Cataract surgery, Phacoemulsification method, and “YAG laser” in necessary cases are performed in our department.

Refractive surgery deals with the diagnosis and treatment of corneal diseases which is the transparent front part of the eye.

There are topography devices that can make a precise measurement of this layer, corneal thickness measurement instruments, specular microscopy, keratometers that display corneal diameter and refractive power in this department.

In the Department of Ophthalmology, refractive errors are corrected with the excimer laser, and corneal transplant (keratoplasty) surgeries are also performed. Organ transplantation is performed when a suitable donor is found.

Cosmetic eyelid and lacrimal drainage surgeries are performed in eye centers.   

Argon laser, fundus fluorescein, and indocyanine green angiography devices are available and retinal detachment and vitrectomy surgeries are performed in Ophthalmology departments.

There are topography devices that can make precise measurements of the corneal layer, corneal thickness measurement instruments, specular microscopy, keratometers that display corneal diameter and refractive power, and the refractive errors are corrected with the excimer laser.

Selection of contact lenses, providing information on their correct uses and making an application are carried out.

Eye laser surgery and laser or intraocular lens method to be chosen are decided following a detailed eye examination. In this examination, a detailed corneal examination is also performed where several factors such as corneal thickness and shape are evaluated.

Eye laser surgeries are performed with Femto LASIK and Excimer LASER devices.

Strabismus (cross-eye) is a condition in which the conjugate gaze of the eyes is impaired.

There may be inward or outward turning as well as up and down turning. Turnings can be roughly related to the paralysis of the eye muscles, or they can be classified as congenital turnings and others.

Elevated intraocular pressure.

If there is a need for eyeglasses when amblyopia is recognized, it is required to wear eyeglasses. In addition to eyeglasses, closure and orthoptic treatments are also performed.

Cataract is the opacification of the natural lens of the eye by losing its transparency and thus, preventing its vision.

• Congenitally in newborn babies,
• In diabetic patients Due to high blood sugar,
• In patients who take cortisone medication for a long time or
• Also after traumas to the eye.

• A gradual decrease in vision
• Vision fading of images and colors
• Deterioration of night vision
• Difficulty in reading
• Frequent change in eye prescription
• Diplopia
• The patients with nuclear cataracts say that they can see up close better. But this good vision is temporary and as the cataract continues to harden, near vision is also impaired.

A detailed eye examination is required for diagnosis. During the examination, visual acuity is measured and the pupil is enlarged with drops to examine the natural lens and the fundus oculi.

The treatment of cataracts is surgery. It cannot be treated with medication or eyeglasses.

The “Phacoemulsification (PHACO)” method is used in cataract surgery. In this method, the cataractous lens is broken up and taken out of the eye with ultrasound energy.

When the PHACO technique is used together with the Femtosecond laser method, this process is called “Femto – PHACO”.

Surgery Application

The surgery is performed with eye drops and sedation. The operation takes about 15-20 minutes. First, incisions are made. Then, the cataractous lens is cleaned by breaking up with PHACO and an artificial lens is inserted into the eye. If a Femtosecond laser will be used during the operation, the incisions to the eye and softening of the lens are performed with a Femtosecond laser.

Risks

The complications such as perforation of the cataractous lens capsule and falling of cataract pieces into the eye may arise during surgery. In this case, the pieces that fall into the eye are cleaned within the same session or in a second operation.

After the operation, complications such as infection of the eye (endophthalmitis), retinal detachment (decomposition in the nerve layer), corneal edema (swelling of the transparent layer), and macular edema may arise.

Preparation for Surgery

Continue to take your usual medication and eye drops before the surgery.

Postoperative

An eye examination is done on the next day of the surgery. The eye drops you will use for one month are prescribed by our ophthalmologists. 1 week after the surgery, an eye examination is done again. 1 month after the surgery, an eyeglass examination is done when necessary.

If a far-near smart lens (trifocal lens) is implanted into the eye, there is no need to wear eyeglasses. However, if only a far lens is implanted into the eye, wearing eyeglasses for near (reading) is required.

No matter what type of lens is implanted into the eye, there is no 100% guarantee that the diopter value will be zero. Usually, 80-90% do not need eyeglasses.

• Use the eye drops prescribed after surgery regularly,
• Wash your hands before dripping the drops.
• Don’t rub your eyes during the first week.
• While washing hair, don’t let dirty and foamy water flowing from the hair touch your eyes.
• Don’t lift heavy things in the first week.
• If severe pain and burring occur in the eye in the first week, consult an ophthalmologist urgently.

