Ophthalmology

When treating diseases in the neurosurgical and neurological sphere, the ophthalmology is a specialty without which the best results can not be obtained. Below you can find part of the diagnoses and therapeutic procedures we have approached:

Cataract

Cataract is the opacification of the lens. The crystalline lens is a structure inside the eye that allows seeing through its natural transparency. When it loses its transparency it doesn’t allow anymore the clear view of things, similarly to a dirty window put in front of the eyes.

Cataract is the opacification of the lens. The crystalline lens is a structure inside the eye that allows seeing through its natural transparency. When it loses its transparency it doesn’t allow anymore the clear view of things, similarly to a dirty window put in front of the eyes.

Cataract is, nowadays, the first cause of blindness and impaired vision worldwide, according to the WHO (World Health Organization).

On large population groups the cataract incidence is about one in 6 persons after the age of 40.

The main type of cataract is age-related, which occurs more frequently in people over 50.

Signs and symptoms of cataracts can vary widely from person to person, but the most common are:

– near and far visual impairment

– glare and decreased color contrast

– myopic shift

– monocular diplopia

Once these symptoms occur, they will always progress, at a variable rate (faster or slower, depending on the type of cataract).

The transformation of the lens with age is the main cause of cataract formation.

As the lens ages, it grows thicker and becomes stiffer. New layers of cortical fiber are added to the nucleus that is becoming denser and harder. Nuclear sclerosis is accompanied by increased pigmentation. Changes in the crystalline proteins lead to the formation of opacification.

Although the pathophysiology of age-related cataracts is not fully understood, the above mentioned changes are well known to be involved in this pathology.

Other less common causes for cataracts are: eye trauma (in traumatic cataracts), various medications, chronic systemic diseases, congenital syndromes, intraocular inflammation.

The main modifiable risk factors are smoking and excessive consumption of alcohol.

A poor nutritional intake seems to be, according to several recent studies, responsible for a higher prevalence of cataracts

The diagnosis of cataract is made mainly clinically with the aid of the slit lamp. This ophthalmological instrument allows a good visualization of eye structures and the correlation of symptoms with the observed structural changes of the lens.

Any decrease in vision should be checked by an ophthalmologist.

Cataract surgery, like any other type of surgery, has risks.

Today, however, the advanced technology used has reduced and minimized them.

The most feared risk is the ocular infection (endophthalmitis) that can lead in the worst cases to the loss of the eye. Fortunately this is an extremely small risk (about 0.1-0.2%) and in our clinic all necessary measures are taken to reduce it.

Simple rules, which seem insignificant, are applied to any eye surgery in our clinic:

The use of intracamerular antibiotics

Sanitizing the operating room for each patient

Laminar flow in the operating room

The use of sterile surgical fields and gloves for each patient

Impeccable preparation of the surgeon : Nail polish, jewelry and other accessories are forbidden in the operating room, and rigorous aseptic technique is used, as recommended by international protocols

The use of sets of sterile surgical instruments dedicated to each patient according to the particularity of the case

Changing the entire surgical set-up between patients

The use of disposable phakoemulsification kits

Our patient will be treated according to the latest standards and consistent with what we now call evidence-based medicine, medicine that is applicable anywhere in the world.

We do not do as “we have seen it works for us” but as “it has been proven to work”.

That’s why removing a perfectly transparent lens (though generally, a much simpler surgical technique) just to get rid of eyeglasses is not recommended by us because of the higher risk taken by the patient comparing to other treatments used today ( ex: laser refractive surgery).

Recurrent corneal erosions

Recurrent corneal erosions are recurrent spontaneous attacks involving the corneal epithelium (the most superficial part of the cornea). The epithelium loses his normal adherence causing periodical abrasions.

Recurrent corneal erosions are recurrent spontaneous attacks involving the corneal epithelium (the most superficial part of the cornea). The epithelium loses his normal adherence causing periodical abrasions.

The most important symptom is severe ocular pain. The corneal surface is innervated by the same nerve that causes dental pain and so the pain is often comparable. Most oftenthe pain occurs upon awakening or even awakens the patient from sleep.

Other symptoms are:

– decreased vision

– lacrimation

– photophobia

– conjunctival hyperemia

Anterior corneal dystrophy: most commonly the basal membrane dystrophy of the epithelium

recurrent corneal traumatic abrasions

– corneal stromal dystrophies

– corneal surgery involving the removal of the epithelium

The diagnosis is made by the ophthalmologist following a slit lamp examination, correlated with the patient’s symptomatology

Is mainly a medical one (drops)

If this is insufficient, small minimally invasive procedures can be performed directly in the consultation room.

