Diseases of the posterior segment of the eye, the retina or the retinal layer, which is one of the most important coatings of our eye, are often the most difficult to treat in modern ophthalmology. To determine the state of the eye’s retina, we use several methods:
- Ultrasound diagnostics
- OCT – optical coherence tomography
- Fundus photography
- Electroretinographic analysis
Posterior Eye Segment Diseases
Diabetic Retinopathy
This is also the most common and most complex eye damage in diabetics. Due to changes in metabolism, there is a disruption in circulation in the blood capillary network of the retina, leading to arterial and venous damage and blood leakage onto the retina surface and vitreous body.
Patients describe these damages as a drop in visual acuity and lower image quality, as well as the appearance of “dark spots or flies” in the visual field.
If you are a diabetic, we recommend that you have an ophthalmological examination at least once a year, even if you do not recognize any of the above symptoms.
How is it treated?
The treatment of diabetic retinopathy is the most demanding form of eye disease treatment. This eye disease must be treated by both a diabetologist and an ophthalmologist. The basis of treatment is primarily based on controlling diabetes and stabilizing its values.
The diabetologist is in charge of controlling diabetes, while the ophthalmologist is entrusted with preventing further leakage from blood vessels and treating changes in the macula.
Anti-VEGF therapy, Avastin, Lucentic, and more recently Eylea, which you can receive at our Special Hospital for Ophthalmology “Dr. Kozomara” in Banja Luka, are the drugs of choice when it comes to therapy for macular edema in diabetes. These medications are painlessly applied to the eye, their action lasts from one to three months, and their goal is to stabilize metabolism in the macula, reduce swelling, and improve the patency of the macular capillary network.
Usually, for successful treatment, 3 doses of the drug are given to the treated eye every month or every three months, and sometimes, depending on the state of the fundus, the number of administered injections can be increased.
Age-Related Macular Degeneration
Age brings many new, beautiful experiences and phenomena, but it also takes something from the overall health picture of a person.
One of the organs that can feel the effects of age is the eyes. Precisely the macula, which is the most important anatomical part of every eye, can suffer from age-related macular degeneration.
How does this disease manifest?
Visual acuity decreases and becomes significantly impaired, due to the accumulation of cellular “waste” that cannot be removed from the eye. Central vision is particularly affected, so patients report having a “spot” in front of their eye that they can’t get rid of. Peripheral vision is preserved in most patients.
Types of Age-Related Macular Degeneration
In practice, there are two forms of this disease: dry and wet.
In the dry form of age-related macular degeneration, central vision damage occurs gradually, over several years, and even decades. Patients feel a blurring of the image they are looking at in front of their eyes but report excellent peripheral vision. Because of this, they often turn their heads to the right or left to see better.
The wet form is much more aggressive, it occurs suddenly, and that is with the appearance of a very dark “spot” in front of the eye. Peripheral vision is also preserved in this form.
How is it treated?
The dry form of age-related macular degeneration still cannot be treated, but the patient will never completely lose sight. More precisely, he will always have peripheral vision, or vision outside the macula, preserved.
The wet form of age-related macular degeneration is successfully treated if detected on time, and that is by applying anti-VEGF therapy (Avastin, Lucentis, Eylea). Indeed, if detected late or inadequately treated, laser therapy will not be of great help because the scar in the macula, which we still cannot treat, forms much faster.
Thrombosis of the Vein and Embolism of the Artery
This condition is also known as an eye infarction and often occurs as a result of high blood pressure or high levels of fats in the blood.
As with heart or brain infarctions, an artery or vein of the eye can become blocked with a clot, leading to damage to part of the visual field or complete vision.
How is it treated?
Thrombosis of the vein and embolism of the artery can be treated by applying anti-VEGF therapy (Avastin, Lucentis, Eylea) or laser photocoagulation of the damaged zones on the retina. In addition to ophthalmology, it is necessary to do detailed internal medicine and neurological examinations with the aim of preventing more severe damage to the heart or brain.
