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Retinal Disorders

What is Retina

Human eye is shaped like a ball (hence the term eyeball) and is filled with a gel like material. The wall of the eyeball has three layers, innermost being the 'Retina'. Function of the retina is to process light that enters the eye and convert it into electrical signals. These signals are sent to the brain, which gives us a perception of vision. If we compare human eye to a camera, then retina would be the film of that camera.

Common Retinal Disorders

Diabetic Retinopathy

A leading cause of blindness in the developed world and now becoming increasingly common in India. The disease is asymptomatic in its early stages, but can be easily detected by a specialist. In advanced stages, vision gets affected, and requires prolonged treatment including retinal laser, intravitreal injections of anti VEGF drugs (Accentrix/Lucentis), and even surgery. The disease may become incurable in advanced stages. Early detection and treatment is crucial to save eyesight. All diabetic patients are advised to get a dilated retina examination at least once a year. Learn more

IN DETAIL

As the name suggests, diabetic retinopathy is a disorder of the retina occurring due to long standing diabetes. In its earliest stages, it causes localized outpouching of the walls of retinal blood vessels. These outpouchings are called microaneurysms and appear as small red dots in the retina on examination by an ophthalmologist. These are asymptomatic and can be diagnosed only on a retina (fundus) examination.

Diabetic Retinopathy Diabetic Retinopathy

As the disease progresses, it causes appearance of pinpoint retinal hemorrhages and cholesterol deposition (hard exudaes) in the retina.

Till this point, the disease does not affect vision. Vision in diabetic retinopathy is affected due to two common causes - macular edema and vitreous hemorrhage. The former is a swelling of the macula, which is the central part of the retina. It is caused by leakage of water from walls of blood vessels of the retina. These walls become leaky after a certain point in diabetic retinopathy. Macular edema can be detected by an experienced clinician on a careful fundus examination, but can be definitively diagnosed by a scan of the retina, called the OCT.

Earlier, macular edema used to be treated by applying laser burns to the macula. This treatment tended to reduce the macular swelling over time and reduce the risk of progression of vision loss. However, there was no gain of vision i.e. vision which had been lost was lost. Over the past decade, specialized medications called anti VEGF (Vascular Endothelial Growth Factor) drugs have come up and revolutionized the treatment of not only diabetic macular edema, but a lot many retinal disorders. These drugs are injected directly into the eye as a simple intravitreal injection. Repeated injections at monthly intervals are required. Anti VEGF drugs are the only treatment that are known to improve the vision in patients suffering from diabetic macular edema. The most widely used of these drugs is Ranibizumab (Lucentris, Accentrix). Other more recent ones include Aflibercept (Eylea). Apart from anti-VEGF drugs, steroid preparations (Ozurdex) can also be injected into the eye, and help in reducing macular edema

The second common cause of vision loss in diabetic retinopathy is vitreous hemorrhage. This means collection of blood inside the eye. This blood comes from certain weak blood vessels that develop in the retina of patients with diabetic retinopathy. These vessels are caused neovessels, and develop in advanced stages of diabetic retinopathy, called proliferative diabetic retinopathy. Being weak, neovessels tend to rupture suddenly at any time, causing a vitreous hemorrhage. These vessels can be diagnosed in time by a fundus examination and confirmed by dye leakage on fluorescein angiography.

Neovessels can be treated with retinal laser before they rupture. Retinal laser causes these vessels to shrink, and averts the occurrence of vitreous hemorrhage. Retinal laser has been a mainstay in the treatment of proliferative diabetic retinopathy.

Another relatively less common, but disastrous cause of reduced vision in diabetic retinopathy is a tractional retinal detachment. This is the most advanced stage of diabetic retinopathy. It develops if the disease is allowed to go untreated for a long time. Once neovessels form, and are allowed to grow without any treatment, fibrous tissue sheets start forming around the neovessels. These sheets then contract and pull the retina away from the layer beneath it. This is called a tractional detachment of the retina. At this stage, vitreoretinal surgery is the only feasible option. The chances of visual recovery are grim.

Periodic fundus examination by a trained retina specialist in invaluable in preventing vision loss from diabetic retinopathy. It can help detect the disease at an early stage, before it has affected vision. This will make the patient more aware, and more focused to control his blood sugar. Also, macular edema can be detected in early stages before it has caused significant vision loss. Earlier the macular edema is treated, better are the chances of visual recovery. In addition, neovessels can be suspected and diagnosed before they have caused a vitreous hemorrhage. All patients with diabetes mellitus should undergo a fundus examination atleast once a year, or earlier if advised by their physician.

