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Facilities
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Digital Fundus Flourescein Angiography with the state-of-the-art
TOPCON Digital imaging system with photodynamic therapy (PDT)
software
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Ultrasonography (Simultaneous A/B Scan) with a facility of 3D
imaging with OTI scan 1000 (USA)
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Laser Photocoagulation with iris 532mm solid state laser system with
delivery system of Haag-streit-slit lamp, Laser indirect
Ophthalmoscope (LIO) and Endo-Laser
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Treatment of CNVM with TTT (Trans-pupillary thermotherapy) and Photo
dynamic therapy (PDT)
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A well -equipped vitreoretina operation theater with the
top-of-the-line leica Wild operating microscope, a fully loaded DORC
Harmony TTC Vitrectomy machine with a facility for phacofragmentation
and other ancillary instruments like Perfluoro Carbon liquid,
cyclopropane gas (C3F8) and Silicon Oil.
Vitreoretina surgical procedure that are routinely performed
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Scleral buckling
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Vitrectomy for endophthalmitis, dislocated lens/ IOL and vitreous
hemorrhage.
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combined buckling and Vitrectomy procedure for complex vitreoretinal
situations (advanced PVR, Tractional retinal detachment, choroidal
coloboma with RD, Giant retinal tear, IOFB removal and advanced trauma
cases)
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Macular hole surgery.
Retinopathy Of Prematurity
What is retinopathy of prematurity?
In premature babies the blood supply of peripheral retina is not fully developed. This a vascular retina stimulates growth of abnormal new blood vessels. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment and permanent blindness. This abnormal vascularisation and its sequelae is called Retinopathy of Prematurity
(ROP).
Who is at risk of developing ROP?
The main risk factor is a premature birth. The condition is common in infants with a birth weight of less than 1700 grams and a gestational age (Length of pregnancy) of less than 32 weeks. The lower the gestational age and birth weight, more are chances of developing ROP.Multiple blood tranfusion, sepsis, hypoxia etc are additional risk factors for development of ROP.
Are there different stages of ROP?
Yes. ROP is classified in five stages, ranging from mild (stage I) to severe (stage V):
Stage I, II AND 111—represents increasing severity of abnormal blood vessel growth when infants have a certain degree of Stage III and "plus disease"(Dilated retinal blood vessels) develops, treatment is considered. Treatment at this point has a good chance of preventing retinal
detachment.
Stage IV — Partially detached retina.
Stage V — Completely detached retina and the end stage of the disease. Most babies who develop ROP have stages II or I and undergo spontaneous resolution. However, in a small number of babies, ROP worsens. Untreated ROP leads to visual impairment or total
blindness.
How is ROP treated?
The treatment relies on the destruction of the areas of the retina that are without blood vessels by means of Laser therapy or cry therapy. By destroying the retina, the stimulus for the growth of the abnormal blood vessels is removed. .
In the later stages of ROP (Stage 4 and 5), other treatment options include vitreoretinal surgeries such as Scleral buckling and
Vitrectomy.
What other complications ROP baby can develop?
Infants with ROP are at higher risk for developing eye problems later in life, such as retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopic (lazy eye), and glaucoma. All premature babies need regular eye examination throughout life to detect these complications in time.
Age-related Macular Degeneration (AMD)
What is Macula?
The eye is a complex organ composed of many parts. Good vision depends on the way in which those parts work together. The eye is like a camera. The pupil, close to the front, is the opening, which allows light to enter the eye. Just behind the pupil is the lens, which focuses the light on the retina at the back of the eye. The retina is a paper-thin tissue that lines the back of the eye and sends visual signals to the brain. In the middle of the retina is a tiny area called the macula. The macula is made up of millions of light-sensing cells that help to produce central vision. The fovea is the very center of the macula. The macula allows us to appreciate detail and perform tasks that require central vision such as reading and colour vision.
What is Age-related Macular Degeneration (AMD)?
AMD is a common eye disease mostly seen in people over the age of 50 years that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading, sewing and driving. In some cases, AMD advances so slowly that people notice little change in their vision. At this stage, it may be detected on routine retina checkup. But in others, the disease progresses faster and may lead to a loss of vision in one or both eyes. AMD usually involves both eyes, although one may be affected long before the other. . AMD causes no pain and almost never leads to total blindness.
How does AMD lead to vision loss?
AMD is of two types:
· Dry AMD- More common type. Ninety percent of all people with AMD have this type. There is a slow atrophy of macula, leading to a gradual loss of central vision.
