Cornea, which is the transparent layer of the eye, is located in front of the coloured layer of the eye and is the most important lens of the eye. The vision loss that occur in corneal diseases may be permanent. Therefore, the diagnosis and treatment of corneal diseases are important in terms of the health of eyes. The corneal diseases are sometimes treated by laser and sometimes by corneal transplantation, along with pharmacotherapy.

The corneal transplantation is the operation of replacing the corneal tissue entirely or partially. While the entire replacement was the application before, with the new techniques, only the affected part may now be replaced. The surgery is operated under general anaesthesia.

Retina is the light-sensitive membranous nerve layer of the eye. There are many important diseases that affects retina. Some basic symptoms such as suddenly starting and repeating photopsies, decreasing vision, visual loss, seeing objects fractured, seeing objects larger or smaller than they actually are, floating specks in front of the eye indicates the existence of a retinal problem.

Common Diseases seen in Retina

• Retinal Decollement (Retinal Detachment)
• Bleeding, oedema and decollements developing due to the vascular diseases of retina such as diabetes and hypertension
• Macula Orifice (Orifice in Yellow Spot)
• Macular Pucker (Epiretinal Membrane)
• Macular Degeneration due to Aging (Yellow Spot)
• Retinal Damage due to Eye Traumas

Retinal Decollement

Laceration in Retina causes the disease called retinal decollement. When the decollement is not treated, it causes permanent visual loss.

What are the symptoms?

• 50% of the patients notices the photopsies. These photopsies are described such as flashes bursting or lightening.
• Black red coloured flying spots are seen.
• The dark shade that starts from the detached retinal area covers the whole eye in time and when the centre of the eye is held, the patient cannot see anything.

Can it be prevented by early response?

In at least 60% of the patients, sudden onset complaints such as photopsy, floating specks or spiders occur during the laceration of retina. When these complaints occur, fundus examination should be done. The laser treatment that will be applied during the occurrence of retinal laceration may prevent the development of retinal decollement. However, in some patients retinal decollement develops despite the laser treatment.

Can it develop with no symptoms?

40% of the cases emerge with visual loss due to decollement, without giving any symptoms.

How is retinal decollement treated?

The first goal of the surgical treatment is to stop the fluid that passes through the laceration by blocking the laceration. The pumping done by pigment epithelial helps the retina to settle. This may be done by various ways.

The most common method used in myopic, hypermetropic and astigmatic treatment and refractive surgery in the world is Excimer Laser technology.

Who can have laser treatment?

• Those over 18 and using glasses or contact lenses,
• Those whose dioptre value did not change over +/- 0.5 dioptre in the recent year,
• Myopic patients with up to -10 dioptre,
• Astigmatic patients up to -6 dioptre,
• Hypermetropic patients up to +5 dioptre,
• Those with sufficient cornea thickness and suitable cornea structure,
• Those who do not have systematic diseases such as Diabetes and Rheumatism,
• Those who do not have any other eye diseases (keratokonus, glaucoma etc.),
•  Those who are not pregnant,
• Those whose eye structure is considered to be suitable for the surgery upon the examination and tests can have the laser treatment.

Pre-assessment for Laser

Our patients who apply to our hospital for the laser treatment are inspected through a detailed ophthalmological examination (gouty – ?) and detailed tests to determine their level of convenience to the surgery. Their level of convenience to the surgery is determined through these and appropriate laser treatment method is advised.

Laser Treatment Methods

Optilasik

With OptiLASIK system which was first applied in Liv Hospital in Turkey, glasses and contact lenses are no longer a problem. The system which consists of the combination of two devices named WaveLight EX500 Excimer Laser and WaveLight FS200 Fetmosecond Laser, is successfully used in healing many eye impairments.

Lasik

This is the method of creating a thin valve named phleb on the upper surface of the cornea layer and restoring the eye dioptres applying excimer laser over the cornea tissue that emerges under this valve.

This method is performed without needle and stitching with topical anaesthesia (drop anaesthetics).

The patient does not feel any pain during or after the operation.

Femtosecond Lasik

This is the name given to the procedure of creating a valve with the help of intralase (femtosecond laser). Femtosecond is the procedure of phleb creation, which is one of the most important phases of laser surgery, under computer control. The advantages of this method are the creation of the phleb, aimed for the treatment, in the desired area, at desired quality and without using a bistoury, and that the risks are low at the phase of procuring the phleb.

