The department of Ophthalmology has advanced and latest state of the art diagnostic techniques and surgical machines for cataract surgery.

Cataract is the most common cause of correctible blindness in the world. It is an opacity/clouding of the crystalline lens of our eye.

The normal human lens is transparent in nature and allows the light from outside to enter our eye and this helps us to form an image on the back part of our eye called the retina. When the lens becomes hazy or opacified due to any reason the external light entering our eye gets blocked which causes blurred vision and also there maybe some other symptoms like shadows around images, decreased vision particularly in bright light, difficulty in driving and other daily activities and reduction in colour vision and contrast sensitivity.

This is a mechanical block to the passage of light. Cataract has no medical treatment so far.

The opacified lens has to be removed surgically. A synthetic lens is placed in the eye by the surgeon.

Diagnostic services :

Our department is fully equipped with world class machines for preoperative assessment of cataract surgery patients

These are:

• IOL master 700 is an optical biometry device used to measure various parameters of the eye such as the axial length and corneal diameters. Using this data the device is equipped to calculate the power of the lens with high accuracy using the latest formulas in-built in the machine. The precision with which the calculations are done leads to less refractive surprise and almost complete glass independence.
• ZEISS CIRRUS OCT – This machine can scan the retinal nerve fibres and give a better judgment of disorders in the macula which is the central fine focusing region of the eye.
  This in turn helps to predict surgical outcomes and give treatment preoperatively if required.
• Specular Microscope-It is used for the evaluation of the health of the corneal endothelium which maintains the transparency of the cornea. By doing so necessary precautions can be taken during surgery to ensure optimal surgical outcome.
• We also have machines to aid in additional tests that are needed for fine tuning calculations for deciding the final lens power. Pachymetry is used to measure the corneal thickness; Topography(Pentacam) is used to measure the corneal surface and curvature; Aberrometry is used to measure aberrations that can affect the quality of vision. Using these devices we can get a holistic and individualized solution for the patient.

Types of cataract surgery :

The cataract can be removed from the eye using various methods -

• Phacoemulsification –It is a technique in which an advanced machine(Alcon Centurion Vision System) is used that delivers ultrasonic waves to the cataractous lens and crushes it into small pieces which can be sucked into the machine. A foldable lens of a specific power is inserted into the eye so that vision lost due to cataract is regained.
  The size of the cut taken by the surgeon is small (2.2-2.8mm)and usually requires no stitches. Thus recovery after surgery is faster and the patient can resume daily activities quickly.
• MSICS – this method of cataract extraction has been around since many years and is done in a few select complicated cases.
  The cut made in the eye is larger than the phacoemulsification cut and so recovery time is a bit longer.

Anesthesia for above surgeries can be by giving small injection or by putting anesthetic eye drops. This decision can be taken after a discussion between our eye surgeon and patient to decide what is best for the patient.

Types of lenses :

The lenses which are implanted can be of various types depending upon the clinical condition, activities and choice of the patient.

1. Monofocal lenses correct the spectacle power for long distance.
2. Edof lenses correct the spectacle power for distance range and intermediate range (eg for laptop work)
3. Multifocal/trifocal lenses correct spectacle power for distance, intermediate and near.This eliminates the need for spectacles after surgery.
4. Toric lenses are another type of specialized lenses which correct spectacle powers that consist of a cylindrical axis.

Our eye surgeon will guide you regarding the choice of lens.

Apart from age related cataract, we also offer services for other types of cataracts-

• Pediatric cataracts- Children’s eyes are quite different from adults and the eye growth and structural changes have to be taken into account. We are equipped to adequately deal with such delicate surgeries.
• Traumatic cataract
• Uveitic cataract

• Services that aimed at treating disorders involving the back part of the eye.
• Common ailment includes diabetic and hypertensive eye disorders, retinal detachment macular holes A.M.D
• Commonly manifest as diminution of vision invo central/peripheral parts of vision and need to be addressed urgently.
• Can potentially lead to permanent deprevation of vision if if not treated promptly
• Facilities required for adequate assessment of disorder available : OCT, Fundus photography, ultrasound ( essential for adequate planning of the treatment)
• Treatment modalities available in entirely – a class leading of equipments such as a vitrectomy machine, LASER machines, cryo etc.
• Treatment services span from neonate to elderly.

