Vitreoretinal Surgery – Dr Asif Khokhar https://engdrasif.trangolabs.com Senior Eye surgeon committed to professional excellence Tue, 19 Sep 2023 07:12:29 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.3 https://engdrasif.trangolabs.com/wp-content/uploads/2023/09/cropped-LOGO2-1-32x32.png Vitreoretinal Surgery – Dr Asif Khokhar https://engdrasif.trangolabs.com 32 32 230074243 Retinitis pigmentosa https://engdrasif.trangolabs.com/retinitis-pigmentosa-2/ https://engdrasif.trangolabs.com/retinitis-pigmentosa-2/#respond Thu, 23 Sep 2021 15:55:51 +0000 https://www.drasifkhokhar.com/?p=3225

In this disease peripheral retina gradually degerates and its functions are disturbed. The abnormal structure is apparent in the picture below

Very severly damaged retina

What are symptom? Very disabling problem is narrowing of the visual field as seen in the following picture

Even more severely damaged visual field

Can we say that this disease dose’nt have any treatment?

No, that doesn’t mean it at all. This disease results in many complications that are treatable. And most patients suffer from these complications, not the underlying disease. The most important thing is to prevent these complications from occurring and if any complications do occur, they should be treated immediately. This can save the patient a lot of trouble and prevent him from becoming completely blind.

Vitamin A and certain medications are sure to slow down the rate at which the membrane deteriorates.
In the same way, if the relationship between the two parents is taken care of when the genetic defect is not present in the marriage, then the chances of this disease appearing in the children are very low.
If cataract has developed, it should be treated properly and consistently.
If white cataract develops, it should be treated in time.

Patients should not take up a profession that involves too much work, otherwise one of the major disadvantages would be that they would continue to feel inferior and deprived, which could lead to mental illness.
Patients with this disease should avoid such places because there is a risk of accident because in addition to the general damage of the accident, there is also a greater risk because their eyelids are already weak; If their veil of vision is torn off, it will be impossible for them to recover.

Have I heard that any modern cure for this has been discovered? is that correct?

The encouraging fact is that more and more research is being done on the treatment of this disease.

A very important treatment is likely to emerge in the near future. This is a method of transplanting photoreceptors created in the laboratory with the help of stem cells. This method has shown very good results in the treatment of some diseases. This method is also being used to treat corneas in the eyes.

Heard the computer chip is installed in the eye from which the vision begins.

Experiments have been performed to insert a computer chip inside the eye that transmits signals to the brain. However, it has not yet been able to be applied to patients’ eyes.
An experiment has also been done to fit a special type of binoculars into a special type of spectacles, which reduces the patient’s disability.

If someone’s retina is damaged, can the retina be replaced?

Some people have also told me that in the United States, the eyelids change, which makes the vision visible.
As far as changing the curtain is concerned, this is not the case. So far no such attempt has been successful. Silence experiments are being performed, but so far no success has been achieved. However, there are very strong expectations in this regard.

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Optic Nerve https://engdrasif.trangolabs.com/optic-nerve-2/ https://engdrasif.trangolabs.com/optic-nerve-2/#respond Thu, 23 Sep 2021 15:55:23 +0000 https://www.drasifkhokhar.com/?p=3224

Where is optic nerve? what is its relation with vision?

This is a nerve which starts in the eye and ends in the brain. In the ey its starting point is called optic nerve. It transmits all visual information generated by retina to the brain. In the following picture relationship of eyees and brain is shown

Optic Nerve

Optic Nerve and brain

Optic Disc in the eye

What are symptoms of optic nerve disease?

Decraese in vision which is not imroved with glasses. Clour vision is affected early.

Is ther any treatment for optic nerve disease?

It depends upon the cause. First of all we try to find the cause then treat according to the cause.

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CSCR https://engdrasif.trangolabs.com/cscr-2/ https://engdrasif.trangolabs.com/cscr-2/#respond Thu, 23 Sep 2021 15:53:33 +0000 https://www.drasifkhokhar.com/?p=3222

CSCR is a disease in which the central area of the retina bulges inwards due to collection of fluid behid it as is seen in the piture

On the right side of the picture is OCT which clearly shows the fluid is present between the two layers of the retina.

FFA images show a leakge from where the fluid is coming

What is the treatment of this disease?

