Cyclodiode Laser Treatment

The diode laser is a highly concentrated beam of light, which can be used to target and treat a selected area. Sometimes, laser treatment is recommended in order to avoid or delay the need for more invasive surgery. The diode laser is used to produce very small burns in the ciliary body, which produces the watery fluid called aqueous humour, and is situated behind the iris (coloured part of your eye). The reduced production of aqueous humour causes the eye pressure to fall.

Vitrectomy Surgery

A vitrectomy surgery is microsurgery performed to remove the jelly and replace it by a saline solution, gas or a special type of silicone oil. The most common reasons for operating on the retina are retinal detachment, diabetes and scarring on the retina.
For more information about vitrectomy surgery in Dubai, contact us today.

Squint Surgery in Adults

This information aims to answer some of the questions you may have about squint surgery. However, it does not cover everything as every patient and squint is different. Your surgeon will discuss your particular case with you. Please ask the clinical staff about anything you want to be made clear.

What is the aim of surgery?

  • To improve the alignment of the eyes, to make the squint smaller in size.
  • In some patients, to reduce or try to eliminate double vision.
  • Occasionally to improve an abnormal position of the head.

How is the surgery done?

Squint surgery is a very common eye operation. It usually involves tightening or moving one or more of the outside eye muscles which move the eye. These muscles are attached quite close to the front of the eye under the conjunctiva, the clear surface layer. The eye is never taken out of the socket during surgery. Stitches are used to attach the muscles in their new positions.
Squint surgery is nearly always a day case procedure so you should be in and out of hospital on the same day.
There are two kinds of squint operation – adjustable and non-adjustable:

Non adjustable surgery

The operation is usually carried out under general anaesthetic. The operation usually takes up to 60 minutes depending on the number of muscles that need surgery. When you have recovered from the anaesthetic and the nurses are happy for you to be discharged, you are free to go home – usually a few hours later.

Adjustable surgery

Squint surgery using an adjustable suture may give a better result in certain types of squint e.g. patients who have had a squint operation before, patients with a squint due to injury or patients with thyroid eye problems.

Part 1 – The main operation

The main part of the operation is carried out in the operating theatre usually under general anaesthetic (with you asleep).

Part 2 – Adjusting the stitch

Once you have woken up from the anesthetic the final position of the muscles is adjusted when you are awake and able to look at a target. This is particularly useful for treating double vision. If you wear glasses for distance or near, these will need to be brought in with you for this part of the operation. Adjustment is usually done on the ward, after drops of anaesthetic have been put into the eye to take away any pain. You may however feel a pressure sensation.

Before the day of surgery

A pre-assessment is performed in the weeks leading up to the operation date.

What happens on the day of surgery?

You will be asked to come early so that you can be prepared for surgery. You should not drink or eat before the operation: the exact timings of this will be given before the day of the operation. Before being discharged after the operation, you will receive eye drops with instructions and a follow up appointment.

Does the surgery cure the squint?

Overall about 90% patients feel some improvement in their squint after surgery. The amount of correction that is right for one patient may be too much or too little for another with exactly the same size squint, so that the squint may not be completely corrected by the operation. Although the eyes may be straight just after surgery, many patients require more than one operation in their lifetime. If the squint returns it may drift in either the same or opposite direction. We can’t predict when that drift may occur.

What are the risks of the operation?

Squint surgery is generally a safe procedure. However, as with any operation, complications can and do occur. Generally these are relatively minor but on rare occasions they may be serious.

  • Under and overcorrection

As the results of squint surgery are not completely predictable, the original squint may still be present (undercorrection) or the squint direction may change over (overcorrection). Occasionally a different type of squint may occur. These problems may require another operation.

  • Double vision

You may experience double vision after surgery, as your brain adjusts to the new position of the eyes. This is common and often settles in days or weeks but may take months to improve. Some patients may continue to experience double vision when they look to the side in order to achieve a good effect when the eyes look straight ahead. Rarely, double vision whilst looking straight ahead can be permanent in which case further treatment might be needed. If you already experience double vision, you might experience a different type of double vision after surgery. Botulinum toxin injections are sometimes performed before surgery to assess your risk of this.