Retinal Detachment
Retinal detachment is one of the most common causes of sudden vision loss in the general population. It essentially involves the retina (one of the three most important layers of the eye) detaching from the rest of the eye.
Symptoms of detachment
In the early stages, while the detachment is still small or just developing, the patient sees the creation of dark curtains. However, when the detachment reaches the center of vision or the macula, which can happen within 1-2 days, vision becomes very weak and it is no longer possible to read or recognize people.
How is retinal detachment treated?
Retinal detachment is treated with a procedure called vitrectomy. As the retina is nourished only while it is attached to the bottom of the eye, and retinal detachment or ablation permanently damages the retina. Therefore, it is necessary to perform eye surgery as soon as possible, and any delay reduces the chance of good vision after the procedure. The operation is usually performed under local anesthesia with analgesia. This means that the patient is given anesthesia near the eye, and sedatives into the elbow vein. This type of eye surgery is completely painless and lasts on average about an hour. After surgery, the patient can go home the same day. During vitrectomy, the eye is entered through 4 small 1 mm openings on the white part of the eye (sclera). During the operation, the vitreous body, which is often one of the causes of ablation, is removed. The vitreous body is later replaced by normal eye water produced by the eye, and the eye functions normally. After removal of the vitreous body, holes in the retina are identified, the retina is returned to its original position, and the holes are closed with a laser.
What is placed in the eye after retinal detachment surgery?
At the end of the operation, gas or silicone oil is placed in the eye to keep the retina in its natural anatomical position, until the retina is fully attached. The advantage of the gas is that it leaves the eye on its own after 2-6 weeks, so there is no need to go for additional surgery for removal, as is the case with silicone oil. In cases where detachments are not detected in time or are complicated and have scars, only silicone oil is placed in the eye, which is then removed from the eye after a few months, but can remain for years if the eye is more damaged. Sometimes, especially in severe detachments, it is necessary to perform surgery more than once to achieve success.
How long is the recovery?
The eye after surgery is not very red or painful, and the recovery is quick. It is necessary to instill drops and apply ointment for a few weeks, and the eye should be closed for only one day. Control examinations are scheduled for the day after surgery, 7 days after surgery, and 2-3 weeks postoperatively. Already after about 10 days in uncomplicated detachments, the patient can return to daily activities. Within about 10 days, rest and body positioning are usually needed on the sides, or sitting with the head bent down. Reading, working on a laptop, or watching TV with the other eye is allowed at all times.
Macular Hole
Surface diseases of the macula
A special group of macular diseases in which a membrane is formed over the center of vision are called surface diseases of the macula and include macular rupture, “cellophane” macula, and vitreomacular traction.
What is a macular hole?
Macular rupture or a macular hole is a retinal defect in the area of the macula that can occur throughout its thickness or in its individual layers. The disease usually develops without a clear cause, all due to aging of the eye. It is more common in people over 60 years of age, and in women compared to men. In a smaller number of patients, eye injury leads to the development of a macular hole.
What are the symptoms of a macular hole?
The disease usually occurs in one eye and is completely painless, i.e., the patient does not notice any pain or discomfort in the eye. The macular hole is divided into four stages, depending on the size of the hole. The fact that the disease occurs only in one eye can lead to a late diagnosis. Since the other eye is usually healthy and the patient sees well on it, symptoms are not noticed initially or are noticed if the healthy eye is accidentally closed. Given that the disease affects the center of the eye, a person has a complete visual field but complains of weaker central vision, i.e., begins to have difficulty noticing facial lines and details of the space around them. When reading, they may notice that letters are missing, or that a straight line becomes broken.
Cellophane maculopathy
Cellophane maculopathy is a disease of the macula in which a membrane forms over the center of vision. As the membrane thickens and progresses into denser scar tissue, the condition is referred to as macular pucker. It manifests as blurring and distortion of the central image, which is most noticeable during reading: letters become blurry and distorted, and lines appear wavy.
