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SAFETY ISSUES RE USING FLUORESCEIN FOR RETINAL EYE EXAMS
14:39 Sep 19 2019 Times Read: 1,380
Safety[edit]
Topical, oral, and intravenous use of fluorescein can cause adverse reactions, including nausea, vomiting, hives, acute hypotension, anaphylaxis and related anaphylactoid reaction,[8][9] causing cardiac arrest[10] and sudden death due to anaphylactic shock.[11][12]
The most common adverse reaction is nausea, due to a difference in the pH from the body and the pH of the sodium fluorescein dye; a number of other factors,[specify] however, are considered contributors as well.[citation needed] The nausea usually is transient and subsides quickly. Hives can range from a minor annoyance to severe, and a single dose of antihistamine may give complete relief. Anaphylactic shock and subsequent cardiac arrest and sudden death are very rare, but because they occur within minutes, a health care provider who uses fluorescein should be prepared to perform emergency resuscitation.
Intravenous use has the most reported adverse reactions, including sudden death, but this may reflect greater use rather than greater risk. Both oral and topical uses have been reported to cause anaphylaxis,[13][14] including one case of anaphylaxis with cardiac arrest (resuscitated) following topical use in an eye drop.[10] Reported rates of adverse reactions vary from 1% to 6%.[15][16][17][18] The higher rates may reflect study populations that include a higher percentage of persons with prior adverse reactions. The risk of an adverse reaction is 25 times higher if the person has had a prior adverse reaction.[17] The risk can be reduced with prior (prophylactic) use of antihistamines[19] and prompt emergency management of any ensuing anaphylaxis.[20] A simple prick test may help to identify persons at greatest risk of adverse reaction.[18]
THIS ABOUT A YOUNG GIRL CALLED DOLLY EVERET WHO TOOK HER LIFE AFTER BEING CONSTANTLY BULLIED AT SCHOOL SHE WAS UNDER 14 YEARS WHEN SHE DIED VIA SUICIDE. THIS COMES FROM THE DIGITAL NEWSPAPER THE HERALD SUN , ONE OF THE MANY DIGITAL NEWSPAPERS I SUBSCRIBE TO.
DEAR SWEET FANGS,
I HOPE YOU HAVE A VERY HAPPY 4TH BIRTHDAY! SO HAPPY YOU ARE NOW 4 IN MORTAL YEARS OR 28 YEARS IN CAT YEARS. SO HAPPY YOU ARE PART OF MY LIFE AND I WANT TO THANK YOU FOR GIVING ME 3 AND A HALF HAPPY YEARS.I AM SO SORRY THAT THE 6 MONTHS BEORE YOU CAME TO JOIN ME, THAT YOU WERE SO CRUELLY ABUSED STARVED AND THAT YOU HAD A HORRID LIFE BEFORE I ADOPTED YOU. THANK YOU FOR THE HAPPINESS AND THE COMFORT JOY AND UNCONDITIONAL LOVE YOU GIVE ME EVERYDAY OF YOUR LIFE. MAY GODDESS BAST AND THE BLESSED GODDESS GRANT YOU A VERY LONG HAPPY AND HEALTHY LIFE. MAY YOU ONLY KNOW THE GOOD THINGS IN LIFE. I AM A HAPPIER AND BETTER PERSON BECAUSE OF YOU.NEVER FORGET THAT I LOVE NEED WANT AND VALUE YOU AND MY LIFE IS COMPLETE BECAUSE OF YOU. HAPPY HAPPY HAPPY BIRTHDAY MY PRECIOUS SWEETEST CAT, LOADS OF LOVE FROM YOUR CAT MOM ME.
Overview
Illustration of LASIK eye surgery
LASIK surgery
LASIK eye surgery can be an alternative to glasses or contact lenses done for the correction of certain common vision problems.
LASIK (laser-assisted in situ keratomileusis) is a type of laser refractive surgery — the best known and most commonly performed. In general, a special type of cutting laser is used to precisely change the shape of your cornea — the dome-shaped transparent tissue at the front of your eye — to improve vision.
Normally, images are clearly focused on the retina in the back of your eye because the light rays are bent properly to contact the retinal surface. With nearsightedness (myopia), farsightedness (hyperopia) or astigmatism, the light is bent incorrectly and it ends up being focused elsewhere, resulting in blurred vision. Traditionally, the blurred vision is corrected by bending (refracting) light rays with glasses or contact lenses. But reshaping the cornea itself also will provide the necessary refraction.
