Vitreo Retina - SNC Chitrakoot

Introduction

The Vitreo-Retina Department of Sadguru Netra Chikitsalaya is a highly sought-after specialty catering to about 5000 patients per month.  We have accomplished Vitreoretinal surgeons and well trained dedicated para-medical staff. The department runs fellowship training in VR for postgraduates in Ophthalmology as well as for paramedical. The operation theatres are furnished with higher end Vitrectomy machines and suitable operation paraphernalia. On an average 300 retinal surgeries, both simple and complicated, are performed every month.

Team

Head of Department

  • Dr. Alok Sen

Consultants

  • Dr. Ashish Mitra
  • Dr. Sachin Shetty
  • Dr. Sonal Gupta
  • Dr. Pawan Malhotra

Senior Residents

  • Dr. Bipul Bhushan
  • Dr. Shrikant Prasad

Services

Investigations and Procedures

  • Fundus Photography
  • Fundus Fluorescein Angiography (FFA)
  • Optical Coherence Tomography (OCT)
  • B Scan & UBM
  • Indocyanine Green Angiography
  • Macular Pigment densitometer (MPD)
  • Fundus autofluorescence
  • Electrophysiology
  • Laser Treatment for Different Retinal Disorders
  • Intravitreal Injections and Intravitreal Implant procedures

Surgical Services

  • Micro incision Vitrectomy (23/25G)
  • Vitreous hemorrhage
  • Epi retinal Membrane
  • Vitreo-macular traction
  • Macular hole
  • Proliferative diabetic retinopathy with hemorrhage
  • Retinal detachment
  • Optic Disc Pit etc.

Statistics/Service Delivery

Courses Offered

The prevalence of vitreo-retinal disorder in our Indian population is increasing day by day, according to studies. AMD, DR, hypertensive retinopathy and retinal vein occlusion are the major retinal problems. The prevalence of vitreo-retinal disorders increase with age and reflects that retinal disorders are a major public health concern. Training the specialist ophthalmologists accordingly is the major maim of Sadguru Netra Chikitsalaya with our experienced faculty is Vitreo-Retina.

  • Long-term Fellowship in Retina – Vitreous
  • Short term Training Course on Medical retina

Team Biography

Dr. Alok Sen

Dr. Alok Sen is the Medical Superintendent and Head of Department, Vitreo Retina.

In year 1997, Dr. Sen did his MBBS from Nagpur University, Maharashtra, and later his MS from the same. He had been the Senior Resident in Bhopal Memorial Hospital and Research Centre. He did his Fellowship in Vitreo Retina at Sadguru Netra Chikitsalaya and joined the institute as the Consultant. He went for the observership to Moorefield’s Eye Hospital (UK).

Dr. Sen has vast experience of handling complex cases in general ophthalmology and especially in Vitreo-retinal cases. In various national and international conferences, he has had his presentations and is a seasoned surgeon for the cataract and retinal diseases.

Dr. Ashish Mitra

Dr. Ashish Mitra is the Senior Consultantin the department of Vitreo-Retina Services of Sadguru Netra Chikitsalaya.

He holds his MBBS from KMC , Manipal and MS from Shyam Shah Medical College, Awdhesh Pratap Singh University , Rewa. He has served as Resident Surgical Officer in Rewa Medical College Later, hejoined his Fellowship in Retina-Vitreo at Sadguru Netra Chikitsalaya and went ahead to work at Delhi before joining at Sadguru. Dr. Mitra has contributed keenly in the hospital.He has few publications in Peer – reviewed, Indexed Journals and is actively involved in research at Sadguru Netra Chikitsalaya.

Dr. Sachin Shetty

Dr. Sachin is Consultant in Vitreo Retina Department.

He did his M.B.B.S. & M.S. from Kasturba Medical College, Mangalore and served as Senior Resident there for 3 years. Following it, he underwent short term Laser & Retina Training at Aravind Eye Hospital, Coimbatore. He completed his fellowship in Vitreo-Retina from Sadguru Netra Chikitsalaya and did his Uvea observership from C.U. Shah Ophthalmic Post Graduate Training Center, SankaraNetralaya under Dr. JyotirmayBiswas.

With an interest in Uvea, he is keen to set new standards in care for his Uvea patients at Sadguru.

Dr. Sonal Gupta

Dr. Sonal is Consultant in Vitreo Retina Department in Sadguru Netra Chikitsalaya.

She did MBBS and MS from Nagpur, MUHS University. Following it she underwent short term SICS and Phaco fellowship from I Care Center, Noida. She has done her Fellowship in Vitreo-Retina and Uvea from Sadguru Netra Chikitsalaya.

FAQ: Diabetic Retinopathy

How does diabetes affect the retina?

Most persons suffering from diabetes develop changes in the retina over a period of time. This is caused by damage to the small blood vessels (or capillaries) in the retina.

