Retina & UVEA
Treatment

This is the internal layer of the eye with which we can see. The retina can be affected in a variety of disorders some of which are listed below :
Diabetes is a large epidemic in India population. Diabetes causes blood flow to the retina to be reduced and ithis causes following complications :

Macular edema:
Here there is development of swelling in the central portion of the Retina due to leakage of fluid and fat from the diseased retinal blood vessels due to which the vision is diminished. The amount and duration of edema determine the outcome

Diagnosis of the edema is done by tests such as OCT (Optical coherence tomography) which gives a detailed and magnified view of the macular structure. It helps in knowing the severity, type and location of the edema and helps in follow up.

Another tool for diagnosis is FFA (FUNDUS FLUORESCEIN ANGIOGRAPHY) where a dye is injected into the veins of the hand and then serial photographs are taken of the Retina. This gives detailed images of the retina and its blood supply and areas of fluid leakage. Disadvantage is that it is an invasive test and sometimes associated with vomiting and rarely allergic reactions.

Treatments :
Injections are administered to help reduce or stabilise the edema. These injections fall in two broad categories AntiVEGF (Avastin, Accentrix) and Steroid(Triamcinolone, Ozurdex). These injections may require to be repeated often to maintain vision.

Laser (green laser) is a therapy which is done to seal microleaks and reduce the blood requirement.

Once there is development of edema it is often not possible to restore complete vision with any modality of treatment. Thus good control of Diabetes right from the start is of utmost importance.

Proliferative diabetic retinopathy :
Here due to lack of blood supply, there is formation of new blood vessels on the surface of the retina. These cause three complications :
  1. BLEEDING IN THE EYE WHICH MAY REQUIRE INJECTIONS , LASER OR SURGERY TO CLEAR
  2. RETINAL DETACHMENT WHICH MAY REQUIRE COMPLEX SURGERY AND
  3. COMPLICATIONS SUCH AS BLEEDING , VISION LOSS, GLAUCOMA , PAINFUL BLIND EYE
This is another common retinal problem caused by blood pressure, diabetes, high lipid levels high homocysteine levels, hih eye pressure. This causes blockage of blood drainage in the retina (whole or part). There is bleeding in the retina and swelling in the macula.

Treatment :
  • Anit VEGF injections and Steroid injections.
  • Laser
  • OCT and FFA tests are done here too.
  • Complications such as bleeding, vision loss, glaucoma, painful blind eye are possible here as well.
This is a problems were the retina detaches from its normal position where there is a significant drop in vision and generally requires surgical management.

Early detection and surgery are necessary for good outcomes after detachment.
Some/significant amount of permanent vision loss is often associated with retinal detachment. It may require multiple surgeries
High Minus numbers are often associated with retinal problems such as Retinal weak aareas(lattice), holes,tears. These need to be diagnosed and often treated to prevent retinal detachment
This is a condition which affects the macula (central retina ) and causes vision deterioration due to aging. It is of two broad types :

  • Dry ARMD : Here there is a degeneration of the retina. Antioxidant tablets and good general health maintenance are the treatments available. Regular followups are necessary
  • Wet ARMD : Here there is formation of new blood vessels under the macula which cause initially distorted vision and later drop in vision.

It is diagnosed by OCT and FFA. Treatments available are anti VEGF injections, PDT (a type of laser)
UVEITIS is a swelling or inflammation of he internal layers of the eye which is treated with steroids and other immunosuppressive agents

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