Glaucoma
Glaucoma and laser treatment
Glaucoma is a condition in which the optic nerve is damaged by factors such as increased intraocular pressure (or ocular pressure). Because the optic nerve is responsible for transmitting visual information to the brain, its damage (gradually) causes the visual field to fail, and if the disease is not treated and progresses, it can eventually lead to complete blindness.
In most cases, a complete clinical examination, including measurement of intraocular pressure, examination of the angle of the eye, examination of the optic nerve, and visual field testing, is sufficient to diagnose glaucoma; But in some special cases, other tests may be needed, such as imaging of the optic nerve and retina
In the course of glaucoma, the optic nerve is gradually damaged and the nerve cells in it gradually die. When glaucoma is diagnosed, there is (currently) no cure for the part of the optic nerve fiber that is lost. The main goal of glaucoma treatment is to prevent the disease from progressing and to maintain the remaining vision for the patient to lead a normal life.
Glaucoma treatment is done in a step-by-step manner. Drug therapy is started and if the laser does not succeed, the eye pressure is reduced, and in acute cases, if the laser treatment is not successful, the surgical method is used.
Correction of refractive errors
LASEK and PRK
LASEK and PRK are other common methods for treating refractive errors and astigmatism, myopia and hyperopia worldwide; The most important difference between this method and LASIK is the location of the excimer laser radiation on the cornea. In LASIK, the laser beam hits the new surface after peeling from the corneal surface and the operation is performed; Whereas in LASIK, the radiation hits the surface of the cornea of the eye without exfoliating the cornea and only after removing the epithelium, the “surface tissue of the cornea”. LASEK, on the other hand, is called the modified version of PRK, however, it has fewer fans than the PRK method.
In PRK or “photorefractive keratectomy” using excimer laser radiation, the patient’s myopia is reduced. Using this method, a very thin layer of the cornea of several tens of microns is removed and by applying changes in the curvature of the cornea, the refractive error of the eye is reduced.
This treatment is an outpatient procedure and is performed in a clinic. The patient’s eye is first anesthetized using topical drops, then the surgeon begins laser excimer treatment after removing the surface layer of the cornea (epithelium), and finally stops the operation after the cornea has regenerated.
Femtolysis
Femtolysis is an advanced alternative to conventional LASIK, and is in fact an advanced form of LASIK. In this procedure, like LASIK, a layer (flap) is removed from the cornea. Unlike conventional LASIK, which is exfoliated by a mechanical device called a microkeratome, in femtolysis, exfoliation is performed by a femtosecond laser. The femtosecond laser is able to make very precise and delicate incisions in the corneal tissue. Using this laser, incisions can be made in any shape and size and at any depth of the cornea. The flap created with the femto device is thinner and more accurate than the microkeratome, and the surface created in the cornea is smoother. In this operation, after the corneal flap is removed, the excimer laser does its job, which is to correct the refractive errors of the eye.
Intraocular lenses
Intraocular lenses are lenses that are permanently implanted with surgery inside the eyeball. These lenses are of two categories. One category is cataract implants and the other category is lenses that are inserted into the eye as an alternative to glasses, LASIK or PRK.
Intraocular lenses at the same time as cataract surgery
These lenses are used in the elderly or people who have cataracts for any reason and need cataract surgery, in combination with cataract surgery and instead of a natural lens inside the eye. Because during cataract surgery, the natural lens of the eye is removed and an artificial lens must be inserted instead.
Intraocular lenses to correct severe eye weakness
These lenses are used in younger people who have a high degree of refractive error (in the term of severe eye weakness). In the above numbers, LASIK or PRK is usually not a good choice and may lead to postoperative visual impairment. Therefore, in these numbers, a better and more suitable alternative is the placement of special lenses inside the eye, which creates a better vision quality for patients. These lenses have the same effect as contact lenses (Contact Lens) that are used by some people and are out of sight at night and during sleep. The advantage of intraocular lenses over contact lenses is that intraocular lenses are permanent and naturally do not have the problem of maintenance, cleaning, insertion and removal.
There are two types of lenses, called ICLs, which are placed behind the pupil and iris. Another example is that Artisan or Artiflex is placed in front of the pupil and is fixed to the iris by two clamps embedded in them. Each of these lenses has its advantages and disadvantages and can not be attributed to the absolute superiority of each. Therefore, the choice of lens type depends on the opinion of the treating physician and his experience.
