Apr 2, 2020

RETINA - extension of brain

Fundus photo of PDR with Vitreous Heamorrhage
Fundus photo of PDR with Vitreous Heamorrhage

Background:

A 42 yr old gentleman was first seen at our hospital on 30th December 2019 by Dr.Praveen R Murthy, Vitreo-Retinal Surgeon. On examination he complained of diminution of vision in both eyes since 1 month. His visual acuity in both eyes was counting fingers at 2 mtr distance. He is a known diabetic since 4 yrs and hypertensive since 1 yr on treatment. Due to renal problems he is on dialysis 3 days a week. Fundus examination showed proliferative diabetic retinopathy (PDR) with vitreous haemorrhage (VH). He was advised to undergo RIGHT EYE VITRECTOMY + MEMBRANE PEELING + ENDOLASER + FLUID GAS EXCHANGE + ENDOLASER + C3F8 GAS UNDER LOCAL ANAESTHESIA.

Surgical Management:

After undergoing all preliminary investigations (physical fitness & Nephralogist opinion) he was posted for surgery on 28.01.2020 @ 05:00pm (post dialysis day). The operating team consisted of Dr.Krishna R Murthy & Dr.Bhargavi Murali – Operating surgeons, Dr.Snehapriya – Assistant Doctor, Mr.Muthuraj - Surgery Assistant, Dr. Naveen – Anesthetist, and OT Assistants- Mr.Suresh & Mr.Umesh

The surgery lasted for 2 hrs. He was discharged on 29.01.2020 with an advice to follow all medications and to maintain strict prone position for 13-14 hrs a day.

Diabetic retinopathy is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). The condition can develop in anyone who has type 1 or type 2 diabetes. The longer the diabetes and the less controlled blood sugar levels, the more likely to develop this eye complication. Complications can lead to serious vision problems

Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily. These new blood vessels have to be treated with laser / antivegf injections. Without any treatment, the bleeding will cause scar tissue that starts to shrink and pull the retina off and the eye becomes blind. If the blood vessels continue to grow despite the above treatments and causing haemorrhages requires surgical interventions.

Careful management of diabetes is the best way to prevent vision loss.

He used to work as projectionist in theatre mall. Due to renal problem he is dependent on dialysis 3 days a week, added to above he started having vision problem, the employer insisted on fitness to continue his work. As a result of which he had to discontinue his work.

Now, post surgery he was able to find another job in the same line and is happy that he can support his family.  He has thanked the entire team.

42 yr old gentleman operated for PDR + VH
42 yr old gentleman operated for PDR + VH
Feb 18, 2020

PREVENTION BETTER THAN CURE

fundus image of APROP
fundus image of APROP

Retinopathy of prematurity (ROP) is related to oxygen-regulated vascular endothelial growth factor and to insulin-like growth factor. The natural course of ROP leads to blindness, causing a social and financial burden on the community. Irreversibly impaired vision may also hinder cognitive and psychomotor development of the affected children.

ROP may be prevented by providing health care for the infant during their stay in the Neonatal Intensive Care Unit (NICU). Oxygen-therapy may be potentially toxic to several organs and tissues, including the still immature retina. Preterm infants are more prone to the effects of oxygen toxicity, since they were used to low oxygen tensions during intrauterine life. After premature birth, there is a dramatic increase in oxygen concentration, which may lead to sustained hyperoxia that may overproduce vascular endothelial growth factor (VEGF). High levels of VEGF stimulate neovascularization of the retina, which in severe cases may result in retinal fibrosis and retinal detachment

Screening programs to detect ROP, including systematic fundus examinations at NICU in infants at risk for ROP, provide the best possibility of diagnosing the disease in order to establish an appropriate treatment prior to progression to more advanced stages and blindness.

  1. A 3 weeks male baby born in 36 weeks of gestation weighing 800 gms was seen on 10.01.2020 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed aggressive posterior Retinopathy of Prematurity with fovea not yet vascularized (fovea is a tiny pit located in the macula of the retina that provides the clearest vision of all and is aligned with the central axis of the lens). The baby was advised of antivegf injection to both eyes at the earliest. The baby was administered injection on 14.01.2020. As on 14.02.2020; vascularisation still in zone 1 and has been advised for close observation.

