All patients with diabetes should have their retina examined once a year to look for signs of retinopathy. Early laser treatment can prevent progression of retinopathy and prevent loss of vision.
Unfortunately, many patients with diabetes are unaware of this and only seek help when the have lost their eye sight. I have come across many young patients with severe diabetic retinopathy in both eyes that cannot be treated with laser.
This is because there is blood in the eye that prevents the laser beam from entering the eye or there is retinal detachment present. The only option left to try to save the eye sight is to carry out vitrectomy surgery.
Surgery for diabetic retinopathy is very challenging. This is because the retina of these patients are already damaged and have poor potential for vision. I often give an injection of Avastin (an anti-VEGF drug) into the eyeball of the patients 1 week before their operation.
This wonder drug causes rapid shrinking of any new blood vessels in the eye and reduces the chance of bleeding during surgery.
I feel that the best approach for diabetic vitrectomy is to use the latest modern sutureless small gauge vitrectomy machines. Although the cost is slightly more expensive, it really makes my life as a surgeon easier.
It is also more comfortable for the patient post op as there are no sutures in the eye and recovery is quicker. Surgery aims to remove all blood in the eye and any scar tissue. This is easier said than done!
Very often, the scar tissue is very tightly stuck to the retina and you can easily cause damage to the retina. It is like trying to peel away two wet pieces of tissue paper that are stuck together. Surgery can often take more than 1 hour.
Once all scar tissue is removed, I often try to flatten the retina by putting air into the eye ball. I then perform extensive laser treatment to try to stick the retina down.
Sometimes, despite all my best efforts and the retina is reattached, the patient fails to see any improvement in vision. This is probably due to the fact that the eye has been deprived of oxygen and nutrients for too long.
It is of course much better to prevent severe diabetic retinopathy from occurring in the first place. A well organized local screening program for all diabetics is key to this as well as good control of the diabetes, lipids and blood pressure.
A cataract is clouding of the lens in your eye. This is usually due to old age but can also occur due to trauma, diabetes, or due to medications.
Cataract surgery is done when the lens in your eye has become cloudy making it difficult for you to see well enough to carry out your usual daily activities. If the cataract is not removed, your vision may stay the same, but it will probably gradually get worse. Waiting for a longer period of time may make the operation more difficult. If you are considering surgery, please let the doctor know if you are taking the following medications: Flomax (Tamsulosin), Doxazosin, Asprin, or any blood thinning drugs like Warfarin, Plavix or Ticlid (Dipyradimole). These medications may need to be stopped before surgery.
You can listen to Dr Fong talking about cataract surgery.
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