Complex Retinal Surgeries in Diabetic Retinopathy

by Vittala International Institute of Ophthalmology
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
Complex Retinal Surgeries in Diabetic Retinopathy
47 yr old operated for RD
47 yr old operated for RD

The retina is the part of the eye that receives the light and converts it into chemical energy. The chemical energy activates nerves that conduct the messages out of the eye into the higher regions of the brain. The retina is a complex nervous structure.

Under our project complex retinal diabetic surgeries we have operated VITRECTOMY SURGERY on a 47 yr old gentleman.

He was seen at our hospital in the month of June 2020 by Dr.Krishna R Murthy. On examination he complained of diminution of vision in left eye since 8 months & gave of history of trauma to his right eye with stone 35 yrs back. Fundus examination in right eye showed total glaucomatous disc and in left eye posterior retinal detachment. (A retina detaches when the retina peels away from its underlying layer of support tissue at the back of the eye). He was advised to undergo LEFT EYE VITRECTOMY + ENDOLASER + FLUID GAS EXCHANGE + SILICONE OIL INJECTION UNDER LOCAL ANAESTHESIA.

Surgical Management:

After undergoing all preliminary investigations (physical fitness) he was posted for surgery on 20.10.2020 @ 02:15pm. The operating team consisted of Dr.Krishna R Murthy & Dr.Bhargavi Murali – Operating surgeons, Dr.Snehapriya – Assistant Doctor, Mr.Umesh - Surgery Assistant, Dr. Naveen – Anesthetist, and OT Assistants- Mr.Suresh & Mr.Muthuraj,

 

The surgery lasted for 2 hrs 30 min. He was discharged on 21.10.2020 with an advice to follow all medications and to maintain strict prone position for 13-14 hrs a day for 3 weeks and review after 1 week. As on 10.11.2020; he is doing well and retina is ON and was suggested to review after 3 weeks for glasses suggestion.

 

By profession he works in a hotel industry as a helper and supports his family. The above helping hand has imbibed confidence in him to get involved in some job to support his family.

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fundus photo of macula off retinal detachment
fundus photo of macula off retinal detachment

Background:

A 53 year old gentleman was reviewed at our hospital on 17.01.2020 by Dr.Bhargavi Murali. He had undergone both eyes cataract surgery in 2015. On examination he complained of diminution of vision in right eye since 4 days. His visual acuity in right eye was counting fingers at 1 mtr distance and in left eye 6/6p. Fundus examination in right eye showed inferior retinal detachment with macula off (It is the status of the macula that defines the urgency with which surgical repair should be un­dertaken, Macular detachment is a detachment involving the fovea with any resulting loss of central Snellen visual acuity).

He was advised to undergo RIGHT EYE VITRECTOMY + ENDOLASER + FLUID GAS EXCHANGE + ENDOLASER UNDER + C3F8 GAS UNDER LOCAL ANAESTHESIA.

Surgical Management:

After undergoing all preliminary investigations (physical fitness) he was posted for surgery on 21.01.2020 @ 02:30pm. The operating team consisted of Dr.Krishna R Murthy – Operating surgeon, Dr.Snehapriya – Assistant Doctor, Mr.Anilkumar - Surgery Assistant, Dr. Naveen – Anesthetist, and OT Assistants- Mr.Suresh & Mr.Ravikumar,

 

The surgery lasted for 1 hr 45 min. He was discharged on 22.01.2020 with an advice to follow all medications and to maintain strict prone position for 13-14 hrs a day for 3 weeks and review after 1 week. As on 21.02.2020; he is doing well and retina is ON and was suggested to review after 3 weeks.

 

By profession he works as a school van driver and supports his family. His profession requires him to have correct eyesight for safe driving. Post surgery his visual acuity in right eye is 6/12. Timely intervention has helped him to continue his profession and support his family

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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
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48 yr old female operated for macula hole
48 yr old female operated for macula hole

Background:

A 48 yr old female was seen at our hospital on 18.11.2019 by Dr.Krishna R Murthy. She was screened in one of the cataract screening camps and was referred to us for retinal evaluation and management. On examination she informed of diminution of vision in right eye since 15 days. Her visual acuity in right eye was counting fingers at 3 mtr distance. Fundus examination of the right eye showed full thickness macula hole in right eye.

She was advised to undergo RIGHT EYE VITRECTOMY + ILM PEELING + FLUID GAS EXCHANGE + C3F8 GAS TAMPONADE UNDER LOCAL ANAESTHESIA.