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Why it's done
Anatomy of the eye
Anatomy of the eye
Image showing nearsightedness (myopia)
Nearsightedness (myopia)
Farsightedness (hyperopia)
Farsightedness (hyperopia)
LASIK surgery may be an option for the correction of one of these vision problems:
Nearsightedness (myopia). When your eyeball is slightly longer than normal or when the cornea curves too sharply, light rays focus in front of the retina and blur distant vision. You can see objects that are close fairly clearly, but not those that are far away.
Farsightedness (hyperopia). When you have a shorter than average eyeball or a cornea that is too flat, light focuses behind the retina instead of on it. This makes near vision, and sometimes distant vision, blurry.
Astigmatism. When the cornea curves or flattens unevenly, the result is astigmatism, which disrupts focus of near and distant vision.
If you're considering LASIK surgery, you probably already wear glasses or contact lenses. Your eye doctor will talk with you about whether LASIK surgery or another similar refractive procedure is an option that will work for you.
Request an Appointment at Mayo Clinic
Risks
Complications that result in a loss of vision are very rare. But certain side effects of LASIK eye surgery, particularly dry eyes and temporary visual disturbances, are fairly common. These usually clear up after a few weeks or months, and very few people consider them to be a long-term problem.
Risks of LASIK include:
Dry eyes. LASIK surgery causes a temporary decrease in tear production. For the first six months or so after your surgery, your eyes may feel unusually dry as they heal. Dry eyes can reduce the quality of your vision.
Your eye doctor might recommend that you use eyedrops during this time. If you experience severe dry eyes, you could opt for another procedure to get special plugs put in your tear ducts to prevent your tears from draining away from the surface of your eyes.
Glare, halos and double vision. After surgery you may have difficulty seeing at night. You might notice glare, halos around bright lights or double vision. This generally lasts a few days to a few weeks.
Even when a good visual result is measured under standard testing conditions, your vision in dim light (such as at dusk or in fog) may be reduced to a greater degree after the surgery than before the surgery.
Undercorrections. If the laser removes too little tissue from your eye, you won't get the clearer vision results you were hoping for. Undercorrections are more common for people who are nearsighted. You may need another LASIK procedure within a year to remove more tissue.
Overcorrections. It's also possible that the laser will remove too much tissue from your eye. Overcorrections may be more difficult to fix than undercorrections.
Astigmatism. Astigmatism can be caused by uneven tissue removal. It may require additional surgery, glasses or contact lenses.
Flap problems. Folding back or removing the flap from the front of your eye during surgery can cause complications, including infection and excess tears. The outermost corneal tissue layer (epithelium) may grow abnormally underneath the flap during the healing process.
Vision loss or changes. Rarely, you may experience loss of vision due to surgical complications. Some people also may not see as sharply or clearly as previously.
Conditions that increase risks
Certain health conditions can increase the risks associated with LASIK surgery or make the outcome less predictable. Doctors may not recommend laser refractive surgery for you if you have certain conditions, including:
Autoimmune disorders, such as rheumatoid arthritis
A weakened immune system caused by immunosuppressive medications or HIV
Persistent dry eyes
Unstable vision due to medications, hormonal changes, pregnancy, breast-feeding or age
Keratitis, uveitis, herpes simplex affecting the eye area, glaucoma, cataracts, eye injuries or lid disorders
LASIK is usually not advisable if you:
Have an eye disease called keratoconus, or if you have a family history of it
Have fairly good overall vision
Have severe nearsightedness
Have very large pupils or thin corneas
Have age-related eye changes that cause you to have less-clear vision (presbyopia)
Participate in contact sports that may be associated with blows to the face
If you're considering LASIK surgery, talk to your doctor about your questions and concerns. He or she can explain how the surgery might benefit you and help put the risks in perspective. Your doctor will discuss with you whether you're a candidate for the procedure.
What you can expect
Before the procedure
Long-term results from LASIK tend to be best in people who are carefully evaluated before surgery to ensure that they are good candidates for the procedure. Your eye doctor will ask about your medical and surgical history and give you a comprehensive eye examination.
In the eye examination, your doctor will evaluate your vision and look for signs of eye infections, inflammation, dry eyes, large eye pupils, high eye pressure and other eye-health conditions. He or she will also measure your cornea, noting the shape, contour, thickness and any irregularities. This helps your doctor assess whether you can undergo the procedure safely.
Your eye doctor also evaluates which areas of your cornea need reshaping. He or she determines the precise amount of tissue to remove from your cornea. Doctors generally use wavefront-guided technology to evaluate your eye in detail before LASIK surgery. In this test, a scanner creates a highly detailed chart, similar to a topographic map, of your eye. The more detailed the measurements, the more accurate your eye doctor can be in removing corneal tissue.
