Common Treatments
Laser Treatment of the Retina
Laser is a highly focused and concentrated beam of light that is usually performed to decrease leakage in the retina, treat abnormal blood vessel growth, or create a beneficial scarring effect that can help prevent a retinal detachment. Laser treatment is performed in our office, with no hospitalization, and generally requires no special postoperative restrictions. Special eye drops are used to numb the eye (topical anesthesia) to reduce any discomfort during the procedure. Sometimes, an injection of local anesthesia to numb the entire area around the eye is needed.
Intravitreal Injections
Intravitreal Injections are increasingly important for patients with retinal diseases. Many of these treatments are directed at inhibiting Vascular Endothelial Growth Factor (VEGF). Vascular Endothelial Growth Factor (VEGF) is a substance made by cells that stimulates the growth and leakage of abnormal new blood vessels. VEGF plays a large role in the development of wet age-related macular degeneration (AMD) and other retinal vascular diseases. Multiple new treatments for wet age related macular degeneration that block VEGF are now clinically available. These treatments are given as a series of injections into the eye (intravitreal injection). Intravitreal injections are performed in the office, using an anesthetic to minimize patient discomfort and antiseptic to minimize the risk of infection. Patients are able to continue with all normal activities after an injection. In many cases, repeated injections are necessary to achieve the desired effect.
Bevacizumab (Avastin): is an anti-VEGF treatment that is FDA approved for intravenous use in metastatic colon cancer. Due to its similarity to other anti-VEGF agents used in macular degeneration and its widespread availability, Avastin has become commonly used by retina specialists in small doses as an intravitreal injection. Avastin is used in an off-label (non-FDA approved) fashion for treating wet age related macular degeneration, diabetic retinopathy, and retinal vein occlusions. Although mounting evidence has demonstrated the effectiveness and safety of Avastin, further trials are underway to investigate the use of Avastin inside the eye.
Ranibizumab (Lucentis): is the newest and most effective anti-VEGF agent approved by the FDA for the treatment of wet age-related macular degeneration (AMD). In 2 clinical trials, a majority of patients receiving monthly injections of ranibizumab maintained their vision. Moreover, approximately one-third of ranibizumab patients had improvements in vision at 12 months. Lucentis is the first treatment for wet macular degeneration to show an average improvement in visual acuity after one year of treatment in clinical studies.
Triamcinolone acetonide and other corticosteroids: corticosteroids are used throughout medicine, and extensively in ophthalmology. Triamcinolone acetonide (Kenalog ™ or Triesence™) or dexamethasone as an intravitreal injection are sometimes used to help in the treatment of wet age-related macular degeneration; to decrease inflammation; and to decrease swelling of the retina (macular edema) associated with diabetic retinopathy or retinal vascular occlusions.
The physicians at Retina Consultants of Houston have extensive experience with the use of all of the anti-VEGF agents. Clinical trials with anti-VEGF agents are continuing to find new ways to treat devastating retinal diseases.
Vitrectomy
A sophisticated microsurgical technique in which the vitreous gel is removed from inside the eye with a small, specialized cutting device, an operating microscope to look into the eye, and microsurgical instruments. The vitreous gel is then replaced with a clear saline fluid. Vitrectomy is performed for many conditions including retinal detachment, diabetic retinopathy, macular pucker or hole, hemorrhage or infection inside the eye, and ocular trauma. Vitrectomy is usually performed under local anesthesia. All RCH physicians are now using a minimally-invasive, small gauge no-suture vitrectomy technique.
Scleral Buckle
A special plastic material is placed around the outside to help close off (or "buckle") retinal tears in patients with a retinal detachment. We also have specialized equipment that enables us to repair certain retinal detachments in the office without the need for hospitalization or scleral buckling.
Photodynamic Therapy
Photodynamic therapy (PDT) is a treatment for some forms of wet macular degeneration. It involves the injection of the FDA-approved drug, Visudyne™, into the bloodstream, followed by a brief laser treatment. The low energy laser (sometimes referred to as a ‘cold laser’) activates the drug which helps shrink blood vessels, tumors, and leakage. This procedure is performed in our main office in the Texas Medical Center.