Retina & Macular degeneration

Retina and macular degeneration surgery

At CIMO Ophthalmological Clinic we are specialists in Retina and macular degeneration surgery by means of micro laser surgery. The ophthalmologist Dr. Julián Cezón is an expert in Retina and macular degeneration surgery.

What is the retina and the Vitreous Humour?

The retina is the membrane inside the eye, made up of several types of cells which receive images which are sent to the brain through the optic nerve. In the retina there are lots of blood vessels. In the centre of the retina, the central fovea, in the middle of the macula area, the area of maximum vision is found.

The vitreous humour is a transparent, colourless, gelatinous mass that fills the space in the eye between the crystalline and the retina. It fills the eye ball and gives it volume.

Decrease in sight

Blurred vision in the centre of the eye (mainly affecting near vision and reading)

Distortion of images, straight lines appear to be bent, leaning or disappearing at some point of the line

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What is macular degeneration?

This is the deterioration of the central area of the retina.

The macula is the central part of the retina, responsible for central vision, reading, vision of the little details and colours, night vision and peripheral or field vision.
The central fovea, in the middle of the macula area, is the area of maximum vision.

The macula can suffer degeneration, that is to say, its structure and function can deteriorate. It is made up of very specialized tissue and it is often found to be damaged in middle –aged people or the elderly. (Age-related macular degeneration AMD or ARMD). Age and nutritional factors play an important role in this. Generally both eyes are affected but often not at the same time or with the same intensity.
When macular degeneration is referred to it is usually understood to be related to age.

Types of macular degeneration.

There are two main types:
A) Dry macular degeneration: the main defect in this condition is that there is a thinning or an atrophy of the macula. This is the most frequent type and it is a slow progressing disease.

B) Exudative macular degeneration: Abnormal blood vessel growth occurs (choroidal neovascularization). Unfortunately, these new vessels are fragile, ultimately leading to blood and protein leakage below the macula. Bleeding, leaking, and scarring from these blood vessels eventually cause irreversible damage to the photoreceptors and rapid vision loss if left untreated.

Sometimes, high levels of myopia, scars, infections, inflammation or watching an eclipse of the sun can damage the fragile macular tissue.

Macular degeneration has certain hereditary factors, close family members of the patient should consult an ophthalmologist when reaching middle age.

To study this condition angiography is usually carried out. A colorant is injected into the veins and the back of the eye is photographedthus, the identification and localization of abnormal vascular processes is achieved. Ocular computerized tomography (OCT) is a series of images, (the patient only notices that the eye is being photographed) which allows the assessment of the layers of the retina and any changes taking place in them. The progress of both the illness and the response to treatment can be monitored in this way.

What are the existing treatments for macular degeneration?

The patient must have general good health, especially concerning cholesterol levels, alcohol must be limited, smoking must be given up, a diet rich in fruit and vegetables must be followed. The eyes must be protected from ultraviolet rays.

For dry macular degeneration all you have to do is take some food suplements and antioxidant vitamins. For exudative macular degeneration, the main therapy is with antiangiogenics (substances which are injected into the eye and act against the neovessels and their effects). Laser treatments are also used. Photodynamic therapy is also used in which photosensitive substances are injected into the veins, and the abnormal vessels which harm the macula are localized and afterwards the laser destroys them. There are also surgical techniques available.

What is the prognosis of the disease?

In spite of the treatments available, macular degeneration can reduce vision due to atrophy or scarring on the retina. With effective treatment, the progress of the disease can be slowed down and acceptable sight can be maintained for longer, an improvement or stabilization can also be achieved in your sight. Exudative macular degeneration can begin again and new antiangiogenic injections will be necessary. Therefore, when any worsening in your sight is perceived, you should go to your ophthalmologist again. This illness requires regular check-ups and multiple injections, (a minimum of three).

If exudative macular degeneration is left to its own devices, it can produce retinal bleeding and scarring causing severe irreversible loss of vision.
Those patients with a severe loss of sight can benefit from far sight optical aids or reading aids. Filters and other optical elements are also available on the market. Peripheral vision is never lost, which is of great help in the rehabilitation of sight and improving the quality of life.

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