How does retinal detachment occur?
RD may be caused due to tears or holes in the retina (Rhegmatogenous RD), traction on the retina (Tractional RD) or if fluid is built up under the retina (Exudative RD)

What are the risk factors for retinal detachment?
A retinal detachment is also more likely to occur in people who have:

• High myopia( near sightedness)
• History of injury to the eye
• History of retinal detachment in the other eye
• Family history of retinal detachment
• History of cataract surgery
• Inflammatory eye disease

What are floaters and flashes of light?
Floaters are small, dark, shadowy shapes that can look like spots, thread-like strands, cob webs or squiggly lines that move in your field of vision. Flashes look like flashing lights or lightning streaks in the peripheral vision even though no light is actually flashing. Floaters are very common and is usually not a sign of a serious condition. However, if floaters and/or flashes begin or increase suddenly, it may indicate a serious problem, and hence needs immediate medical attention.

Scleral buckle surgery involves suturing a silicone “buckle” to the eye that indents the wall of the eye to support the retinal breaks allowing the retina to reattach.Cryopexy (freezing) treatment is usually used to seal the retinal tears.
The silicone buckle is usually left on the eye permanently. Someone looking at you cannot see the buckle, as it is stitched to the sclera somewhere towards the back of the eye.

At Kumta Eye and Retina clinic, we perform highly specialized minimally invasive buckling technique called Minimal Scleral Buckling.

Vitrectomy involves removing the vitreous gel and filling the eye with gas or silicone oil bubble. Gas or silicone oil placed in the vitreous cavity helps to hold the retina in place.The holes and tears are sealed with laser, and fluid under the retina is drained.
If silicone oil has been used, it requires a second surgery to remove the oil, at a later date. Gas bubble doesnot require to be removed and usually gets absorbed within 4 weeks.

At Kumta Eye and Retina clinic, we perform MIVS (Microincisional Vitrectomy Surgery) using very tiny self sealing incisions which do not require sutures and hence recovery is very quick, healing time is much faster and postoperative discomfort, pain, and redness is minimal as compared to conventional vitrectomy. This is performed with the most advanced high speed vitrectomy machine (Constellation). (Scroll down for more details)


What is the success rate of retinal detachment surgery?
The anatomical success rate(chances of retina getting attached) is about 90% .There is a small risk (about 10%) of redetachment of the retina after surgery, in which case, a repeat surgery to reattach the retina may be required. This usually occurs if there is a scar tissue formation over the retinal surface called proliferative vitreoretinopathy (PVR) which causes the retina to redetach.
The functional success rate (visual outcome) depends on factors like duration and type of detachment, age of the patient. Although the retina gets settled well after surgery, vision remains compromised in these cases, since there is permanent damage to the vision cells of the retina whenever the retina gets detached.

RETINAL VEIN OCCLUSION (RVO)

What is retinal vein Occlusion (RVO)?
RVO occurs when there is a blockage in the retinal vein (which drains blood away from the retina) causing the walls of the vein to leak blood (haemorrhage) and fluid into the retina. Fluid accumulation under the macula causes sudden painless blurring of vision. If RVO is not treated, it can sometimes lead to complete loss of vision.,

What are the types of RVOs?
RVOscan be mainly of two types:

What are the types of CRVO?
Non ischemic CRVO – it is a is a milder form of the disease where the blood supply of the retina is not affected Ischemic CRVO – it is a more serious form where the blood supply of the retina is lost, hence can lead to the development of significant complications,vision loss and rarely loss of eye.

What are the symptoms of RVO?
Patient with RVO may complain of sudden painless loss of vision in the affected eye. There may be minimal or no symptoms if macula is not affected.

What are the risk factors for RVOs?
High blood pressure, Diabetes, High cholesterol, elevatedHomocysteine levels, Ocular hypertension & Glaucoma, Fasting especially water deprivation

What is the treatment for RVO?
There is no treatment proven to reopen occluded retinal veins. Strict control of all risk factors is very important.

Intravitreal Anti-VEGF injections ( Lucentis /Avastin)–to reduce macular edema and improve vision. It may sometimes be combined with a steroid injection.

Intravitreal steroid injections (Triamcilnolone/ Ozurdex implant) – to reduce macular edema and improve vision. Can be combined with Anti VEGF injections.

Laser Photocoagulation-Laser treatment is applied to whole peripheral retina (PRP in ischemic CRVO) or affected retinal area in BRVO to decrease the risk of further complications. Laser does not improve sight.