Diagnostic facilities for diabetic retinopathy available at Medanta

OCT (Optical Coherence Tomography)

This is essentially a scan of the retina. It helps in measuring the thickness of the retina in its central part. This not only helps in diagnosing macular edema, but also plays a significant role in its treatment. It shows how much a particular treatment has worked by measuring change in retinal thickness with treatment. The Optovue Avanti OCT suite at Medanta is the most advanced OCT technology in the world. This state of the art machine scans the retina at a rate of 26000 scans per second, and gives crystal sharp images in high definition for diagnosis of the minutest of defects

FFA (Fundus Flourescein Angiography)

In this test, a dye (Sodium fluorescein) in injected into a vein in the patient's body. The dye circulates through the blood and reaches the blood vessels of the retina. At this point, serial photographs of the retina are taken with a specialized fundus camera. The flow of dye through the blood vessels can be seen. Any neovessels, if present, will show leakage of the dye into the retina. This helps in diagnosis of proliferative diabetic retinopathy.

Subsequently, a retina laser can be planned to shrink the neovessels. FFA also helps in recording response to treatment by documenting the decrease in size and leakage pattern of neovessels after retinal laser. The Zeiss Visucam 500 Angiography machine at Medanta is the leading angiography machine in the world. Combining Zeiss' incomparable expertise in optical technology with the latest image processing software, it delivers the best quality of retina images, making the doctor's work that much easier.

Treatment modalities for diabetic retinopathy available at Medanta

Intravitreal injections

Intravitreal injections of Ranibizumab (Accentrix, Lucentis), Ozurdex and triamcinolone are routinely done at our centre, by doctors fully trained and certified in the procedure, and having an experience of over 5000 injections. We ensure the highest standards of quality, safety and efficacy in the administration of intravitreal drugs.

Retina laser

Retina laser is the gold standard in the treatment of proliferative diabetic retinopathy. Laser spots applied to the required area of the retina lead to shrinkage of neovessels that develop in proliferative diabetic retinopathy. Done in time, retina laser prevents the occurrence of vitreous hemorrhage from rupture of neovessels. Retina laser is also less commonly used in the treatment of diabetic macular edema. Low intensity laser burns are applied to the macula at prespecified spots, and lead to regression of macular edema. We at Medanta use the Alcon Purepoint laser machine, which is one of the most precise laser delivery systems available anywhere in the world. Our doctors have a combined experience of over 2000 retinal lasers. We guarantee accurate, convenient and safe laser treatment for diabetic retinopathy.

Vitreoretinal surgery

Surgery for diabetic retinopathy is the most challenging of all retinal surgeries, and requires tremendous expertise, innovation, skill and patience. Our retina specialty has surgeons thoroughly trained in such surgeries. The Alcon Constellation vitrectomy machine that we use is the single most advanced vitrectomy machine in the world today, preferred by leading eye centers the world over. Outcomes of surgery for diabetic retinopathy at our centre are at par with the best centres in the world.

Central Retinal Vein Occlusion (CRVO)/Branch Retinal Vein Occlusion (BRVO)

Vein occlusions are another common cause of sudden loss of vision in an eye. They are more common in patients with diabetes and high blood pressure. Treatment involves retinal laser and intravitreal injections of anti VEGF drugs (Accentrix/Lucentis) or steroids (Ozurdex). Repeated checkup by a retina specialist is important to prevent other complications, which may lead to permament loss of eyesight. Learn more

IN DETAIL

Central and Branch Retinal Vein Occlusions, as the name suggests, are disorders caused by the blockage of the central vein of the retina or one of its branches. This blockage may be caused by a blood clot forming elsewhere in the body, like for example, the heart in a patient with mitral valve disease. However, more commonly, the blockage occurs due to progressive deposition of cholesterol in the walls of retinal arteries. This causes the arteries to become stiff, and in turn, compress neighbouring retinal veins and block them.

In some ways, this is similar to a stroke or a heart attack, which are caused by blockage of blood vessels supplying the brain and heart, respectively. It is common knowledge that excessive blood cholesterol is related to diabetes and high blood pressure. This explains why patients with diabetes and high blood pressure are more prone to develop retinal vein occlusions.

