Ahmed Shunt for Rubeotic Glaucoma under Donor Sclera.

Treatment of various eye diseases is usually divided into Medical vs Surgical treatment. Medical can be things like pills and drops but also include injections. Surgery usually refers to the operating room but also can be lasers, cryotherapy and gas bubble injections done in the office. Many times there is an underlying medical condition that make the eye disease worse such as diabetes and hypertension affecting the eye problem. Controlling these factors with the help of your primary physician improves the results of the eye surgery or medical treatment. Periodically we communicate with the patient’s primary physician and the referring physician to keep them up to date so that if the patient shows up at their office, they are better informed about the eye health and treatment that is being done. When all the physicians involved in the patient’s care communicate well, the patient wins.

Here is a partial list of the more common eye problems we treat:

Age Related Macular Degeneration (Dry and Wet) The dry form does not have a drug just yet but the vitamins have been shown to slow the progression of both forms of the disease. (See Blog of vitamins). The wet form is usually much more rapid in the vision loss and has several drugs that slow or stop the progression of the wet form. It also does not have a cure at this time and needs ongoing periodic injections to keep it controlled. (See Injection Blog).

Retinal Detachment This is usually a more urgent problem that needs rapid intervention but not always. Sudden vision loss of any kind should be examined to determine what shoould be done and how soon. This usually needs surgery of some kind to fix this (In office: Laser, cryo. In hospital surgery, See Surgery Blog). There are “blister like” retinal detachments that do not need surgery but may need injections or other medical interventions.

Tractional Retinal Detachments These are usually the result of scar tissue growing in the eye as the body tries to heal an injury like trauma or medical injury from uncontrolled diabetes causing damage. When these progress to threaten the central vision, then they can be operated.

Diabetic retinopathy (edema) High blood sugar and blood pressure can combine to cause damage to the blood vessels in the back of the eye causing swelling and blurred vision. Laser and injections of drugs can reduce the edema but ultimately tight control is the best way to stop the ongoing damage.

Vitreous hemorrhages (from all reasons) The cause of bleeding in the eye is the most important item to determine as that helps choose the better treatment for this. Some times is it laser or cryotherapy to stop retinal tears that can lead to larger retinal detachments. If Diabetes is thought to be the problem causing the bleed inside the eye, then laser (PRP), cryotherapy, injections of drugs and ultimately vitrectomy surgery may be needed.

Epiretinal membranes Scar tissue growing in the back of the eye for no particular reason can distort and blur the vision. There is no drug to help this and when this gets bad enough, then vitrectomy surgery with a membrane peel will be needed.

Posterior Vitreous Detachment Sudden onset of flashes of light with an increase in the number and severity of the floaters in the vision can indicate that the vitreous gel is shrinking as it ages and is pulling away from the back of the eye. Immediate exam is indicated to see if you are developing a retinal detachment and need a laser to stop it. Most of the time it does not need treatment but the important first step is to get a dilated eye exam right away.

Nevus/Uveal Melanoma Freckles or a slowly growing pigmented spot in the back of the eye needs routine serial exams to determine if it is becoming a tumor (melanoma) and treatment is needed.

Ocular Trauma This can be blunt or sharp trauma to the eye but needs examination quickly to determine the severity of the trauma, sometimes in the hospital emergency room. Any penetrating injury must immediately go the the local Emergency room. Blunt trauma can still cause blindness and should be evaluated sooner than later.

Ruptured Globes This is similar to the penetrating injury in that is needs immediate Hospital Emergency Room evaluation but unfortunately carries a much poorer prognosis. Surgery is most likely needed but the timing may vary due to the conditions encountered.

Dislocated Lenses The lens of the eye (either natural or implanted lens after cataract surgery) may dislocate into the front or back of the eye (out of normal position). This can be caused by rubbing the eye habitually, trauma, medical conditions like Marphans, or other issue. If the sight is good and the lens does not seem to be about to fall, then obseervation may be elected. If the lens is slowly falliing into the back of the eye, then more urgent surgery is needed to repair the process.

Endophthalmitis (Post surgery or injection infection) Infections inside the eye are an emergency to treat as soon as possible as the longer the infection lasts, the worse prognosis is. Sometimes the kind of infection can determine the prognosis due to the toxicity of the organism and not the treatment. Early diagnosis by getting cultures and injecting the first antibiotics is key to success in most cases.

Rubeotic Glaucoma (Ahmed/Baerveldt Shunts) The eye pressure inside the eye can suddenly rise rather high damaging the sensitive optic nerve in the back of the eye. The higher the pressure is and the longer it stays high, the more urgent it is to bring it down. The cause is can be diabetes out of control of a broken blood vessel in the back of the eye. Usually there are drops that are used followed by injections, Laser and Cryotherapy depending on the cause of the pressure problem. If all of this fails, then surgery using shunts (Ahmed or Baerveldt) combined with vitrectomy may be needed.

There are many other problems that we handle and if there is a question, please call and find out if we handle your particular case.

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