These lenses are able to correct high degrees of myopia and astigmatism, but their use in cameras has limitations. The condition of these lenses is that the depth of the anterior chamber of the eye is at least 3 mm, which is evident in the photographs. To examine and prescribe these lenses, it is necessary to take different pictures of the eye. Although these lenses have no effect on the retina and their operation does not increase the chances of retinal detachment, but due to the fact that in people close to the retina is thin, a complete retinal examination is performed before surgery and if necessary retinal consultation Takes place
Like any surgery, these lenses can have side effects, but fortunately their side effects are rare and in most cases treatable. These include inflammation and bleeding inside the eye, intraocular infection, spontaneous or traumatic lens dislocation, cataracts, and corneal opacity. But it must be said that the benefits of these lenses outweigh the risk of their side effects, and their long-term results in high numbers are better than other applications.
Eye aberration
What is strabismus?
It is said that the eyes are not coaxial. This complication is one of the most common eye problems in children, affecting about 4% of children under 6 years old (girl or boy). In this disease, one or both eyes may deviate inward, outward, up or down, and more than one of these conditions may be seen in a child at the same time. Another name for this disease is “Luchi”.
Simultaneous eye function:
In natural vision, when two eyes focus on a single point, the brain combines the images formed in the two eyes into a single, three-dimensional image, which gives a deeper understanding of objects. When one eye is not in its natural axis, two different images are sent to the brain. In children, the brain learns to ignore the distorted eye image and see only the healthy eye image, yet even if there is diplopia at first, it quickly disappears and the child loses deep understanding of objects. Give.
Specific Luchi treatment in children is performed based on the following criteria:
Child age, general health and medical history
Tolerance of the child to accept specific treatments
The cause of strabismus
Type of strabismus and its severity
Note: Treatment should include one or more of the following:
– Use glasses or prism
– Eye drops
– Eye exercises
Apply the coating on one or both eyes intermittently (if lazy eye is present at the same time, this method helps to correct it.)
Surgery: If the doctor diagnoses and does not respond to other treatments, this method is one of the safest and most effective methods of treating strabismus.
* Treatment goals:
Align the eyes
Proper performance of binocular movements
Optimal development of vision and achievement of binocular vision
Cataract or cataract disease
Cataract
Cataract is a common eye disease and its operation is the most common eye operation. The disease occurs when the lens of the eye loses its clarity and changes from light to white or dark. In this case, turbidity prevents the creation of a clear image in the eye, and over time and with increasing turbidity, the patient loses his sight and needs surgery. In the figure, you can see the blurred and bleached lens in a patient with cataracts.
Symptoms include gradual blurred vision, pain, redness, and other discomfort. This disease can be easily diagnosed by eye examination by an ophthalmologist. In most cases, cataracts are not preventable, but protecting the eyes from trauma and injury, early diagnosis and treatment of internal diseases, proper nutrition, protection of environmental factors and premarital genetic counseling can play a preventive role in vulnerable families. Cataracts have many causes, but the most common cause is aging. Other causes include eye trauma, medications, internal diseases such as diabetes, metabolic and infectious diseases. Cataracts can also occur in children, usually due to congenital and inherited causes, but internal and general diseases can also cause cataracts in this age group.
Cataract treatment
Definitive treatment of cataract is surgery. By surgery, the opaque lens of the eye is removed and an artificial lens is inserted instead. The result of cataract treatment is very good and effective. In the past, large incisions were used to perform cataract surgery, but today, using a incision less than 3 mm, the operation can be performed and there are special lenses that are flexible and foldable. These lenses enter the eye from the same small incision made and then open in the eye and get their original shape. A device called a “fico” is used to remove the lens of the eye. This device crushes the lens by ultrasonic energy and removes the lens from the eye by suction, and then the foldable artificial lens is placed in the patient’s eye and in the place of the natural lens. With this type of surgery, vision recovery is rapid and the patient can return to work and activity in the first days after surgery.
Intraocular lenses
These lenses have undergone many changes in their evolution. Today, these lenses are flexible and although their diameter is about 6 mm, they enter the eye through 3 mm and smaller cuts. Lenses have also improved in quality, in the past these lenses only corrected long-distance vision, but recently a type of lens has been made that, like the natural human eye, can correct far and near vision at the same time.
There are different types of lenses. Ordinary single-focus lenses are the lenses that most people use. You will be able to see well with these lenses, but you will need glasses to see close objects such as book lines, cell phones, and writing and similar activities. Other types of lenses are suitable for people with astigmatism. These lenses are called Toric. Toric lenses are suitable for people who suffer from astigmatism in addition to cataracts. Toric lenses allow this group of people to see far and wide, but still, you will need glasses to study and get close. Obviously, people with astigmatism will wear glasses for both far and wide after surgery if they wear regular contact lenses. There is a third type of lens called Multifoca Lens (Multi-Focus, Two-View, Three-View) that aims to allow you to cover different distances such as near (study), medium (computer) and far (TV). See well). Of course, you can use these lenses if your eyes are not astigmatic (fortunately today there are lenses that simultaneously correct near and far vision and astigmatism, but these lenses are expensive and not suitable for everyone).
