• Cataract Surgery
• Laser Refractive Surgery
• Corneal Transplant – Keratoplasty
• Retinal Detachment
• Glaucoma
• Congenital Glaucoma
• Strabismus Surgery
• Eyelid Surgery – Blepharoplasty
• Ptosis Surgery In Children
• Types Of Ptosis:
• Consequences
• Treatments
• Surgery

CATARACT SURGERY

The only solution to treat the loss of transparency of the lens is cataract surgery, which replaces the eye’s natural lens with an artificial intraocular lens (pseudophakic lenses) and allows clear vision to return. This is the goal of cataract surgery, the most commonly performed procedure in ophthalmology.

Also called phacoemulsification, it involves fragmenting and aspirating the cataract using ultrasound. This allows us to remove it from the eye through a small incision in the cornea, which is also used to insert the intraocular lens into the place previously occupied by the lens.

Increasingly reducing the size of this incision (to less than 1.5 mm) is one of the major advances in cataract surgery. Technological innovation—through the introduction of surgical microinstruments, cutting-edge lasers, and intelligent image-guided systems—allows for highly precise and safe cataract surgery results, as well as faster recovery times.

Additionally, we must add the advantages offered by new intraocular lens designs, which correct refractive errors (such as myopia, hyperopia, astigmatism, or presbyopia) and offer clear, glasses-free vision at various distances. These lenses are also used for most patients with presbyopia or who wish to do without glasses. This corrects this refractive error and prevents the development of cataracts in the future, since the lens will have been replaced, which, over time, not only loses focusing ability but also becomes opaque.

Premium lenses, which go beyond the single-vision lenses used a few years ago and still do today, offer good quality vision at different distances and regardless of glasses:

Trifocal lenses: These allow for good near, medium, and far vision. They are most often indicated for older patients with cataracts or presbyopia.

Extended-focus lenses: These are the most recent developments and extend the depth of focus compared to single-vision lenses.

Contrary to what many people think, it is not necessary to wait until the cataract is very “mature” or you notice significant deterioration in your vision to have it removed.

Cataract surgery is very quick (usually taking about 20 minutes) and is usually performed with local and topical anesthesia (drops) and without the need for sutures in the eye, due to the small size of the incisions. As it is an outpatient procedure, you can go home the same day of surgery.

You will soon notice an improvement in your vision, and within 24 hours you will be able to resume your normal activities, taking certain precautions that your ophthalmologist will explain to you. It is also important that you follow the prescribed postoperative treatment and attend the prescribed follow-up checkups.

Removing blurred vision will contribute to improving your quality of life and will help you function more independently. According to some studies, after cataract surgery, patients see their risk of mortality associated with accidents reduced by 40%, while the chances of fracturing a hip after a fall decrease by 16% and the chances of being involved in a traffic accident decrease by 13%.

LASER REFRACTIVE SURGERY

Refractive surgery is a surgical procedure aimed at correcting major refractive errors. One option is laser techniques.

Laser-based refractive surgery procedures (such as PRK, LASIK, LASEK, or EPILASIK) offer the possibility of altering the thickness and/or curvature of the cornea and, consequently, its dioptric value. They thus allow for the correction of refractive errors such as myopia, hyperopia, or astigmatism.

One of the most innovative techniques is Relex SMILE (Small Incision Lenticule Extraction), which uses a femtosecond laser to modify the corneal prescription through a microincision of just 2 mm, without the need to open the surface of the cornea.

Laser refractive surgery may also be indicated to treat presbyopia, compensating for the loss of the lens’s ability to accommodate vision that leads to near vision problems, which generally appear from the age of 40 to 45.

Laser surgery is performed on people with refractive errors who want to reduce their dependence on glasses or contact lenses. This is one of the many surgical options currently available to achieve this goal. Therefore, the ophthalmologist must determine whether the patient is a candidate for refractive surgery and, if so, select the most appropriate technique, taking into account factors such as eye characteristics, age, personal preferences, and profession.

CORNEAL TRANSPLANT – KERATOPLASTY

Corneal transplantation (keratoplasty) can be penetrating, when the entire cornea is replaced, or lamellar or selective, when only the affected layers are replaced.

Likewise, depending on the location of the damage, we distinguish different types of lamellar transplantation:

Posterior corneal transplantation (DMEK): when the injury occurs in the endothelium or innermost layer.

Anterior corneal transplantation: when the injury occurs in the stroma, which represents 95% of the total thickness of the cornea.

If the affected part is the epithelium, the outermost layer, a corneal stem cell transplant is required.

Keratoplasty is performed to maintain corneal transparency and regularity, and thus vision. This procedure is especially indicated for patients who, due to conditions such as keratoconus or accidents, have damaged the entire thickness of the cornea or some of its layers. In the latter case, specialists generally opt for lamellar techniques, which are less invasive than penetrating keratoplasty.