There is no definite treatment for this uptill now. A vast research is going on.

  • Very large number of patients ecove without any treatment although it takes many weeks.
  • If there is leaking spot at a location wher laser can be safely applied, then laser can be applied.
  • Different medicines are prescribed with variable results.
    • Anti-VEGF injections
    • Rifampicin, acetazolamde, and others
  • But mostly its treatment is controversial.
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Laser treatment of retina https://engdrasif.trangolabs.com/laser-treatment-of-retina/ https://engdrasif.trangolabs.com/laser-treatment-of-retina/#respond Thu, 23 Sep 2021 07:01:55 +0000 https://www.drasifkhokhar.com/?p=3211

My dad has had diabetes for a long time. A few days ago, his vision suddenly deteriorated. When the doctor examined him, the doctor told that a blood vessels had ruptured. He has prescribed medicines. How does the vessel ruptures? Can the problem be treated with laser or surgery?

With the help of laser rays, the hole can be sealed-off, which stops the leakage and resoles the swelling. The laser is also applied to prevent the detachment of the retina. However, it is important not to delay the treatment by laser. Since most people start treatment too late, so the benefit is minimal.

Retina appearance when damaged by diabetese

In this retina has been severely damaged by diabetese

I am treating retina by laser

Retinal before laser treatment and after treatment

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How can I know that my eye has retinal damage due to diabetese? https://engdrasif.trangolabs.com/how-can-i-know-that-my-eye-have-retinal-damage-diabetese/ https://engdrasif.trangolabs.com/how-can-i-know-that-my-eye-have-retinal-damage-diabetese/#respond Thu, 23 Sep 2021 06:41:27 +0000 https://www.drasifkhokhar.com/?p=3208

How to know about damage by diabetese?

The only method for prevention is regular check-up by some physcian. And whenever there is a doubt go to eye specialist. Best way is annual check-up.

When the defect has been started then different test become compusory. OCT, FFA, etc

My father is feeling that his eyesight is continuously deteriorating. He has diabetes and he doubts that his eyesight is getting worse due to diabetes. How diabatese damages eyes?

Worrisome aspect of diabetes is that the damage caused by it appears very late. And usually when it comes into knowledge, it is too late. The time for best treatment may already have passed!

  • If the diabetese is properly controlled and kept under constant control, it has very little effect on the eye. However, if it is not properly controlled, then the eyes can be affected in several ways as follows:
    1. In old age, because the retina and blood supply system becomes weak and diabetes also weakens them, the chances of getting worse at this age are also higher.
    2. Diabetes damages the lens of the eye which is actually transparent but becomes opaque. The common name for this disorder is cataract.
    3. Worst damage occurs in the retina. The walls of retinal blood vessels are damaged and they start to leak and break.
    4. Due to this, the blood components leak into various parts of the retina and cause swelling of different portions of the retina. This leads to decrease in retinal sensitivity to light and decrease in vision. At this stage, generally glasses do give any benefit.
    5. Many blood vessels are blocked and results into stoppage in blood supply for different portions of the retina. If the macular vessels are affected, then vision is severely decreased. If blood supply of other parts is only affected, then vision may not be decreased at this stage. They lead to formation of membranes, which contract. The vessels in these membranes frequently rupture and cause recurrent bleedings in the eye.
    6. Diabetes can damage the cornea.
    7. If the optic nerve is damaged, the eye may become completely blind.
    8. A very devastating complication is neovascular glaucoma. This is a preventable complication but when it gets established then very very difficult to treat!

Following pitures are showing swelling and leakage of blood

Following pitures are showing membranes on the retina

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How diabetes damages the retina? https://engdrasif.trangolabs.com/diabetese-and-eyes/ https://engdrasif.trangolabs.com/diabetese-and-eyes/#respond Tue, 07 Jan 2020 05:52:18 +0000 https://www.drasifkhokhar.com/?p=1649

?What is the effect of diabetes on retina

The visual system cannot function properly due to impaired retina.

  1. Many blood vessels are blocked due to diabetic damage, which leads to ischemia of many parts of the retina. This results into lack of oxygen supply which leads into formation of membranes on the retina and into the vitreous. These membranes that form on the retina reduce vision. The blood vessels in these membranes are very fragile, which repeatedly rupture and bleed, which clots on the retina or cloudifies the vitreous and causes reduction of vision.
  2. These membranes contract and cause detachment of retina; they may make breaks in the retina leading to detachment of retina. These consequences may lead to permanent loss of vision especially if not managed timely.

