Ocular diseases

Age related cataract

Age related cataract

Age-related cataract is a very important eye condition caused by the opacification of the crystalline lens, the natural lens of the eye that focuses images of the external world onto the retina. The loss of transparency of the crystalline lens occurs frequently in older people and usually causes blurred and/or reduced vision ability. Without surgical treatment, cataract can lead to complete blindness. In the initial phase of cataract, the patient may perceive blurred/reduced vision, dazzling, altered color perception and other vision disturbances. When these conditions interfere with a normal working or social activity, surgical removal of cataract should be considered. Cataract surgery is nowadays a fast, minimally invasive and non-painful ambulatory surgery and consists in the removal of the clouded crystalline lens and its replacement with a new, perfectly transparent, synthetic lens.

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Steroid-induced cataract

 Steroid-induced cataract

Cataract is an eye condition due to the opacification of the crystalline lens, it causes cloudy vision and other vision impairments that may be quite significant. There are different types of cataract: Age-related cataract is surely the most common one, whereas steroid-induced cataract is the most relevant type of cataract in general medicine, due to the large use of steroid drugs in the treatments against inflammatory diseases, asthma and rejection after organ transplantations. The correlation between cataract development and the prolonged use of systemic, topical or inhaled steroids must lead to pay much attention in the prescription of these drugs. There are no pharmacological remedies against cataract, the only treatment available  nowadays is cataract surgery, i.e. the removal of the opacified crystalline lens and its substitution with a synthetic perfectly transparent lens.

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Cataract Phacoemulsification

Cataract Phacoemulsification

Cataract is an eye condition due to the opacification of the crystalline lens. The loss of transparency of the crystalline lens can cause significantly reduced vision ability and, if not treated, blindness. There are no pharmacological remedies against cataract, hence cataract surgery is nowadays the only treatment able to restore clear vision. Cataract surgery consists in the removal of the opacified crystalline lens and its substitution with an artificial perfectly transparent lens. This surgical procedure is performed in an outpatient modality, it usually lasts 10-15 minutes and presents a post-operative period with no particular discomfort, it is minimally invasive and offers excellent results in the majority of the cases. Serious complications and collateral effects are extremely rare, but people who need cataract surgery should always consider such eventualities together with their eye doctor before making a decision.

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Secondary cataract

Secondary cataract

Posterior capsulotomy is a laser treatment that becomes necessary when the capsule, the transparent tissue that surrounds the crystalline lens of the eye, undergoes a process of opacification known as capsular fibrosis. This phenomenon happens to most people who have had cataract surgery, months or years after the surgical procedure itself, it causes cloudy vision and is improperly called secondary cataract. The treatment against posterior capsulotomy makes use of a YAG laser able to make a small incision on the posterior surface of the opacified capsule, freeing the optical axis and restoring clear vision without the need of surgical instruments. Posterior capsulotomy is performed in an outpatient modality, it is a non-invasive and absolutely non-painful treatment that lasts only a few seconds. Risks and complications of posterior capsulotomy are extremely rare, but still they have to be considered very seriously before undergoing this treatment.

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Photorefractive keratectomy PRK

Photorefractive keratectomy PRK

Photorefractive keratectomy (PRK) is a surgical procedure used to eliminate or reduce refractive errors such as myopia, hypermetropy and astigmatism. PRK uses an excimer laser to reshape the surface of the cornea, in order to modify permanently the curvature of this natural lens of the eye and solve or improve focusing problems. This procedure is carried out in an outpatient modality and usually lasts about 15 minutes. Not everyone is a good candidate for PRK, in fact there are several criteria that have to be met in order to make this procedure safe and successful. Eligibility for PRK can be established by a very accurate eye examination. Before surgery, it is of fundamental importance to talk with the eye doctor in order to understand what degree of visual improvement can be expected and to carefully evaluate all possible risks.

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Fluorescence angiography

Fluorescence angiography

Fluorescence angiography is a diagnostic examination that allows the eye doctor to obtain very detailed imagines of the blood vessels in the back of the eye. This technique permits to diagnose vascular retinal pathologies, to plan and control with extremely high precision photocoagulation laser treatments and monitor their effects. Angiography is a minimally invasive procedure that uses a non-toxic fluorescent contrast medium, which is injected into a vein of the arm and enters the bloodstream; a few seconds after the injection, the presence of the fluorescent dye in the blood allows to visualize the vascular component of the retina (if the dye is fluorescein) or of the choroid (if the dye is indocyanine green). The ocular fundus is analyzed with dilated pupils by a special angiographic instrument that reconstructs digital images. The whole procedure lasts less than 30 minutes, is painless and usually does not give rise to any collateral effect.

