Retina | Vitreous Services

The Vitreoretina service at The Himalayan Eye Institute is a major referral center that deals with the management of diabetic retinopathy, retinal vein occlusion, age-related macular degeneration, retinal detachment, infections, trauma & various other retinal disorders. Our diagnostics are equipped with the most advanced machines, such as Optical Coherence Tomography (3D OCT-1 Maestro, Topcon, Japan), and Fluorescein Angiography (Carl Zeiss, Germany) for accurate diagnosis of retinal disorders. Purepoint Laser (Alcon, USA) is available for laser photocoagulation of the retina in disorders such as proliferative diabetic retinopathy, retinopathy of prematurity, central serous chorioretinopathy, retinal vein occlusion, and peripheral retinal hole/tear. Our OT is equipped with the Constellation® Vision system (Alcon, USA), which is the most advanced machine for vitreoretinal surgeries.

Retina Services

Retina Services FAQ's

The retina is the sensory membrane which lines the inner surface of the back of the eyeball. It converts light into electrical signals which are then transmitted to the brain through optic nerve, which helps us to "see". A healthy retina is necessary for good vision.

The common diseases affecting the retina are:

  • Retinal vascular diseases e.g. Diabetic retinopathy, Hypertensive Retinopathy, Venous occlusions, Arterial occlusions.
  • Macular disorders e.g. ARMD, CSCR, CNVM, macular dystrophies, macular hole
  • Retinal detachment
  • Vitreous Haemorrhage
  • Retained intraocular foreign body after trauma
  • Anterior segment complications e.g. Subluxated lens, Dropped Nucleus, Dropped IOL, Endophthalmitis etc.

It is recommended for anyone above the age of 40 years to get their full eye checkup, including retina examination, once in a year. Apart from this, individuals who have the following risk factors are at a higher risk of retinal disorders:

  • Diabetes mellitus
  • Hypertension
  • High myopia
  • Family history of retinal disorders

Retina checkup is mandatory for such individuals.

A retina examination takes a little more time than a routine eye exam. It involves dilation of your pupils, examination by the retina specialist and diagnostic testing if required. It may take about 2-3 hours for the complete examination. Dilation enlarges your pupils to allow the doctor a better view inside your eye. It is important to know that your vision will be blurred and you will be sensitive to light (photophobic) for several hours following this. Therefore, we recommend that you bring sunglasses and not drive after your appointment. It is better to have an attendant with you for this test.

If required, the patient’s eye is then examined using advanced diagnostic technologies such as OCT, angiography, and fundus photography. A photographic documentation of the retina helps to make an accurate diagnosis and keep a track of the improvement in the eye.

Retinal laser or photocoagulation is a process by which laser is applied through a binocular indirect ophthalmoscope or slit lamp laser delivery system for treatment of leaking blood vessels (diabetic retinopathy/retinal venous occlusion) or peripheral retinal holes and lattice degenerations.

Intravitreal injection involves using a very fine injection to deliver a medicine directly into the vitreous cavity of the eyeball. They can be of the following types:

a) Anti-VEGF injections: These injections are given in patients of diabetic retinopathy, retinal venous occlusion, wet age related macular degeneration, CNVM and retinopathy of prematurity. These drugs allow rapid resolution of fluid inside the retina, as well as prevent growth of new leaky blood vessels, hence preventing bleeding inside the eye. Following anti-VEGF injections are available at the Himalayan Eye Institute:

  • i) Accentrix (RANIBIZUMAB, Novartis)
  • ii) Razumab/ Ranieyes/Oceva (Indian Biosimilar Ranibizumab)
  • iii) Eylea (AFLIBERCEPT, Bayer)
  • iv) Pagenax (BROLUCIZUMAB, Novartis)
  • v) Avastin (BEVACIZUMAB, Roche) - (off-label drug)

*anti-VEGF injections are not suitable for any patient who has a history of a heart attack or stroke in the last 3 months, or in pregnant women.

b) Steroid injections: In certain patients (diabetic retinopathy/retinal venous occlusion) for whom anti-VEGF injections are not suitable, or are not giving adequate results, intravitreal steroid may be used, if suggested by your doctor. The following injections are available:

  • i) Ozurdex implant (Dexamethasone implant, Allergan) - implant slowly releasing medicine upto 3-4 months
  • ii) Triamcinolone

*Intravitreal steroid may cause increase in intra-ocular pressure and cataract formation, and requires regular monitoring for the same.

c) Antibiotic Injections - In endophthalmitis cases, intravitreal antibiotic injections are required.

*It is pertinent to note that intra-vitreal injections may need to be repeated multiple times for adequate treatment, depending on the stage of the disease. They help to stabilise the disease progression, and may provide limited visual gain.

Intravitreal injection is a very fine injection given inside the OT. The eye is anesthetized using eyedrops, making the injection painless. It is a day care procedure, and the patient is discharged soon after.

Vitrectomy is a surgery done to repair or prevent retinal detachment, especially when it threatens to affect the macula. Vitrectomy is also carried out to clear bleeding inside the eye i.e, vitreous haemorrhage which can occur  in cases of  diabetics, trauma or venous occlusions. Advanced macular surgeries for macular hole, epiretinal membrane, vitreo-macular traction, are also available. We have the most advanced vitrectomy machine and the expertise to deal with complex retinal problems.