FFA Images: The images below show signs of leakage and inflammation caused by impaired blood vessels, as seen in the FFA test. In the areas that are black blood vessels have been blocked. This blockage results into elimination of blood supply to those parts. Those areas that are looking too white, are those areas in which blood vessels are leaking into the retina.

These blood vessels are abnormal. These have grown in attempt of compensation of the blocked blood supply. But these are can't compensate rather these are very slender and fragile and bleed easily. And also give rise to membranes.

In the images the retina has entered the final stages of the damage. Due to these membranes, the retina has been pulled from its place. The middle photo shows a thick layer of membranes. In the image at left side the entire retina has been affected and has been detached and lifted-up. In this way the ability of retina to feel the light is severely affected. And the retina becomes completely non-functional.

Does the operation of retina is successful? People are warning us. We are also afraid that the operation of the retina will not be benficial and the vision will be completely lost. It is heard all over that the retinal disease is incurable?

The problem of retinal impairments is very important in Pakistan. The main reason for this is that there are very few places for its treatment, and there are very few doctors trained to treat it. As a result, people develop a frustrated and careless attitude towards treatment of retinal disorders, so the disease goes on progressing far beyond. When the treatment is approached the disease is really incurable. In fact, the delay in initiating treatment makes the cure uncertain. However, even at that stage it is possible to at least reduce the amount of disability.

With the emergence of innovative methods of treatment, 90% of patients can now be treated successfully, but many of them have to undergo a second or third operation. It is extremely difficult to predict about the prognosis.

I am performig laser procedure for diabtic retinopathy

Retina looks like these after laser application

My dad has had diabetes for a long time. A few days ago, his vision suddenly deteriorated. When the doctor examined him, the doctor told that a blood vessels had ruptured. He has been prescribed medicines. How does the vessel ruptures? Can the problem be treated with laser or surgery?

With the help of laser application, the hole can be sealed-off, which stops the leakage and resoles the swelling. The laser is also applied to prevent the detachment of the retina. However, it is important not to delay the treatment by laser. Since most people start treatment too late, so the benefit is minimal.

Most of such patients do not benefit from laser treatment. Intravitreal injections are mostly dangerous and there is risk of development of tear in the retina due to these injection.

Most of these patients need vitrectomy operation.

In these images different hemorrhages within the eye are visible

Retinal membranes: at this stage only vitrectomy is beneficial.

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How is retinal defects are treated? https://engdrasif.trangolabs.com/how-is-retinal-defects-are-treated/ https://engdrasif.trangolabs.com/how-is-retinal-defects-are-treated/#respond Tue, 07 Jan 2020 05:50:57 +0000 https://www.drasifkhokhar.com/?p=1647

Does the operation of retina is successful? People are warning us. We are also afraid that the operation of the retina will not be beneficial and the vision will be completely lost. It is heard all over that the retinal disease is incurable?

The problem of retinal impairments is very important in Pakistan. The main reason for this is that there are very few places for its treatment, and there are very few doctors trained to treat it. As a result, people develop a frustrated and carefless attitude towards treatment of retinal disorders, so the disease goes on progressing to final stages of the disease. When the treatment is approached till that time the disease may has become incurable. In fact, the delay in initiating treatment makes the cure uncertain. However, there are some disorders that cannot be cured, although even in many of such cases it is possible to at least reduce the amount of disability.

With the emergence of innovative methods of treatment, about 90% of patients can now be treated successfully, but many of them have to undergo a second or third operation. It is extremely difficult to predict about the prognosis in those who have come late for treatment.

How is retinal disorder treated? Will retina become OK with intravitreal injections?

In fact, treatment can only be done if the cause of the illness is treatable. In many patients it is not possible to cure the cause of the disease. Many patients do not start treatment on time, they start very late so the condition becomes untreatable.

