Portfolio of services

As human tissue, the amnion can be used in ophthalmology for the treatment of the cornea and conjunctiva, namely

• as a graft (transplant) where there is loss of cornea tissue (deep tumour) or to replace the conjunctiva in cases of major loss of conjunctiva tissue (e.g. due to injuries, chemical burns or tumour removal).
• as a patch (biological dressing), among other things to suppress inflammation and to prevent the formation of scars following chemical burns, for scar-forming conjunctiva diseases and to support healing of the cornea.
• as a sandwich (combining the two methods above). The amnion can be used in transplants to replace lost cornea tissue in cases of cornea tumours. In this transplant procedure as well, the amniotic membrane is stitched on as a dressing in order to encourage wound closure and healing.

Glaucoma surgery

Our clinic performs various surgical techniques to lower the intraocular pressure, including:

Trabeculectomy

This is the actual 'fistulating' procedure in which a small part of the trabecula (the point where the intraocular fluid flows out) is surgically removed (trepanning). The intraocular fluid can therefore flow out directly below the conjunctiva and hence lower the inner pressure of the eye.

Cyclophotocoagulation

Cyclophotocoagulation differs from the first method in that the formation of intraocular fluid is reduced, instead of inducing its outflow. This is performed by means of a special laser treatment of the ciliary body (the point in the eye that produces the intraocular fluid). This procedure does not require any surgery on the eye itself and can be performed externally by applying a laser probe. It does involve the destruction of productive tissue, however, so this technique is usually selected for cases in which the surgery described above fails or there are reasons to assume that it would not be successful.

Basal iridectomy

Basal iridectomy is a surgical procedure that involves creating an aperture, usually in the upper section of the iris.

The intervention is performed via a small opening on the border of the cornea. The hole in the peripheral iris enables direct outflow from the posterior chamber of the intraocular fluid circulating in the eye and inflow into the anterior chamber. The purpose here is to move the iridocorneal angle among patients with narrow angle glaucoma and hence to prevent an acute attack of angle closure. Iridectomy is usually performed under local anaesthetic and generally takes only a few minutes.

Some diseases of the cornea prevent us from using conservative means (drops, surface treatments) to help patients. In most cases a variety of illnesses will have clouded the cornea to such an extent that clear eyesight is no longer possible and the patient therefore experiences significantly blurred vision.
But where the eye is otherwise healthy, so that the opaque cornea is the only thing preventing clear vision, we can help the patients by 'planting' a donor cornea using perforating keratoplasty. This involves cutting out a circular part of the old, clouded cornea and replacing it with a slice of donor cornea in a matching shape.

This is a treatment method that involves administering various medications into the inside of the eye; it is usually performed as outpatient surgery. It allows us to directly treat the diseased tissue (retina or choroid) located within the eye over a longer period. The location of this tissue in the intraocular space makes it otherwise largely inaccessible for medication. At present, this treatment method is mainly used for

• age-associated macular degeneration (wet AMD)
• retinal damage caused by pathological vascular processes (e.g. venal thrombosis, vascular malformation)
• retinal damage caused by diabetes
• swelling in the area with the most acute vision (macula)

Until just a few years ago, influencing the progression of these conditions was impossible or largely impossible. Now, through the administration of intravitreal medication, not only is it possible to stabilise the findings, but in many cases also to noticeably improve the eyesight of many patients.
The procedure lasts only a few minutes. Usually a local anaesthetic will be administered to the eye. For a short time afterwards, the patient will see small round shadows (air bubbles) that disappear by themselves quite quickly. The method may also lead to a temporary increase or lowering of the intraocular pressure, as well as to minor haemorrhaging, but these symptoms are harmless and disappear by themselves. Although extremely rare, severe complications are possible and are thoroughly discussed with the patient prior to injection.

Cataract surgery is doubtless among the most frequently performed procedures in modern ophthalmology. Depending on the indication and after consulting with the patient and the attending ophthalmologist, we remove the opaque lens (cataract) either in an inpatient or outpatient setting.
Outpatient means that the person comes to the clinic in the morning of the surgery and is usually able to leave again in the afternoon, two hours after the operation. In most cases postoperative treatment will be assigned to the attending ophthalmologist after one check-up at the Eye Clinic.
We will include special lenses (compensation of defective vision, also multi-focal lenses) for the treatment of cataracts in the near future.

Surgery

We use the state-of-the-art procedure to remove opaque lens on most of our patients, namely phacoemulsification (ultrasound technology is applied to break up the lens). In addition, we use what is currently the most progressive form of small incision surgery, the clear cornea technique, in which the lens is removed through a very small (just 2.8 mm) cut and then a folding, artificial lens is inserted through the same opening. This minimises the trauma for the eye, and the patient very quickly acquires more acute vision after the procedure.
One of the benefits associated with the modern surgical technique is that it can also be performed with drops as anaesthetic, so without the need for an injection.

Procedure for outpatient treatment

After receiving the hospital referral, the Eye Clinic writes to the patient with an appointment for a preliminary examination. This is used to obtain findings, biometric data to measure the necessary lens thickness and to inform the patient. The patient is given Floxal drops to apply to both eyes the day before surgery.
The patient is also informed of the surgery appointment and precise time. After surgery, the patient receives two hours of aftercare and can then return home. Before discharge, eye drops are given for use at home.
In most cases the patient will return to the clinic the next day for a follow-up examination, although it can also be performed by the attending ophthalmologist in an outpatient setting in exceptional cases. This depends on surgery outcome, the patient's place of residence, wishes and not least on the opinion of the referring ophthalmologist, who is naturally responsible for post-surgical treatment as well.