If we treat the eye as a round sphere, its front is formed by the glazy transparent layer (cornea) and the iris which determines the color of the eye. A transparent gel structure we call “vitreus” fills the area behind the iris layer, which determines the color of the eye, or the inside of the sphere.

The retina is a very thin (about 0.2 mm) layer at the thickness of a paper that covers the interior wall of this sphere just like a wallpaper.

The retina layer consists of millions of nerve cells that enable us to see and perceive the light entering the eye. The light perception of these cells is conveyed from the retina to the visual cortex in the brain by the (optic nerve).

We can say that the retina, optic nerve, and brain are the continuation of each other. When the nerve cells in the retina are entirely damaged and cannot perceive light, the nerve cells do not reproduce again. In other words, permanent nerve damage leads to a permanent loss of our vision.

As the nerve cells in the retina work very fast, they must be fed with the vessels, and herein, they are fed both from the vessels inside the retina and from the choroid outside the retina.

Let’s compare retinal nerve cells to the pixels of a cell phone. Just as when the screen of the cell phone is damaged, that area looks black and the shape cannot appear, the person sees the damaged area in the retina as dark, dull, blurry, or very dark black.

Early detection of retinal damage and timely treatment by eye surgeons specialized in the retina (such as eye drops, intraocular drug applications, laser treatments, photodynamic treatment, vitreoretinal surgeries) are very important to prevent irrevocable loss.

The yellow spot or the area we call the “macular” medically are cells of approximately 1 mm at the exact center of the retina layer where the light entering the eye focuses. It is the sharp visual cortex of the eye. With the cells here, we select the detail where we look, read the letters and perceive the colors.

In the case of entire damage of this spot, the person can have a clear view of up to five percent. The person cannot choose the exact center of the place looked at. For example, when the person looks at a friend’s face, he can see his hair but cannot recognize his face.

There may be impairment in the nerve cells of the retina or the vessels that feed it. The causes of these deteriorations may vary depending on the age of the person. Retinal and nourishing vascular layers may also be affected by other diseases in the body.

• Age-related degeneration, bleeding, fluid accumulation in the yellow spot (age-related macular degeneration)
• Areas prone to thin tear in the retina (degeneration), tear in the retina, detachment of the retinal layer and aeration towards inside of the eye (retinal detachment),
• Retinal hemorrhages, edema at the yellow spot, retraction, bleeding into the eyeball hollow, internal contraction and aeration of the retina (detachment), specifically in people whose diabetes is not well controlled,
• Retinal hemorrhages, occlusion of the nutrient artery or veins that carry venous blood, bleeding due to systemic hypertension,
• Puncture, membrane formation, contraction, and edema at the yellow spot, which develops due to the defects in the area between the yellow spot and the gel,
• Fluid accumulation in the yellow spot for various reasons,
• Tear in the retina and other layers as a result of blunt or penetrative impacts, retinal detachment, bleeding into the gel, presence of a foreign body in the eye, intraocular infection, injury of the eye lens and its detachment, and falling into the intraocular space,
• Bleeding due to the inability of the retinal vessels to develop normally in premature babies and retinal detachments that can progress to eye loss,
• Diseases that show a similar genetic transition and show progressive damage to retinal cells over the years, most commonly known as “night blindness” (retinitis pigmentosa),
• Less commonly, benign and malignant tumors of the retina or vascular layer, metastases due to other cancers in the body.

The person should test the near and far vision quality of his eye by closing one eye. If we look with both eyes, we may notice the reduced vision in one eye much later.

The simplest self-control we can do would be to evaluate the visual clarity of both eyes separately by selecting an object and distance and closing one eye in turn.

If one of the following symptoms of retinal diseases is present in far or near vision, consult an ophthalmologist without any delay.

• Blurred vision,
• Blurred/dark vision at the exact center,
• Blurred/curtain-like/dull vision while looking at a place,
• Inability to choose color tones well, a difference between two eyes,
• Seeing straight lines you are looking at, lines while reading, places such as far doors and window ledges as curved, moving, or broken,
• Feeling flashes of light in the eye when there is no light in the dark,
• Stains, strands, and various shapes that suddenly appear in front of the eyes.

The person can roughly control himself by making the test, which we call the Amsler chart consisting of small squares in equal size, separately.

For this, the person wears reading eyeglasses if worn or checks whether or not he sees all the square lines properly and there are dark areas, by looking at a point at the exact center in such a way that he sees the near most clearly, according to his age (which can be without eyeglasses in myopia). This test is specifically the test of yellow spot and does not evaluate other retinal areas.

If you have the aforesaid complaints in your vision when you do the Amsler Chart Test or when you check your eyes separately with far and near shapes, consult your retinal ophthalmologist without any delay:

The treatment of retinal diseases may vary from person to person and the time of treatment, as they have a wide variety of disorders.

