Diseases of the posterior segment of the eye, the retina, are often the most difficult to treat in modern ophthalmology. To determine the state of the eye’s retina, we use several methods:
This is also the most common and complex eye damage in diabetic patients. Due to changes in metabolism, there is a disturbance in circulation in the capillary network of the retina, leading to damage to arteries and veins and leakage of blood onto the surface of the retina as well as into the vitreous body. Patients describe these damages as a decrease in visual acuity and poorer image quality, as well as the appearance of “dark spots or floaters” in the visual field. If you are diabetic, we recommend that you undergo an ophthalmological examination at least once a year, regardless of whether you recognize any of the symptoms mentioned above.
Age brings many new, beautiful experiences, but also takes something from the overall health picture of a person. We know that one of the organs that can feel the effects of aging is precisely the eye, more specifically the macula, which is one of the most important anatomical parts of each eye.
Visual acuity decreases, and the damage is particularly pronounced in the “central” vision. The patient feels a large “spot” in front of one or both eyes, causing objects to appear blurry, but still maintains preserved peripheral vision.
In practice, two forms of this condition are present: dry and wet. In the dry form of senile macular degeneration, damage to central vision occurs gradually, over several years, even decades. Due to pronounced atherosclerosis of the retinal blood vessels, there is accumulation of cellular metabolic waste, hindering the normal functioning of remaining living cells. The accumulated material is called drusen.
The wet form is much more aggressive, occurring suddenly, marked by the appearance of a distinctly dark “spot” in front of the eye. Sudden vision loss is caused by the rupture of atherosclerotic retinal blood vessels and bleeding into the area of the macula. Even with this form of macular degeneration, peripheral vision may remain preserved.
The dry form of senile macular degeneration still cannot be treated, but the patient will never completely lose vision. Specifically, they will always retain what is known as peripheral vision, or vision outside the macula.
The wet form of senile macular degeneration is successfully treated if detected early with the application of anti-VEGF therapy (Avastin, Lucentis, Eylea). However, if detected late or inadequately treated, therapy may not be very effective due to the rapid formation of scarring in the macula, which remains untreatable.
This condition is also known as an eye infarction and often occurs as a result of uncontrolled or poorly controlled blood pressure, as well as high levels of fat in the blood.
Just as in a heart or brain infarction, a blockage of an eye artery or vein by a clot can occur, consequently leading to damage to a part of the visual field or complete visual acuity.
Vein thrombosis and arterial embolism can be treated with the application of anti-VEGF therapy (Avastin, Lucentis, Eylea) or laser photocoagulation of the damaged areas on the retina.
In addition to ophthalmological treatment, it is necessary to perform detailed internal medicine and neurological examinations to prevent more severe damage to the heart or brain.
Retinal detachment is one of the most common causes of sudden vision loss in the general population. It actually involves the separation of the retina (one of the three most important layers of the eye) from the rest of the eye.
In the beginning, when the detachment is still developing, the patient sees the formation of dark curtains. However, when the detachment reaches the macula, which can happen within 1-2 days, vision becomes very poor.
Retinal detachment is treated with a surgical procedure called vitrectomy. Since the retina is nourished only while it is “attached” to the back of the eye, any retinal detachment permanently damages its cells. Therefore, it is necessary to perform eye surgery as soon as possible, as any delay reduces the chance of good vision after the procedure. The surgery is most often performed under local anesthesia with analgosedation. This means that the patient receives anesthesia next to the eye and sedative medications in the elbow vein. This method of eye surgery is completely painless and typically lasts about an hour. After the surgery, the patient can go home the same day.
During vitrectomy, the surgeon enters the eye through four small openings, each 1 mm in size, on the white part of the eye (sclera). During the operation, the vitreous body, which is often one of the causes of the detachment, is removed. The vitreous body is later replaced by the normal aqueous humor produced by the eye, allowing the eye to function normally. After removing the vitreous body, holes (tears) in the retina are identified, the retina is repositioned, and the holes are sealed with a laser.
At the end of the surgery, gas or silicone oil is placed in the eye to keep the retina in its natural anatomical position until it fully reattaches. The advantage of gas is that it naturally exits the eye after 2-6 weeks, so no additional surgery is needed to remove it, as is the case with silicone oil. In cases where the detachment was not detected in time, is complicated, or has scars, only silicone oil is used, which is then removed from the eye after a few months, but it can remain for years if the damage is extensive. Sometimes, especially in severe detachments, it is necessary to perform multiple surgeries to achieve success.
After the surgery, the eye is not very red or painful, and recovery is quick. Eye drops and ointment need to be applied for a few weeks, and the eye needs to be closed for only one day. Follow-up examinations are scheduled for the day after surgery, 7 days after surgery, and 2-3 weeks postoperatively. For uncomplicated detachments, the patient can return to everyday activities within about 10 days. When gas is in the eye, rest and body positioning, usually on the sides or sitting with the head down, are required for about 10 days. During this time, reading, working on a laptop, or watching TV with the other eye is allowed.