Retinal damage

Holes or tears in the retina may ultimately cause it to detach. To prevent this, a laser device is directed at the affected areas to bond the retina to the underlying layer of the eye. Once the effects of the laser have healed, the penetration of water below the retina is stopped, which prevents it from becoming detached.

Diabetes-related retinal changes

Diabetes mellitus can have very serious effects on the retina of the eye and hence on the patient's vision and may, in the worst case scenario, lead to blindness. This is why diabetes patients must attend regular check-ups with an ophthalmologist to detect and suitably treat any relevant changes as early as possible. Laser treatment is the most important method used for diabetic retinal changes (also diabetic retinopathy). Depending on where the changes are located, it involves applying the laser either to the entire retina or only to the specific section with the most acute vision (the macula). Doing so prevents the formation of new vessels or causes them to regress. It is also a method of deliberately reducing accumulations of fluid, which stabilises and in some cases improves the central acuity of vision.

Cataract aftercare

Once the artificial lens has been implanted, it is possible that an unwanted tissue membrane may form on the remaining capsular sac. The laser beam can be used to open the opaque posterior lens capsule.

Lachrymal fluid is produced in the tear duct. Blinking spreads the lachrymal fluid across the eye to ensure continuous moistness. The lachrymal drainage systems start at the inner corner of the lid. They consist of the upper and lower lachrymal points and ducts, the lachrymal sac and the naso-lachrymal duct. Narrowing or complete occlusion of the lachrymal drainage system can be a congenital condition. But mostly it develops over the course of life and is caused by inflammations of the conjunctiva and lachrymal sac, or alternatively by infections of the nose and sinuses. Narrowing or occlusion of the lachrymal drainage system will cause a persistent, often very annoying flow of tears. We perform a variety of measures to restore normal lachrymal drainage. Mostly we use irrigation, probes and lachrymal drainage system splints.
A common, essential feature of all interventions is that the anatomy of the outflow system must be preserved. When lachrymal drainage system splints are used, small silicon tubes are inserted carefully into the channels, where they remain for a few weeks until a normal flow of tears has been restored. If the lachrymal sac is completely blocked due to a persistent inflammation, it is also possible to perform surgery according to the Toti method, which involves creating an artificial outflow for lachrymal fluid leading from the lachrymal sac to the nasal cavity.

Retinal and vitreous body surgery (pars plana vitrectomy) is used to treat several diseases affecting the retina and the vitreous body of the eye. Vitrectomy means surgical removal of the vitreous body. The term 'pars plana' describes the position (around 3.5 mm behind the edge of the cornea) that is used as an entry point to introduce instruments into the eye. The surgeon can then manipulate the retina and remove pathological changes.
We also perform conventional laser therapy in addition to surgical treatment of retinal and vitreous body diseases. Our clinic injects medication into the eye itself (IVOM) as a minimally invasive surgical interventions for the treatment of age-associated macular degeneration (AMD), diabetic retinopathy and retinal changes following vascular occlusion.

Surgical procedure

To prevent the eye from collapsing when extracting the vitreous body, fluid is constantly introduced into the eye by means of a mini-infusion and a less than 1 mm opening in the wall of the eye. Other, also small openings are used to insert the instruments into the eye, to illuminate the vitreous body cavity, to extract the vitreous body and to treat the retina, e.g. using laser, slender tweezers, scissors or similar. In order to ensure that these instruments are introduced carefully into the eye, we use small tubes to bridge the wall of the eye, which can also be used to illuminate the interior of the eye. The tiny openings disappear behind the conjunctiva after the operation and are only noticed by the patient for a short time or not at all. The vitreous body substance, which on average measures 6 ml, is replaced during extraction by a solution which is then added to or replaced by fluid that forms in the eye itself. In some cases, gases or oil are added to replace the vitreous body so as to promote the healing process in the eye.

Are complications possible?

There is no such thing as surgery without a risk. However, not only are the risks low, they are – above all – less significant than the risks that must otherwise be expected if the diseased eye is not properly treated. Among the most important aspects is to make every effort to prevent infection and to keep the inflammatory reactions that inevitably occur after surgery within a reasonable extent. This applies to the surgery itself, as well as to the first few days after intervention. Measures must be taken one or several times each day to prevent an infection of the eye following surgery. Behavioural rules in regard to hygiene after surgery, the limits of stress exposure and head posture during the day and at night are given to the patient to reflect their personal situation. It is absolutely vital that the patient cooperates during the first few days after surgery in order to ensure a successful outcome. Apart from infections, severe (e.g. retinal detachment) or mild (e.g. slight haemorrhaging or increase in the intraocular pressure) complications are possible, which in extremely rare cases can lead to the loss of the eye, although mostly they can be corrected quite easily.

Retina surgery hours

It is only possible to tell whether surgical treatment will be necessary and which method is indicated after a thorough examination by the ophthalmologist, which gives due consideration to the personal situation of each patient. Our clinic offers retina surgery hours (Mondays and Wednesdays, 9:00 am – 2:30 pm).

Corrective procedures for squints

Squint surgery is frequently performed for aesthetic reasons. In certain cases, a surgical procedure can enable spatial vision with both eyes.
The procedure is conducted on the muscle controlling the misaligned eye in most instances. But sometimes it is necessary to operate on both eyes.

Surgical procedure

The operation is performed on children under general anaesthetic, but a local anaesthetic is sufficient for adults. It exposes the muscles that are responsible for the squint. The misalignment is corrected by extending or shortening these muscles. The eye itself is not opened during corrective surgery on a squint.
In over 90% of cases, one or several squint surgery procedures will produce a satisfactory aesthetic outcome.