Ophthalmology

Defne Hospital

Ophthalmology

Eye health is very critical in terms of quality of life. Certain eye diseases can progress and cause irreversible damages, including loss of vision, if they are not managed at early stage. Therefore, eye examination at regular intervals is very crucial to diagnose potential eye diseases before they progress. Healthy people should have their eyes checked once a year, while others with any problem in eye health should present to Ophthalmology Department. Ophthalmology department deals with vitreo-retinal diseases, cataract – refractive surgery, oculoplastic surgery, glaucoma, diagnosis and treatment of macular degeneration, refraction – refractive errors, strabismus, pediatric ophthalmology, retinopathy of premature and retina and cornea.

Structure of Eye

Iris is the colored part of our eye. It is covered by cornea that is the outermost, watch glass-like transparent tissue of the eye. The opening at central zone of iris is called pupil. Sclera is the white part of the eye and it is covered by a membrane, called conjunctiva. Native lens is located behind the iris. Eyeball is filled by a gel-like fluid, called vitreus, in posterior part of the eye. The nerve fiber layer that covers this space is called retina. Choroid, the vascular layer, is located immediately beneath the former one. Optic disc, where our optic nerve (the nerve that carries signals of sight) originates from, looks pink to white in color at posterior part of the eye and it can be inspected with special devices. The macula – an eye tissue that looks darker relative to its periphery nearby the optic disc – ensures detailed vision. The light follows the route of eye tear, cornea and lens and finally retina. Here, the image is signaled to the vision center in our brain with nerve fibers. Here, light stimuli are arranged and processed into a meaningful image. All these structures and the muscles located around the eyeball should be healthy for good sight.

Strabismus

This department deals with diagnosis and medical and surgical treatment of strabismus that usually develops in childhood and that are mostly secondary to refractive errors.

Cornea

Cornea unit deals with diseases that develop in anterior chamber of the eye. All surgical procedures are performed, primarily including cataract surgery. YAG laser procedures are performed along with evaluation methods that include but not limited to dry eye examination methods, specular microscopy and corneal topography.

Retina

Diseases of posterior segment such as hypertensive and diabetic retinopathy, retinal detachment, age-related macular degeneration (yellow spot disease), intraocular hemorrhage are evaluated in this unit. Angiography and laser therapy are performed in retina unit..

Refractive surgery

Surgical procedures are performed to correct refractive errors – myopia, hyperopia and astigmatism – using laser technology. Certain examination methods, such as corneal topography and keratometer, are used followed by surgery that is performed using a special laser system.

Glaucoma

High intraocular pressure (glaucoma) is evaluated in this unit. Patients, who have high intraocular pressure that is determined in a routine examination, are checked at regular intervals and followed up through visual field examinations..

Neurophthalmology

This unit deals with eye diseases that are associated with neurological conditions. Ophthalmic involvement of Myasthenia Gravis and thyroid diseases, movement disorders of eyes, ocular (retinal) migraine and other neurological problems are evaluated. Certain tests, such as visual field test, color sight and other tests that analyze movements of eyes, are used along with imaging modalities, such as MRI and CT.

Uvea

Inflammatory diseases that develop in iris, sclera and choroid are diagnosed and treated in Uvea unit.

Oculoplasty

Surgical procedures are performed for diseases of eyelids and lacrimal canals in this unit. These surgeries include removal of eyelid tumors, correction of deformities and ptosis and obstructed lacrimal canal.

Contact lens

Contact lenses can be used for all refractive errors, such as myopia, hyperopia and astigmatism, but it can also correct keratoconus, bullous keratopy, persistent epithelial defect and some other ocular diseases. Colored, colored-corrective contact lenses are present for aesthetic purpose or correcting refractive error.

Physicians use up-to-date technologies in diagnosis and treatment of eye diseases.

Structure of Eye

Iris is the colored part of our eye. It is covered by cornea that is the outermost, watch glass-like transparent tissue of the eye. The opening at central zone of iris is called pupil. Sclera is the white part of the eye and it is covered by a membrane, called conjunctiva. Native lens is located behind the iris. Eyeball is filled by a gel-like fluid, called vitreus, in posterior part of the eye. The nerve fiber layer that covers this space is called retina. Choroid, the vascular layer, is located immediately beneath the former one. Optic disc, where our optic nerve (the nerve that carries signals of sight) originates from, looks pink to white in color at posterior part of the eye and it can be inspected with special devices. The macula – an eye tissue that looks darker relative to its periphery nearby the optic disc – ensures detailed vision. The light follows the route of eye tear, cornea and lens and finally retina. Here, the image is signaled to the vision center in our brain with nerve fibers. Here, light stimuli are arranged and processed into a meaningful image. All these structures and the muscles located around the eyeball should be healthy for good sight.

