil.
The laser ophthalmologist makes small burns in the affected areas, creating connective tissue that, depending on the diagnosis, seals the retinal hole, stops the leakage of abnormal thin-walled blood vessels or slows their growth.
You may experience light flicker or feel while your doctor is using a laser. This procedure can be repeated several times if necessary.
- Anti-VEGF treatment (eye injections)
Today, the standards of treatment have changed and the first line of treatment is the application of intravitreal injections from the group of anti-VEGF. The application of these injections is through local anesthesia with anesthetic drops and is completely painless.
The injection is given once a month for several months or a year. With the help of this therapy, in addition to stabilizing the condition of the retina, we often have an improvement in vision.
Vitrectomy is the most complex microsurgical operation that treats diseases of the posterior segment of the eye such as: bleeding in the eye, retinal detachment (retinal ablation), macular degeneration, diabetic retinopathy, rupture (hole) of the macula and the like.
The surgeon makes incisions through 4 small white holes (less than 1 mm) to remove the vitreous in the eye, after which it is replaced with a special gas (which is resorbed over time) or silicone oil. If the patient has ruptures (holes) in the retina, they are repaired by laser photocoagulation.
At the end of the operation, a tamponade is made with gas or silicone oil, which depends on the condition of the retina.
After the operation, the patient is taken to an apartment. About half an hour after the operation, the patient goes home (one-day surgery) with a bandage on the operated eye.
- Retinal ablation (retinal detachment)
Retinal ablation or retinal detachment is an emergency that must be operated on within 24 hours. At Sistina Ophthalmology we can organize the operation within 24 hours during a working day or a holiday.
In retinal ablation, vitrectomy is performed.
During the operation, the vitreous, which is painful and has caused the ablation, is removed. The vitreous is then replaced by the normal aqueous humor that the eye produces itself and the eye functions normally. Once the vitreous has been removed, retinal “holes” are identified, and the retina together with the holes are patched with the help of laser.
At the end of the operation, gas or silicone oil is placed in the eye to hold the retina until it is completely attached. The advantage of the gas is that it comes out of the eye by itself and after 2 to 6 weeks it is not necessary to go for additional surgery to remove the silicone oil. In cases where the ablation is not detected in time or it is complicated and has created scars in the eye, silicone oil is put which is then removed from the eye after several months, but it can remain for a year if the eye is severely damaged.