Retina – ROP FAQ :

• Premature Baby’s & risk of ROP (Retinopathy of Prematurity):

  The inside of the eye (the retina) is not fully developed in a premature baby

  Abnormal blood vessels can develop in such a retina; this can cause bleeding inside the eye and retinal detachment leading to low vision or blindness

• Do all babies need a retinal examination for ROP?

  Babies with a birth weight of less than 1700 gm or those born at less than 35 weeks of pregnancy are most likely to have ROP. Any other preterm baby with problems after birth (lack of oxygen / infection / blood transfusion / breathing trouble, etc.) is also vulnerable.

• How can we detect ROP?

  A trained ophthalmologist can detect ROP by dilating the pupils of the eye using eye drops. An indirect ophthalmoscope is used to examine the retina to detect ROP.

• How often should the retina be examined?

  ROP if treatable disease is present worsens in 7-14 days and, therefore, needs a close follow-up till the retina matures.

• What is the treatment for ROP?

  ROP is treated with LASER rays & intravitreal antiVEGF injections which helps to stop further growth of abnormal vessels thus preventing vision loss. Surgery is required in advanced stage of the ROP.

• How are the results after treatment?

  If treated on time, the child is expected to have reasonably good vision. All premature babies need regular eye examinations. They may need glasses or treatment for lazy eyes / cross-eyes, sometimes, for cataract, glaucoma, retinal detachment.

• Is it too late for my baby’s eyes?

  Follow the “Day-30” rule. The retinal examination should be completed before “day-30” of the life of a premature baby. It should preferably be done earlier at 2 - 3 weeks of birth.

Investigations offered :

1. Fundoscopy:

   Fundoscopy, also known as ophthalmoscopy, is a diagnostic procedure used to examine the interior surface of the eye, particularly the retina, optic disc, macula, and blood vessels. It is performed using an instrument called an ophthalmoscope, which shines light into the eye and allows the doctor to view these structures through the pupil. Fundoscopy is essential for diagnosing various eye conditions such as diabetic retinopathy, glaucoma, macular degeneration, and retinal detachment. It also provides valuable information about systemic conditions like hypertension or diabetes, which can affect the retinal blood vessels.

2. Fundus photography:

   Fundus Photography is a specialized type of medical imaging that captures detailed images of the retina, the back part of the eye. It is a valuable tool for diagnosing, monitoring, and documenting various eye conditions. Fundus photographs allow you to actually see what is wrong in your eyes so that you understand your disease better.

3. OCT (Optical coherence tomography):

   OCT (Optical Coherence Tomography) is a non-invasive imaging test that uses light waves to take cross-sectional pictures of the retina. These images allow your ophthalmologist to view each of the retina’s distinctive layers, providing information about its thickness and detecting signs of disease. No special preparation is needed. The patient may need to have their eyes dilated for a better view of the retina. The patient will be seated with their chin resting on a support. The OCT machine takes scans of the retina using light beams, and the test is quick, lasting only a few seconds. There is no physical contact with the eye.

4. OCT-A (Optical coherence tomography – angiography):

   OCT Angiography (OCTA) is an advanced imaging technique that provides a detailed view of the retinal and choroidal blood vessels without the need for dye injections, as is the case with traditional fluorescein angiography. OCTA uses the principles of standard OCT but also captures the motion of red blood cells within retinal blood vessels, creating detailed 3D images of retinal and choroidal blood flow. OCTA is particularly useful in assessing blood flow in the retina and diagnosing various vascular-related eye diseases, like

5. Fundus Fluorescein Angiography (FFA) :

   Fundus Fluorescein Angiography (FFA) is a diagnostic procedure used to examine the circulation of the retina and choroid using a fluorescent dye and a specialized camera. This test helps to assess blood flow in the back of the eye, detect abnormalities, and diagnose various retinal conditions.

   Q. What are the common conditions when FFA is needed?

   Diabetic retinopathy, Age-related macular degeneration (AMD), Retinal vein occlusion, Macular edema, Choroidal neovascularization (CNV) and posterior uveitis are a few of the conditions when FFA might be useful.