Femtosecond Wavefront Laser

Femtosecond wavefront laser method is the customized application of Femtosecond Lasik method (with wavefront technique).

Wavefront Technique (Customized Laser Technology)

It is the laser treatment method performed by transferring the results acquired via customized measurements and by assessments of wavefront analysis devices to excimer laser device, untouched by human hands.

Femtosecond wavefront laser method is the most up-to-date laser technology today and is the combined version of wavefront technology which is the customized treatment.

PRK

It is the method of dioptre correction by applying laser to the area created, after removing the epithelial tissue, which is the membrane tissue on top of the cornea layer, from the surface.

PTK (Corneal Macula / Irregularities’ Treatment)

Corneal Maculas may occur due to some illnesses and eye injuries. In this case, for the removal such maculas, laser application to the eye is performed by the technique called PTK. It is necessary for maculas to be superficial for PTK to be applied. In the cases where maculas are in deeper layers of the cornea, PTK cannot be applied, a corneal transplantation is required.

The Cases where PTK is applied:

• Eye injuries
• Previous cornea infections (cornea catching an infection)
• Genetic cornea diseases called dystrophy
• Recurrent corneal erosion syndrome (the wounds that happened in the cornea due to an injury once, later often reoccurring itself)
• Corneal macula left after pterygium surgery
• Irregularities of the surface of cornea

Points the Patients Should Take into Consideration before the Laser Treatment

• The patient should not use perfume/deodorant before the laser surgery.
• The patient should not wear make-up coming to the surgery.
• If the patient uses contact lenses, these should be taken out a while before coming to examination, if the patient uses soft lenses, the contact lenses should be removed 3 days-1 week before the examination, if it is hard lenses, this time range should be 10 days – 3 weeks.
• The patient should not use blood thinner pills (aspirin etc.) and should not drink alcohol one day prior to the surgery and when coming to the surgery.
• The patient should schedule 3-4 hours on average for the surgery.
• The patients should not drive vehicles to the surgery. If possible, they should have a companion.
• The patients may have their preferably UV protecting sunglasses with themselves not to be disturbed by the light after the surgery.

Points the Patients Should Take into Consideration after the Laser Treatment

• The patient needs to come for the control the 1^st day after the laser treatment.
• The patient does not need his/her eye to be covered after the treatment.
• There are no medications/lotions that patient should use after the treatment.
• The patient should not scrub, itch his/her eye, should not wash his/her face and should not bath in the first 24 hours after the treatment.
• The patient should not wear eye make-up for 1 week after the laser treatment.
• The patient may swim in the sea or pool by 20^th day after the laser treatment.
• The patient may use cosmetic-aimed contact lenses after the surgery, but it is advised to use at least 1 month after the treatment and under doctor control.

This is a disease that causes visual loss by damaging the visual nerve as a result of the increase in intraocular pressure. If it is not noticed and treated, it may even cause permanent blindness. The measurement of eye pressure, corneal thickness and the thickness of the tendons of visual nerves, and visual space examination is very important for the diagnosis. When starting to treatment, various factors such as the status of eye pressure, how much damage was caused are assessed. The treatment starts with the appropriate from the options of pharmacotherapy, laser treatment or surgical operation.

Symptoms

Eye pressure generally does not present any symptoms in the early phase. As the disease develops slowly and as the loss occurs from periphery to centre, the loss in a specific visual space is not noticed. The development of glaucoma can be stopped with early diagnosis. The visual nerve damage that occurred is permanent. For the diagnosis, detailed eye examination and abovementioned tests are required. In a rarely seen version of eye pressure, nausea, vomiting, pain and visual haze may occur. As angle closure constitutes a few of these patients we call eye pressure, such symptoms may not exist in other eye pressure patients.

Factors that increase the risk of Glaucoma

• Advancing Age
• Glaucoma history in the family
• Smoking
• Diabetes
• High Blood Pressure
• Myopia
• Long-term cortisone treatment
• Eye injuries

Diagnosis

Measurement of eye pressure with the devices called tonometer, assessment of visual nerve damage, fundus examination, visual space test and analysis of visual drainage angle, further methods that analyse visual nerve and nerve tendon layer play an important role in the diagnosis of glaucoma and planning of its treatment.

Treatment

The treatment of Glaucoma is done in three ways.

