RIK has a well equipped operation theatre for performing all types of eye surgeries. Phacoemulsification for cataract and vitrectomy for retinal diseases are the main types of surgeries undertaken in RIK. Stringent aseptic techniques and sterilization methods ensure that the infection rate is kept far below the accepted standard. Most surgeries are done as day care surgeries.

INTRAVITREAL INJECTIONS

The injection procedure starts with an anesthetic eye drop to numb the surface of the eye. This is often followed by a cotton-tipped applicator soaked in anesthetic and placed over the injection site on the sclera . The eye is then prepared with an antiseptic solution (usually containing iodine) to help sterilize the ocular surface and reduce the risk of infection. Once the numbing has taken effect, the eye is held open briefly and a small needle is entered at the injection site, through the sclera and into the vitreous cavity. The medicine is injected very gradually and carefully over a few seconds, and the needle is then withdrawn. The eye pressure is checked after a few minutes; sometimes it is necessary to drain a tiny amount of fluid from the front of the eye to normalize the pressure. At the conclusion of the procedure, there is sometimes mild redness at the injection site. There is occasional tenderness, but most patients do not report any pain. No eye patch or eye shield is necessary after this procedure, and activities are not restricted. Sometimes, an antibiotic eye drop is prescribed for several days to help prevent infection.

The intravitreal injection procedure is generally safe and effective. The specific details depend on the disease being treated and the drug being injected; these issues will be discussed with you in detail by your retina doctor.

MICROINCISION CATARACT SURGERY / PHACOEMULSIFICATION WITH POSTERIOR CHAMBER IOL IMPLANTATION

In phacoemulsification, ultrasound power is used to break the hard cataract into minute pieces, which are then sucked out through a small 1.5-2.8mm incision. A foldable lens (IOL) of the required power is then implanted. The soft construction allows the lens implant to be folded for insertion through a 1.5 to 2.8mm micro incision. Once in place, the lens unfolds to its regular size of 6 mm.

VITRECTOMY FOR MACULAR HOLE

The operation usually takes about 1 to 1.5 hours to perform. The procedure can be done under local or general anesthesia. The procedure requires that the vitreous jelly inside your eye be removed as well as the membranes which cause the hole. We usually stain the membrane with a dye so it can be seen well and completely removed . The eye is then filled completely with a gas bubble which lasts about two weeks, and resorbs spontaneously. You may get up to eat or go to the bathroom, otherwise you must remain face down. If you do not position face down, the hole will close but a dense cataract will form immediately and usually will have to be removed within a month to restore vision.


You are not permitted to fly or ascend in altitude more than 2000 feet by car for about two weeks after the operation. If you do not follow these instruction the eye pressure during ascent may rise and choke off the circulation to the optic nerve resulting in severe permanent visual loss. Your doctor will tell you when it is safe to remove these restrictions. If you have to have general anesthesia within a few weeks of the eye surgery for some reason, you must let the doctors know, especially the anesthesiologist, that your eye contains a gas bubble.


RETINAL DETACHMENT SURGERY

Scleral buckling procedure
Scleral buckling is a surgical sewing of silicon band or tire on the outside of the eyeball. The band pushes the wall of the eye inwards or indents and deliberately kinks the retina against the retinal hole thereby closing the hole and allowing the retina to reattach. The band does not usually have to removed. This technique achieves reattachment in over 90 to 95% of the cases. It is usually combined with cryotherapy.

Scleral buckling procedure is a time tested and proven technique and is universally accepted. However, the most common side effect of the scleral operation is myopic shift. That is the operated eye will be short sighted after the operation due to change in the contour of the eyeball. In some cases the patient has to undergo re surgery due to persistent vitreous traction that was not relieved by the scleral buckle

Vitrectomy

It utilizes intra ocular micro surgical instruments of small caliber. i.e. as thin as 23, 25 or 27 gauge cutter to enter the eye and to cut and remove the vitreous gel, traction and also clearing membranous growth on the retina. Once the vitreous gel is removed by micro surgery, it is usually filled with gas bubble of silicon oil to push the retina against the back wall of the eye. The silicone oil is a sterile colourless viscous liquid injected into the eye and mechanically holds the retina in place until it reattaches. The oil is not intended to remain in the eye permanently and the oil is usually removed from the eye around 3-6 months, if the retina remains attached.

VITRECTOMY FOR PROLIFERATIVE DIABETIC RETINOPATHY

WHY IT IS DONE

Vitrectomy may be done to:

  • Repair or prevent traction retinal detachment, especially when it threatens to affect the central part of the eye( macula).
  • Reduce vision loss caused by bleeding in the vitreous gel (vitreous hemorrhage) when bleeding is severe or when the blood does not clear on its own after several months.
  • To treat severe proliferative retinopathy that causes severe scar tissue formation or when growth of new blood vessels on the retina (neovascularization) continues despite repeated laser treatment.

HOW WELL IT WORKS

  • Vitrectomy has been shown to greatly improve visual acuity in many people who have severe vitreous hemorrhage that has not cleared on its own.
  • In general, surgery can restore some vision that is lost as a result of traction retinal detachment and may help prevent further detachment. But the results tend to be better when the detachment has not affected the center of the retina (macula) and the central vision it provides.

VITRECTOMY FOR EPIRETINAL MEMBRANE

WHAT CAUSES AN EPIRETINAL MEMBRANE?

Most epiretinal membranes happen because the vitreous (the jelly inside the eye) pulls away from the retina. This most commonly happens to people over the age of 50. The membrane may also form following eye surgery or inflammation inside the eye.

TREATMENT OF EPIRETINAL MEMBRANES

The only way to treat an epiretinal membrane is by having an operation called a vitrectomy. Eye drops or glasses are not effective. During the vitrectomy, the surgeon makes tiny cuts in your eye and removes the vitreous from inside. They then grasp and gently peel away the epiretinal membrane from the retina.

COLLAGEN CROSS LINKING (C 3 R/ CXL):

Crosslinking with riboflavin and UV-A is the first-line treatment for people with eye conditions such as keratoconus, pellucid marginal degeneration and corneal weakness (ectasia) afterLASIK.

The aim of this treatment is to arrest progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation.

The cross-linking involves a one-time application of riboflavin (Vit B2) solution to the eye that is activated by illumination with UV-A (Ulatraviolet light A) light for approximately 30 or less minutes. The riboflavin causes new bonds to form across adjacent collagen strands in the stromal layer of the cornea, which recovers and preserves some of the cornea's mechanical strength. The corneal epithelial layer is generally removed to increase penetration of the riboflavin into the stroma.