Glaucoma Services

The prevalence of glaucoma in adults over the age of 40 years is estimated to be 2.5-3.0% in rural India. The Glaucoma services handles patients with primary Glaucoma which is largely inherited, secondary Glaucoma caused by trauma, inflammation, diabetes, retinal vascular disorders and hypermature cataracts and congenital glaucoma. Equipped with the most advanced diagnostic tools, patients with early disease are diagnosed and treated early to prevent significant loss of vision.

All Glaucoma suspects or patients diagnosed to have Glaucoma are thoroughly examined by documentation of intraocular pressure, detailed fundus examination using +78.0D lens and documentation of structural changes in the optic nerve head by fundus photographs. Visual field analysis is done by either Octopus perimeter or Humphrey Field Analyser with the latest software packages like Sitafast and SWAP. Patients are advised medical management or laser treatment as the case may be. The laser treatment for glaucoma that is done are YAG laser iridotomy and Laser trabeculoplasty.

Patients with advanced glaucoma are advised surgery which includes trabeculectomy with or without wound modulating agents like mitomycin or 5-fluouracil.

Paediatric patients are evaluated under general anaesthesia. Combined Trabeculotomy with Trabeculectomy under GA is being done for them.

All patients with Glaucoma are regularly being followed up for progression of the disease and appropriate treatment given accordingly.

Cornea Services

Corneal blindness is the second leading cause of blindness in the developing world. Common causes of corneal blindness include trauma, infections and hereditary disorders. All patients are assessed using Topcon slit lamp system. In the Cornea Clinic we manage the following conditions:

1. Microbial Keratitis – We have a full fledged microbiology and pathology back up where all the samples are processed. Appropriate treatment is started depending upon the micro reports.
   
   
2. Trauma - All open globe injuries are taken care of round the clock. Wherever needed consultation from other specialties are sought.
   
   
3. Dry Eye Syndrome - Patients are evaluated in detail which includes tear film break up time, Schirmer’s Test, ocular surface staining and treated.
   
   
4. Cyanoacrylate glue and Bandage Contact Lens for small corneal perforation and corneal thinning disorders.
   
   
5. Superficial Keratectomy with Sodium EDTA chelation for Band Shaped keratopathy.
   
   
6. Anterior stromal puncture for Bullous Keratopathy with no visual potential.
   
   
7. Penetrating and Lamellar Keratoplasty.
   
   
8. Contact Lens services.
   
   
9. Amniotic membrane transplantation
   
   
10. Human fibrinogen glue application
    
    
11. Corneal tattoing for corneal leukomas
    
    
12. Assessment of Corneal endothelium by Specular microscopy and pachymetry
    
    

Cataract and Refractive Surgeries

Cataract being a major cause of blindness in India, the Department of Ophthalmology, SRU is doing its part in the eradication of blindness. The procedures that are being done include:

1. Extra capsular cataract extraction
   
   
2. Small incision cataract surgery with rigid IOL implantation
   
   
3. Phacoemulsification with foldable lens implantation under topical anaesthesia
   
   
4. Microphacoemulsification with rollable IOL implantation under topical anaesthesia
   
   
5. Foldable lenses that are implanted include both unifocal and multifocal lenses.

Astigmatic Keratotomies and Limbal Relaxing incisions are routinely being done in the quest for restoration of normal vision.

Retina Clinic

Eye being the index of systemic problems both for the young and the old, retinal examination becomes important in the complete examination of the eye. Blindness due to Diabetes is a major cause for irreversible blindness in old age. 8% of urban and 2% of rural population are diabetics. Diabetes, Hypertension, Renal diseases, Collagen vascular diseases, all affect the retina resulting in decreased vision. The Retina Clinic is equipped with state of the art Digital camera for documentation of retinal diseases and for Fundus Fluorescein Angiography. Retinal Lasers which is the mainstay in the management of Diabetic Retinopathy are being done.

Patients with Rhegmatogenous detachments are operated. The procedures that are commonly done are explants or explants with encirclage.