• Pharmacotherapy
• Laser treatment
• Surgical treatment

A large variety of surgical methods are existent. Methods such as opening a way that eases the extra fluid in the eye to be removed, pressuring the creation of eye fluid or draining the fluid in a reservoir tube may be applied.

Oculoplasty
Under-eye bags usually develop as the person ages, but they may also be seen in younger ages. This condition can be corrected with cosmetic eyelid surgery.
This procedure involves removal of excessive skin and fat tissue from lower and upper eyelids. However, the volume of tissue to be removed should be well defined or sometimes, cosmetic surgery requires only transposition. Younger appearance can be gained if the surgery is properly performed.
Oculoplastic surgery is carried out under local anesthetics. The incision is made under the skin fold for the upper eyelid. Therefore, no scar can be seen while eyes are open. The incision for the lower eyelid can be made immediately below the eyelashes. Therefore, no incision scar will be visible. Moreover, the skin of eyelids is characterized with the least scar formation. When a cosmetic surgery is planned for eyelids, other problems that may influence functions of eyelids should be well addressed. For patients with loose or drooping eyelids, such conditions should be eliminated in one session. Otherwise, some postoperative problems can be faced, including but not limited to retracted eyelids, improper position or watery eyes.
If you have concerns about possible hazards to eye although you want to have cosmetic surgery for eyelids and if you want to have your eyes handed to an ophthalmologist, please make an appointment. Prof. Ümit Beden, M.D., will help you to answer all your questions in mind with this significant experience in the field of oculoplasty.

ORBITAL DECOMPRESSION OPERATION

Prof. Dr. Ümit Beden
Ophthalmologist

Some of our patients have bulging eye which arise morphologically or out of thyroid diseases. Orbital decompression operation can be applied to these patients in order to protect eye functions and to establish a better appearance. Orbital decompression is applied to expand orbita. Orbita is a bony structure which contain eyeball, the adjacent muscles and nerves. Since osseus walls are rigid, these walls are not flexible. In case of tumors which cause an increase in the volume of eyes and the adjacent area or in case of thyroid-related ophthalmopathy (Graves), eyeball and eye nerves fall under pressure for osseus walls are not flexible. In such cases, osseus walls of orbita are opened and expanded, and the pressure increase on eye nerves and eyeball are treated thus. Ophthalmic hypertrophy is the best example to be given which frequently develop relevant to thyroid. Muscles and adipose tissues adjacent to eye incur an increase in volume for such patients. The eye is pressed frontward due to the osseus structure of orbita walls and the optic nerves behind commence to be decompressed. The optic nerves incur injury due to decompression if this situation is prolonged. Besides, such patients complain about definite increase in pressure and pain in eye and the surrounding area. In such cases, the pressure on eye and the adjacent area is normalized through expanding orbita with orbital decompression operation. The patients ensure protection against loss of vision with this operation as well as relief from pain and pressure sensation. Detailed tomographies are taken of eyehole and the adjacencies (nasal sinuses) while planning orbital decompression operation. Thereby, the adjacency of eye hole is analyzed and the extent of orbita expansion is determined.
The operation to be performed is made under general anesthesia. The outer wall (ear side) of the eyehole (orbita) is taken out and orbital space is expanded towards temporal area during this operation. Subsequently, the inner wall (nasal side) of orbita is also taken out and orbital space is expanded towards the sinuses around nasal area. In consequence of this procedure, the protruding eyeball will retreat and a natural look will be achieved. Besides, optic nerve which is under risk will be freed from pressure increase and constraint. Orbital decompression is generally applied to the patients who suffer from eye diseases associated with thyroid (Graves ophthalmopathy disease) in which optic nerve is frequently under pressure. Apart from that, this operation can also be required in cases of trauma and accident when optic nerve is under pressure. In many of such patients, orbital decompression constitutes an urgency and the operation must be carried out as soon as possible. Otherwise, optic nerves may incur permanent damage and vision of loss may be caused irremediably. This surgical procedure is performed more frequently compared to the previous years due to its emergency and since the rates of cross eye (20%) and loss of vision (%1-3) which may occur following the operation are decreased to a minimum level. Thereby, orbital decompression operation have become a method used more frequently in the treatment of excessively large eyes apart from emergency cases. Surgical risks are reduced thanks to surgical techniques and medical devices and the application of this operation for cosmetics is rendered possible. For this reason, orbital decompression have become applicable for cosmetic purposes for patients whose eyes have a protruding nature.