Basic options:

Eye drop,
Application of drugs inside the eyeball:

It is a treatment option that we use frequently. It is specifically applied in age-related macular degeneration when edema occurs in the yellow spot due to miscellaneous diseases. Since the drug enters directly into the eye gel, its effect on the retina becomes much earlier and more effective. The drugs are effective in the eye for about a month. Repetition may be required.

Argon laser photocoagulation:

It is used in many retinal diseases such as diabetes, vascular occlusions.

How is it applied?

The patient sits in a device-like chair for examination by light. The eye is anesthetized with drops. With a lens, laser light is focused on the retina and the patient only hears the sound. It does not feel any suffering and pain. The operation is usually completed in 10-20 minutes and the patient leaves the hospital without closing eyes. The person can continue routine life that day. He cannot have a clear view for a few hours since his pupil is enlarged just before the operation.

Photodynamic treatment:

It is similar to laser application. Since intraocular drug applications are much more effective today, their application has decreased. When necessary, a drug is administered intravenously and a cold laser is applied. It is expected to affect the underlying vascular tissue without damaging the retina. After the application, the patient should protect his eyes and other open areas of the body from light for 48 hours. The patient is given protective eyeglasses.

Retina Surgery or Vitreoretinal Surgery (Vitrectomy, Microsurgery technique):

Retinal surgeries are performed by eye surgeons who undergo training specifically in these surgical techniques. The ophthalmologist should specialize in retinal surgery after standard eye training.

The information concerning the technique to be applied and how soon the surgery should be performed is explained to the patient by the retina doctor.

It may be required in many retinal diseases. Specifically, retinal detachment, intraocular hemorrhages, hole in the yellow spot, membrane formation, contraction, and accordingly edema, retinal retraction due to uncontrolled diabetes, and damage due to eye traumas are the prominent causes.

It is performed under general or local anesthesia in operating room conditions. The techniques can be listed as follows:

a. Vitreoretinal Surgery (Vitrectomy, Microsurgery technique):

It is the technique we most frequently use. Vitrectomy surgery is performed in a closed system like laparoscopic surgeries which are performed inside the abdomen. By entering the eye at 3 points from the white area around the eye (conjunctiva) through cannulas, the problems in the eye gel and retina are eliminated, the retina is brought to where it should be, the microscopic membranes on the retinal surface are peeled off, and argon laser is applied when necessary. The cannulas we use in vitrectomy are approximately 0.5 mm thick.

At the end of this surgery, sometimes only liquid and sometimes air or gas, and in some cases, liquid silicone oil is left in the eye. Detailed directions are given to the patient before the surgery. If the patient has a cataract or is technically necessary for the success of vitrectomy surgery, cataract surgery can be added in the same session.

b. Cerclage, Buckling Technique:

It is the surgical technique that we apply to the eye from the outside. In some eyes, it can also be performed in addition to vitrectomy surgery as occasion requires.

Thin strips made of silicone (usually 3-5 mm thick) are placed under the eye muscles to remain under the conjunctiva layer covering the white of the eye.

By applying external pressure to the eye, the retina is settled. It is applied together with either Argon laser or cryotherapy (permanent adhesion is created with cold application).

c. Pneumatic Retinopexy (Intraocular gas injection):

This is the technique that we usually use the least. Because the case where this technique will be successful is not seen frequently.

In eyes with torn retinal detachment, gas is injected into the eye in the early period and its settlement into the retina is ensured by resting the patient in an appropriate position. Afterward, argon laser treatment is applied.

Sometimes, in case of bleeding in the yellow spot, gas is injected into the eye to detract the bleeding from this area.

Before the operation, detailed information is given to the patient about the post-operative condition.

• In cases where gas or silicone oil is applied into the eye, it may be required to lie/sit face downwards for the period prescribed by the surgeon (varying from 1 day to 2 weeks).
• Just like after cataract surgery, the patient uses eyedrops gradually decreasingly for a month.
• The first week is a particularly important time to prevent the eye from catching an infection. It is very important not to be in very crowded, dusty, dirty environments, not to touch the eyes, not to rub them, and to keep them clean.
• In general, it is ideal to take one week's leave and rest in the first week after the surgery. This period may vary depending on the severity of the disease.
• When air/gas is left in the eye, it is prohibited to travel to high altitudes such as mountains or to travel by plane. Seek medical attention from a surgeon.
• In the first month after the surgery, it is beneficial to avoid strenuous activities such as heavy exercises, lifting weights, bending before frequently, straining, and severe coughing.

The level of vision varies according to the cause of the disease. Your doctor will give you detailed directors about this.