Complex Retinal Surgeries in Diabetic Retinopathy

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.

    

Retina – Neural portion of the eye

Background:

A 60 year old gentlemen who is one eyed was evaluated by Vitreo-Retinal surgeon in the month of May 2019 vide our hospital MRD #106294. He presented with complaints of diminution of vision with flashes and floaters in left eye since 3 months and has progressed since 10 days. He also gave a history of undergoing cataract surgery to both eyes 5 yrs back & subsequently gave a  loss of vision in right eye due to corneal opacity. His visual acuity in right eye was absence of perception of light and in left eye presence of perception of light and projection of rays. On Fundus examination surgeon was unable to view eye fundus in right eye and showed total retinal detachment with macula off in left eye which is the only Seeing Eye.

Retinal detachment is an important cause of decreased visual acuity and blindness. It is one of the most common ocular emergencies today, most frequently affecting the middle aged and elderly. The central portion of the retina is the macula. The macula has a high concentration of photoreceptors and is responsible for capturing central vision. The macula is the functional center of the retina. Any pathology affecting the retina will have symptoms like a sudden or gradual increase in either the number of floaters, which are little “cobwebs” or specks that float about in the field of vision, and/or light flashes in the eye & any pathology affecting the macula will affect the central vision.  Damage to the macula usually causes much more severe vision loss than damage to the rest of the retina, which provides side (peripheral) vision.

 He was advised to undergo LEFT EYE VITRECTOMY + MEMBRANE PEELING + FLUID GAS EXCHANGE + ENDOLASER + CRYO + SILICONE OIL INJECTION UNDER LOCAL ANAESTHESIA.

 Surgical Management:

After undergoing all preliminary investigations (physician fitness) he was posted for surgery on 24.05.2019 @ 3:00 PM. The operating team consists of Dr. Krishna R Murthy & Dr.Bhargavi Murali – Operating surgeons, Dr.Nayana – Assistant Doctor, Mr.Anil Kumar - Surgery Assistant, Dr.Raghavendra – Anaesthetist & OT assistant Mr.Muthuraj and Mr.Suresh.

The surgery lasted for 2 hrs. He was discharged on 24.05.2019 with an advice to follow all medications and to review after 1 week. As on 18.06.2019; he is doing well and his visual acuity in left eye is counting fingers at 2 mtr distance improving to 6/36p with pinhole. He has been suggested glasses and is advised to review after 1 month.