  • Allergy/stitches

Some patients may have a mild allergic reaction to the medication they have been prescribed after surgery. This results in itching/irritation and some redness and puffiness of the eyelids. It usually settles very quickly when the drops are stopped. You may develop an infection or abscess around the stitches. This is more likely to occur if you go swimming within the first four weeks after surgery. A cyst can develop over the site of the stitches, which occasionally needs further surgery to remove it.

  • Redness

The redness in the eye can take as long as 3 months to go away. Occasionally the eye does not completely return to its normal colour, particularly with repeated operations.

  • Scarring

Most of the scarring of the conjunctiva (skin of the eye) is not noticeable by three months, but occasionally visible scars will remain, especially with repeat operations.

  • Lost or slipped muscle

Rarely one of the eye muscles may slip back from its new position during the operation or shortly afterwards. If this occurs, the eye is less able to move around and, if severe, further surgery can be required. Sometimes it is not possible to correct this. The risk of slipped muscle requiring further surgery is about 1 in 1,000.

  • Needle penetration

If the stitches are too deep or the white of the eye is thin, a small hole in the eye may occur, which may require antibiotic treatment and possibly some laser treatment to seal the puncture site. Depending on the location of the hole, the sight may be affected. The risk of the needle passing too deeply is about 2%.

  • Anterior segment ischaemia

The blood circulation to the front of the eye can very rarely be reduced following surgery, producing a dilated pupil and blurred vision. This usually only occurs in patients who have had multiple surgeries. The risk is about 1 in 13,000 cases.

  • Infection

Infection is a rare complication but the risk  increases if drops are not instilled as directed and treatment not sought promptly. Significant infection is extremely rare but in the worst cases can cause loss of vision or the eye (endophthalmitis, orbital cellulitis).

  • Loss of vision

Although very rare, loss of vision in the eye being operated can occur from this surgery. Risk of serious damage to the eye or vision is approximately 1 in 30,000.

  • Anaesthetic risks

Anaesthetics are usually safe but there are small and potentially serious risks. Unpredictable reactions occur in around 1 in 20,000 cases and unfortunately death in around 1 in 100,000.
Remember: these complications are detailed for your information and that the vast majority of people have no significant problems. After the operation the eye(s) will be swollen, red and sore and the vision may be blurry. The eye may be quite painful.
Start the drops you have been prescribed that evening, and painkillers such as paracetamol and ibuprofen can be taken. The pain usually wears off within a few days. The redness and discomfort can last for up to 3 months particularly with adjustable and repeat squint operations.
You should not sign any legal documents or drive for 48 hours after the general anaesthetic.
We would advise that you may need one or occasionally two weeks off work. Work and normal activities including sport can be resumed as soon as you feel comfortable to do so. It is quite safe to use the eyes for visual tasks, for example reading, watching television. You should return for follow up as advised.

Summary of care after the operation

  • Use the eye drops
  • Use painkillers such as paracetamol and ibuprofen if the eyes are painful
  • Use cooled boiled water and a clean tissue or cotton wool to clean any stickiness of the eyes and avoid water entering the eyes from the bath or shower for the first two weeks
  • Don’t rub the eye(s) as this may loosen the stitches
  • No swimming for 4 weeks
  • Attend the postop clinic appointment
  • Continue using glasses if you have them
  • Avoid contact lens wear in the operated eye(s) until advised it is safe by the doctor or orthoptist

Selective Laser Trabeculoplasty

Selective Laser Trabeculoplasty (SLT) is a procedure used to reduce the pressure in the eye (also known as intra-ocular pressure). A laser beam is applied to the drainage channels, which helps to unclog them. This means the aqeous humour flows through the channels better, reducing the pressure in the eye. This is not a permanent treatment, and may need to be repeated in the future to control the eye pressures adequately. The procedure does not require admission to hospital and is carried out in the outpatients department.

Refractive Surgery

Most refractive errors can be corrected (or at least improved) by means of Refractive Surgery. This is a generic term, which comprises both Laser Refractive Surgery and correction by means of lens implants inside the eye. The latter is called Phakic intraocular lens (IOL) surgery.
Most refractive errors can be corrected (or at least improved) by means of Refractive Surgery. This is a generic term, which comprises both Laser Refractive Surgery and correction by means of lens implants inside the eye.