In fact, 70% of corneal transplants performed are selective, as they are less invasive procedures that reduce recovery time, improve prognosis, and reduce short- and long-term complications, as well as the risk of rejection.

RETINAL DETACHMENT

Retinal detachment occurs due to the spontaneous separation of the neurosensory retina (inner layer of the retina) from the pigment epithelium (outer layer).

Early diagnosis and treatment of retinal detachment is essential.

It is a serious eye disease that can lead to total vision loss if not treated promptly. Therefore, it requires carefully selected surgical treatment, as there are several types of surgery available.

It is important for those at risk to undergo regular eye exams at least once a year.

Furthermore, the sudden appearance of floaters or a sudden increase in floaters, as well as the appearance of flashes of light or any other of the symptoms described, should be a reason for an urgent consultation with an ophthalmologist.

It is very important to make a diagnosis as quickly as possible, as the chances of improvement are greater if the macula or central area of ​​the retina does not become detached.

Preventive laser treatment is advisable when retinal tears are present, even if they have not yet caused a detachment.

Preventive laser treatment can also be useful for high-risk patients with peripheral retinal degenerative lesions that could lead to a tear.

Since they do not cause pain and, in many cases, are not accompanied by initial vision loss, it is important to be alert to the symptoms of retinal detachment, even if they are seemingly harmless.

These symptoms, which usually appear successively, include:

Seeing floaters (black dots that move when the eye is moved). These are caused by changes in the vitreous.

Seeing flashes of light. This is a more important symptom, reflecting the existence of traction on the retina. It usually appears after a tear has already occurred.

Seeing a black curtain falling across some area of ​​the visual field. This occurs when a retinal detachment already exists, so a visit to an ophthalmologist is essential.

Image distortion and subsequent significant loss of visual acuity. This symptom appears if the central area of ​​the retina (macula) is damaged.

Treatment for retinal detachment involves different surgical techniques, depending on the degree and stage:

Laser photocoagulation. Lasers cause controlled burns around the detached area. These burns eventually heal and seal the retinal tear, preventing the vitreous humor from infiltrating between the two layers.

Vitrectomy. This involves removing the vitreous humor from inside the eye. The retina is then reapplied using heavy liquids and laser treatment from inside the eye.

Scleral surgery. A solid silicone band is placed around the outermost layer of the eye wall (the sclera) to maintain external pressure on the eyeball, which facilitates closure of the tear.

It is very important to perform surgery early, as if surgery is delayed for more than a week, the chance of restoring vision is much lower.

GLAUCOMA

Glaucoma is one of the most common causes of blindness.

It encompasses a group of diseases that cause progressive and irreversible damage to the optic nerve. This structure is key to vision because, through it, the images captured by the retina (converted into nerve impulses) are transmitted to the brain for interpretation and vision generation.

Glaucoma is a chronic disease caused by the premature death of retinal ganglion cells, whose axons form the optic nerve, which begins to become depleted due to their absence.

As a result, there is a loss of function and the patient’s visual field narrows if the disease is not treated promptly.

The main risk factor that can trigger glaucoma is ocular hypertension. This condition generally occurs because, for various reasons, the aqueous humor (the fluid that bathes the inside of the eye) does not drain properly and accumulates, exerting excessive pressure on the optic nerve and causing “stress” that the eye cannot withstand.

However, there are people with elevated intraocular pressure who do not have glaucoma, and patients with normal values ​​(less than 21 mm Hg of pressure) who, on the contrary, develop the disease.

It should be noted that glaucoma is not only the consequence of a “mechanical” defect in the aqueous humor drainage system but is a multifactorial disease whose origin is still poorly understood. Research is ongoing in this field, and it is suspected that vascular problems may be associated with cases of glaucoma with normal intraocular pressure, since the blood vessels inside the eyeball are among the finest in the body and, therefore, especially fragile. On the other hand, genetic predisposition is a significant factor in certain types of glaucoma, such as primary open-angle glaucoma (familial)—the most common—or congenital glaucoma (which appears in the first months of life) and juvenile glaucoma.

The key to preventing the irreversible damage caused by glaucoma to the optic nerve is early diagnosis of the disease so it can be controlled before it progresses further. Since in most cases it does not cause symptoms until the advanced stages of the disease, it is recommended to undergo ophthalmological checkups every two years starting at age 40, the age at which the degenerative process of the eye is activated, and the incidence of glaucoma begins to increase.

There are many types of glaucoma, the most common being the following:

Primary open-angle glaucoma is characterized by a malfunction of the trabecular meshwork, the area that drains the aqueous humor. As a result, the outflow of aqueous humor (a fluid produced within the eye) is slower than normal, causing an increase in intraocular pressure, which progressively damages the optic nerve.

Angle-closure glaucoma occurs because the iridocorneal angle (where the trabecular meshwork is located) closes, preventing the outflow of aqueous humor. In this case, there is also an increase in intraocular pressure, with the resulting associated neural damage in the optic nerve.

