Retina and Vitreous

Ophthalmology is a medical specialty that shows the most advances in research field as well as finding new treatments for ocular diseases.
In particular, the treatment for vitreoretinal diseases, until recently considered untreatable, has shown considerable evolution. Some of the common vitreoretinal conditions we specialize in are:

1. Vitreoretinal Surgery: it is done utilizing modern equipment with new small gauge (25) illumination system. Surgery is done through self- adhesion incisions (postoperative suture is not needed) achieving fast recovery, less ocular inflammation and preservation of the conjunctive.

Treatment for AMD (Age- related macular degeneration) – it is the main cause of blindness in individuals over 50 years of age. The treatment as well as the prevention of the AMD has not yet reached satisfactory levels. However the ingestion of vitamin C, beta-carotene, vitamin and, Zinc and Copper have proved beneficial for some cases of AMD in the exsudative neovascular form. The use of Laser photocoagulation has been shown to reduce pronounced vision in patients affected by CNV (choroidal neovascularization) and of extrafoveal lesions or subfoveal lesions related to the AMD.

The Transpupillary Thermotherapy (TTT) is another kind of long pulse laser coagulation that makes possible the occlusion of neovascular tissue without injuring the retina; it is, however limited to one small sub-group of membranes.
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The Bevacizumab (Avastin®, the first anti-VEGF drug) approved by the FDA, has been used for the treatment of AMD. It is administered by intravitreous injections and has been used about one year with sufficiently satisfactory results.
Although all the currently available treatments have limited results, they cause significant impact in the quality of life of the patients.

2. Diabetic Retinopathy (DR) - Diabetic retinopathy is the set of retinal and vitreous alterations caused by diabetes. It is the second most frequent cause of irreversible blindness, topped only by ARMD (Age-related macular degeneration). It is the main cause of blindness in patients between 25 and 75 years of age. In most diabetic patients, blindness can be prevented if the retinopathy is detected early on and adequate treatment is carried through. Basically the treatment of the diabetic retinopathy is done through good clinical control, medicines, laser photocoagulation and vitrectomy surgery.

All diabetic patients must be submitted to ophthalmologic examination periodically. The rigorous control of blood sugar levels reduces the risk of developing DR in 76% of the cases. In patients who already have DR, controlling sugar levels reduces the progression of the retinopathy in 54% of the cases.

In recent years some medicines have proved useful for the treatment of DR. Among them, the most used are corticosteroids (triamcinolone) and in the angiogenic pathway (Avastin® - these have a beneficial therapeutic effect for treating macular edema as well for the vascular proliferation of the DR). Both are injected directly into the eye.

The Laser photocoagulation detains the vision loss in 90% of cases when initiated early. This treatment is indicated for Proliferative retinopathy or Non Proliferative retinopathy with significant macular edema.

When DR already is in an advanced stage, for example, when there is vitreous hemorrhage and/or retinal detachment, the recommended treatment is vitrectomy surgery. The operation results improvement of the vision acuity in 80% of the cases; in some patients it prevents the progression of retinopathy and when there is significant retinal thrombosis the prognosis is uncertain.

3- Retinal detachment (RD) - is the separation of the retina from the choroid in the back of the eye, usually resulting from a hole in the retina that allows the vitreous humor (fluid) to lick between the choroid and the retina. It can be rhegmatogenous RD that is, caused by liquid that comes of the vitreous space, causing the layers of retina to separate; or Trational, in which strands of vitreous or scar tissue create traction in the retina, pulling it loose.

Retinal ruptures can be treated before they cause Rhegmatogenous Retinal Detachment. The best treatment is done by laser, in intention to surround the rupture, closing it.

The treatment for Retinal Detachment is surgery, with the purpose of closing the ruptures, to positioning the sensorial retina and relieving eye pressure.
The Dr. Rogério Horta Eye Institute has a highly qualified staff trained to do better diagnosis and to treat the disease, using state-of-art equipment to fit each patients need.

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