6. Indocyanine green angiography:

   Indocyanine Green Angiography (ICGA) is a diagnostic test used to image the blood vessels in the choroid, the layer beneath the retina. It is particularly useful for identifying abnormalities in deeper layers of the eye that are difficult to visualize with other imaging techniques like Fundus Fluorescein Angiography (FFA). The procedure uses a dye called indocyanine green (ICG), which fluoresces under infrared light, allowing visualization of the choroidal circulation. Conditions in which ICG might be advised are Polypoidal choroidal vasculopathy (PCV), Central serous chorioretinopathy (CSCR), Inflammatory diseases like posterior uveitis, Tumors or vascular abnormalities in the choroid.

Treatments offered :

1. Green laser :

   Retinal lasers are an essential tool in ophthalmology for treating various retinal conditions by using focused light to create controlled burns or coagulate tissues in the retina. These procedures are typically outpatient, minimally invasive, and can be completed in a few minutes. Here are some of the main uses:

   1. Diabetic Retinopathy (DR)

      Panretinal Photocoagulation (PRP): In cases of proliferative diabetic retinopathy, laser burns are applied throughout the peripheral retina to reduce the oxygen demand and control abnormal blood vessel growth, reducing the risk of severe vision loss.

      Focal and Grid Laser for Macular Edema: Lasers are targeted at leaking blood vessels in the macula to reduce swelling, aiming to stabilize or improve vision.

   2. Retinal vein occlusion

      Retinal laser has a role in preventing complications arising after vein occlusions.

   3. Retinal Tears and Detachments

      Retinopexy: A retinal laser can be used to treat retinal tears or holes by creating a ring of scar tissue around them, effectively sealing the retina in place and preventing progression to retinal detachment.

   4. Central Serous Retinopathy (CSR)

      In chronic CSR cases, a laser can help treat persistent fluid leakage under the retina, aiding reabsorption and recovery.

2. Intravitreal injections :

   Intravitreal Injection is a procedure of placing a medication directly into the vitreous cavity that is the space at the back of your eye. This cavity is filled with a jelly-like fluid called the vitreous humor.

   Q. Which medications are available as intravitreal injections?

   1. Anti-VEGF cab be used routinely for diabetic macular edema, retinal vein occlusions and age related macular degeneration.

   2. Intravitreal triamcinolone might be advised by your retina specialist in case of inflammatory macular edema or other causes of longstanding macular edema.

   3.Intravitreal antibiotics are advised in cases where there is infection involving all the layers of the eye, because it is more effective than antibiotic eyedrops.

   4. Intravitreal anti-virals are advised when there the retina is affected by vision threatening viral infections.

   Q. Which diseases are treated with intravitreal injections?

   Macular edema due to diabetes (diabetic macular edema

   Retinal vein occlusion

   Age related macular degeneration

   Choroidal neovascularization due to various causes

   Uveitis

   Post surgical cystoid macular edema

   Endophthalmitis

   Viral retinitis

   Aggressive retinopathy of prematurity

   Q. What is the procedure for the intravitreal injection?

   Intravitreal injections are carried out in the Operation theatre in sterile conditions. After instilling numbing drops to your eye, the correct dose of the medication is injected in your eye, with a needle so small that you will not be able to see with the naked eye! The procedure is almost painless and hasslefree.

3. Intravitreal implants:

   If you need an intravitreal steroid medication for a longer duration, your retina specialist might advise an intravitreal implant. OZURDEX is a tiny implant that slowly releases corticosteroid medication over time, without the need for monthly injections. It will dissolve naturally and will not need to be removed.

4. Vitreo-retinal surgeries :

   Retinal surgeries encompass a range of procedures to treat diseases and injuries affecting the retina. These surgeries are typically performed by a retina specialist and can be crucial for preventing vision loss or restoring vision, depending on the condition.

   MIVS (Microincision Vitreo-retinal surgery) is a minimally invasive surgical approach in vitrectomy that uses smaller gauge instruments, so as to not require sutures. All VR surgeries performed in our OT are microinvasive.

   Below are some of the primary types of retinal surgeries:

   1. Pars plana vitrectomy

      The vitreous gel inside the eye is removed to gain access to the retina, followed by the appropriate retinal surgery. Silicon oil or gas may be injected to support the retina as per the need. This surgery treats retinal detachments, macular holes, epiretinal membranes, advanced diabetic eye disease, complications of cataract surgery, and many other retinal conditions.