Screening for Retinopathy of prematurity

The retina clinic undertakes screening for retinopathy of prematurity in all neonates referred from the Department of Neonatology. The screening protocol is based on the guidelines of the American Academy of Ophthalmology. Premature infants who are at risk are screened for ROP at the Neonatal ICU which is well equipped to tackle any emergency that may arise during examination of a neonate like neonatal apnoea and cardiac arrest. Those neonates identified to have ROP are further examined at frequent intervals till the vascularisation is complete or advised cryopexy or laser ablation if required.

Considering the ocular lesions that these infants may occur later in life, these infants are advised frequent follow up.

Uvea Clinic

The Uvea Clinic extends its services towards patients with ocular inflammatory diseases which includes uveitis. Although statistically, uveitis cases form only a small percentage of the total number of cases examined daily at the out patient department, the magnitude and severity of ocular damage they can cause is extremely high. The new patients and the review patients are examined.

Special investigations including serological, histopathological examinations and Fundus Fluorescein Angiography are performed to confirm the diagnosis. Infectious cause of the uveitis is high in our country as are systemic associations such as rheumatological diseases and solution to the situation is often sought in concurrence with the physician.

Squint Clinic

Children with squint are thoroughly evaluated by documentation of vision, assessment of extraocular movements and a detailed fundus evaluation.

Squint evaluation includes cover test, alternate cover test, measurement of angle of deviation by prism cover test and correction of refractive errors by prescription of spectacles. Surgeries are done whenever indicated. Children are regularly followed up for Amblyopia and recurrence of deviation. Treatment of Amblyopia is aggressive and long-term.

Children with ADHD (Attention Deficit and hyperactive Disorders) and Cerebral palsy are being evaluated for squint and periodically followed up.

Paediatric Ophthalmology

The paediatric ophthalmic services offers comprehensive services to all children upto the age of 18 years. It undertakes screening of schoolchildren for childhood disorders like refractive errors, Vitamin A deficiency, squint, Amblyopia and cataract.

Children with cataract are thoroughly evaluated for systemic disorders with appropriate consultation with the Paediatrician . Screening for Congenital Glaucoma and for Retinopathy of Severity is routinely done jointly with Glaucoma clinic and Retina clinic respectively. Those with corneal opacities are managed by penetrating keratoplasty.

Neurophthalmology Clinic

The Neurophthalmology clinic deals with the evaluation and management of patients with ophthalmic manifestations of neurological diseases. These include Optic Neuritis, Papilloedema, Oculomotor palsies and diplopia.

The Neurophthalmological work up includes documentation of patient’s vision, colour vision, assessment of pupillary reaction, fundus examination and evaluation of visual fields by Humphrey’s field analyzer. Patients with diplopia are followed up with diplopia charting by Hess Screen.

Many a time the neurophthalmologist opinion is sought by the neurologist in the treatment of Traumatic Optic Neuropathy. SRU being a multi-speciality center with an excellent Trauma Care Unit, we do get many cases of Traumatic Optic neuropathy following Head injury.

Orbit and Oculoplasty Services

Orbit and Oculoplasty is a newly emerging sub-speciality in the field of Ophthalmology. The focus of the Orbit and Oculoplasty services is on the evaluation and management of Orbital and adnexal disorders. The blemish created by lid abnormalities and socket deformities are corrected.

Surgical correction of Ectropion(outward turning of eyelid), Entropion(inward turning of eyelid) and Ptosis(drooping of eyelid) are regularly being performed. Cosmetic surgery such as Brow lifts both internal and external are also done. Enucleation or Evisceration with orbital implants is performed when indicated. Patients who have undergone orbital implants are being fitted with either prefabricated prosthesis or custom made prosthesis with excellent results.

The Orbit and Oculoplasty services also deal with the management of orbital infections and inflammations with joint consultation with General physicians and ENT surgeons.

Patients with Thyroid Eye Disease are regularly being referred from the department of Endocrinology for thorough evaluation and management.

Baggy eyelids and droopy eyebrows can give rise to a tired appearance.When severe,these may even lead to impaired vision.Baggy eyelids and droopy eyebrows can be corrected by what is known as Aesthetic eyelid surgery.