Unresponsive and complicated cases can benefit from laser treatment (PTK – phototherapy therapeutic keratectomy)

Pterygium

Is an elastotic degeneration of the conjunctiva, which grows abnormally on the surface of the cornea, having a triangular shape. This leads to corneal deformity and ocular symptoms.

Is an elastotic degeneration of the conjunctiva, which grows abnormally on the surface of the cornea, having a triangular shape. This leads to corneal deformity and ocular symptoms.

Initially, the patient is bothered just by the signs of ocular irritation: redness, pain, tearing

If the pterygium becomes large enough, a decrease in vison occurs most often because of a newly installed astigmatism (corneal deformity) or even by the advancement of the pterygium towards the visual axis.

Prolonged exposure of the eyes to irritant agents may lead to structural changes in the conjunctiva (most commonly of the nasal conjunctiva) over time with the appearance of abnormally fibro-vascular subepithelial tissue

Risk factors

It is known the close relation between pterygium and excessive sun exposure (UV exposure)

Other risk factors are exposure to wind, dust and other agents that can cause chronic irritation, as well as smoking and male sex.

Is a clinical one.

A series of non-invasive tests may be required.

Is only necessary in a symptomatic or a rapidly growing pterygium.

The medical treatment is effective for the treatment of pterygium-induced ocular irritations. When this is not enough, surgical treatment is required.

It consists in removing the pterygium under local anesthesia and replacing the excised tissue with a conjunctival graft. The operation is performed under the microscope,using microsurgical instruments.

Treatment is more efficient if done early in the course of the disease. This avoids complications such as: residual permanent astigmatism, more invasive surgery, more difficult recovery.

Fuchs endothelial dystrophy

Fuchs endothelial dystrophy is the most common form of posterior corneal dystrophy in people over 50.It appears sporadically, most commonly, but can also be genetically inherited.It is a dystrophy that affects both eyes and has a slow progression.

Fuchs endothelial dystrophy is the most common form of posterior corneal dystrophy in people over 50.

It appears sporadically, most commonly, but can also be genetically inherited.

It is a dystrophy that affects both eyes and has a slow progression

Fuchs dystrophy involves a dysfunction of the posterior corneal layer: the corneal endothelium.

The cornea (which is like a glass that protects the inside of the eye) begins to “swell” and gradually thickens because the endothelium, which acts as a pump that maintains a certain degree of hydration of the cornea, is abnormal.

Thus structural changes occur in all corneal layers, more or less severely, depending on the stage of evolution of the disease

– Genetic factors

– People over 50-60 years are more affected

– Female sex

– A recent article demonstrates an association between smoking and an increased incidence of Fuchs endothelial dystrophy

The diagnosis of Fuchs endothelial dystrophy is done in an ophthalmological consultation.

The patient is examined with the slit lamp and subjected to a series of painless and non-invasive tests that will measure corneal thickness, endothelial cell count, intraocular tension, and evaluate the corneal surface.

Medical treatment:

Initially, treatment aims to reduce corneal edema and control the pain with the help of eyedrops, a therapeutic lens or even an amniotic membrane graft

Surgical treatment:

It is the one that targets the cause.

It consists of replacing the endothelial cell layer with a new one from a donor. In most cases this is done by an operation called DMEK (Descement Membrane Endothelial Keratoplasty). It is the most recent and efficient treatment of corneal endothelial dysfunctions. The visual results are excellent and the rate of complications much diminished. For example, graft failure is much rarer than with previous techniques. Recovery is faster, better final BCVA (best corrected visual acuity) in most cases.

DMEK is the successor of Penetrating Keratoplasty (total corneal replacement) and DSAEK and ultrathin-DSAEK (the graft also retains a thin layer of the cornea and does not conservatively replace only the endothelium).

Untreated, Fuchs endothelial dystrophy progresses towards a severe decrease in vision.

Due to corneal edema that reaches up to the most superficial layer (epithelium), ocular pain and even the risk of eye infection occur. Because of the possible severe complications there is a risk of blindness.

Treatment is more efficient at incipient stages when recovery is rapid and complications are minimal.

List of others ophthalmological investigations and interventions

Ophthalmological investigations and interventions in Neurohope (list is not exhaustive)

– OCT (retina / optic nerve)

– Angiofluorography

– Fundus camera

– Anterior segment imaging

– Visual field

– Intraocular tension

– Autorefractometry

– Corneal topography

– Specular microscopy (determination of the number of corneal endothelial cells)

– Ocular ultrasound

– Aberometry

– Biometry

– Cataract Surgery

– Pterygium Surgery

– Corneal grafts (DMEK, DALK, KP)

– Scleral sutured IOL

– Intravitreal injections

– Removal of corneal / conjunctival foreign bodies

– Periocular / conjunctival wounds suture

– Chalazion removal

– Capsulotomy

– Iridotomy

– Trabeculoplasty