There are many different ways to treat the diseases of the retina. The key methods are mentioned below:

  1. Various types of medicines that are used orally or in the form of drops.
  2. Some medicines are given in the form of injections. These injections are given into the vitreous. The injected medicines reach internal layers. Some injections are given under the superficial membranes of the eye called conjunctiva and Tenon’s capsule.
  3. Laser are very important and useful method of retinal treatment.
  4. Some operations are performed:
    1. To weld the retinal holes.
    2. To clear the opaque vitreous.
    3. To inject silicon oil.
    4. To tie silicone bands around the eye and stitched to the eye, so that the retina may not detach again.
  5. The most important operation is vitrectomy operation. In this operation the membranes are peeled away, and blood is cleared, and laser is applied where necessary.

?Does retina heals with laser? Can retina be re-attached with laser

Laser is used to seal the hole. When the leakage stops, the swelling resolves. The laser is also applied to prevent the tearing of the retina. This prevents te detachment of retina.

Laser application can prevent the detachment but can’t reattach a detached retina!

I am performing laser procedure on the retina to seal a retinal break so that detachment can be prevented

Diabetic retina after application of laser

How is vitrectomy performed? Why this operation so much costly?

Vitrectomy operation is performed to for many puposes. Very important is to reattach the retina is by welding the holes or breaks with laser after removing the subretinal fluid. This is done by using highly sophisticated tools and machines.

This method of operation is one of the most precious discoveries of today. We should be thankful to Allah, and also to those researchers whose hard work has resulted in the blessing for human being. The technology is constantly evolving. This treatment is a great blessing. At one time, the operation-time used to be many hours, but now the same thing is sometimes done with better quality in less than one hour. No stitches are required; no anesthesia is needed, the retinal function is restored within a few days.

Major problem with this operation is that this is very costly. The reason is the heavy costs of machines, very costly disposable parts of the machines, due to heavy investments operation theater charges are very high, and last but not least that the maintenance of the machines is very much demanding and the models of the machines are frequently improving compelling to upgrade!

This is silicon band which we fix with the eye on outer surface. It presses the eye from outside so that the retina may not detach

You can see how a torn piece reathaches. inner view is also shown

You can see how instruments work during vitrectomy operation

It has been shown that clotted blood is being extracted by inserting various tools inside the eye.

Take a closer look at how tools are being used in a real operation:

In the first phase of operation, laser is being applied to the edges of the break in retina after cleaning the vitreous.

Laser is being applied during vitrectomy operation

I am performing vitrectomy operation by Alcone's Constellation Vectrectomy Machine, Zeiss Company's Lumera Model Operation Microscope, and BIOM. This modern method requires neither general anesthesia nor stitching.

I am performing vitrectomy operation by The Storz Company's Millinuim Vectrectomy Machine, Zeiss Company's Lumera Model Operation Microscope, and BIOM. This modern method requires neither general anesthesia nor stitching.

I am performing vitrectomy operation by Oertli Company's Feros microsurgical system machine, Zeiss Company's Lumera Model Operation Microscope, BIOM. This modern method requires neither general anesthesia nor stitching.

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What defect develops in the retina? https://engdrasif.trangolabs.com/what-defect-causes-retinal-detachment/ https://engdrasif.trangolabs.com/what-defect-causes-retinal-detachment/#respond Tue, 07 Jan 2020 05:47:02 +0000 https://www.drasifkhokhar.com/?p=1645

What is the problem with retina? Which is the defect?

  • There are two layers which make retina; which separate apart from each other. A fluid collects between the two layers. Mostly it develops due to a tera or hole in the inner layer of the retina.
  • Another problem is that when due diabetes of other diseases the blood vessels of retina become damaged, it results into three of following:
    • lack of blood supply which is called ischemia.
    • leakage from blood vessels which is called edema.
    • leakage of blood which is called retinal hemorrhage.
  • These all problems result into decreased sensitivity of retina and decreased vision.
  • The part of retina which is mostly affected by all these is the central part which is called macula.
    • The damage to macula results into difficulty in recognizing objects; especially near vision and and fine distant vision.
    • The objects may look distorted.
  • The lack of blood supply (ischemia) leads to formation of membranes on the retina. The membranes are abnormal growth and the blood vessels supplying to these membranes are very fragile. They bleed as a results of any minor insult. Pre-retinal hemorrhages, and vitreous hemorrhages are very common in patients who have such membranes.
  • The membranes extend to anterior chamber angle and thus very resistant glaucoma results.
  • Very dangerous complication of these membranes is that they cause traction on the retina which leads to retinal detachment.
  • Even they contract and tear some part of retina and a hole of break develops.
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