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Central serous chorioretinopathy

Central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is an eye pathology that affects the macula, the central part of the retina responsible for fine and detailed vision. CSCR determines a focal retinal detachment from the neuroepithelium and a following deficit in central vision. This pathology affects mainly persons of the male gender, aged between 20 and 55, with personalities and/or lifestyles that involve a constant generation of stress associated to adrenergic hyperactivity with hyperproduction of cortisol. CSCR can be diagnosed and monitored by fluorescein angiography (FAG), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Nowadays, CSCR can be treated with low-fluence photodynamic therapy (PDT). Relapses of CSCR are dangerous and must not be neglected; prevention can be made by eliminating radically all primary factors that determine stress.

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Macular hole

Macular hole

With aging, the vitreous – i.e. the gel-like substance that fills the interior of the eye – undergoes chemical and physical changes which often induce the vitreous contraction and detachment from the posterior wall of the eye. Usually, the posterior detachment of the vitreous is asymptomatic; in some cases, though, the contraction of the vitreous pulls the retina, sometimes at the level of the macula, the central part of the retina responsible for fine and detailed vision. An excessive and prolonged pulling on the macula can give rise to a macular hole, a serious eye condition that determines a blind spot in the central vision and in some cases even the loss of central vision. Macular hole can be diagnosed and examined with optical coherence tomography (OCT); once diagnosed, it must be treated urgently by vitrectomy, a surgical procedure able to help restore lost central vision or at least preserve residual central vision. The potential risks associated with this procedure are unimportant compared to the serious vision impairment that may arise in the absence of treatment.

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Retinal detachment

Retinal detachment

The retina can be subjected to structural damages and breaks consequently to different types of traumas. One of the most frequent causes is the contraction of the vitreous, the gel-like substance that fills the inside of the eye. When the vitreous contracts, it detaches from the posterior wall of the eyeball and hence from the retina. This usually occurs asymptomatically, but if the vitreous remains attached to the retina and pulls it, this can determine tears in one or more areas of the retina and even retinal detachment. The detached retina undergoes a progressive and irreversible degeneration, with a serious vision impairment that can evolve to blindness. Depending on their nature and typology, retinal breaks and retinal detachment can be treated with different laser or surgical procedures. There are risks associated with retinal detachment treatments, but these risks become unimportant if compared to vision impairment that would derive in the absence of treatments.

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Macular pucker: Surgical treatment

Macular pucker: Surgical treatment

The contraction of the vitreous – a phenomenon that occurs frequently with aging – can cause an alteration of the retinal surface and stimulate the formation of a scar-like tissue at the level of the macula, the central part of the retina responsible for fine and detailed vision. This scar-like tissue can contract and wrinkle, giving rise to a macular pucker (or epiretinal membrane), an ocular condition that causes a more or less significant image distortion. The diagnosis of this eye pathology can be made with a non-invasive examination called optical coherence tomography (OCT), which allows to analyze the structure of the retina and the evolution of an eventual macular pucker with extreme precision. When symptoms are not serious, the macular pucker does not need any treatment, when visual deficit is strong, a surgical removal of the macular pucker – called vitrectomy for macular pucker – may become necessary.

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Floaters

Floaters

With aging, the vitreous – the gel-like substance that fills the cavity of the eyeball – undergoes chemical and physical changes that may give rise to clumps of collagen fibers and dead cells. These clumps float in the vitreous and project their shadow onto the retina. These shadows are perceived as moving grey spots in the visual field, they can have several shapes and sizes and are called floaters. When floaters formation is due to the physiological changes of the vitreous, they are not a sign of danger for the eye and very rarely they obstruct vision such as to make their surgical removal necessary. The sudden formation of floaters, on the other hand, especially if associated to the perception of flashes, may represent the symptom of retinal breaks or the premonitory symptom of retinal detachment. In this case, call your eye doctor immediately for a detailed eye examination and an eventual urgent treatment for retinal detachment.

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Peripheral retinal degenerations

Peripheral retinal degenerations

Peripheral retinal degenerations are areas of the retina with structural fragility; they are more frequent in persons with high myopia, due to the elongation of the eyeball and consequent thinning of the retina in its periphery. Peripheral retinal degenerations themselves are not a pathology, but they do represent a risk for the development of retinal breaks, which can in turn give rise to retinal detachment. Retinal breaks and retinal detachment can happen when the vitreous – the gel-like substance that fills the eyeball cavity – shrinks with aging and detaches from the back of the eye pulling the retina. In the presence of peripheral retinal degenerations, a laser treatment is necessary. The procedure consists in sealing the retinal areas at risk with one or more rows of laser spots, allowing to confine eventual retinal breaks and preventing retinal detachment. This treatment is performed in an outpatient modality, is painless and takes only a few minutes.