Presbyopia

Presbyopia is a vision condition which makes it difficult to focus on close objects. During middle age, usually beginning in the 40s, people experience blurred vision at near points, such as when reading, sewing or working at the computer.
Presbyopia is a natural part of the ageing process of the eye. It is not a disease, and it cannot be prevented. Presbyopia is diagnosed with a routine eye examination. Eyeglasses with bifocal or progressive addition lenses are the most common correction for presbyopia.

Posterior Vitreous Detachment

PVD is a common degenerative change, which affects one or both eyes in many people after middle age. It may present earlier in shortsighted patients or those who have sustained traumas to the eyes.
Thickening of the jelly casts shadows on the retina and are seen as floating shapes. These black “floaters”in your vision move with the eye and then settle as the eye rests. These are often described by patients as a “cobweb” or “insects”.
You may also be aware of flashing lights, like little flickers in the outer periphery. Usually these do not highlight a problem, however, it is important to have the eye thoroughly checked, as occasionally a retinal tear or a retinal detachment may occur.

Post-Operative Instructions

Following Retinal Surgery on leaving the hospital you are advised to have a quiet evening at home and to avoid strenuous exercise.
For General Anaesthetic patients, as above and:

  • Do not drive a vehicle
  • Do not make any crucial financial decision
  • Do not eat heavy meals or drink alcohol for 24 hours after being discharged

Myopia

Myopia is a common refractive condition which causes individuals to be near-sighted: they see near objects clearly but distant objects are blurry. Myopia occurs when the cornea and lens focus the light in front of the retina instead of exactly on it. Symptoms of myopia include; difficulty seeing distant objects, squinting frequently, holding books or other objects very close to the face, difficulty seeing writing on signs or watching television and difficulty with driving (particularly at night). Myopia should be diagnosed by a qualified Optometrist, Ophthalmic Surgeon or Eye Specialist. Myopia is best treated with eyeglasses or contact lenses which compensate for the elongated shape of the eye allowing the light to focus properly on the retina. Refractive surgery is another option that eliminates dependence on glasses or contact lenses.

Corneal Transplantation (PK)

Why do you need a corneal transplant?

The cornea is a window of transparent tissue at the front of the eyeball. It allows light to pass into the eye and provides focus so that images can be seen. Various diseases or injury can make the cornea either cloudy or out of shape. This prevents the normal passage of light and affects vision.
A cloudy cornea can be replaced by a healthy one from a donor to restore vision.If the full thickness of the cornea is affected by disease, then a full thickness transplant is performed. This is known as a penetrating keratoplasty.

Benefits of penetrating keratoplasty

Improved vision

  • Approximately 75% of transplant recipients have vision sufficient to drive legally but may need glasses or contact lenses or sometimes further surgery for best results.
  • It may take up to 18 months until the full improvement in vision is appreciated.

Risks of penetrating keratoplasty

Rare but serious complications

  • Sight-threatening infection (1 in 1,000)
  • Severe haemorrhage causing loss of vision
  • Retinal detachment
  • Severe inflammation or other rare causes of loss of vision

Corneal transplant rejection
A corneal transplant can be identified and attacked by your immune system. This happens in one in six patients in the first two years after transplantation and can cause graft failure. It can often be reversed if anti-rejection medication is started promptly.
Rejection remains a possibility for your lifetime.
Graft failure
When a graft fails, your cornea becomes cloudy again and your vision becomes blurred. This happens in one in 10 transplants for keratoconus in the first 10 years.
Glaucoma
This can usually be controlled by eye drops, but occasionally requires surgery and can damage the sight.
Cataract
This can be removed surgically.