Blockage of retinal veins has several effects. Firstly, back pressure in the veins increases (similar to a pipe getting blocked), causing leakage of blood into the surrounding retina. Thus, one of the earliest signs of a retinal vein occlusion is the occurrence of retinal hemorrhages. These are spread throughout the retina in central retinal vein occlusion, and in the area around the affected branch vein in branch retinal vein occlusion.

Occurrence of retinal hemorrhages, per se, does not affect vision. At this stage, the patient is asymptomatic, but can be diagnosed on a routine retina (fundus) examination by a specialist.

The second consequence of blockage of the retinal veins is the formation of shunt vessels around the obstruction. Shunt vessels, also called collaterals, are fine thin walled blood vessels, that connect a point before the occlusion to a point after it, thereby shunting blood around the obstruction.

These collaterals have leaky walls. Leakage leads to collection of fluid in the retina, causing a retinal thickening. If this thickening occurs in the central part (macula) of the retina, it causes a sudden decline in vision. This macular thickening, also called macular edema, can be seen by a retina expert on careful fundus examination. Definite diagnosis, however, requires a scan of the retina, called an OCT scan.

Macular edema requires treatment to preserve and restore vision. Till a decade ago, the mainstay of treatment was retinal laser. This treatment modality involves applying laser burns to the macula. Though it reduces macular edema, it is in itself a destructive procedure with depressing visual outcomes, and is now largely outdated. The current gold standard of treatment is injection of specialized class of drugs, called anti – VEGF (Vascular Endothelial Growth Factor) drugs, directly into the eye. These drugs are very effective in reducing macular edema and in recovery of vision. Repeated injections at monthly intervals are required. The most common anti VEGF drug is Ranibizumab (Accentrix, Lucentis). Aflibercept (Eylea) is another recently patented drug which may help patients not responding to ranibizumab. Some steroids (Ozurdex, Triamcinolone) can also be directly injected into the eye, and help in reduction of macular edema, but results are generally inferior to anti-VEGF drugs.

The third consequence of retinal vein occlusion is the reduction of blood supply to the area of the retina being served by the blocked vein. This causes retinal damage, and through a complex mechanism, leads to the formation of new retinal blood vessels. These new blood vessels, also called neovessels, are fragile and can rupture at any time, leading to bleeding inside the eye. This bleeding is called vitreous hemorrhage, and is another cause of sudden loss of vision in retinal vein occlusions. Vitreous hemorrhage required a vitreoretinal surgery to clear it up. Neovessels can be detected before they have ruptured by a trained doctor on a careful retina examination. Fluorescein angiography (see below) confirms neovessels by showing leakage of dye.

Apart from the retina, neovessels in retinal vein occlusions, especially central retinal vein occlusion, can form in other parts of the eye, like the iris which is the brown-black part of the eye visible from front.

If so, they can be even more dangerous. Neovessels in the iris have the potential to raise the pressure of liquid inside the eye (called the intraocular pressure). If persistent or excessive, raised intraocular pressure (otherwise known as glaucoma) can cause damage to the optic nerve (structure that connects the brain to the eye), and lead to irreversible vision loss. Careful examination by a retina or glaucoma specialist is the only way to detect iris neovessels in time.

Treatment of neovessels in the iris or the retina requires laser treatment of the retina. Laser burns are given to the entire retina outside the central part (the macula). It is believed to reverse the complex mechanism that led to formation of neovessels in the first place. This causes shrinkage of neovessels and avoids the complications of vitreous hemorrhage or glaucoma (raised intraocular pressure)

All patients diagnosed to have a retinal vein occlusion should meet a retina specialist as a priority. Timely and complete treatment is crucial to save vision.

Diagnostic facilities for retinal vein occlusions available at Medanta

OCT (Optical Coherence Tomography)

This is essentially a scan of the retina. It helps in measuring the thickness of the retina in its centre part. Macular edema due to retinal vein occlusions can be easily diagnosed as thickness and collection of fluid in the central part of the retina. OCT also helps in monitoring response to treatment by documenting the reduction in macular thickness over time. The Optovue Avanti OCT suite at Medanta is the most advanced OCT technology in the world. This state of the art machine scans the retina at a rate of 26000 scans per second, and gives crystal sharp images in high definition for diagnosis of the minutest of defects

FFA (Fundus Flourescein Angiography)

In this test, a dye (Sodium fluorescein) in injected into a vein in the patient's body. The dye circulates through the blood and reaches the blood vessels of the retina. At this point, serial photographs of the retina are taken with a specialized fundus camera. The flow of dye through the blood vessels can be seen. Any neovessels, if present, will show leakage of the dye into the retina.