Surgical Management:

After undergoing all preliminary investigations (physical fitness) she was posted for surgery on 22.11.2019 @ 04:40pm. The operating team consisted of Dr.Krishna R Murthy & Dr.Bhargavi Murali – Operating surgeons, Dr.Megha Agarwal – Assistant Doctor, Mr.Anilkumar - Surgery Assistant, Dr. Naveen – Anesthetist, and OT Assistants- Mr.Umesh & Mr.Ravikumar.  

The surgery lasted for 1 hr and it was uneventful. She was discharged on 23.11.2019 with an advice to follow all medications and to maintain strict prone position (Face-down positioning is the recovery posture following vitrectomy with gas tamponade for treating macular hole closure) for 13-14 hrs a day for 3 weeks & review after 1 week.

Full thickness macular hole is an eye disease, which can cause permanent visual impairment. It is a small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular hole can cause blurred and distorted central vision. Early detection and referral of these patients is vital so that early surgical intervention can be carried out to improve their vision.

Tamponade is the closure or blockage. C3F8 (perfluoropropane) is a gas tamponade used for macular hole repair which prevents further fluid flow into the subretinal space. The bubble acts as a bandage

She works as a support staff involved in inspecting car spare parts which requires good eye sight. Due to her vision problem she was unable to carry on the work and support the family. Financial constraints made her hesitant to go for eye checkup. Hoping for free eye treatment she attended one of the cataract camps organized near her place. As she required retinal evaluation and management she was guided to our hospital for help and support.

As on 30.12.2019; she is very happy with the improvement in her vision and has been suggested for glasses checkup after 2 weeks.

fundus photo of macula hole
fundus photo of macula hole
fundus photo of macula hole
fundus photo of macula hole
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31 yr old male operated with Vitrectomy
31 yr old male operated with Vitrectomy
  1. Background

     

    A 31 yr old male gentleman was seen at our hospital on 15.07.2019 by Dr.Bhagya. He was treated elsewhere for infective retinitis with topical and systemic medications but with no significant improvement. His left eye vision was progressively deteriorating and he presented with visual acuity of counting fingers close to face in left eye and in right eye was 6/18. Anterior segment examination showed fibrin membrane in pupillary area. Fundus examination showed dense vitritis in right eye and with no view in left eye. He was advised for some special blood investigation and was maintained on topical steroid management. Even with topical steroid management his visual acuity in left eye still deteriorated to hand movements close to face. He was advised for RIGHT EYE VITRECTOMY + ANTERIOR CHAMBER VITREOUS TAP FOR FUNGAL, HISTOPATHOLOGY AND KOH GREAM STAIN INVESTIFATIONS + INTRAVIT ANTIBIOTIC AND ANTIFUNGAL INJECTIONS UNDER LOCAL ANAESTHESIA.

    Surgical Management:

    After undergoing all preliminary investigations (physical fitness) he was posted for surgery on 26.07.2019 @ 02:30pm. The operating team consisted of Dr.Krishna R Murthy & Dr.Bhargavi Murali – Operating surgeons, Dr.Anusha – Assistant Doctor, Mr.Suresh - Surgery Assistant, Dr. Raghavendra – Anesthetist, and OT Assistants- Mr.Muthuraju & Mr.Anilkumar. The anterior chamber tap was sent to outsourced lab for the required investigations.The anterior chamber tap came positive for pan fungal genome and he was treated with multiple doses of antifungal intravitreal injections. He was also sent for systemic evaluation to rule out systemic vasculities.

    The surgery lasted for 1 hr 15 min. He was discharged on 27.07.2019 with an advice to follow all medications and to review after 1 week. He was on regular and close follow-up post surgery. His visual acuity started improving gradually and as on 25.09.2019; he is doing fine and his visual acuity in right left eye is 6/6.

    Uveitis is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. Iridocyclitis is an inflammation of the iris (the colored part of the eye) and of the ciliary body (muscles and tissue involved in focusing the eye.

    He and his family are dependent on the produce from the agricultural land. He owned around 1 acre of agricultural land on which he used to reap Jowar and millet. Since past 3 years he had been running around to eye hospitals for his eye problem. The expenses of the investigations forced him to sell some portion of his agricultural land. He was very much depressed due to uncertain treatment and management done till now and due to his deteriorating vision he was unable to earn and support the family. Relatives and friends pitched in with some financial support and they guided him to our hospital.

    He is very happy with the improvement in his vision and he is able to carry on his regular work activities. He thanked the entire team for the outcome.

     

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Vittala International Institute of Ophthalmology

Location: Bengaluru, Karnataka - India
Website:
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Project Leader:
Krishna Murthy
Medical Director
Bengaluru, Karnataka India
$921 raised of $74,000 goal
 
12 donations
$73,079 to go
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