· Wet AMD--Although only 10 percent of all people with AMD have this type, it accounts for 90 percent of all blindness from the disease. As dry AMD worsens, formation of abnormal fragile blood vessels cause "wet" AMD. These new blood vessels often leak blood and fluid under the macula. This causes rapid damage to the macula that can lead to the loss of central vision in a short period of time.
Who is at risk of developing it?
At the moment the exact cause for AMD is not known. However there are a number of risk factors, which have been identified.
Age – AMD is an age related condition so growing older makes the condition more
likely.
Gender – Women are more affected than men.
Genetics – There appear to be a number of genes, which can be passed through families which may have an impact on whether someone develops AMD, or
not.
Smoking – A definite risk factor. Stopping smoking can reduce the risk of macular degeneration
developing.
Sunlight – Blue rays of sunlight may accelerate macular degeneration. It is a good idea to wear sunglasses with UV filters to protect the eyes during outdoor
activities.
Nutrition – Research suggests that supplementation with antioxidants like Vitamin C and E, and minerals like zinc and selenium can help protect against macular degeneration.
What are the symptoms?
The symptoms may not be noticeable in early Dry AMD if only one eye is affected to begin with. In the early stages your central vision may be blurred or distorted, with objects looking an unusual size or shape and straight lines appearing wavy or fuzzy (Metamorphopsia). This may happen quickly or develop over several months.
People with advanced stage will often notice a black patch or dark spot in the centre of their sight. This makes reading, writing and recognizing small objects or faces very difficult.
There may be a sudden painless loss of central vision when wet AMD develops.
Can AMD be detected in time?
AMD being a slowly progressing disease is detected mostly on a routine
ophthalmological evaluation.
The comprehensive eye exam includes:
· Visual acuity test. This eye chart test measures how well you see at
various distances.
· Dilated eye exam. Drops are placed in your eyes to widen, or dilate,
the pupils. The retina examination involves a special magnifying lens to
examine your retina and optic nerve for signs of AMD and other eye
problems
· Amsler grid. The pattern of the grid resembles a checkerboard. You will
cover one eye and stare at a black dot in the center of the grid. While
staring at the dot, you may notice that the straight lines in the pattern
appear wavy. You may notice that some of the lines are missing. These may
be signs of AMD.
· Fluorescein angiogram. In this test, a special dye is injected into
your arm. Pictures are taken as the dye passes through the blood vessels
in your retina. The test allows your eye care professional to identify any
leaking blood vessels and recommend treatment.
· Optical coherence Tomography This gives the cross sectional image of
macula identifying the exact location of the choroidal neovascular
membrane breathe the macula.
How can AMD be prevented?
AMD cannot be prevented. Early diction is important to prevent
severe visual loss.
Protecting your eyes from the sun, eating a well balanced diet with plenty
of fresh fruits and vegetables and stopping smoking may all help to delay
the progress of AMD
What are the treatment options?
Dry AMD
Once dry AMD reaches the advanced stage, no form of treatment can prevent
vision loss. However, treatment can delay and possibly prevent early dry
AMD from progressing to the advanced stage, in which vision loss occurs.
Nutrition and antioxidants- The role of antioxidants is not clear but
supplementation with Lutein ,zeaxanthin ,Vitamin C and E and other
minereals has shown a beneficial effect in slowing the progression of
disease.Quit smokingDaily monitoring with Amsler chart
Wet AMD
Wet AMD can be treated with laser surgery, photodynamic therapy, and
injections into the eye. None of these treatments is a cure for wet AMD.
Each treatment may slow the rate of vision decline or stop further vision
loss, but the disease and loss of vision may progress despite treatment
· Laser Phtocoagulation. This procedure uses a laser to destroy the
fragile, leaky blood vessels. A high energy beam of light is aimed
directly onto the new blood vessels and destroys them, preventing further
loss of vision. However, laser treatment also may destroy some surrounding
healthy tissue and some vision. Only a small percentage of people with wet
AMD can be treated with laser surgery. Laser surgery is more effective if
the leaky blood vessels have developed away from the fovea, the central
part of the macula
· In some cases, vision loss may progress despite repeated
treatments.
· Photodynamic therapy.A drug called verteporfin is injected into your
arm. It travels throughout the body, including the new blood vessels in
your eye. The drug tends to "stick" to the surface of new blood
vessels. Next, a light is shined into your eye for about 90 seconds. The
light activates the drug. The activated drug destroys the new blood
vessels and leads to a slower rate of vision decline. Unlike laser
surgery, this drug does not destroy surrounding healthy tissue. Because
the drug is activated by light, you must avoid exposing your skin or eyes
to direct sunlight or bright indoor light for five days after treatment.
