High Myopia/ Hyperopia/Astigmatism Surgery


The correction of these defects is often not achievable with the excimer laser due to either limitation of the system or because of the risk of damaging the cornea (excessive reduction of its thickness).


In these cases, very often the correction is still possible by means of implanting a “phakic lens”.


There are different types of these lenses: The selection of the one to be used for a specific case will be determined by the kind of defect and based on experience, the surgeon’s preference.



Ocular diabetes


It is a well known fact that at one or another stage of the disease, diabetes can severely affect the eye .The most frequent affectation being diabetic retinopathy.


Due to an increasingly impaired microcirculation different events take place in the retina leading to blindness if left untreated.


Usually the disease progresses without any warning signs therefore the patient does not realize a deterioration is taking place, especially in the early stages.


Although still a very serious problem, especially in the later stages, however there are a number of treatment options to at least stop or slow down the damage to the retina thereby preserving the level of the remaining sight or at least reducing the rate of decline.


Vitreous-Retina Surgery


With recent advances in surgical techniques together with the use of highly sophisticated machines, we can now treat conditions thought to be impossible only a few years ago.


The success rate in even highly complicated retina detachment cases has greatly increased.


These techniques also allow to deal with complicated diabetic pathology, again in cases not considered possible a few years ago.


As far as technology is concerned the refinement of vitrectomy machines as well as laser systems have become one of the main steps. Hopefully together with surgeon’s brain.


These changes have occurred, primarily due to technological improvements and refinements in the operating equipment, laser systems and medication now available.


Functional & Cosmetic Eyelid Surgery


There are a number of surgical procedures for the correction of eyelid conditions.


Basically these are repair, functional and cosmetic surgery.


Cosmetic blepharoplasty is normally used to eliminate redundant skin and fat in the upper eyelids or excessive fat in the lower ones to achieve a younger looking aspect as well as an improved function.


Age Related Macular Degeneration


The incidence of this condition is growing due to an increasingly ageing population.


Macular degeneration produces a severe deterioration of the central vision and the ability to read is often lost even during the early stages.


There are basically two types of macular degeneration: dry and wet. In the wet type, newly formed vessels grow under the retina. There, they usually loose either fluid, blood or both which accumulate in the retina and lead to its progressive destruction.


Until only eight years ago the only known treatment was laser coagulation of these vesels to obliterate them and stop the leakage.


Depending on the kind of laser used a certain degree of retina destruction occurred which had to be accepted. Moreover the results were often very disappointing.


About eight years ago a breakthrough in the treatment of this disorder by using anti- Vegf (vascular endothelial growth factor) agents has occurred.


These drugs are normally injected into the vitreous body by a small surgical procedure.


There, they interfere with new vessel formation and by being less destructive to the retina than the laser treatments that had been formerly used.


Cataract Surgery


When the biological lens of the eye turns hazy it is called a cataract. It may happen as a consequence of ageing, or other causes such as trauma or intraocular inflammation.


As a matter of fact the cristallin is a biological lens within the eye which accounts for approximately

30 % of the dioptric power of the eye.


In the beginning there is a progressive deterioration of vision which may be compensated for by modifying the spectacles prescription.


When the opacity increases, only cataract removal and implantation of an intraocular lens can solve the problem.


Nowadays cataract surgery is usually performed by a well established technique called phacoemulsification which uses ultrasound to emulsify the hard part of the cristallin in order to remove it by aspirating it off.


The softer parts of the biological lens will simply be aspirated by the same system without using ultrasound.


In special cases when ultrasound may be too harmful for the eye (especially the cornea), a small incision perfected by Dr Infantes may be used as the alternative least invasive procedure. It is the so called “manual small incision cataract surgery”.


Depending on the technique employed the incision size lies somewhere between 1.5 and 3.2mm. The lens is always implanted in a folded manner for implantation to allow it to pass through the small incision.


When reaching the required position in the eye, the lens will unfold to occupy the void left by the removal of the cristallin lens in the capsular bag.


The replacement intraocular lens has a built in prescription to suit the patients normal required optical correction and also one which will compensate for the dioptric power lost by the removal of the cristallin lens allowing the patient to remain spectacle-free most of the time.


Being a minimally invasive procedure there is literally no discomfort experienced by the patient.

Rehabilitation is usually very quick, the patient being allowed to do many things immediately after surgery.



Refractive surgery LASIK technique


This is the type of surgery which we perform to eliminate the refractive errors caused by myopia, astigmatism, and hyperopia.

In myopia the eye has an excessive dioptric power which focuses the image in front of the retina instead of on it, the patient perceiving a blurred image if no correction is applied.

In hyperopia the opposite applies. The eye has a deficient dioptric power and the image is formed behind the retina.

In the astigmatic eye the cornea has not a uniform shape. Both axis have a different dioptric power and the image is formed in different points either in front of or behind the retina.

The cornea contributes approximately to 70% of the overall refractive power of the eye. It is the cornea helping, together with the cristalin, to focus the images on the retina.

The dioptric power of the cornea is mainly determined by its curvature.

Basically the laser technique consists of modifying the anterior curvature of the cornea to change the dioptric power of the eye as to correct a pre-existing refractive error.

The LASIK technique ( LASer In situ Keratomyleusis) is the current refractive technique used for small to middle refractive errors.

From Greek: keratos means cornea and myleusis being “sculpting”. The modification of the curvature is brought about by applying Excimer laser on the corneal surface after having lifted a thin flap of its anterior layers , which after reapplying will attach without having to use sutures.

A simple drop of an anaesthetic agent is enough to perform this procedure without any discomfort for the patient. Actually the concentration of the anaesthetic agent reached in the outer layers of the cornea together with the short duration of the procedure makes it possible.



Glaucoma


Glaucoma is a progressive deterioration of the optic nerve function which manifests as narrowing of the visual field leading to complete blindness in the late stages of the disease.


Normally (although not the only one) the main factor involved is an intraocular pressure elevation which interferes with blood supply in the back of the eye affecting several structures like retina and optic nerve.


Typically, events in this disease take place very gradually making it difficult for the patient to realize their vision is changing. This usually means late diagnosis and decreased therapeutic success because of damage being so far advanced by the time the patient realizes something is wrong with his/her eyes. It is very important to realize that glaucomatous damage is truly irreversible. In view of these facts, early diagnosis (usually in the form of a routine examination) and correct treatment are obviously of the utmost importance in preserving the patients’ sight.


Treatment: The treatment is mainly directed to reduce intraocular pressure values to a safe level for a given patient.(This is very individual and every single case has to be dealt with in a specific manner). Nowadays we have basically 3 options to reduce intraocular pressure.

Laser: This is normally effective, very comfortable, painless and easy to apply. In our view it should be considered as the first option due to these facts. There are hardly side effects known. Very often it is considered as a second option when drops fail. In my opinion this is wrong because laser cannot possibly work if every single drug used has failed. There are different types of laser used for glaucoma treatment.

Drops: It is the most widely used way of treating glaucoma. There are many different drugs which lower the intraocular pressure by different mechanisms of action. The right selection is always an individual matter depending on many facts like efficiency, tolerance and lack of side effects.

Surgery: When every other treatment modality has failed, surgery becomes the only option. Again there is quite a selection of surgical techniques which can be applied. The best option depends on the given case and the surgeons’ criteria.


 

Special Procedures

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