About the operation

The operation
The operation is performed under general or local anaesthetic. The operation takes about one hour. A central 8mm button of your cornea is removed and a similar-sized button of the donor cornea is stitched in with tiny stitches (see front cover). These cannot be felt or seen. The abnormal cornea, which is removed, is sent to our pathology laboratory for examination under a microscope.
After the operation
You will usually be examined by the surgical team after the surgery and can generally go home the same day. You will be seen again within one week in the outpatient clinic and regularly thereafter (approximately six visits in the first year). We generally recommend that you take two weeks off work – discuss your individual circumstances with your doctor. You will need to use anti-rejection eye drops for at least six months and in some cases indefinitely. Individual
stitches may be removed from three months after the operation, but complete stitch removal is not performed until at least one year after the procedure.
What if my transplant fails?
A failed transplant can be replaced in a procedure known as a regraft, but the risk of subsequent rejection and failure increases each time for regrafts.
The percentages of full-thickness corneal grafts that are still functioning well five years after the operation under various conditions are:

Condition %
Keratoconus 95
Fuchs’ dystrophy 80-90
Stormal Scar 80-90
Stromal dystrophies 80-90
Bullous keratopathy 50-80
Bacterial infections 50-80
Herpetic keratitis 50-80
Fungal infection 0-50
3rd or higher number regraft 0-50
4 quadrants of blood vessels 0-50
Inflammation at time of surgery 0-50
Severe ocular surface disease 0-50
Grafts greater than 10mm 0-50

Consenting for information sharing
We are required to share your information with the Eye Bank who supply donor corneas, to ensure high quality transplant material.
Corneal transplant rejection
Rejection needs urgent treatment as this can lead to failure of the transplant and loss of vision.
Symptoms of rejection are:

  • Red eye
  • Sensitivity to light
  • Visual loss
  • Pain

If you experience any of these symptoms, you should immediately call our 24-hour emergency phone line 055 516 1586.

Corneal Transplantation (EK)

Why do you need a corneal transplant?

The cornea is a window of transparent tissue at the front of the eyeball. It allows light to pass into the eye and provides focus so that images can be seen. Various diseases or injury can make the cornea either cloudy or out of shape. This prevents the normal passage of light and affects vision.
The cornea has three layers (thin outer and inner layers and a thick middle layer). In some diseases, only the inside layer (endothelium) is affected, causing corneal oedema (swelling) and clouding (see below). Endothelial keratoplasty is a modern technique to replace the inside layer of your cornea with the inside layer from a donor cornea through a relatively small incision (opening).

Benefits of endothelial Keratoplasty

Improved vision
The majority of transplant recipients have sufficiently good vision to be able to drive legally although many need glasses. It can take up to six months until the full improvement is appreciated. Comfort is improved in some cases.

Risks of endothelial Keratoplasty

Rare but serious complications

  • Sight-threatening infection (1 in 1,000)
  • Severe haemorrhage causing loss of vision
  • Retinal detachment
  • Severe inflammation or other rare causes of loss of vision

Corneal transplant rejection
A corneal transplant can be identified and attacked by your immune system. This happens in between 6% and 10% of DSAEK recipients in the first two years after transplantation and can cause graft failure. It can often be reversed if anti-rejection medication is started promptly. Rejection remains a possibility for your lifetime. The rejection risk in DMEK appears to be lower than in DSAEK.
Graft failure
When a graft fails, the cornea becomes cloudy again and vision becomes blurred.
Glaucoma
This can usually be controlled by eye drops, but occasionally requires surgery and can damage your sight.
Graft dislocation
About 10% of endothelial grafts dislocate and need to be repositioned in theatre.
Cataract
This can be removed surgically.

Possible advantages of EK over full-thickness graft

  • Faster recovery
  • Fewer stitches, which means that the shape of the cornea is more “normal” and you are less dependent on glasses/ contact lens
  • Smaller wound so fewer wound complications such as leakage or wound rupture after accidental injury

About the operation

The operation
The operation is usually performed under local anaesthetic and takes about one hour. Through a small incision (opening), your endothelium is removed and an 8.5mm disc of donor endothelium is inserted and pressed in position against the back of your cornea by a bubble of air. You will need to lie flat for one hour after the operation. Usually, only two stitches are used to close the incision.
After the operation
You will usually be examined by the surgical team after your surgery and can generally go home the same day. You will be seen again the next day and within one week to make sure the graft stays in position. You will have about six visits to the outpatient clinic in the first year. We generally recommend that you take two weeks off work – discuss your individual circumstances with your doctor. You will need to use anti-rejection eyedrops for at least six months and in some cases indefinitely. The stitches are usually removed at about three months.