Retinal surgeries
What is vitrectomy?
There are several factors that threaten our eyesight and eye health; Ophthalmologists typically use a variety of methods to treat vision disorders; The goal is to cure the disease and increase the quality of a person’s vision. One of these methods is vitrectomy.
What is a vitrectomy?
It is a type of eye surgery that is used to treat some disorders of the retina and vitreous. The retina is the light-sensitive tissue at the back of the eyeball. The vitreous is a clear, jelly-like substance that fills the middle part of the eye. In vitrectomy, the vitreous is emptied and the ophthalmologist replaces it with a special solution.
People who have been diagnosed with the following symptoms by an ophthalmologist are candidates for vitrectomy:
Diabetic retinopathy, especially if there is bleeding and strain on the retina.
Some cases of retinal detachment
Infection of the inner parts of the eyeball
– Severe eye injury
Wrinkles of the macula (central area of the retina)
– Macular hole
– Following the occurrence of some disorders after cataract surgery
Vitrectomy often improves or stabilizes vision. Blood or debris from an infection or inflammation that may block or blur the image to focus on the retina is surgically removed.
Damaged tissue that may cause displacement, wrinkles, or rupture of the retina is removed with vitrectomy. If the retina is not in its original position, vision is reduced.
With this method, it is also possible to remove a foreign object that has fallen inside the eye after a blow. If these objects are not removed, vision will often be damaged.
Corneal surgeries
corneal transplantation
What is a cornea?
The cornea is the transparent part in front of the eyeball that separates the inside of the eye from the outside environment like glass. The cornea has two important functions: one is to direct light rays into the eye and focus them on the retina, and the second is to protect the structures inside the eyeball.
In order for light to enter the eye and reach the retina, it must first pass through the cornea. Therefore, the transparency of the cornea is very important in vision. Just as if we look at objects from behind a dirty glass, we see them blurred, if we look at objects from behind a opaque cornea, we see them blurred. In addition, distorted images can be seen from behind a corrugated or wooded glass if the surface of the cornea is uneven. Therefore, a healthy and clear cornea with a smooth surface and natural curvature is essential for natural vision. In many cases, corneal transplantation is performed to remove the opaque parts of the cornea and replace it with a transparent cornea.
As mentioned, one of the most important functions of the cornea is to protect the buildings inside the eyeball. In cases where a hole is created in the cornea due to infection or burn, there is a possibility of destruction and contamination of the tissues inside the eye. In this case, to protect the structures inside the eyeball, it is necessary to repair the hole quickly, and corneal transplantation is a suitable method for this purpose.
What is a corneal transplant?
Corneal transplantation is a surgery in which the damaged part of the patient’s cornea is removed and replaced with a new healthy cornea. Corneal transplantation is usually done for one of the following reasons:
Creating better vision in cases where corneal opacity has caused blurred vision.
Corneal repair to protect buildings inside the eyeball.
Treatment of eye pain in cases where there is severe pain due to disease or swelling of the cornea.
Eradicate the infection in cases where the corneal infection is not treated with medication.
In what diseases is corneal transplant performed?
The most common diseases that are treated with corneal transplantation are:
Corneal inflammation after cataract surgery
Keratoconus
Corneal opacity (often after recurrent herpes infection or microbial infections)
Chemical burns of the cornea
Inherited diseases that cause turbidity or inflammation of the cornea.
Corneal transplantation is usually performed under general anesthesia. Of course, if due to other diseases, such as heart or lung problems, there is no possibility of complete anesthesia, the person becomes drowsy with the help of medicine and the eye becomes locally numb. In this case, the patient does not feel any pain. During the operation, the surgeon uses a microscopic device to remove a circular piece from the middle of the patient’s cornea and instead inserts a round piece that fits the healthy cornea of the donor and sews it with many stitches. Zarif stares into the patient’s eyes. The surgery takes between one and two hours. Depending on the condition, cataracts or glaucoma can sometimes be done at the same time as a corneal transplant. After the operation, the eye is bandaged.
Corneal hump
Keratoconus
Corneal hump means conical cornea. The cornea is the transparent layer in front of the eyeball. If we compare the human eyeball to a car lamp, the cornea can be compared to a glass. Normally, the shape of the cornea is spherical and regular, and like a convex lens, it transmits light and creates a clear image on the retina. But in keratoconus, the shape of the cornea changes and instead of being spherical, it becomes conical and can be said to be in the shape of a “sugar head” or hump, and the symptoms become irregular and uneven. This problem does not create a clear image of the object in the eye and the person suffers from blurred vision.
