Eye surgeons, Health News, ET HealthWorld

New devices prove visionary to treat retinal bleed patients: Eye surgeons

Pune: The advent of a foot-switch-controlled syringe this year to navigate an extremely fine needle has resulted in a vision-saving development for the elderly, injured, or select group of eye patients, who may experience a blood clot occurring right under the retina. Thanks to a combination of these innovations, administering the clot-busting cardiac drug to treat this condition has no longer remained ‘a shot in the dark’.

Using the latest devices, the cardiac drug can be delivered right at the site of bleeding under the retina – as against administering the drug above it (vitreous cavity), which was done in the past, often leading to compromised care and poor outcome.

Eye surgeons we spoke to said the newer additions have enhanced vision-saving accuracy and added predictability to treatment results.

For six-odd years, standard care for a difficult-to-treat blood clot in an inaccessible region of the retina has been injecting the cardiac drug Tissue Plasminogen Activator (TPA) right into the eye and then using a particular gas.

“However, there was uncertainty about absorption of the drug. The new devices – a 40-gauge needle and foot-switch control method of injecting – have significantly improved results,” said eye surgeon Dr Aditya Kelkar, National Institute of Ophthalmology (NIO).

Delivering the drug at the right place is extremely crucial. “We need to ensure that the blood clot not remain in contact with the macula (central part of retina) for long. This is as iron particles (haemoglobin) in blood can cause toxicity to photo-receptors, resulting in vision loss,” he said.

Dr Kelkar added, “Unlike the old intravenous needle (20-23-gauge) used to administer the cardiac drug, the new 40-gauge needle since 2016 is as thin and fine as a human hair, can go deeper into the retina.”

Dr Kelkar said that the USFDA approved the US-made foot-switch control syringe in 2022. “I used this on a patient six months ago. I came to know about this syringe when I attended a conference in America in October. The common syringe cost Rs2 in bulk purchase, but the imported foot-switch syringe costs Rs20,000,” he told.

Weighing in, Dr Ketan Jathar, eye surgeon at the Deenanath Mangeshkar Hospital, said, “The development has improved the accuracy of administering the drug at the right spot. Besides, intra-operative optical coherence tomography (OCT) helps to determine or confirm the accuracy of the drug delivery and whether it has reached the right location.”

“Elderly people suffering from age-related macular degeneration often have bouts of bleeding under their retina, which can cause devastating long-term effects on vision if not addressed early. These innovations are game-changers in their treatment,” said Dr Preetam Samant, retina surgeon at PD Hinduja Hospital and associate professor at Grant Medical College and JJ Hospital in Mumbai.

He added, “Blunt injury to the eye, like a cricket ball or road traffic injury, can result in similar blood collection under the retina and macula. Again, TPA can be used to save vision before it’s too late.”

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