Photodynamic therapy is relatively painless. It takes about 20 minutes and
can be performed in a doctor's office.Photodynamic therapy slows the rate
of vision loss. It does not stop vision loss or restore vision in eyes
already damaged by advanced AMD. Treatment results often are temporary.
You may need to be treated again.
Transpupillary Thermotherapy
A special type of laser is used to heat up the membrane without destroying the overlying retina.
Injections(Anti VEGF therapy). Wet AMD can now be treated with a new drug that is injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with Wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor.
You will need multiple injections, usually given about six weeks apart. The eye is numbed before each injection. After the injection, you will remain in the doctor's office for a while and your eye will be monitored. As with photodynamic therapy, the main benefit for patients treated with the drug is to slow vision loss from AMD.
TTT
Transpupillary thermotherapy (TTT) is a special type of laser procedure that can be used to treat Choroidal neovascular membranes (CNVM) of different etiologies like Age related macular degeneration( AMD), Inflammation, High Myopia and idiopathic.
TTT differs from standard photocoagulation therapy in that it uses infrared radiation to apply over a larger area. A low energy, longe exposure diode laser energy gently heats up the CNVM leading to closure of abnormal leaky blood vessels without damaging the overlying neurosensory retina without fear of causing additional vision loss.
This is why TTT can be used in cases of occult wet AMD, where the physician cannot determine the clear outline of the abnormal blood vessel growth on the Flourescein angiogram.
The treatment itself is relatively quick and painless. The ophthalmologist applies anesthetic drops to your eye. You will be seated at a slit lamp and a lens will be placed on your cornea. Laser energy will be applied for 60 seconds. There are no external drugs used along with this laser treatment as there are in PDT. So there is no risk of photosensitivity and patient can go back to routine work after the treatment.
The goals of TTT treatment to seal the leaking vessels and preservation of the vision. Repeated treatments may be require in recurrent or persistent CNVM.
Photo Dynamic Therapy
What is Photo Dynamic Therapy( PDT )Treatment?
Macular degeneration is of 2 types- Dry AMD and Wet AMD. Most people lose vision as a result of the wet type of macular degeneration. In Wet AMD, abnormal blood vessels grow under the central part of retina (Macula) and these vessels leak fluid and blood, which cause the macula to degenerate.
With standard laser photocoagulation treatment, though abnormal blood vessels get eliminated ,but it also damages the normal structures of the retina in the overlying and immediate surrounding areas thereby damaging the vision.
In photodynamic therapy , The non thermal laser selectively close the abnormal blood vessels, thereby stopping the leakage and bleeding without damaging the normal structures of the retina.
How this procedure is carried out?
Photodynamic therapy (PDT) is a treatment that uses a photosensitizing drug and red laser light to kill abnormally growing cell.
Photodynamic therapy is a two step procedure.
First, the dye called Visudyne (verteporfin)is injected through a vein in the hand or arm. This dye circulates through the body and sticks to the walls of the abnormal blood vessels beneath the macula.
Second, a beam of red laser light is aimed onto choroidal neovascular membrane. The light activates the dye, causing it to block the abnormal blood vessels, but does not damage the adjacent retina.
It often takes more than one treatment to stop the leakage from these vessels
What precautions to be taken after treatment?
Avoid exposure of skin and eyes to direct sunlight or bright light for 5 days.
Retinal Detachment
What is Retinal Detachment?
A retinal detachment occurs when the retina is pulled away from its normal position in the back of the eye. The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. Retinal detachment can cause permanent vision loss If not treated in time.
What are the types of retinal detachment?
There are 3 types of RD
Rhegmatogenous retinal detachment - A rhegmatogenous retinal detachment occurs due to a hole or break in the retina that allows fluid to pass into the subretinal space between the sensory retina and the retinal pigment epithelium.
Exudative or secondary retinal detachment - An exudative retinal detachment occurs due to inflammation that results in fluid accumulating underneath the retina without the presence of a hole or break.
Tractional retinal detachment-A traction retinal detachment occurs when fibro vascular tissue on surface of retina pulls the sensory retina from the retinal pigment epithelium as seen in diabetic retinopathy cases.
What are its symptoms?
A retinal detachment is commonly preceded by a posterior vitreous detachment (shrinkage of vitreous jelly and its separation from retinal suface) which gives rise to these symptoms:
Flashes of light (photopsia) - mostly experienced in the temporal (outside away from the nose) part of vision
Floaters- black cobweb like spots moving in front of eye
A curtain like shadow coming in field of vision
Sudden Vision Loss when macula is detached
Who is at risk for retinal detachment?
A retinal detachment can occur at any age, but it is more common in people over age of forty.
