FAQ Retina

The spots, “cobwebs,” or “floaters” are the most common symptoms of vitreous degeneration in the eye. The vitreous is a gel-like substance that fills the eyeball. Over time, it loses its fluidity, drying up, and its irregularities are visible in the form of floaters, spots, or cobwebs. This is a natural degenerative process, which mostly occurs in older individuals, but in young people with nearsightedness, it can occur much earlier. It does not require any treatment but rather regular patient monitoring. In some cases, if it significantly bothers patients, a deep operation to remove the vitreous, called vitrectomy, can be performed. It is important to note that although this is a normal process in the eye, regular monitoring of patients with changes in the vitreous is necessary because it is possible that during the contraction and detachment of the vitreous from the retina, a rupture may occur, which can cause retinal detachment. Symptoms indicating this type of damage include, along with the usual floaters or cobwebs in front of the eyes, a sudden increase in their number, flashes with closed eyes or in twilight, or a curtain covering the visual field. In that case, it is necessary to urgently consult an ophthalmologist who will, if there is a rupture, perform outpatient laser treatment, or in the worst case, plan urgent surgical intervention for retinal detachment.

Distortion of lines represents a macular disease, the yellow spot which represents the center of vision at the back of the eye. There are two forms of macular degeneration, dry and wet. Dry macular degeneration progresses slowly, but the spreading process can only be slowed down by taking a vitamin complex. Wet macular degeneration can be treated with Avastin or Lucentis injections, or the so-called anti-VEGF therapy, which reduces the permeability of diseased blood vessels and prevents fluid accumulation in the macula.

The danger of bleeding from blood vessels at the back of the eye primarily depends on the location of the bleeding. If the bleeding is distant from the optic nerve and the macula, and is minimal and sporadic, then monitoring and normalization of blood sugar levels are advised. If the bleeding is near or within the macula, it is important to undergo treatment with laser photocoagulation or anti-VEGF therapy.

Diabetes is a chronic and progressive disease that damages the blood vessels of the retina in the eye. Laser photocoagulation is performed to seal off areas that leak fluid and blood, preventing further deterioration of the disease. However, laser therapy cannot cure the underlying disease. If diabetes is not well controlled, it continues to damage the eyes despite the laser treatment.

Avastin and Lucentis are medications used in the treatment of wet macular degeneration. They belong to the group of anti-VEGF antibodies (vascular endothelial growth factor), which reduce the permeability and growth of newly formed blood vessels. Avastin was originally developed for the treatment of metastatic colorectal cancer but is widely used off-label in ophthalmology worldwide. Lucentis was specifically developed for ocular use and has a smaller molecular structure compared to Avastin. There is currently no known difference in their effectiveness, and studies are ongoing to compare both drugs. Eylea is the most modern drug in this group of therapies, and it differs from the previous two in its molecular approach to treating macular disease and its lower need for repeat dosing. It is important to note that patients can always switch between these medications during treatment.

Depending on the extent of the thrombosis, symptoms can vary. Ocular vein thrombosis often leads to fluid accumulation and swelling (edema) of the macula, the central part of the retina responsible for detailed vision. The standard treatment for this condition today is anti-VEGF therapy with drugs like Avastin, Lucentis, or Eylea, administered via injections every 1-3 months. Starting therapy as early as possible increases the chances of recovery. A recent advancement, also available at the Special Hospital for Ophthalmology “Dr. Kozomara,” is a new injection of the depot formulation Ozurdex, a slow-release corticosteroid that provides effects for up to 6 months.

Given your age, it’s most likely central serous retinopathy (CSR). It often occurs in young men. The cause is not well understood but is associated, among other things, with stress. Therapy is typically supplemented with dorzolamide tablets (Diamox) and diclofenac eye drops (Naclof), along with modifications. The condition usually resolves on its own within a month without leaving any lasting effects on vision. However, in some cases, the condition may become chronic, requiring more aggressive therapy (laser, anti-VEGF), as it can cause lasting visual impairments.

This is also a condition of the macula, where the thin membrane at the front, resembling cellophane in appearance, wrinkles the macula, leading to visual impairment. The only treatment option is surgery through vitrectomy, where microsurgical instruments are used to peel off the membrane from the surface of the macula through small openings in the eye’s sclera. The restoration of visual acuity depends on the duration of the disease; the shorter the duration, the higher the chances of a complete recovery of visual acuity.

Air is typically used in uncomplicated surgeries such as removing blood from the eye. It usually remains in the eye for a week or two and then naturally dissipates. Patients with air in their eyes are advised not to fly for two weeks due to the potential increase in eye pressure. Gas is used in diabetic patients, uncomplicated detachments, superficial macular diseases such as macular holes, and so on. It remains in the eye for about a month. It’s important to note that patients cannot see while gas or air is in the eye. With gas, they should also avoid flying for a month for the same reason as with air. Silicone oil is used when a strong tamponade is needed, usually in more severe detachments and diabetic patients with proliferative diabetic retinopathy. The advantage is that the patient can see immediately, but the disadvantage is that the oil must be removed in a separate surgical procedure. Additionally, of all these options, oil tamponade has the highest risk of cataract development, so it is sometimes recommended to combine cataract surgery with vitrectomy. Other complications, such as increased eye pressure, are also possible.

Bionic eye implants are not currently performed at the Special Hospital for Ophthalmology “Dr. Kozomara” as they are still in the experimental phase. However, we maintain constant communication with institutions abroad that are researching bionic eye technology, and we provide our patients with updates on any developments. At the moment, you would not be a candidate. Patients eligible for bionic eye implants typically need to be completely blind but have a preserved optic nerve. Bionic eyes currently provide modest results such as distinguishing between light, darkness, and shapes.


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