FFA also helps to detect the total area of the retina affected by the occlusion of the particular vein. This is seen as absence of dye perfusion in the affected area. This has practical importance in treatment. While doing laser for new vessels formation, it is mandatory for the doctor to ensure that the entire non perfused area of the retina is lasered. This ensures efficacy of the laser in regressing the neovessels. Apart from neovessels, the collateral shunt vessels discussed above can also be seen on fluorescein angiography as extremely fine vessels connecting one large vessel to another.

The Zeiss Visucam 500 Angiography machine at Medanta is the leading angiography machine in the world. Combining Zeiss' incomparable expertise in optical technology with the latest image processing software, it delivers the best quality of retina images, ensuring that not even the tiniest of neovessels or non perfused area of the retina escapes detection. This makes treatment all the more effective.

Gonioscopy

This is a test designed to detect iris neovessels. More specifically, neovessels in the 'angle' of the eye. The 'angle' of the eye is a specialized structure at the corner of the iris. It is the part where openings that drain liquid out of the eye are located. Neovessels in the angle can block these openings and lead to liquid retention in the eye, causing raised intraocular pressure. The angle, being in the corner of the eye, cannot be directly examined from front. It requires a specific lens, called a goniolens, to be applied to the front of the eye. The process of examining the angle is called gonioscopy. It requires years of intensive training to master the art of gonioscopy. We, at Medanta, have experts with over 6 years of training and 30 years of experience in the procedure. We offer the best quality of diagnostic gonioscopy services.

Treatment modalities for retinal vein occlusions available at Medanta

Intravitreal injections

Intravitreal injections of Ranibizumab (Accentrix, Lucentis), Ozurdex and triamcinolone are routinely done at our centre, by doctors fully trained and certified in the procedure, and having an experience of over 5000 injections. We ensure the highest standards of quality, safety and efficacy in the administration of intravitreal drugs.

Retina laser

Retina laser is the gold standard in the treatment of iris, angle and retinal neovessels. Done in time, retina laser shrinks the neovessles and prevents the dreaded complications of vitreous hemorrhage and glaucoma We at Medanta use the Alcon Purepoint laser machine, which is one of the most precise laser delivery systems available anywhere in the world. Our doctors have a combined experience of over 2000 retinal lasers. We offer accurate, convenient and safe laser treatment for retinal vein occlusions

Vitreoretinal surgery

Vitreous hemorrhage in retinal vein occlusions can only be cleared by a vitreoretinal surgery. Vitreoretinal surgery is the most technically complicated of all eye surgeries. It requires both cutting edge machinery and considerable surgical expertise. The Alcon Constellation machine at Medanta is the single most advanced vitrectomy machine in the world today. It provides laser sharp precision, iron strong suction and probes with extremely fine ends to ensure the safety of the retina. We have expertise to match the technology at our disposal. Our retina specialty has surgeons with specialized training in vitreoretinal surgery, and a practice devoted entirely to retinal disrders. Success rates of retinal surgery at our centre are at par with the best centres in the world.

Trabeculectomy

This is a surgery required for the management of raised intraocular pressure which is not responding to eye medications. As discussed above, persistently or excessively raised intraocular pressure has the potential to cause irreversible vision loss from damage to the optic nerve. Initially, we try to lower intraocular pressure with medications. But if medications don't help, surgery is needed before damage to the optic nerve sets in. This surgery, called trabeculectomy, is done by a glaucoma specialist. Though small and technically simple, the possibility of complications with a faulty surgery is massive. Detailed attention to the smallest of eye parts with utmost patience is required to ensure good surgical outcomes. Our glaucoma specialists have an experience of over a thousand such surgeries. We ensure surgical finesse and painstaking attention to detail in all our surgeries.

