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Intra Vitreal Ozurdex Injection

Intravitreal Ozurdex is a sustained release steroid device, which continues to release dexamethasone for a period of 3-6 months. It is a very effective way of treating macular edema due to various causes like retinal vein occlusions branch or central , diabetic macular edema, cystoid macular edema and uveitis conditions especially non infectious. Usually in Retinal Vein Occlusions patients , the first line of treatment for majority of patients is Anti VEGF injections like.
Avastin, Razumaor Lucentis , Once it becomes long standing, ozurdex or
steroid injection is used. Cataract formation and rise in Intraocular pressure ( Glaucoma ) can be complications occasionally and rarely infection and ususally are manageable. In diabetic macular edema also ozurdex is considered for long standing edema or swelling when other treatments have not given good results or patient has undergone cataract surgery in the past.

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Anti VEGF Intra Vitreal Injections viz. Lucentis, Avastin, Eylea, Razumab

Anti VEGF injections are becoming increasingly used for treatment of various retinal pathologies like retinal vein occlusions central or branch; wet age related macular degeneration, diabetic retinopathies maculopathy or proliferative diabetic retinopathy. They have revolutionised the treatment of conditions such as Wet ARMD, Diabetic Retinopathy and Retinal Vein Occlusions. These drugs reduce the swelling in macula immediately within one or 2 injections most of the
time and help patient to improve in vision clarity in the interim period. However it
is to be understood that these injections form the palliative treatment and final outcome depends on the nature of the basic disease and treatment for the associated systemic health factors like blood pressure, diabetes and high cholesterol etc. control is equally important. In many of these conditions
tobacco usage in the form of smoking or with paan etc have to be stopped.
AVASTIN injection ( Bevacizumab) is widely used injection which is more of
prototype drug hence cheaper, and almost equally effective as proved by various studies done internationally like CATT study. However it's FDA approval is for
cancer of intestine , but is still widely used drug in clinical practice. Government of India had banned usage of this drug in between but now there is no ban. The effect of injection lasts for about 4 to 6 weeks.

LUCENTSor ACCENTRIX Ranizumab) is a refined drug made by Genetech Company and marketed by Novartis company in India. It is designed for the eye use and there is FDA approval also for the same. It has been in the market for
also almost 10 years. The effect of one injection lasts about 4 weeks.
RAZUMAB ( Ranizumab) is a drug manufactured by Indian company Intas and is available since 1 year. It has been also used quite extensively like Lucentis and is called Biosimilar drug technically. It is cheaper then Lucentis and the effect
lasts for 4 weeks.
EYLEA ( Aflibercept) is the latest addition in the anti VEGF injection list and is the best available at present time . It is FDA approved for the eye and the duration of action is about 4 to 6 weeks after single injection. Recently we use it for some complicated or severe cases like advanced diabetic macular edema, or wet macular degeneration woth a variant called Polypoidal Choroido vasculopathy . The primary reason being the cost of the injection.

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Fellowship Training in India

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Retinal Detachment

Retinal detachment is quite a common condition. Some 50 years ago, this disease was untreatable and patients would remain blind. Then, the treatment started with modest results of success in 50% of patients. Today, with advances in modern vitreoretinal surgical techniques, more than 90% retinal detachment can be refixed.

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Diabetic Retinopathy

Diabetes Mellitus us a disorder of sugar/glucose metabolism in the human body in which the body cannot utilize it for energy. The extra unutilized sugar acts like poison for the whole body affecting every organ especially the eyes, heart, kidney and brain. Retina needs a lot of oxygen and has plenty of blood vessels, so it gets affected and the condition is known as DIABETIC RETINOPATY. It results in loss of vision.

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Macular Degeneration

Age related macular degeneration is a disease that robs clarity of vision of elderly individuals who need sharp vision the most for their activities in retired life. Previously, no treatments were available. Now, there are striking advances in the treatment. In particular with wet AMD, the expensive alternatives (PDT, macugen or lucentis) are there which stabilizes the disease process. However this process may need repeated treatments as the disease is due to aging. The cheaper alternative like avastin injections also work equally efficaciously.

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Macular Hole

One of the common causes of macular hole is idiopathic- which is without any apparent cause and is usually seen in elderly people. It can often affect both eyes though in varying degrees. Other causes could be following trauma or following other retino-vitreous diseases in which the macula is pulled leading to hole formation.

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Macular Pucker

Macular pucker or ERM is an abnormal scar tissue that forms on the most sensitive part of the retina called macula. The macula provides the sharp, clear, central vision we need for reading, driving and seeing fine detail. This condition is surgically treatable in symptomatic patients with good results.

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Retinal Vein Occlusions

Retinal vein occlusions are the most common retinal disease seen in clinical practice. Recognition of these diseases is important as their complications can lead to lots of vision problems. Timely intervention can substantially reduce the incidence and severity of these complications. Also, improved treatment of underlying medical problems can lead to better quality of life.

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Central Serous Retinopathy

Central Serous Retinopathy also called as CSCR-Central Serous Chorio Retinopathy is a condition usually seen in young people, mainly who are very active with Type-A personality. It usually affects the central part of the retina (Macula).

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Uveitis is the commoner condition which quite often is not diagnosed. It can lead to severe sequel and permanent loss of vision.

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Glaucoma is a general term for a group of eye disease that, if left untreated, will elevate pressure inside the eye, ultimately causing optic nerve damage. This damage creates irreversible loss of vision. Glaucoma is a disease of the optic nerve. The optic nerve carries the image s we see from our eye to the brain. It is like an electric cable containing a huge number of wires.

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It is an inflammation of internal coats of eye including intraocular cavities (which contains gel like structure called vitreous), usually caused by an infection and rarely by non infectious agents like retained lens material or toxic agents. If all the 3 coats of the eye are involved than the condition is known as Panophthalmitis.

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Lattice Degeneration

Lattice Degeneration is not so uncommon these days. This condition has potentially blinding results if not treated. Prevention is better than cure. The common causes are lattice degeneration which can be detected by proper screening of retina and timely treatment by laser photocoagulation. Lattice degeneration is a term given to weak parts in the retina. Lattice degeneration are oval cigar shaped lesions with lattice texture, some of then could also have holes inside them.

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Fundus Fluorescein Angiography

Fundus Fluorescein Angiography is most commonly used in diabetic retinopathy, ARMD, Choroiditis, Chorioretinitis, Central Serous Retinopathy, Branch Retinal Vein Occlusion, Central Retinal Vein Occlusion, Retinal Tumors, Macular Edema, Clinically Significant Macular Edema and Cystoid Macular Edema.

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Laser is a pure form of a particular wavelength of light which is a powerful beam. it is used for good therapeutic uses in many eye disorders. Lasers are of different varieties used in different varieties used in different eye conditions as follows

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Endophthalmitis due to very organisms or unresponsive to medical treatment can be treated by vitrectomy in a good no. of patients

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Education Power Point Presentation

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Rationale of Retinal Detachment Management

Post Graduate lecture taken at our Clinic on 6th March 2010

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