   2. Scleral Buckling

      A silicone band (scleral buckle) is placed around the eye’s outer wall to indent the eye and bring the retina closer to the wall, helping to reattach it. It is primarily used for retinal detachment repair. It can be used alone or in combination with vitrectomy for complex cases.

   3. Pneumatic Retinopexy

      A gas bubble is injected into the vitreous cavity, pressing the retina against the eye wall. The patient’s head is positioned so that the bubble seals the retinal tear. It is effective for certain types of retinal detachments, especially when they are less complex and located in the upper parts of the retina.

   4. Cryopexy (Cryotherapy)

      Freezing temperatures are applied to the sclera (outer wall of the eye) to create a scar that helps seal retinal tears or small detachments. It is used for retinal tears, often combined with other retinal detachment repair methods.

   5. Macular Hole Repair

      A vitrectomy is performed, and often a gas bubble is injected to close the macular hole. It specifically treats macular holes, which can cause central vision loss if left untreated.

   6. Epiretinal Membrane Peeling

      The thin layer of scar tissue on the retina’s surface (epiretinal membrane) is peeled off during a vitrectomy. It treats conditions causing visual distortion or blurriness due to the membrane pulling on the retina.

   7. Surgeries for complications of cataract surgery

      Rare complications of cataract like retained cataractous material, aphakia or endophthalmitis need to be treated by vitreoretinal surgery.

   8. Surgery for advanced retinopathy of prematurity
   9. Repair of traumatic eye perforation
5. Vitreous biopsy :

   A vitreous biopsy involves extracting a small sample of the vitreous gel from the eye to diagnose and manage various ocular diseases. This procedure is typically performed by a retina specialist, often in conjunction with a vitrectomy (partial or complete removal of the vitreous). The vitreous sample is subjected to the appropriate microbiological or histological test. Vitreous biopsy is invaluable for diagnosing infections, inflammatory conditions, and some intraocular malignancies.

Ophthalmic plastic surgery or ‘ Oculoplasty ‘ is the subspeciality of ophthalmology that deals with problems of important structures around the eyes like eyelids, eyebrows, orbit and the tear system which are vital for normal appearance and function of our eyes.

Various surgeries that are covered under this speciality are as follows :

1. Lacrimal surgeries :
   • External DCR
   • DCT
   • Punctuloplasty and curettage foir tear duct infections
   • Punctuloplasty and stenting
   • I & D of tear sac abscess
2. Lid surgeries :
   • Ptosis surgery – for droopy eyelids
   • Entropion and extropion surgery for lid malpositions
   • Surgeries for lid masses ( both non cancerous and cancerous growths)
   • Cosmetic Lid reconstructions and repair of tear duct injuries in extensive facial trauma and burns.
3. Orbital surgeries :
   • Scarless surgeries for orbital wall fractures repair
   • Orbitotomy for intra orbital growths ( benign and malignant ), orbital foreign bodies
   • Orbital decompression surgeries in Thyroid eye disease.
4. Ocular oncology :
   • Surgeries for diagnosis and management of intraocular and adnexal cancers
   • Inj. Botox and fillers for periocular and facial rejuvenation
   • Inj. Botox in blepharospasm and facial dystonias
   • Tarsoraphy for abnormal lid closures post paralysis, trauma or surgeries

DMH PediatricOphthalmology and Strabismus department offers comprehensive ophthalmic care of your child including – Estimation of vision in kids ( “ just born” upto “ teens” ) and evaluation of vision anomalies in them like refractive error ( glasses number), colour vision defects.

1. Pediatric cataract –

   Those children who have cataract since birth or develop in very early years of life or because of some trauma / injury.

2. Squint in Pediatric and Adult patients -

   Optical and surgical treatment for both.

3. Amblyopia management –

   Diagnosis and treatment of lazy eyes

4. Pediatric oculoplasty –
   • Ptosis ( drooping of one or both eyelids)
   • Management of nasolacrimal duct obstruction ( causing watering of eyes since birth)
   • Abnormal positioning of eyelids
   • Orbital / lid mass such as hemangiomas.
5. Pediatric ocular surface discorders –

   Such as allergic conditions, corneal ectasias such as keratoconus, other corneal discorders since birth

6. Pediatric uveitis –

   Diagnosis and management of all inflammatory / autoimmune conditions followed by visual rehabilititions in children.

