|Year : 1990 | Volume
| Issue : 2 | Page : 49
Retina and vitreous-the decade of eighties
P N Nagpal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nagpal P N. Retina and vitreous-the decade of eighties. Indian J Ophthalmol 1990;38:49
In general the estimates are that the medical knowledge and for that matter the knowledge in any field today is accumulating at a speed that it doubles itself in 6-7 years. But if we look at the developments in the field of Retina and Vitreous, probably the above estimate will be too conservative. The decade of eighties has seen tremendous changes. The information and technology have grown at an exponential rate. The developments may be reviewed as under.
Diabetic Retinopathy along with many other vascular disorders was a subject of very deep and long term studies. The Diabetic Retinopathy Study (DRS), the Early Treatment Diabetic Retinopathy Study (ETDRS) and the Diabetic Retinopathy Vitrectomy Study (DRVS) have contributed a lot to our knowledge about the management of this blinding complication of metabolic disorders. DRS has proven beyond doubt that Xenon arc and Argon laser photocoagulation can prevent the progression of advanced retinopathy, and reduce the rate of severe loss of vision. ETDRS showed that laser photocoagulation is of value in non proliferative and mild proliferative diabetic retinopathy. The DRVS demonstrated the definite value of early vitrectomy for some patients with severe proliferative diabetic retinopathy.
In cases of Central Retinal Vein Occlusion (CRVO) although no treatment has been consistently shown to be effective, the occurrence of rubeosis iridis and secondary glaucoma can be markedly decreased by Argon laser Pan retinal photocoagulation. In ischaemic type of CRVO the incidence of this complication falls to 5% from 50%.
The results for branch vein occlusion study have shown benefit by grid pattern argon laser coagulation in the sector involved.
Macular degenerations with subretinal neovascular membrane and the resultant oedema and haemorrhage have shown a short term benefit by Argon or Krypton laser coagulation.
Photic or light maculopathy was brought to more light due to the more common use of microscope in surgery. Use of blockers and filters have been recommended.
Lasers have become increasingly useful in retinal and vitreous disorders. The endolaser usage (Argon and now Diode) has changed the outlook of many diabetic vitrectomies. The modality has also proved useful in endocyclolaser therapy for reducing the tension in otherwise intractable glaucomas. The development of double frequency Yag laser may help overcome the maintenance problems of Argon and Krypton lasers. This will be good news for the developing world.
The development of use of SF6 C3H8 C2H6 (Perfluorocarbons) has helped settle many retinas in early manifestation of PVR.
The use of Silicone oil with vitrectomy has favourably influenced the course of giant tears and re-proliferating PVR. The Retina society classification of PVR has helped in exchange of results achieved by different techniques. The use of heavy silicon oil is helping still more.
The Open Sky and closed Vitrectomy have helped treat many a hitherto untreatable cases of ROP (Retinopathy of Prematurity) or what was known as Retrolental fibroplasia. Presently the later term is for the late cicatricial stage of ROP.
Pulsed Nd Yag laser was found useful in cutting some membranes in vitreous but has great limitations. Yag and Argon laser no doubt found use in some cases of subhyaloid haemorrhage dispersal by bursting the post hyaloid. This helped in quick restoration of vision when blood collected in the macular region.
The awareness of the fact, that removal of the lens in eyes undergoing vitrectomy for the complication of .Diabetic retinopathy led to 4 fold increase in incidence of neovascular glaucoma has helped a great deal in saving a lot of painful blind eyes.
The extensive discussion of implants versus explants, diathermy versus cryo of the last decade have given way to discussions about the new techniques of pneumoretinopexy, balloon buckles, primary vitrectomy for simple cases of retinal detachment and use of Healon Buckles.
Use of vitrectomy for Trauma, for removal of IOFB's, for endophthalmitis and for removal of the rare worms in the vitreous has dramatised ophthalmology.
The use of retinal tacks and magnetic attraction is already helping the giant tears and big retinotomies. Similarly cyanoacrylate glue will help the same cause.