Age Related Macular Degeneration

With age, the macula, which is the central part of the retina, undergoes progressive thinning and degeneration in some people. This leads to progressive decrease in vision. In more severe forms of this disease, a leaky membrane forms beneath the retina, which leads to leakage of fluid and blood in the surrounding retina. This form, the wet ARMD, can cause sudden drastic fall in vision. Treatment is with intravitreal eye injections of anti VEGF drugs (Accentrix/Lucentis) Learn more

IN DETAIL

Age related macular degeneration is an exaggeration of age related changes that occur in the retina. With age, the retina of every person gets thinner. Also, yellow colored material, called lipofuscin, deposits in the macula, which is the central part of the retina. Normally, these changes are mild and do not affect vision. But in some people, they get pronounced. Clumps of lipofuscin, called drusens, form in the macula. Retinal thinning leads to progressive decline in vision.

In advanced cases, the whole of the central retina loses it color and becomes dysfunctional. This form is called geographic atrophy

All the above-mentioned changes fall under dry ARMD. Except for geographic atrophy, vision remains grossly intact in dry ARMD. This is fortunate, indeed, for there is no treatment available for dry ARMD. Special vitamin supplements are available which reduce the rate of progression of the disease, but there is no way to reverse the damage that has already occurred.

The more visually troublesome variant of ARMD is the wet form. Here, the barrier between the retina and the choroid (layer of the eyeball beneath the retina) gets breached. Choroidal tissue then grows into the retina, forming a membrane in the retina called choroidal neovascular membrane.

This membrane leaks fluid and blood into the surrounding retina, which severely affects the eyesight. CNVM is a common cause of sudden vision loss in the elderly.

Till about a decade ago, treatment outcomes for chroidal neovascular membrane were depressing. At best, patients could just hope to retain whatever vision they had left. In the last 10 years or so, specialized drugs called anti-VEGF (Vascular Endothelial Growth Factor) drugs have come up. These drugs are injected directly into the eye (intravitreal injection). They regress the vascular tissue in a Choroidal neovascular membrane, leading to shrinkage of the membrane. Also, the fluid and blood that have collected in the retina around the CNVM dry out, thereby improving vision. Most widely used among the anti-VEGF drugs is Ranibizumab (Accentrix, Lucentis). Another recently approved drug is Aflibercept (Eylea). Multiple injections of anti-VEGF drugs at monthly intervals are required to achieve complete shrinkage of the CNVM. Eventually, the CNVM completely shrinks, leaving a scar with some residual vision loss.

Sometimes, the CNVM breaks through the retina and caused bleeding into the lumen of the eyeball. This bleeding is called vitreous hemorrhage. It leads to sudden drop in vision, and requires vitreoretinal surgery to clear it up

Diagnostic facilities for age related macular degeneration available at Medanta

OCT (Optical Coherence Tomography)

This is a scan of the retina. It shows the entire structure of the retina, including thickness at different points and any changes inside it. OCT is useful in the diagnosis and treatment of many retinal disorders. In dry ARMD, it shows the central retina to be thinner than normal. Also, the layer that separates the retina from the choroid appears irregular.

In the wet form of ARMD, CNVM tissue is seen inside or beneath the retina. Adjacent fluid may be seen below the retina.

OCT is also useful to monitor response to treatment over time. With repeated intravitreal injections , the CNVM can be seen to shrink and retinal fluid can be seen to decrease. The Optovue Avanti OCT suite at Medanta is the most advanced OCT technology in the world. This state of the art machine scans the retina at a rate of 26000 scans per second, and gives crystal sharp images in high definition for diagnosis of the minutest of defects

FFA (Fundus Flourescein Angiography)

In this test, a dye (Sodium fluorescein) in injected into a vein in the patient's body. The dye circulates through the blood and reaches the blood vessels of the retina. At this point, serial photographs of the retina are taken with a specialized fundus camera. The flow of dye through the blood vessels can be seen. CNVM appears as a bright white structure, as it binds to dye strongly. If the CNVM is active and leaking, dye may be seen to be spreading around it after a few minutes. This denotes activity of the CNVM, and the need for treatment, even if the OCT does not show any fliud around the membrane.

The Zeiss Visucam 500 Angiography machine at Medanta is the leading angiography machine in the world. Combining Zeiss' incomparable expertise in optical technology with the latest image processing software, it delivers the best quality of retina images, ensuring that not even the tiniest of defects go unnoticed.

Treatment modalities for age related macular degeneration available at Medanta

Intravitreal injections

Intravitreal injections of Ranibizumab (Accentrix, Lucentis), Ozurdex and triamcinolone are routinely done at our centre, by doctors fully trained and certified in the procedure, and having an experience of over 5000 injections. We ensure the highest standards of quality, safety and efficacy in the administration of intravitreal drugs.