7. Pediatric retinal diseases –

   ROP and congenital retinal hereditary or acquired disorders are diagnosed and co-managed along with vitreo retinal surgeons.

8. Pediatric glaucoma screening and diagnosis, co-managed with glaucoma surgeons
9. Binocular vision anomalies in children and Adults
10. Myopia clinic

    Thorough evaluiation and strategies to control increase of minus spectacle number in kids including use of special glasses , eyedrops, contact lenses.

11. Low vision aids
12. Neuro ophthalmic discorders in children and adults –

    Includes conditions like nystagmus ( shaking of eyes ), paralytic squints, diplopia ( double vision), optic nerve disorders caused by infective, inflammatory, demyelinationg, metastatic or such causes, effects of raised intracranial pressure etc

Laser vision correction (LVC) is removal of spectacle power with the help of advanced laser machines by treating the cornea ( front transperant layer of eye). Different types of treatments are available for myopia ( short sightness), hyperopia ( far sightedness)? And astigmatism ( cylindrical power for clear vision). Various tests like Pentacam TM, Topolyser TM etc are performed prior to surgery to judge suitability for surgery. The wave light TM excimer laser by Alcon can perform several types of treatments like

1. PRK ( Photo Refractive Keratectomy ) for myopia and hypermetropia, Streamlight TM( TransPRK)
2. LASIK ( Laser Assisted In Situ Keratomileusis ) for large range of powers of muopia and hypermetropia.

• CONTOURA LASIK, a LASIK for crisp vision with less glares and haloes. It is usually done in persons with irregular corneas.
• PTK ( Photo Therapeutic Keratectomy ) for some corneal conditions like superficial white scars on cornea ( front transperant ) layer of eye) and as part of laser assisted corneal collagen crosslinking ( C3R) for early keratoconus ( condition in which there in bowing of cornea).

In persons with very high glass power, LVC may not be possible. In such patients ICL/IPCL.Phakic IOL may be a suitable option. In this treatment a wafer thin artificial lens is placed in front of natural crystalline lens.

1. Corneal transplant surgeries
   • Lamellar surgeries where only layer by layer cornea is replaced depending on the condition, like post cataract surgery corneal problems or corneal thinning conditions.
   • Full thickness corneal transplant surgery where in some cases, layer by layer can’t be changed, this option is used, in cases of corneal infections and opacities due to past traumatic incidences.
2. Ocular surface reconstruction surgeries
   • In cases of industrial chemical injuries, or domestic injuries due to lime, ocular surface is damaged which can be treated with surgical methods like Amniotic Membrane Transplant (AMG) and Modified Simple Limbal Epithelial Transplant (MSLET), where the cells in the damaged area of the surface are replaced.
   • After industrial or domestic trauma, if there is rupture or tear in the corneal tissue, it can be surgically repaired
3. Keratoconus
   • For corneal ectasia conditions like keratoconus, we offer advanced treatments like Cornel Collagen Crosslinking, Scleral Contact Lens, and Phakic Intra ocular lens implants
4. Investigations offered
   • Topography
   • Pentacam
   • Anterior segment OCT

Venu Madhav Eye Bank is one of the most active eye banks in the city, with all the advanced facilities 24 X 7 availability of trained personnel to attend to the eye donation call collect it.

We offer services of corneal transplant and its allied surgeries to patients requiring it, in conditions like corneal scars, infections, thinning and ectasia.

We have facility of collection of corneal tissues from deceased donors, who have previously pledged their eyes or whose relatives have consented to their deceased relatives eyes.

What is glaucoma?

Glaucoma is a disease that damages the optic nerve,the nerve which sends information from the eye to the brain. If left undetected and untreated, it can eventually lead to permanent vision loss.

Exact cause is not known, the most common cause associated with glaucoma is raised intraocular pressure.

There is a fluid within the eye called aqueous humor which provides nourishment to the eye tissues. In glaucoma, this fluid drains inefficiently or the passage through which it drains becomes blocked, causing eye pressure to build up. This causes damage to the blood vessels and nerves in the optic nerve resulting in permanent vision loss.

What are the symptoms of glaucoma?