What can I do to limit the diabetic damage to my retina? 

You should consult the doctor treating you for diabetes regularly and follow all instructions regarding diet and medication. It is a fact that only strict control of blood sugar will help minimize damage to the retina. Frequent examination of the retina after full dilation of the pupil can help detect retinopathy early, leading to better treatment outcomes. This retinal examination should be done periodically even if your vision is clear.

Can diabetes affect other parts of the eye?

Retinal changes are the major problem, but at times diabetes can also cause a rise in eye pressure (glaucoma), clouding of the lens (cataract), and weakness of the optic nerve or eye muscle. Cataracts often occur at a younger age in diabetic patients. Glaucoma can cause damage to the optic nerve. In fact diabetes is one of the several possible causes of glaucoma.

Damage to the small vessels of the optic nerve can affect vision, and weakness of the eye muscles may cause double vision. A diabetic is also more likely to develop sudden vision loss due to occlusion of the retinal vessels (branch or central retinal vein occlusion), bleeding in the vitreous cavity, detachment of the retina, or infections of the cornea and vitreous.

How does diabetic retinal disease (diabetic retinopathy) affect the vision?

Swelling (edema) in the central part of the retina (macular edema) can cause blurring of fine vision. Fragile new blood vessel sprouts may break and bleed into the interior of the eyeball, causing blurring of the entire field of vision. In the early stages of the disease the vision remains good therefore, the disease may escape notice. That is why it is essential to have regular retinal examinations if you know that you have diabetes.

How can this disease be treated?

Swelling of the central part of the retina may be controlled with limited laser treatments. Sometimes one laser session will suffice, though some patients require several sessions. Abnormal blood vessel sprouts require extensive laser treatment involving 2,000 to 3,000 laser spots, i.e., three or more laser sessions. More acute problems with severe bleeding or retinal detachment require surgery such as scleral buckling or vitrectomy or both.

FAQ: Retinal Detachment with Scleral Buckling

What is retinal detachment?

Normally the retina is firmly attached to the back of the eyeball. If it becomes detached, the eye loses vision. This is a rare disease occurring in about one person out of 10,000, each year. The immediate cause is usually a hole in the retina. It may be due to injury or surgery, but is usually due to weakness of the retina. This is sometimes called degeneration.

What is scleral buckling surgery?

The surgery may be done under general anaesthesia (you will be sound asleep) or local anaesthesia (you will be awake but an injection will prevent any pain). The retina is reattached by freezing (cryosurgery) and with the placement of a permanent silicon patch (buckle) on the wall of your eyeball. The external stitches will melt away and do not have to be removed. Usually the eye responds to one operation; occasionally, additional surgery may be required. The eyelashes are cut before surgery but they always grow back. You will probably spend one or two nights in the hospital after the operation. Normally, only the operated eye is bandaged but, sometimes, both eyes may be bandaged for a few days. Most patients can return to work in four to five weeks.

What may I do after surgery?

You must stay at home for at least three weeks, traveling should be avoided except to visit the doctor. After surgery you will be given written instructions regarding medication and precautions to be taken. You should carefully observe these instructions. You may be advised to lie on your side or stomach while sleeping or resting.

What are the chances of success?

In most cases (85%) the retina can be reattached with a single operation. Occasionally additional surgery is necessary; this brings the final cure rate up to approximately 95%. The final degree of clarity of vision will not be known for three months. If you had lost your reading vision before surgery, you should find considerable improvement but probably not 100%. If your reading vision was not lost before surgery, good vision will be retained (after convalescence) in more than 90% cases. In 5% cases the retina may not re-attach, necessitating further surgery.

What are the common side effects and complications of the surgery?

Your vision will be blurred. The eye will be painful, red and swollen and there may be some mucus discharge. The pupil will be large and you may see double. These side effects are usually temporary and last only a few weeks. In many cases the eye will become more near-sighted; this can be corrected with spectacles.

Over 90% cases have no significant complications. Occasional problems include bleeding or infection or re-detachment. Very rarely such complications could lead to the loss of all vision. Anesthesia-related complications are also rare; the anesthetist will discuss these with you.

What about the future of my retina?

If the retina remains attached for three months after surgery, the chance of recurrence is only 10%. If the retina of your other eye appears normal at this time, the chance of developing a detachment later on is approximately 12% in the eye that has not been operated.

Can retinal detachment be prevented?

In some cases the retina is more fragile and prone to formation of holes or breaks. If these are detected and sealed in the early stages by laser or cryosurgery, retinal detachment can be prevented. People who are likely to develop retinal detachment should have periodic examinations done after dilation of the pupils. Some of the situations where this is desirable are:

  • History of detachment in one eye
  • Family history of retinal detachment
  • History of injury to the eye or its surrounding bones
  • History of flashes and floaters
  • Sudden onset of floaters or change in the character of floaters

FAQ: Vitrectomy

What is Vitrectomy?