 

  1. A 6 weeks female baby born in 28 weeks of gestation weighing 1120 gms was seen on 05.12.2019 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed presence of ROP in both eyes in stage 2 in zone 2 in both eyes. The baby was advised of laser intervention to both eyes. The baby underwent laser treatment on 09.12.2019. As on 03.02.2020 the baby is doing well; ROP has regressed in both eyes
baby treated for APROP
baby treated for APROP
baby treated with laser therapy
baby treated with laser therapy
Feb 10, 2020

Eyes - Image creator

7 months baby operated for congenital glaucoma
7 months baby operated for congenital glaucoma

Most of the children in their school going age are unaware of their visual needs or vision related problems. The proverb “an ounce of prevention is worth a pound of cure” is true with children’s eye care. As children progress throughout their education, they face increasing demands on their visual abilities. When certain visual skills have not developed, or are poorly developed, learning is difficult and stressful. Children will typically attempt to do the work, but with a lowered level of comprehension or efficiency. Eye exams by an eye doctor are an important way to identify problems with your child's vision. Problems that are found early have a better chance of being treated successfully

CONGENITAL GLAUCOMA:

A 7 months old male baby was seen by us on 31.10.2019 in Glaucoma Department. The baby has the systemic condition called sturge weber syndrome with seizure. It is a congenial disorder and a rare neurological condition that affects the development of certain blood vessels causing abnormalities in the brain, skin and eyes from birth. It is characterized by a port-wine birthmark on the child’s face. On examination parents informed of treatment at Indira Gandhi Institute of Child Health care for epilepsy since 1 month. During visual acuity examination the child was able to follow and fix light in both eyes. Anterior segment examination showed megalo cornea in both eyes. An intraocular pressure in right eye was 24 mmHg and in left eye was 28 mmHg. The child was advised to undergo BOTH EYES EXAMINATION UNDER ANAESTHESIA + TRABECULECOTMY + TRABECULOTOMY UNDER GENERAL ANAESTHESIA. The child was advised to start perioperatively oral propranalol 1 week prior to surgery (to treat high blood pressure and circulatory conditions after pediatrician opinion)

After undergoing all preliminary investigations (paediatrician fitness) the baby was posted for surgery on 30.12.2019. The surgery lasted for 1 hr 45min and was uneventful.

As on 21.01.2020; the baby is doing well and examination under anaesthesia has been advised.

DEVELOPMENTAL CATARACT

A 7 year old female child was seen at our hospital in the month of September 2019. On examination parents gave a history of undergoing cataract surgery to left eye 2 yrs back elsewhere. The child complained of diminution of vision in right eye. Her visual acuity in right eye was counting fingers at 1 mtr distance and in left eye was 6/60. Anterior segment examination showed presence of cataract with diffuse lenticular opacities. The child is suffering from chronic disease known as nephritic syndrome. (Nephritic syndrome is the name given to a collection of different signs and symptoms that occur as a result of inflammation in the kidneys. This inflammation causes the kidneys to works less effectively. It also causes protein and red blood cells to leak from the blood stream into the urine. There are many conditions that may cause nephritic syndrome and it can occur in people of all ages. Common causes are infections, immune system disorders and inflammation of the blood vessels. The main symptoms are passing less urine than normal, leading to a fluid buildup in the body, and having blood in the urine. People with nephritic syndrome also often develop high blood pressure). The child is under treatment for the above condition. The child was advised to undergo RIGHT EYE CATARACT EXTRACTION + ANTERIOR VITRECTOMY + IOL IMPLANTATION + POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA. Post surgery close monitoring on child’s BP fluctuations was advised by the paediatrician and was monitored round the clock.

 After undergoing all preliminary investigations (paediatrician fitness) the child was posted for surgery on 05.10.2019

7 year old girl child operated for cataract
7 year old girl child operated for cataract
 
WARNING: Javascript is currently disabled or is not available in your browser. GlobalGiving makes extensive use of Javascript and will not function properly with Javascript disabled. Please enable Javascript and refresh this page.