Macula
Mr Ajai K Tyagi MS FRCS
Mr Ajai K Tyagi MS FRCS, obtained his Fellowship of the Royal College of Surgeons (Edinburgh) in 1994. He completed his Registrar training in general Ophthalmology at The Birmingham & Midlands Eye Centre, Birmingham. Following this he underwent sub-specialist training in Vitreoretinal Surgery at Newcastle-upon-Tyne. He also undertook an Observership at John Hopkins Hospital, Baltimore to study new techniques in managing patients with retinal and in particular macular diseases.
Mr Tyagi was appointed as Consultant Ophthalmologist at The Birmingham & Midlands Eye Centre in 2001. This is the second largest eye hospital in UK and is a dedicated teaching hospital for medical students and Ophthalmologists in training. Mr Tyagi also trains surgeons from across the globe in vitreoretinal surgery. He has a large tertiary referral base with patients being from all over the country. He has presented at various international conferences and has published research papers in prestigious medical journals.
Mr Tyagi has specialist interest in medical and surgical management of patients with vitreoretinal diseases. Few of these are:
- Intravitreal lucentis and avastin: These new drugs can restore vision in patients with macular degeneration, retinal vein occlusion and diabetic retinopathy
- Retinal detachment:He undertakes surgery for simple retinal detachments and the more complex cases associated with proliferative vitreoretinopathy, giant retinal tears, trauma etc
- Macular holes: He performs internal limiting membrane peel to improve the success of the surgery. Short acting intraocular gasses are mainly used to reduce the duration of postoperative rehabilitation. Patients who cannot posture following the surgery are adviced to have the long acting gas.
- Age related macular degeneration: He is involved in both the medical and surgical management of patients with AMD. He performs the full range of treatment options for AMD including macular translocation for patients who will not benefit from medical treatment for AMD, new intravitreal drugs such as Avastin/Lucentis (improves vision in wet AMD).
- Diabetic retinopathy: He is happy to review patients with diabetic retinopathy and will perform retinal laser treatment or vitrectomy if necessary.
- Central retinal vein occlusion: He performs vitrectomy with optic neurotomy and intravitreal steroid injection. This surgery in some cases can prevent severe loss of vision
- Branch retinal vein occlusion: If indicated, new surgeries such as vitrectomy with sheathotomy are performed by him
- Epiretinal membranes: He performs internal limiting membrane peel along with ERM peel as this additional step can improve the outcomes following vitrectomy.>
- Subluxated/dislocated lens or IOL: Surgical management carried out by him may include vitrectomy, scleral sutured IOL implant or iris fixated IOL.
- Intravitreal triamcinolone: This drug can be used for macular oedema due to various conditions such as diabetic maculopathy, vein occlusion, uveitis, post cataract surgery etc.
- Retinal laser treatment: He performs laser treatment for patients with diabetic retinopathy, retinal tears etc.
- Ocular Trauma: He is keen to manage patients with ocular trauma and perform surgery if necessary.
Age Related Macular Degeneration
Age related macular degeneration is the leading cause of visual loss in the over 65s in the developed world. As the elderly population increases the incidence of this disease consequently also increases. Various different treatments have been evolving to manage this condition over the years.
- Laser
- Photodynamic therapy
- Surgery
- Anti-VEGF therapies
- Possible nutrient prophylaxis (Age Related Eye Disease Study)
Risk Factors:
- Age
- Smoking
- Genetics
- Gender
- Nutrient status (possibly)
When are treatments for ARMD useful?
Laser, Photodynamic therapy, Surgery and anti-VEGF therapies are only useful when choroidal neovascularisation has occurred. The process of choroidal neovascularisation occurs when blood vessels accompanied by inflammatory cells grow under and through the retinal pigment epithelium to disrupt and damage the delicate overlying retinal cells.
The tissue invasion is as described above not only new blood vessels but also inflammatory cells. Specific treatments to target either or both of these components are being actively researched. Anti-VEGF treatments principally target the vascular components. Injectable steroids such as triamcinolone target principally the inflammatory cell component This has been termed a two component target therapeutic model for CNV
(Gasparini G, et al. (2005)J Clin Oncol 23:1295-1311)
Cathedral Eye Clinic are currently using both anti-VEGF, intraocular steroids and laser photocoagulation as part of the therapeutic modalities designed to manage these conditions.