Glaucoma is largely an aysymptomatic disease. Most people are unaware that they have a problem because there are no symptoms at the start. That is why glaucoma is called the ‘silent killer of sight’

Thus regular screening is very important for detection of glaucoma

What are the risk factors for glaucoma?

Increasing age (40+)

Parents / siblings with glaucoma

High refractive error( myopia /hypermetropia)

Diabetes mellitus

Steroid use

Eye injury

How is glaucoma diagnosed?

Glaucoma is diagnosed by a comprehensive eye examination which includes a slit lamp examination, measurement of intraocular pressure by Goldmann applanation tonometry, examination of the angles of the eye by gonioscopy and assement of the optic nerve head.

Investigations which help in aiding the diagnosis include pachymetry, optical coherence tomography (OCT) and visual field analysis by perimetry.

What is pachymetry?

Pachymetry is the measurement of the thickness of the cornea. The intraocular pressure and progression of glaucoma is associated with the corneal thickness. Hence , pachymetry is an important part in the diagnosis and management of glaucoma.

What is OCT?

OCT ( optical coherence tomography) ( OCT )is a non-invasive technology used for imaging the nerve fiber layer and to study the topography of the optic nerve. It is extremely useful in documenting and studying the damage due to glaucoma in its early stage before it is clinically visible. The follow up of the patients is also done very systematically and accurately with this tool.

An anterior segment OCT helps in studying the anterior chamber angle.

What is perimetry?

The field of vsion is tested by perimetry. In glaucoma the peripheral field of vision gets affected in the early stages and in advanced cases central field of vision gets affected. This can be documented with the help of perimetry.

What is the treatment of glaucoma?

It is important to realize that there is no cure for glaucoma. Once nerve fibers die and visual function is lost, it cannot be recovered. Treatment can only help preserve remaining vision; hence it is imperative to detect the disease in its earliest stage.

Treatment is in the form of drops, laser or surgery

Eyedrops are generall y the first line of treatment in glaucoma. Drops once started have to be used lifelong.

Lasers in glaucoma include laser peripheral iridotomy, selective laser trabeculoplasty.

Surgery in glaucoma includes trabeculectomy, shunt surgeries and minimally invasive glaucoma surgery(MIGS)

FACILITIES AVAILABLE AT DEENANATH MANGESHKAR HOSPITAL

Diagnosis and investigation :

1. Slit lamp biomicroscopy
2. Applanation tonometry /Perkin’s tonometer( handheld applanation tonometer)
3. Non contact tonometer
4. Gonioscopy
5. Pachymetry
6. OCT (Zeiss Cirrus HD OCT 5000)
7. Humphrey HFA 3 perimetry

Lasers :

1. Nd yag laser iridotomy
2. Nd Yag laser capsulotomy
3. Green laser for laser suturolysis

Surgeries offered :

• Combined cataract and glaucoma surgery. Trabeculectomy
• Repeat Trabeculectomies.
• Bleb needling and revisions.
• Management of leaking/ failed blebs.
• Trabeculotomy in Paediatric age group.
• Glaucoma implants in complicated cases.(Ahmed glaucoma implant)

Minimally Invasive Glaucoma Surgeries such as IStent, Kahook Dual Blade(KDB) excisional goniotomy and Bent angle needle goniotomy(BANG).

Specialised and complex cataract surgeries in eyes with previous glaucoma surgeries, Pseudoexfoliation, non-dilating pupils, traumatic eyes needing repair and special conditions like nanophthalmos, anterior segment dysgenesis are also done in addition to the standard combined cataract and Glaucoma surgical procedures.

Uvietis is inflammation of the middle coat of the eye . It can be due to infection, immune mediated or other causes.

Diagnosis –

Various diagnostic tests required are

• Laboratory test
• Fundus photo
• Fundus Fluorescein Angiography
• OCT
• USG B-Scan
• Radiological imaging
• PCR studies
• Uvietis workup including microbiological studies

Treatment –

All management of Uvietis are

• Local
• Systemic by immune-modulation.
• Newer treatment modalities .

  Interdisciplinary approach involving physician, infectious disease specialist, rheumatologist and other specialist.

• Various diagnostic and therapeutic procedures .

  Periocular and intraocular injections.

  Biopsies

  Surgical procedures like vitrectomy etc.