This is a very delicate operation performed with an operating microscope and special needle-sized instruments. The most common indication for this operation is removal of the vitreous, which has lost its transparency and, therefore, has become an obstacle to the incoming light. In this surgery most of the non-transparent vitreous is removed and replaced with a clear solution. Vitrectomy may also be used to remove the pulling forces of the vitreous, which may have led to detachment of the retina. This operation may also be used to remove blood clots, infectious material, cataract, foreign bodies, and abnormal membranes from the interior of the eyeball. Sometimes it is done for diagnostic purposes for diseases of unknown origin. Occasionally it may be necessary to inject air, gas, or silicone oil into the eye after removing the vitreous gel.

How is the operation performed?

The surgery may be done under general anesthesia (sound asleep) or under local anesthesia (you are awake but feel no pain). The operation takes two to four hours. Usually one operation is sufficient, occasionally additional surgery may be required. The eyelashes are cut but they always grow back. Most patients stay in hospital for one or two days; longer hospitalization may sometimes be necessary. A face-down position for sleeping may be suggested for several days. The operated eye will be bandaged for one day. Occasionally both eyes may need to be bandaged to ensure complete ocular rest.

What may I do after the operation?

For the first two weeks you should rest at home. Travelling should be avoided except to see the doctor. If gas has been injected into the eye, you should avoid air travel for several weeks until specifically authorized by the doctor. Postoperative instructions will be given to you at the time of discharge and these should be strictly followed. Most patients are able to return to their routine in four weeks.

What are the chances of success?

The vision improves to some degree in 90% of simple vitrectomy cases. In difficult cases however, improvement is seen in approximately 60% of the cases while in others it may remain the same or even decrease. The final degree of clarity of vision is usually not evident for about three months. How much vision a patient will ultimately have is difficult to predict in individual cases. Patients are usually able to see large objects but fine vision and reading vision may not improve.

FAQ: Cryo Treatment of The Retina

What is cryosurgery?

'Cryo' means extremely cold or freezing. This operation employs a delicate instrument that freezes small spots which are transformed into pinpoint scars that strengthen the retina. The temperature required for cryosurgery is approximately minus 70 degrees centigrade.

What are the do's and don'ts after cryosurgery?

Generally patients can return to their normal routine the following day. But they are advised to relax on the day of surgery. In cases where there has been a tearing of the retina, the surgeon may ask patients to limit their activities for at least ten days. The restrictions may include the following:

  • If an eye pad was used after the cryosurgery, it should be removed after one day of use.
  • Do not bend over so that your head is below your waist.
  • Do not lift anything that weighs more than five kilograms.
  • Avoid rubbing the affected eye.
  • Avoid strenuous activities: you may cook or wash dishes, but no housework that involves bending or lifting weights. 
  • You may watch television or read.
  • Alcoholic beverages should be avoided.
  • No sexual intercourse.
  • No automobile trips except to the doctor's office.

What is fundus angiography?

Fluorescein and indocyanine green angiography are tests that use special cameras to photograph the structures in the back of the eye. These tests are very useful for locating the damage to the blood vessels that nourish the retina (light sensitive tissue) and in turn, checking on the health of the retina itself. In both tests, a colored dye is injected into a vein in the arm of the patient. The dye travels through the circulatory system and reaches the vessels in the retina and those of a deeper tissue layer called the choroids. Neither of the tests uses any harmful forms of radiation.

Fluorescein is a yellow dye, which glows in visible light. Indocyanine is a green dye that fluoresces with invisible infrared light; it requires a special digital camera sensitive to these light rays This indocyanine green angiography helps your doctor make the correct diagnosis and plan the best course of treatment especially in diseases like age-related macular degeneration (AMD).

What are the side effects?

Both fluorescein angiography and indocyanine green angiography are considered very safe and serious side effects from these tests are uncommon. However, there is the possibility that a patient may have a reaction to the dyes. While fluorescein contains no iodine and is safe in patients known to be allergic, indocyanine green is currently formulated with iodine and should not be used in individuals with any known allergies. Some people may experience slight nausea after the dye injection, but the feeling usually passes quickly.

Patients who are allergic to the dye can develop itching and a skin rash. These symptoms generally respond quickly to oral medications such as anti-histamines or steroids. Very rarely, a sudden life-threatening allergic reaction called anaphylaxis can occur. This condition requires medical treatment.

There is also the possibility of an infiltrate of the dye into the skin at the injection site; this may cause some discomfort or discoloring of the skin for several days. The fluorescein dye will turn the patient's urine orange and may slightly discolor the skin as well for a brief period. Your physician can explain the individual risks of these procedures for certain patients, including pregnant women.