Membrane peeling, surgical management of macular holes

• Perimetry
• OCT (Optic Coherence Tomography)
• Evaluation of corneal surface
• Laser
• YAG Laser
• Green Laser

What is ROP (Retinopathy of Prematurity)?

It is an eye disease of premature infants and it is the most significant cause of blindness in childhood in developed countries. It is not observed in infants, who are given birth in term and who are given birth in term and are undergone phototherapy for jaundice. The risk is higher in all infants with birth weight below 1500 g or given birth before 32 weeks. The risk is especially higher in infants with poor overall health, who require oxygen therapy at intensive care unit. The risk further increases in infants with cerebral hemorrhage, lung disease and sepsis.

Development and maturation of retinal blood vessels that are located in innermost part of our eye and ensure our sight is completed immediately before birth in intrauterine life and even 1 month after birth. In premature infants with underdeveloped and immature retinal vessels, who are born before term and are especially given intensive care and oxygen therapy, high oxygen rate suddenly decrease VEGF, a substance that stimulates vascular growth. Blood vessels contract secondary to low VEGF concentration and thus, retinal layer is not fed sufficient blood. In response, VEGF increases dramatically in vascular area that is poorly fed. This condition leads to abnormal vascularization and tissue hypertrophy. Abnormal blood vessels and tissues lead to intraocular hemorrhage and retinal detachment. The detachment that is the cause of loss of vision in R.O.P. develops when the baby is approximately 10 weeks old. R.O.P. has five stages. Stage 1 and 2 does not pose a serious risk. Stage 3 is the critical phase that is also the optimal one for treatment. A tear develops in retina in Stage 4. In final stage (Stage 5), retina is completely torn and detached.

When should the baseline evaluation be done?

Since R.O.P. does not have a symptom that can be recognized by parents, pediatricians refer babies to an ophthalmologist, who can perform ROP examination, 4 to 6 weeks after birth. Therefore, parents should necessarily bring their babies to an ophthalmologist one month after birth. This period can be 8 weeks in very premature infants. R.O.P. can be examined with portable devices in babies who are monitored at intensive care unit. We advise at least one examination for all infants, who were born before 36 weeks and weighed 2000 g in birth and who are managed at intensive care unit.

May babies with ROP have an eye problem in the future?/h4>

ROP spontaneously regresses by 80 percent. Treatment and follow-up is required in 20% of patients. Patients with Stage 3 ROP are especially optimal candidates for treatment. In advanced stages, the disease progresses and it may cause blindness. Failure of follow-up and treatment poses high risk of loss of vision especially in high-risk babies. Even if ROP regresses, lazy eye, refractive errors (myopia, astigmatism), strabismus and glaucoma is more common in these patients relative to general population. Retinal tears can be observed in advanced ages. Therefore, these patients should have regular eye check-ups in the future.

How is ROP evaluated?

Eyes are numbed with a drop (topical anesthesia) in ROP examination. It does not require general anesthesia. Pupils are dilated with an eye drop half an hour before the procedure. After eyes are numbed, eyelids are retracted with a tool that does not cause any ocular discomfort. Retina is examined in detail in each eye. Vascular maturation, presence of disease and its stage are determined. Next, it is decided if it is necessary to re-examine the condition and the frequency of follow-up, if required. The examination takes 10 to 15 minutes.

How is ROP followed up?

Baseline ROP examination should be performed in premature babies 4 to 6 weeks after birth. Next, the examination is repeated at 1- to 2-week intervals depending on presence and stage of the disease until the baby is 46 weeks old. Follow-up intervals should not exceed 1 week in very premature infants (25 o 26 weeks). Follow-up even at 2- to 3-days can be required in some cases. Detailed examination is performed in each examination, as is the case with baseline examination

What are treatment alternatives for ROP?

The most important phase of treatment is regular follow-up in ROP. ROP spontaneously regresses in 80% of patients and it requires treatment in an approximately 10% of babies, who are followed up. Treatment method is dictated by stage of the disease and vascularization rate. Weekly follow-up is appropriate for Stage 1 or 2 conditions. Stage 3 is the critical phase. Threshold disease is observed in this phase. Timely diagnosis and treatment of threshold disease (within 3 days) is a very important factor to prevent blindness in babies with ROP. Laser therapy is performed for high-risk patients at this stage. Recently, medication treatments also produce successful outcomes.