What are the causes of keratoconus?
In most cases, the disease has no cause and begins to develop during adolescence and progresses over time. Thus, keratoconus, in contrast to cataracts, is a disease of adolescents. Rarely, hereditary and environmental factors may play a role. Of course, there is a chance of developing this disease in people who have severe eye allergies and rub their eyes regularly.
Is keratoconus a dangerous disease that leads to blindness?
No, fortunately in keratoconus only the cornea is affected and other sensitive layers of the eye such as the lens, retina and nerve of the eye are normal, and even if the disease progresses to its fullest, it never leads to blindness. brings.
What is the treatment for keratoconus?
Treatment of this disease depends on whether it is mild or severe, the patient’s age and vision. In very mild cases where the patient does not feel much problem and has relatively good vision, no special action is needed and the patient should be followed up. In cases where the patient has vision loss, glasses are prescribed for the patient and corrected with his glasses. In more advanced cases where the patient’s vision cannot be corrected with glasses, contact lenses can be used. These lenses are of the hard lens type and with the training given to the patient, he can put the lenses in or out of the eyes himself. Usually these lenses should be taken out of the eye at night and during sleep. Following the doctor’s recommendations and proper care of the lenses and eyes can prevent the complications of these lenses.
When is surgery needed?
Although surgery has good results, it is recommended only when the patient does not have good vision with glasses and is not able to use the lens. It is even recommended that if the patient has used the lens before, his lenses be re-examined and if necessary, newer lenses are prescribed for him. But if the patient is not able to use the lens for any reason and with glasses, a good view of If not, he will inevitably be a candidate for surgery.
What is done for keratoconus?
There are several treatments for this disease, the most common of which are intracorneal rings and corneal transplants. Cross-linking by UV is one of the new methods used in these patients.
Rings inside the cornea
Intracorneal rings are rings that are inserted into the corneal tissue to correct certain diseases and improve a person’s vision by changing the shape of the cornea. These rings are now mainly used to correct keratoconus. The diameter of these rings is between 5 and 7 mm and they exist in two pieces or a complete ring. Their thickness also varies (between 150 and 450 microns) and is selected based on the severity of the disease, their diameter and thickness. Special mechanical devices are used for their brokerage, and today more and more femtosecond laser devices are used. After creating one or two canals in the depth of the cornea, a piece or two pieces of the cornea are placed inside the canal and with the pressure applied on the corneal tissue, they cause the corneal surface to become more regular and vision to improve. To insert the complete ring, a round incision must be made inside the cornea in the form of an envelope.
The choice of the type of rings, their thickness and diameter depends on the condition of the corneal disease as well as the taste and experience of the treating physician. Currently, different types of these rims are used in Parsian Clinic using the advanced technology of femtosecond laser.
corneal transplantation
The most effective procedure for these patients with severe keratoconus is corneal transplantation. In the past, corneal transplantation was performed on the entire thickness of the cornea, but since the inner layer of the cornea, which plays a critical role in corneal transparency, is normal in these patients, today it is tried to perform the transplant “lamellar” or half-thick and only The anterior layer of the cornea is removed and transplanted, leaving the inner layer. This technique significantly reduces “corneal transplant rejection” because the remaining inner layer does not undergo rejection or so-called rejection. Of course, it is not possible to do this technique in all people and it can be done in 70 to 90% of people.
The result of the transplant operation is relatively good and its success is high. However, it should be noted that some people develop myopia and high astigmatism after surgery, which will require surgery again. Also, a small percentage of people may have a transplant rejection and need medical treatment, and may need a re-transplant if they do not respond. The possibility of a transplant is greater in the first months and years, and as time goes by the probability decreases. However, it should be noted that if the patient sees a doctor immediately after the “rejection of the transplant”, it is very likely that his cornea will return to normal with drug treatment. Therefore, transplant patients are advised to see a physician or eye emergency center immediately if they experience any blurred vision, redness, or eye discomfort.
Corneal transplantation does not mean the removal of glasses, and these patients may need glasses or vision correction after surgery.
Is there a way to prevent keratoconus or prevent its progression?
Cross-linking by UV (CXL)
As mentioned, UV radiation can be used to stop the progression of the disease today. Cross-linking by UV is a new method that we used for the first time in Parsian Clinic. In this method, by irradiating the surface of the cornea, radiation is created between the collagen of the cornea and increases the strength of the cornea. This method is currently used in people whose keratoconus is developing.