A macular hole is the presence of an opening in the macula, which is the central area of the retina. There are two main types of macular holes:
Idiopathic Macular Hole: also called senile, because it's directly related to the patient's age, it usually appears after the age of 55.
Myopic Macular Hole: occurs in patients with high myopia. It tends to appear at a younger age and can cause retinal detachment.
Myopia is a refractive defect or error in visual focusing. Images are focused in front of the retina and not on it, making long distance vision difficult. When the visual error exceeds six dioptres, it is referred to as high myopia. High myopia affects about 2% of the population and results in a greater predisposition to suffer from certain eye disorders.
These disorders include: Retinal detachment; Degeneration of the Central Retina caused by Atrophic Patches; Growth of Blood Vessels Beneath the Retina in the Macular Area; Myopic Macular Hole; Separation of the Layers of the Macular Retina (schisis).
These conditions can cause significant visual disability and directly affect the quality of life of patients, especially when they are of working age.
Age-Related Macular Degeneration (ADM):
AMD is a degenerative disease of the macula, the central area of the retina, which causes progressive deterioration of the cells and the retinal pigment epithelium. It causes a loss of central vision.
There are two types:
Dry AMD: Affecting 80% of patients, its progression is slow and gradual. The deposits that accumulate in the area cause atrophy of the macula, producing slow vision loss in the central area of the field of vision.
Wet AMD: Characterised by the growth of new blood vessels with very thin walls, resulting in the leakage of fluid and blood into the macula. Vision loss is rapid.
Retinal detachment is an eye disorder caused by the spontaneous detachment of the neurosensory retina (inner layer of the retina) from the pigment epithelium (outer layer). Through trauma on the head, or face, or due to changes in the composition of the vitreous gel, a rupture of the retina surface may occur, which will allow entry of the vitreous gel separating the retina layers, pigment and neural, progressively.
People with a high degree of myopia are more prone to retinal detachment, since they generally have larger eyes and more fragile and thinner retinas.
Retinal detachment is painless. It manifests itself through the occurrence of a dark shadow, or the slip of a "veil", which may arise from above, from below or from either side. In some cases, it may be preceded by light flashes, similar to lightning or sparks or floating images of varied and irregular shapes, called "floaters." The detachment is progressing until it's complete, which can happen suddenly or take several weeks. Loss of vision should be treated immediately, or it will become definitive. The treatment of retinal detachment is through surgery and the results obtained depend on the precocity with which it is performed and the post-surgical care.
Macular Epiretinal Membrane (MEM):
Macular Epiretinal Membrane (MEM) means tissue grows over the surface of the retina in the macular area that can contract and cause a loss of sight and image distortion.
Floaters – also called muscae volitantes (from the Latin, meaning ‘flying flies’) – are small deposits that many people see moving in their visual field, especially when looking at a plain background, such as a wall or the sky. They are small particles of gelatinous material that form in the vitreous humour, the clear liquid that fills the inside of the eye.
They are generally of minor importance, associated with the aging process.
On occasions, when the adhesion is very strong, the vitreous gel can cause bleeding or even a retinal tear when it detaches from the retinal surface. This can cause the appearance of new floaters. If the tear is not treated, it can lead to retinal detachment, a condition that requires urgent surgical treatment.
Retinal Vein Occlusions:
It is partial or full retinal vein occlusion. There are the following two types:
Central Vein Occlusion: the central vein of the retina is obstructed.
Branch Vein Occlusion: this consists of an obstruction caused by a blockage in the areas where the arteries and veins cross.
Diabetic retinopathy is the most common vascular disease of the retina. It is caused by damage to the retinal blood vessels due to diabetic metabolic decompensation. It can result in significant loss of vision.
Retinitis pigmentosa is the most common hereditary disease of the retina that affects about 1 in every 4,000 people and is characterised by the gradual degeneration of the retinal photoreceptor cells: the cone and rod cells.
Ocular tumours can appear on the eyelids, in the eye (conjunctiva, choroid or retina) and in the orbit (the cavity that houses the eyeball). Given their delicate location, early diagnosis and treatment is necessary. Time is of the essence to save vision, the eye and even the life of the patient in the most serious cases.
There are several types of benign and malignant tumours that affect the eye and its different structures. The main intraocular tumours include:
Melanoma: This can affect various tissues, although melanomas located in the choroid (choroidal melanomas) are the most common primary malignant intraocular tumour in adults.
Retinoblastoma: Most common malignant eye tumour in children. It is very aggressive and, therefore, early diagnosis and treatment are essential.
Choroidal Hemangioma: Benign tumour (no risk of metastasis) that, however, develops very quickly and aggressively, involving a risk to the eyesight because its growth threatens the optic nerve (transmitter of images from the retina to the brain) and the macula (central area of the retina that provides high-acuity vision).
Orbital tumors are rare, and their most common manifestation is the appearance of unilateral exophthalmos, with slow and progressive evolution (except for certain tumors that may be bilateral).
Uveitis is an inflammation of the uvea, the membrane that envelops the interior of the eyeball. The uvea is highly sensitive to infectious and inflammatory processes as its tissue contains the greatest number of blood vessels in the human body. Uveitis is one of the leading causes of blindness in the world. Infection of the uvea causes severe vision loss due to its contact with delicate eye structures such as the retina.
Scleral buckling is a surgery that involves fitting silicone elements over the sclera. These elements are sutured to the wall of the sclera, where retinal tears usually occur. It is also necessary to combine the fitting of Silicone Elements with Cryocoagulation or Laser Coagulation to repair the Retinal Tears.
Scleral Surgery Intraocular Tumour:
This treatment involves destroying the intraocular tumours from the ocular surface without invading the eyeball. In principle, the scleral surgery technique is used primarily in melanin-type tumours, such as Choroidal Melanomas and, in some cases, Vascular or Metastatic Tumours.
This technique consists of applying laser to the damaged areas of the retina to treat or prevent retinal problems. It is performed for many retinal disorders, including the repair of retinal tears to prevent detachment and the treatment of Retinal Vascular Diseases, Diabetic Retinopathy, Vein Blockage, Aneurysms, etc.
Intravitreal injections are used to locally administer medication to treat the secondary complications of diabetic retinopathy. The treatment is mainly indicated for Diabetic Macular Edema (accumulation of fluid in the macula), in which corticosteroids or anti-angiogenic drugs are administered intraocularly.
Intravitreal Injections with Anti-Angiogenics:
Intraocular injection of anti-angiogenic drugs is the preferred treatment for Wet Age-Related Macular Degeneration (AMD).
Photodynamic therapy is a treatment that involves the intravenous injection of a photosensitive drug, which is subsequently activated in the retina by applying a special light to the affected area. Currently, this therapy is not used as extensively as Anti-Angiogenic Injections for the treatment of Wet AMD. It is used in some specific subtypes of Wet AMD and more frequently to treat Central Serous Coriorretinopathy or some types of Vascular Tumours of the Choroid or Retina.
Vitrectomy is a surgery to remove the vitreous (the gel that fills the eyeball). The procedure is also performed when it is necessary to remove the vitreous to work directly on the retina, even when the vitreous is in good condition. The technique is indicated to treat vitreous diseases, and even if the vitreous is in good condition, it may be necessary to extract it, work directly on the retina, or other diseases that affect this tissue.
There are many ocular diseases that require vitrectomy: Diabetic Retinopaty; Retinal Detachment; Eye Injury or Trauma, Diseases of the Macula, Macular Holes or Neovascular Macular Degeneration; Secondary Problems or Eye Inflammation; Pathologies Related to High Myopia; Occasionally Complications after Cataract Surgery.