What if my transplant fails?

A failed transplant can be replaced in a procedure known as a regraft. However, the risk of subsequent rejection and failure increases each time for second and subsequent regrafts.
Consenting for information sharing
We are required to share your information with the Eye Bank who supply donor corneas, to ensure high quality transplant material.
Corneal transplant rejection
Rejection needs urgent treatment as this can lead to failure of the transplant and loss of vision.
Symptoms of rejection are:

  • Red eye
  • Sensitivity to light
  • Visual loss
  • Pain

If you experience any of these symptoms, you should immediately call our 24-hour emergency phone line 055 516 1586.

Corneal Transplantation (DALK)

Why do you need a corneal transplant?

The cornea is a window of transparent tissue at the front of the eyeball. It allows light to pass into the eye and provides focus so that images can be seen. Various diseases or injury can make the cornea either cloudy or out of shape. This prevents the normal passage of light and affects vision. The cornea has 3 layers (thin outer and inner layers and a thick middle layer). In some diseases, only the middle layer or part of the middle layer is affected (see below).

DALK is a modern technique whereby the outer two layers of the cornea are removed and replaced with the outer 2 layers from a donor cornea to give a partial-thickness transplant.

Benefits of Deep Anterior Lamellar Keratoplasty

Improved vision

  • 90% of transplant recipients reach driving standard if the eye is otherwise healthy but can need glasses or contact lenses or sometimes further surgery for best results.
  • It may take up to 18 months until the full improvement in vision is appreciated.

Risks of Deep Anterior Lamellar Keratoplasty

Rare but serious complications

  • Sight-threatening infection (1 in 1000)
  • Severe haemorrhage causing loss of vision
  • Retinal detachment

Corneal transplant rejection

A corneal transplant can be identified and attacked by your immune system. This happens in less than 10% of DALK recipients in the first two years after transplantation and can cause graft failure. It can often be reversed if  anti-rejection medication is started promptly. Rejection remains a possibility for your lifetime.

Graft Failure

When a graft fails the cornea becomes cloudy again and vision becomes blurred.

Glaucoma

This can usually be controlled by eyedrops but occasionally requires surgery.

Cataract

This can be removed surgically. Conversion to penetrating keratoplasty. Occasionally it is not possible to perform a partial thickness transplant and a full-thickness transplant must be performed instead. This happens in 10% of intended DALK procedures.

Possible advantages of DALK over full-thickness graft

  • Lower risk of intraocular problems such as serious infection or bleeding.
  • Lower risk of graft rejection.
  • The corneal wound after DALK is stronger than that after a full-thickness graft (PK). This means that stitches can be removed sooner.

Possible disadvantages of DALK over full-thickness graft

DALK recipients have a slightly lower chance of achieving 6/6 vision (excellent vision) than recipients of full thickness grafts.

About the operation

The Operation

The operation is performed under general or local anaesthetic. The operation takes about one hour. A central partial thickness 8mm button of the patient’s cornea is removed and a similar-sized button of the donor cornea is stitched in with tiny stitches (see front cover). These cannot be felt nor seen. The abnormal cornea, which is removed is sent to our pathology laboratory for examination under a microscope.After the operation

After the operation you will usually be examined by the surgical team after the surgery and can usually go home the same day. You will be seen again within 1 week in the outpatient clinic and regularly thereafter (approximately 6 visits in the first year). We generally recommend that you take 2 weeks off work – discuss your case with your doctor. You will need to use anti-rejection eyedrops for at least 6 months and in some cases indefinitely. Individual stitches may be removed from 3 months after the operation but complete stitch removal is not performed until at least 1 year.

What if my transplant fails?

A failed transplant can be replaced in a procedure known as a regraft. However the risk of subsequent rejection and failure increases each time for second and subsequent regrafts.Corneal Transplant Rejection

If not treated urgently this can lead to failure of the transplant and loss of vision.

Symptoms of rejection are:

  • Red eye
  • Sensitivity to light
  • Visual loss
  • Pain

If you experience any of these symptoms, you should immediately call our 24-hour emergency phone line 055 516 1586.