How are macular holes and cellophane maculopathy treated?
In general, a macular hole is treated surgically, though, for small holes, medicinal treatment involving injections into the eye is available. However, this treatment has proven less effective than expected, so surgery remains the preferred method. Cellophane maculopathy is treated solely with surgery. As with retinal ablation, the eye surgery used to treat these macular diseases is called vitrectomy. This is a minimally invasive surgical procedure performed under local anesthesia. Through small 1mm openings, the surgeon enters the depths of the eye and removes the changes that are pulling or covering the macula. The surgery has a high success rate, with the holes being closed and the cellophane being removed in over 98% of cases. The procedure is quick and painless for the patient. After the surgery, the patient is immediately discharged, and a follow-up examination is conducted the next day.
By closing the hole or removing the cellophane, vision weakening that would inevitably progress is halted, and most patients experience vision improvement. The improvement in vision is greater if the disease is diagnosed early.
How are macular holes and cellophane maculopathy diagnosed?
An experienced ophthalmologist diagnoses the disease through an eye examination after dilating the pupils, and a more detailed view of the size of the hole or the thickness of the cellophane is achieved with a non-invasive diagnostic method called OCT (Optical Coherence Tomography). Assessing and classifying the size of the hole is crucial in further monitoring and treatment. Small holes and mild cellophane usually cause mild symptoms and often go unnoticed by patients. Large holes or thicker cellophane membranes significantly weaken vision and usually do not progress but require treatment.
What is the recovery process after surgery?
Recovery after eye surgery is fast, the eye is not irritated and is not painful. During a few weeks, it is necessary to apply drops and use ointment. As the eye contains air or gas, vision gradually returns as the gas leaves the eye. The surgeon may ask the patient to position themselves lying on their side or sitting with their head down during the first few days. However, in our eye clinic, we do not routinely recommend positioning with the head down.
Foreign body deep in the eye
A foreign body in the eye can be anything – from particles of dust, plants, and glass, to metal. When a foreign body is found in the eye, it means it has penetrated the cornea and/or sclera, damaging the internal structures of the eye such as the iris, lens, or in severe cases, the retina.
What are the most common symptoms of a foreign body?
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, photosensitivity, increased blinking, inability to open the eye, redness or eye contusion. Foreign bodies cause scratches or cuts/erosions of the cornea. These injuries are usually minor and heal under antibiotic drop therapy, as well as the application of therapeutic soft contact lenses. If there is also leakage of fluid or blood from the eye or sudden vision weakening, the patient must urgently see an ophthalmologist.
How is a foreign body removed from the depths of the eye?
If there is a penetrating injury with a foreign body in the eye, the patient undergoes surgery to remove the foreign body and stitch the cornea or sclera. If the foreign body is located inside the eyeball, a deep surgery – vitrectomy, with retinal care, is required. Sometimes after such types of injuries, traumatic cataracts can develop requiring cataract surgery in the same act.
What is the examination of an eye with a foreign body like?
During the examination, anesthetic eye drops are applied so the patient can be thoroughly examined and the foreign body removed from the cornea or conjunctiva. The eye is then stained with fluorescein dye to see the size of the cuts where the dye accumulates and whether there is a sign that the cornea has been penetrated. A mandatory part of the examination is pupil dilation with drops to thoroughly examine the internal structures of the eye. The foreign body can usually be seen directly. If there is bleeding, then the examination is supplemented with an ultrasound of the eye.
What is the prognosis?
Penetrating injuries can cause corneal opacities (which can be resolved by corneal transplantation), lens injuries that cause cataracts, and retinal injuries that can cause retinal detachment, which is managed with vitrectomy. The final visual acuity depends on the damage that the foreign body has caused inside the eye, but also on the speed and skill of injury management.