A specific group of macular diseases in which a membrane forms over the center of vision is called macular surface diseases and includes macular hole, macular pucker, and vitreomacular traction.
A macular hole is a defect in the retina in the macular area that can occur through its entire thickness or in its individual layers. The disease most often develops without a clear cause, usually due to aging of the eye. It is more common in people over 60 years old and more frequently affects women than men. In a smaller number of patients, eye injury can lead to the development of a macular hole.
The disease usually occurs in one eye and is completely painless, meaning the patient does not notice any pain or discomfort. Macular holes are divided into four stages, depending on the size of the hole. The fact that the disease occurs only in one eye can lead to late diagnosis. Since the other eye is usually healthy and sees well, symptoms may not be noticed initially unless the healthy eye is accidentally closed.
As the disease affects the center of the eye, the person has a completely preserved visual field but complains of weaker central vision, having difficulty recognizing facial features and details of the surrounding space. While reading, they may notice missing letters or that straight lines become broken.
Macular pucker is a condition of the macula in which a membrane forms over the center of vision. As the membrane progresses and becomes denser scar tissue, the condition is referred to as macular pucker. It manifests as blurring and distortion of the central image, most noticeable when reading: letters become blurry and distorted, and lines become wavy.
An experienced ophthalmologist diagnoses these conditions through an eye examination after dilating the pupils, and a more detailed insight into the size of the hole or thickness of the membrane is achieved using a non-invasive diagnostic method called OCT (optical coherence tomography). Assessing and classifying the size of the hole is crucial for further monitoring and treatment. Small holes and thin membranes usually cause mild symptoms and often go unnoticed by patients. Large holes or thicker membranes cause significant vision loss and typically require treatment.
Macular holes are usually treated surgically, although there is medical treatment available for small holes with injections into the eye. However, this treatment has proven less effective than expected, and surgery remains the treatment of choice. Macular pucker is treated only surgically. As with retinal detachment, the surgery to treat these macular conditions is called vitrectomy. It is a minimally invasive surgical procedure performed under local anesthesia with analgosedation. Through small 1 mm openings, the surgeon enters the eye’s depth and removes the changes that pull or cover the macula using the finest instruments. The surgery has a high success rate, with holes closing and membranes being removed in more than 98% of cases. The procedure is quick and painless for the patient. After the surgery, the patient goes home immediately, and a follow-up examination is conducted the next day. Closing the hole or removing the membrane stops the progressive vision loss, and most patients experience vision improvement. Vision improvement is greater if the disease is diagnosed early.
Recovery after eye surgery is quick, the eye is not irritated or painful. Drops and ointments need to be applied for a few weeks. Since there is air or gas in the eye, vision gradually returns as the gas or air exits the eye. The doctor may ask the patient to position themselves lying on their side or sitting with the head down for the first few days. However, in our eye hospital, we routinely do not recommend positioning the head down.
A foreign body in the eye can be anything from a particle of dust, plants, glass, to a piece of metal. When a foreign body is in the eye, it means it has penetrated the cornea and/or sclera, damaging internal structures such as the iris, lens, or, in the most severe cases, the retina.
Symptoms of a foreign body in the eye are numerous, the most common being a feeling of discomfort or pressure in the eye, pain, tearing, light sensitivity, increased blinking, inability to open the eye, redness, or blood in the eye. Foreign bodies cause scratches or cuts (corneal erosions). These injuries are usually minor and heal with antibiotic drops and therapeutic soft contact lenses. If there is fluid or blood leaking from the eye or sudden vision loss, the patient should see an ophthalmologist immediately.
If it is a penetrating injury with a foreign body in the eye, the patient undergoes surgery to remove the foreign body and suture the cornea or sclera. If the foreign body is in the eyeball, deep surgery – vitrectomy – is required, with retinal repair. Sometimes, after such injuries, a traumatic cataract may develop, necessitating cataract surgery in the same procedure.
During the examination, anesthetic drops are used to numb the eye for a detailed examination and removal of the foreign body from the cornea or sclera (conjunctiva). The eye is then stained with fluorescein to see the size of the cuts where the dye accumulates and to check if the cornea is perforated. An essential part of the examination is dilating the pupils to examine the internal structures of the eye in detail. The foreign body is usually visible directly. If there is bleeding, an ultrasound of the eye supplements the examination.
Penetrating injuries can cause corneal opacities (which can be resolved with a corneal transplant), lens injuries causing cataracts, and retinal injuries that can lead to detachment. Final visual acuity depends on the damage the foreign body caused to the internal structures of the eye, as well as the speed and skill of treating the injury.