CONGENITAL GLAUCOMA

Congenital glaucoma is a rare or minority disease, affecting 1 in 10,000 people in industrialized countries. It usually manifests and is diagnosed during the first months or years of life and can severely affect the vision of affected children.

Normotensive glaucoma

Normotensive glaucoma occurs in people with statistically normal intraocular pressure (below 21 mmHg). However, people who suffer from it experience damage to the optic nerve fibers, similar to other types of glaucoma, with the resulting loss of vision and visual field.

As it is a disease caused by many factors, the causes of this type of glaucoma are currently unknown. However, research is underway in this field, and it is suspected that it may be linked to vascular problems.

Regarding treatment, therapeutic strategies for normotensive glaucoma are aimed at controlling and reducing intraocular pressure (either with eye drops, laser, or surgery) to try to maintain and preserve the condition of the affected optic nerve.

STRABISMUS SURGERY

Adult strabismus surgery is the treatment to correct this visual problem, which consists of a loss of parallelism between the two eyes, causing them to be misaligned and each eye to look in a different direction.

Generally, all cases of strabismus are operable, and in those where the condition appeared during childhood, surgery can be performed at any age.

It is considered a reconstructive surgery that allows patients to be very satisfied with the result and experience a noticeable improvement in their social status.

The operation, performed on an outpatient basis and with topical anesthesia and sedation or general anesthesia, involves manipulating one or more of the six muscles involved in eye movement to correct the deviation of the eye, shortening, lengthening, or repositioning it depending on the direction the eye needs to be directed.

The surgical approach is extraocular, as the surgeon works on the eyeball, which helps minimize the risk of potential complications. After surgery, the change perceived by the patient is immediate (although the final results are seen after a month), and the use of prisms may sometimes be recommended.

Prisms modify the direction of the image and thus eliminate diplopia. They are also used as a temporary aid before surgery and are a possible option for some patients who do not wish to undergo surgery.

The success rate of this surgical procedure can exceed 90%, restoring parallelism of the eyes and eliminating bothersome double vision, in addition to solving an aesthetic problem with significant psychological consequences.

EYELID SURGERY – BLEPHAROPLASTY

Blepharoplasty is a surgery that aims to correct excess skin and bags under the eyelids.

Depending on the patient’s case, this surgical procedure can be performed on both eyelids or focus only on the upper or lower eyelids.

Blepharoplasty is the most common cosmetic eyelid surgery and one of the most requested plastic surgeries in Spain.

Most blepharoplasties are performed to correct eyelid bags, which usually appear with age or due to congenital causes or associated with kidney or heart disease.

As we age, the skin around the eyes becomes redundant, the muscles weaken, and fat moves forward from the orbit. This laxity of the eyelid skin and muscles, along with orbital fat and, in some cases, the presence of fluid, gives the face an aged and tired appearance that is generally corrected for cosmetic purposes.

When the eyelids impede good vision, blepharoplasty not only serves to cosmetically correct the appearance of the eyes, but is also performed to ensure that the position of the eyelids does not affect the patient’s peripheral or side vision.

The surgery works on the eyelids to release and remove excess skin and tighten the orbicularis oculi muscle, as well as to remove excess fat, if applicable, and eliminate eyelid bags.

Laser-assisted blepharoplasties cause less bruising, reducing postoperative swelling and allowing for a faster recovery.

Blepharoplasty is a complex surgery that must be performed by expert hands. In this sense, choosing a specialist knowledgeable in the ocular and periocular area is essential to ensure good postoperative results and minimize associated risks.

Furthermore, when this surgery is performed on the upper eyelid, special care must be taken since the levator muscle is located in this area, and this can cause ptosis, or drooping of the eyelid.

Regarding the lower eyelid, the main complication associated with this procedure is retraction, which can occur in 20% of cases when inappropriate techniques are used. This complication causes the lower eyelid to sit too low, leaving the eye wide open. In addition to being unsightly, it causes additional dryness and other ocular complications due to lack of adequate eyelid closure.

When it comes to the lower eyelid, laser-assisted blepharoplasty is usually performed using a transconjunctival approach. The main advantages of this technique are:

The incision is not visible.

The risk of eyelid retraction is reduced.

After the operation, the patient usually feels no pain, although they may experience discomfort, eyelid swelling, redness, and bruising.

However, upon leaving the operating room, the first results can be seen, which are most evident after a week. The final results begin to appear after about a month.

This procedure is often combined with other skin treatments such as chemical peels or laser resurfacing. In these cases, it is advisable to avoid sun exposure and continually moisturize the treated area.

PTOSIS SURGERY IN CHILDREN

The term ptosis refers to the drooping or displacement of an organ. Palpebral ptosis, blepharoptosis, or droopy eyelids are ophthalmological terms used to describe the drooping of the upper eyelid. It can occur in both adults and children in one or both eyes. If it occurs in children, it is usually a congenital problem. It is one of the most common oculoplastic conditions.

Types of ptosis:

Consequences

Treatments

Surgery