Vitreoretinal surgery

In the rare cases of wet ARMD which are complicated by a vitreous hemorrhage, vitreoretinal surgery is required. Vitreoretinal surgery is the most technically complicated of all eye surgeries. The Alcon Constellation vitrectomy machine at our centre is the single most advanced vitrectomy machine in the world today. Our retina surgeons have experience of over a thousand vitreoretinal surgeries. We provide the best combination of cutting edge machinery and surgical expertise in the management of retinal disorders.

Retinal Detachment

A common cause of sudden loss of vision in an eye. The condition starts with formation of a hole somewhere in the retina. Through this hole, the liquid that fills the eye (vitreous humor) goes under the retina, and causes the retina to detach from the layer below it (called the choroid). Retinal detachment requires urgent surgery. Various types of surgery for retinal detachment are done at our centre : pneumatic retinopexy (gas injection), scleral buckling and vitreoretinal surgery (vitrectomy + silicone oil/gas injection in the eye). Chances of vision recovery depend on how soon surgery is done after the onset of vision loss.

Retinal lattices and holes

Upto 40 percent of normal people may have a hole or a lattice somewhere in the corner of their retina. A retinal lattice is an area where the retina is thinner than normal. Holes may develop in the lattice or elsewhere. Lattices and holes are asymptomatic, and usually do not cause any problems throughout life. However, in some unlucky individuals, especially those using high minus powered glasses and those with family history of retinal problems, these may cause a retinal detachment, which is a calamity. This complication can be completely avoided by timely laser of the lattices and holes. Those using high minus powered glasses or contact lenses (myopes) are strongly advised to get their retina screened at least once a year, and get any retinal lesions lasered in time.

Uveitis

A collective name given to a group of diseases affecting the uvea, which is the layer of the eye wall beneath the retina. Uveitis can cause variety of symptoms, ranging from mild redness and sensitivity to light to complete loss of vision. Diagnosis requires diligent eye examination by a specialist trained in the disease. Long term treatment with strong medicines with potentially dangerous side effects may be required. Repeated checkups and investigations are required to achieve maximum disease control with minimum side effects.

Common Symptoms of Retinal Disorders

  • Flashes of light,
  • Floaters,
  • Curtain descending in field of vision from one side,
  • Blurring/loss of vision,
  • Extreme sensitivity to light

Diagnostic Technologies for Retinal Disorders

Fundus Flourescein Angiography (FFA)

A dye (Sodium fluorescein) is injection in one of the arm veins. The dye circulates to reach the eye veins. Photos of the eye are then taken using a special camera to detect the sites of spread of the dye. Any leakage from any artery or vein in the eye can be seen. This test in invaluable in the management of diabetic retinopathy, retinal vein occlusions and age related macular degeneration

Spectral Domain Optical Coherence Tomography (SD-OCT)

This test has revolutionized the diagnosis of retinal disorders. It provides an enlarged, detailed image of different layers of the retina and its thickness in different parts. Current treatment guidelines for most retinal disorders is based on OCT measurements

Ultrasound/B-scan of the eye

Is a useful test for the assessment of the retinal anatomy in conditions where the retina cannot be directly seen e.g. cataract, bleeding in the eye. It is also useful in the evaluation of retinal tumors and some types of uveitis.

Electroretinogram (ERG)

It is an electrophysiological diagnostic test, somewhat similar to ECG for the heart. It detects the electrical impulses that the retina sends to the brain. By noticing the pattern of these impulses and the change from normal, the ERG helps in the diagnosis and management of some genetic retinal disorders, like retinitis pigmentosa.

Treatment Modalities for Retinal Disorders

Retina laser

Safe, easy and highly effective. Retina laser is an important part of the treatment of many retinal disorders. It also helps prevent visually disabling complications in some non retinal disorders.

Intravitreal injections

The injections deliver specialised medicines directly into the eye. Most commonly given injections are of anti-VEGF, a category of drugs that has changed the face of retina treatment over the past decade. Many diseases that were previously considered incurable can now be successfully managed with these drugs. Antibiotics and steroids can also be given as eye injections.

Vitreoretinal surgery

Currently one of the most technically demanding eye surgeries. Has made rapid strides in the last 10 years in terms of safety and precision. In expert hands, excellent surgical results can be achieved. Currently performed for retinal detachment, vitreous hemorrhage, macular hole, epiretinal membrane and intraocular foreign bodies