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Central retinal vein occlusion

Central retinal vein occlusion

Central retinal vein occlusion (CRVO) is a serious, relatively rare, retinal vascular disorder that causes a sudden and significant vision reduction associated to potentially dangerous ocular complications. The seriousness of symptoms depend on the duration of the ischemic event, during which one or more retinal areas are not perfused with blood and respond by developing new abnormal blood vessels. In some cases, the ischemic event can be associated to an hemorrhage in the vitreous (hemovitreous), which can further reduce vision ability. CRVO requires laser treatments of the ischemic areas that stimulate the growth of new pathological blood vessels by producing a molecule called VEGF. Monitoring and control of cystoid macular edema (CME), one of the main complication of CRVO, is also very important and is made with intravitreal injections of anti-VEGF drugs or the application of intravitreal steroid implants, that release drugs slowly, with efficient and prolonged therapeutical effects. Hemovitreous can be removed by vitrectomy associated to a laser treatment.

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Central retinal artery occlusion

Central retinal artery occlusion

Central retinal artery occlusion (CRAO) is a serious ocular condition that causes a sudden interruption of the blood flow in the retina, this gives rise to retinal ischemia, which is followed by immediate loss of central vision. When central retinal artery is obstructed, there is no treatment able to restore lost vision. The only way to fight central retinal artery occlusion is prevention: The consciousness that artery hypertension, hypercholesterolemia and several blood pathologies represent important risk factors for this eye pathology allows people at risk to follow meticulous protocols of monitoring and prevention.

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Glaucoma

Glaucoma

Glaucoma is a serious ocular pathology caused by the increase of the intraocular pressure (IOP). High IOP damages the optic nerve causing shrinking of the visual field, a visual deficit that can evolve to complete blindness. IOP is determined by the quantity of aqueous humor in the anterior chamber of the eye, where it is produced and drained constantly at the same speed. The correct functioning of the drainage mechanism of the aqueous humor allows to keep IOP values between 14 and 21 mmHg; when this mechanisms is slowed down or blocked, IOP becomes higher and causes glaucoma. Glaucoma is a very subtle disease because in most of the cases it develops asymptomatically, so that when symptoms become evident vision is often too far compromised. Nowadays, modern diagnostic techniques allow early diagnose and prevention of glaucoma. Together with pharmacological methods and laser and surgical treatments, early diagnose and prevention of glaucoma allow to keep this dangerous eye pathology under control.

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Open-angle glaucoma: Laser trabeculoplasty

Open-angle glaucoma: Laser trabeculoplasty

Laser trabeculoplasty is a parasurgical procedure used to treat open-angle glaucoma, a very dangerous ocular pathology caused by a pathological increase in the intraocular pressure (IOP), which impairs the optic nerve and hence vision. A typical symptom of glaucoma is the progressive shrinking of the visual field; in the absence of a prompt and adequate treatment, this pathology can lead to complete blindness. There are two types of trabeculoplasty: Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT); both treatments act on the trabecular meshwork, the ocular structure that drains the aqueous humor out of the anterior chamber of the eye and whose obstruction causes the increase of IOP responsible for glaucoma. Trabeculoplasty is carried out in a few minutes, it is a painless and non-invasive procedure and it generally does not entail risks and complications.

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Angle-closure glaucoma and acute angle-closure glaucoma

Angle-closure glaucoma and acute angle-closure glaucoma

Laser iridotomy is a surgical procedure used to treat or prevent angle-closure glaucoma and acute angle-closure glaucoma, conditions caused by the obstruction of the drainage angle followed by sudden and consistent increase in the intraocular pressure (IOP), an extremely dangerous event that can lead to complete and irreversible blindness in a very short time. IOP is determined by the quantity of aqueous humor in the anterior chamber of the eye, where it is produced and drained constantly at the same speed, allowing IOP values to be kept within 14 and 21 mmHg. In the presence of angle-closure glaucoma or acute angle-closure glaucoma, the outflow of the aqueous humor is slowed down or completely blocked. Laser iridotomy creates a small hole in the iris, allowing aqueous humor to flow out of the eye restoring normal values of IOP.

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Glaucoma Trabeculectomy

Glaucoma is a dangerous ocular pathology that affects the optic nerve and it is caused by an increase in the intraocular pressure (IOP). IOP depends on the quantity of aqueous humor in the anterior chamber of the eye, where the aqueous humor is produced and drained continuously at the same speed, which gives constant IOP values ranging from 14 to 21 mmHg. If the drainage mechanism of aqueous humor is slowed down, the consequent increase in IOP causes with time a shrinking of the visual field which, in the absence of an adequate treatment, may evolve to complete and irreversible blindness. Glaucoma is a particularly subtle and dangerous disease because in most of the cases it develops asymptomatically and when the first symptoms become evident vision is often too far compromised. Nowadays there are several pharmacological therapies and laser treatments able to lower IOP; in the cases where these treatments do not succeed in restoring physiological values of IOP, a surgical procedure called trabeculectomy becomes necessary.

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