Common risk factors for developing RD are-
· High Myopia –Especially more than 5 Dioptre · After cataract surgery
· Retinal detachment in the other eye
· Family history of retinal detachment
· Presence of other eye diseases , such as retinoschisis,
degenerative myopia, or lattice degeneration
· Following an eye injury
What are the treatment options?
Retinal hole or breaks are treated with laser photocoagulation or cryopexy (a freeze treatment) as outdoor procedure. During laser treatment , dot like burns are placed around the hole to "weld" the retina. In Cryopexy the area around the hole is frozen and it helps reattach the retina.
Retinal detachments are treated with surgery viz sceral buckling and complex vitreoretinal surgery involving use of Silicon oil or gases.
In scleral bucking, a silicon band, is placed anchored with stitches around the eyeball to gently push the wall of the eye against the detached retina.
In vitrectomy -the surgeon makes tiny incisions in the sclera (white portion of the eye). Vitrectomy instruments are placed inside the eye to take out the vitreous gel and it is replaced with silicon oil or gases to push the retina in place .Laser or cryopexy is done around the breaks to seal it.
With modern vitreoretinal instrumentation, around 90 percent of cases with a retinal detachment can be successfully treated, Visual results are good if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. This is important to contact your retina surgeon in time when you notice any flashes or floaters or a curtain in field of vision.
Flourescein Angiography
What is Flourescein Angiography?
It is an extremely valuable test in which a series of photographs of the retina are taken with the help of a special camera to analyze the blood circulation of choroids and retina.
How this test is performed?
You need to be fasting for 2 hours only before the test. The pupil is dilated with dilating eye drops. A special dye, called Flourescein, is injected into a vein in the arm. The dye reaches to the blood vessels inside the eye in few seconds, A camera equipped with special filters takes the photographs of the back part of the eye as the dye circulates though the blood vessels .
Why is this test necessary?
This test is done to evaluate, diagnose and guide treatment for certain diseases of retina like Diabetic retinopathy, Age related macular degeneration and Retinal vascular blockage etc.
What are its side effects?
Few patients may experience nausea and vomiting or transient giddiness or itching. All the side effects are temporary and pass of within few minutes. Very rarely seriously allergic reaction may occur.
Your urine will be dark colored for 24 to 48 hours as the dye passes through urine.
When do I get my report?
We have the digital imaging system, which allows us to interpret the results immediately, and you can get the report of your test within 15 minutes.
Can I drive after the test?
It is advisable not to drive for 5 hours after the test because your pupils are dilated and your vision remains blurred.
Faculty
Dr. Neeraj Sanduja is a senior vitreoretina consultant and one of the director of the Delhi Retina Centre.
Dr. Neeraj is well trained and has wide experience in the management of vitreoretinal conditions. He has worked as vitreretinal consultant at the Shroff Charity Eye Hospital, New Delhi and has numerous achievements to his credit.
1.Graduate and Post Graduate form Postgraduate Institute Of
Medical Science (PGIMS), Rohtak.
2.Research fellowship & Vitreous fellowship of Dr. S. S.
Badrinath and Dr. Lingam Gopal from one of the premier
vitreoretina institute of world, Sankara Nethralaya, Chennai.
3.Traning in the Surgical Management Of Pediatric Retinal
Diseases at William Beaumount Hospital, Michigan, USA
under the guidance of Dr. Michael Trease, a world renowned
pediatric retina specialist.
4.Recipient of scholarship from the International Society for
prevention of Childhood Blindness, USA.
5.Recepient of Rashtriya Gourav Award in 2004
Dr. Neeraj has organized various conferences and symposia on Diabetic retinopathy, AMD and retinopathy of prematurity involving national and international faculty. He has been active as guest speaker and instructor at various regional and national ophthalmological meetings.He is an executive member of Delhi Ophthalmological society.
Dr. Ajay Aurora is a senior Vitreoretina consultant and one of the director of the Delhi Retina Centre.
He was Asstt. professor at Schell Eye hospital, CMC Vellore Institute of ophthalmology, Aligarh also head of vitreoretina services at Shroff Charity Eye hospital, New Delhi. He is a Post-graduate in ophthalmology from JIPMER, Pondicherry & did his fellowship in vitreoretina at Retina foundation Ahemdabad, University of California San Diego. He underwent training in Transpupillary Therapy under Dr. Eilas Reichel of New England medical Centre, Boston, USA & management of retinopathy at Harvard University, Boston. He has ,many publications both in National & International journal to his credit. An eminent surgeon with more than twenty years of experience, and is a recipient of many national & international awards.
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