In fundus angiography, a small amount of yellow fluorescein dye is injected which travels to the eye, where it highlights the blood vessels. It is particularly useful in showing leaking blood vessels and highlighting where the blood supply in the eye is poor. After this, photographs of the eye are taken.

Retina Services

Common Disorder of The Retina

Diabetic Retinopathy

What is diabetic retinopathy?

Diabetic retinopathy (DR) is a common vascular retinal disease affecting about 40% of type 1 diabetics and 20% of type 2 diabetics. Duration and control of diabetes is the most important risk factor for DR.

All people with diabetes - both type 1 and type 2 - are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.

Diabetic retinopathy is symptomless in the early stages. By the time symptoms appear it becomes too late to stop the process of deterioration.

Nonproliferative diabetic retinopathy is characterized by leakage of small blood vessels in the retina, which causes reduced vision. Proliferative retinopathy is characterized by the growth of new blood vessels on the surface of the retina, which may lead to vitreous hemorrhage and retina detachment.

  • Cataract often occurs at a younger age in diabetics.
  • Decrease in vision due to ClinicallySignificant Macular Edema, which affects fine vision.
  • PDR (proliferative diabetic retinopathy) may cause sudden bleeding inside the eye
  • Neo vascular Glaucoma can cause damage to the optic nerve and very difficult to treat and control.
  • At times, diabetes can also cause optic nerve or eye muscle weakness.
  • A diabetic patient is also more likely to develop sudden vision loss due to occlusion of the retinal vessels (branch or central retinal vein occlusion), vitreous hemorrhage, retinal detachment, or infections of the cornea and vitreous.

Diabetic retinopathy is detected during a comprehensive eye exam that includes:

  • Visual acuity test: This eye chart test measures how well you see at various distances.
  • Dilated eye examination: Drops are given to dilate the pupils and then retina is examined (Fundoscopy).
  • To confirm the diagnosis, to know the extent of damage, to plan the treatment schedule, and to record various changes for future reference,the doctor may suggest a PCT and/or FFA.

  • The indications for treatment depend on the extent of severity of the disease.
  • The various treatment options include Intravitreal anti-VEGF injections, Steroids, Laser Photocoagulation and Surgery.

Retinal Detachment

What is a retinal detachment?

A retinal detachment is a separation of the neurosensory layer from the Retinal Pigment Epithelium. In other words, the retina is displaced from its normal position, causing sudden vision loss. Most retinal detachments are a result of a retinal break, either a hole or a tear.

  • Sudden vision loss
  • Flashing of lights and floaters
  • Shadow or curtain-like sensation that affects any part of the vision

  • Younger adults (25 to 50 years of age) who have a high minus number (myopic)
  • Associated with peripheral retinal degenerations
  • Family history of retinal detachment
  • Other eyes affected by retinal detachment
  • Following complicated cataract surgery.
  • Blunt trauma, as from a tennis ball or fist.
  • Penetrating injury by a sharp object.
  • Diabetes can lead to retinal detachment caused by pulling on the retina (traction) alone, without a tear.

Retinal detachment can be prevented by doing a prophylactic barrage laser. Barrage laser is indicated in the following conditions.

  • One-eyed, Myopic, Aphakic
  • History of detachment in the fellow eye
  • Symptomatic peripheral retinal degenerations

A tear or hole of the retina that leads to a peripheral retinal detachment causes the loss of side (peripheral) vision. Almost all of these patients will progress to a full retinal detachment and loss of all vision if the problem is not repaired. Early diagnosis and repair are urgent since visual improvement is much greater when the retina is repaired before the macula or central area is detached.

Age-Related Macular Degeneration

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is an age-relateddisease that affects the macula (central part of the retina)by accumulating metabolic by-products and thus blurs the sharp, central vision for activities such as reading, sewing, and driving.

  • The greatest risk factor is old age.
  • Smoking - Smoking may increase the risk of AMD
  • Obesity - Research studies suggest a link between obesity and the progression of early and intermediate-stage AMD to advanced AMD
  • Family history - Those with immediate family members who have AMD are at a higher risk of developing the disease.
  • History of AMD in other eye
  • Gender - Women appear to be at greater risk than men.

  • For the "dry" stage of AMD, only anti-oxidant supplements are given, and the patient is kept on regular checkups
  • For "wet" stage, anti-VEGF injections are required.
Retina Services


What is Retinopathy of prematurity?

Retinopathy of prematurity ( ROP ) is a disease affecting the retina of babies born premature i.e, born early, < 34 weeks of gestation or who weigh less than 2 kilograms at birth.

  • Gestational age < 34 weeks ( preterm delivery )
  • Birth weight < 2 kg
  • Anaemia
  • Respiratory distress / breathing difficulty
  • Blood transfusion
  • Excessive oxygen or prolonged ventilation
  • Infection
  • Failure to gain weight

  • Early diagnosis plays a crucial role in preventing vision problems in babies at risk of developing ROP.
  • ROP is diagnosed after clinical examination of the eye after putting drops to dilate the pupil
  • Babies who are at risk can be screened for ROP while still in the hospital or within 30 days of birth.

  • Usually no treatment is required in early stages as it may regress on its own. However frequent follow ups are necessary with the treating surgeon
  • Advanced stages need treatment which may be in the form of Injections (AntiVEGF) into the eye, Laser photocoagulation to the areas of avascular retina or Surgery in presence of retinal detachment.

Retina Services Doctors

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