The retina is an important part of the eye that acts like a camera film. The lens inside the eye acts like the lens of the camera. The central part of the retina is called the macula and is vital for activities involving the central vision, like reading and recognizing objects and faces. The peripheral part of the retina is responsible for peripheral vision. The optic nerve connects the retina to the brain. The blood supply to the optic nerve and the retina is responsible for maintaining healthy retinal tissues. The inside of the eye is filled with a gel-like substance called the vitreous, which lies immediately in front of the retina. The vitreous is closely attached and related to the retina, hence the diseases involving the retina are called vitreoretinal diseases.
The retina department is equipped with trained doctors from reputed institutions, state-of-the-art machines, and surgical setups for the management of all types of retinal diseases.
A. Investigations for vitreoretinal diseases
The equipment for the investigation and diagnosis of the various vitreoretinal diseases includes:
● Fundus Photography
● Fundus Fluorescein angiography (FFA)
● Optical Coherence Tomography (OCT)
● Ultrasonography B Scan (USG-B Scan)
● Ultrasound Bio-Microscopy (UBM)
B. Management of medical retinal diseases
1. Retinal Lasers:
In the laser therapy of retinal diseases, a laser is a high-intensity beam of light energy that is precisely delivered to the diseased portion of the retina to form a spot that will either destroy or adhere the tissues together. It is usually painless and can be done in the outpatient department or inside the operating theater, depending on the disease for which the laser is being used. There are different types of lasers used for the management of vitreoretinal diseases, the details of which are described to the patients before the treatment is planned. The lasers can be delivered by slit-lamp delivery, indirect ophthalmoscopy, and endolaser delivery.
Retinal lasers are being done for various retinal diseases like
● Proliferative diabetic retinopathy (PDR)
● Diabetic macular edema (DME)
● Retinal vein occlusions (CRVO and BRVO)
● Central serous chorioretinopathy (CSCR)
● Age-related macular degeneration (ARMD)
● Polypoidal choroidal vasculopathy (PCV)
● Retinal breaks and retinal detachment (RD)
● Retinal and vitreous hemorrhage (VH)
● Retinopathy of prematurity (ROP).
2. Intravitreal injections:
Intravitreal injections are a recent breakthrough in the management of various vitreoretinal diseases. Various intravitreal injections include anti-VEGF injections, steroids, and antibiotic injections. Anti-VEGF injections include bevacizumab (Avastin), Ranibizumab (Accentrix, Lucentis), Aflibercept (Eylea), Brolucizumab (Pagenax), and biosimilar injections. Steroid injections include Ozurdex and triamcinolone acetonide (IVTA). Intravitreal antibiotics against bacteria, viruses, and fungi are useful in the infection of the posterior segment of the eye. Intravitreal injections are given in the operation theatre and the patients are counseled in detail about the dos and don’ts related to the injections.
Anti-VEGF injections are commonly used for the management of retinal diseases like
● Diabetic macular edema (DME)
● Proliferative diabetic retinopathy (PDR)
● Retinal vein occlusions (CRVO and BRVO)
● Wet age-related macular degeneration (ARMD)
● Choroidal neovascular membrane (CNVM)
● Polypoidal choroidal vasculopathy (PCV)
● Retinal and vitreous hemorrhage (VH)
● Retinopathy of prematurity (ROP)
Intravitreal steroids are useful in the management of retinal diseases like
● Posterior uveitis
● Cystoid macular edema
Intravitreal antibiotics are useful in the management of infection of the posterior segment of the eye, like
● Endophthalmitis
C. Vitreoretinal surgeries:
The vitreoretinal department is having operating theaters equipped with state-of-the-art vitrectomy machines, lasers, and microscopes with posterior visualization systems. Complex vitreoretinal surgeries are done for diseases of the retina which include
● Retinal Detachment (RD)
● Diabetic Tractional Retinal Detachment (TRD)
● Vitreous Hemorrhage (VH)
● Macular holes (MH)
● Epiretinal membranes (ERM)
● Ocular trauma
● Open globe injury with intra-ocular foreign body (IOFB)
● Scleral fixated intra-ocular lenses (SFIOL)
● Complications of cataract and anterior segment surgeries
D. Retinopathy of Prematurity (ROP)
The vitreoretinal department is involved in screening and managing retinopathy of prematurity (ROP) in the base hospital and NICUs in other hospitals. Other pediatric retinal conditions like FEVR, PFV, and tumors are managed appropriately. The interventions for pediatric retinal diseases include retinal lasers, intravitreal injections, and vitreoretinal surgeries.
E. Teleophthalmology
The vision centers of Trilochan Netralaya are connected to the base hospital in Sambalpur. Patients visiting the vision centers consult with the doctors at the base hospital over video conferencing. The retinal and other eye images are taken by the technician in the vision center and sent to the base hospital via the internet, which helps the treating doctors at the base hospital for the diagnosis of the disease. The patient is advised about the treatment in the vision center or referred to the base hospital, as per the treatment requirement.
F. Special note on the management of vitreoretinal diseases:
The management of vitreoretinal diseases is complex and challenging and carries a guarded prognosis if the presentation to the eye hospital is delayed. Also, the management of vitreoretinal diseases may need multiple interventions and multiple visits to the hospital. However, an earlier presentation to the hospital and compliance with the instructions of the treating medical team results in favorable outcomes.