Vitrectomy – May be required in cases of non resolving vitreous haemorrhage due to RVO.

AGE RELATED MACULAR DEGENERATION (AMD)

Dry AMD -Occurs when the light sensitive cells in the macula slowly break down gradually blurring central vision.

What are the Symptoms of AMD?
Blurred central vision, distorted vision, difficulty in recognizing faces and reading


What is the treatment for AMD?
There are two main treatment options for wet AMD:

• Intravitreal Anti-VEGF injections (Lucentis (FDA approved)/ Avastin(non FDA approved)) to prevent the growth of new blood vessels.
• Laser treatment to destroy abnormal blood vessels in the eye.
• Photodynamic therapy (PDT) with Visudyne - PDT uses a light sensitive dye – Visudyne which when injected, accumulates in abnormal blood vessels in the eye and a cold laser is used to activate the drug which then seals the abnormal vessels without damaging the overlying sensory retina.

DIABETIC RETINOPATHY (DR)

What is Diabetic Retinopathy?
Diabetic Retinopathy (DR) is a progressive damage to the tiny retinal blood vessels caused by complications of long-standing diabetes, which if not treated at an appropriate stage can eventually lead to complete loss of vision

What are the symptoms of Diabetic retinopathy?
In DR, patient may be asymptomatic (no vision complaint) unless it reaches an advanced stage or macula is affected. Hence every diabetic should get a comprehensive dilated eye examination done once in a year for early detection of DR.
In Diabetic macular edema, patient may have blurred vision, difficulty in reading, and recognizing faces.
In PDR with vitreous haemorrhage, patient may complain of sudden drop in vision with associated floaters.

What are the stages of Diabetic Retinopathy?
DR can be classified into two stages:

What is Diabetic macular edema (DME)?
DME is swelling or thickening of the macula due to fluid leakage from damaged blood vessels within the macula due to diabetes causing blurring of vision. DME can occur at any stage of DR.

How is Diabetic Retinopathytreated?
In the early stages of NPDR, treatment other than regular monitoring is not required. Strict control of diabetes, blood pressure and cholesterol is very important to control progression of DR.

• Laser Photocoagulation- In severe NPDR or PDR, laser treatment is applied to peripheral retina (PRP) to decrease the risk of complete vision loss. Laser does not improve sight.
  At Kumta Eye and Retina Clinic, we use the latest laser technology including MULTISPOT PATTERN LASER & MICROPULSE which have very less side effects & virtually painless (scroll down for more details)
  
• Intravitreal Anti-VEGF injections ( Lucentis /Avastin)– In cases of vitreous haemorrhage due to PDR, anti VEGF injections cause new abnormal blood vessels to shrink and hence stop further bleeding.
• Vitrectomy (with or without silicone oil injection)– In advanced stages of PDR, surgery may be indicated.
  
  What is the treatment for DME?
  DME if mild can be treated directly with laser. If edema is more, then intravitreal injections are first required to reduce the swelling and then laser is done to seal leaking blood vessels.The injections can be of 2 types:
• Intravitreal Anti-VEGF injections ( Lucentis /Avastin) - It may sometimes be combined with a steroid injection.
• Intravitreal steroid injections (Triamcilnolone/ Ozurdex implant) - Can be combined with Anti VEGF injections.
  

What are Vitreoretinal Interface Diseases?
The vitreous gel is strongly attached to the retina (at macula) since birth. This gel starts liquefying and separating from the retina with age. Changes in vitreous gel may cause pull on the retinal surface and macular distortion. Some of the commonly seen vitreoretinal interface diseases are:

1. 1. Vitreomacular traction syndrome (VMTS)
2. 2. Epiretinal membrane (ERM) or Macular pucker
3. 3. Full thickness macular hole (FTMH)

What are the symptoms of Vitreoretinal diseases?
Since this is a macular disease, central vision is mainly affected - blurred central vision with difficulty reading and recognizing faces, distorted vision, gray spot in central vision (central scotoma)

How is VMTS treated?
The treatment of VMTS is vitrectomy surgery to release all adhesions of the gel to the macula, and to peel away any residual membranes on the surface of the macula that may also be contributing to distortion of the vision. Sometimes the eye is filled with a gas at the end of surgery to help with healing. If used, the gas slowly disappears over days to weeks.