If you wear contact lenses, which can change the shape of your cornea, you'll need to completely stop wearing them and wear only your glasses for at least a few weeks before your evaluation and surgery. Your doctor will provide specific guidelines depending on your situation and how long you've been a contact lens wearer.
Before surgery, your doctor will discuss the risks and benefits of LASIK, what to expect before and after surgery, and any questions you may have.
Steps you can take to prepare for surgery include:
Know what surgery may cost you. LASIK surgery is usually considered elective surgery, so most insurance companies won't cover the cost of the surgery. Be prepared to pay out-of-pocket for your expenses.
Arrange for a ride home. You'll need to have someone drive you to and from your place of surgery. Immediately after surgery, you might still feel the effects of medicine given to you before surgery, and your vision may be blurry.
Skip the eye makeup. Don't use eye makeup, cream, perfumes or lotions on the day before and the day of your surgery. Your doctor may also instruct you to clean your eyelashes daily or more often in the days leading up to surgery, to remove debris and minimize your risk of infection.
During the procedure
LASIK surgery is usually completed in 30 minutes or less. During the procedure, you lie on your back in a reclining chair. You may be given medicine to help you relax. After numbing drops are placed in your eye, your doctor uses an instrument to hold your eyelids open.
A suction ring placed on your eye just before cutting the corneal flap may cause a feeling of pressure, and your vision may dim a little.
Your eye surgeon uses a small blade or cutting laser to cut a small hinged flap away from the front of your eye. Folding back the flap allows your doctor to access the part of your cornea to be reshaped.
Using a programmed laser, your eye surgeon reshapes parts of your cornea. With each pulse of the laser beam, a tiny amount of corneal tissue is removed. After reshaping the cornea, the surgeon lays the flap back into place. The flap usually heals without stitches.
During the surgery, you'll be asked to focus on a point of light. Staring at this light helps you keep your eye fixed while the laser reshapes your cornea. You may detect a distinct odor as the laser removes your corneal tissue. Some people describe smelling an odor similar to that of burning hair.
If you need LASIK surgery in both eyes, doctors will generally conduct the procedure on the same day.
After the procedure
Immediately after surgery, your eye might itch, burn and be watery. You'll probably have blurred vision. You generally will experience little pain, and you'll usually recover your vision quickly.
You might be given pain medication or eyedrops to keep you comfortable for several hours after the procedure. Your eye doctor might also ask you to wear a shield over your eye at night until your eye heals.
You'll be able to see after surgery, but your vision won't be clear right away. It takes about two to three months after your surgery before your eye heals and your vision stabilizes. Your chances for improved vision are based, in part, on how good your vision was before surgery.
You'll have a follow-up appointment with your eye doctor one to two days after surgery. He or she will see how your eye is healing and check for any complications. Plan for other follow-up appointments during the first six months after surgery as your doctor recommends.
It might be a few weeks before you can start to use cosmetics around your eyes again. You might also have to wait several weeks before resuming strenuous contact sports, swimming or using hot tubs.
Follow your doctor's recommendations about how soon you can resume your normal activities.
Results
LASIK often offers improved vision without the hassle of glasses or contact lenses. In general, you have a very good chance of achieving 20/25 vision or better after refractive surgery.
More than 8 out of 10 people who've undergone LASIK refractive surgery no longer need to use their glasses or contact lenses for most of their activities.
Your results depend on your specific refractive error and other factors. People with a low grade of nearsightedness tend to have the most success with refractive surgery. People with a high degree of nearsightedness or farsightedness along with astigmatism have less predictable results. In some cases, the surgery might result in undercorrection. If this happens, you might need another surgery to achieve the proper correction.
Rarely, some people's eyes slowly return to the level of vision they had before surgery. This might happen due to certain conditions, such as abnormal wound healing, hormonal imbalances or pregnancy. Sometimes this change in vision is due to another eye problem, such as a cataract. Talk with your doctor about any vision changes.
By Mayo Clinic Staff
LASIK eye surgery care at Mayo Clinic
I DIDNT WRITE THIS IT COMES FROM THE RAINBOW BRIDGE WEBSITE. WWW.RAINBOWBRIDGE.COM
CHRISTMAS AT THE RAINBOW BRIDGE by Ginny Brancato
As the midnight hour approaches on Christmas Eve, a tremendous
celebration begins. If you listen closely you will hear the exuberant sounds of glee as each Bridgekid joyfully prepares for the remarkable moment that comes but once a year.
Puppies romp through the tall green grass, chasing butterflies and rolling over and over until fits of giggles bring them to a tumbling stop. The sound increases as kittens, cats, tigers and lions purr in pure
delight while the wings of snow-white doves gently caress the air.
The babbling brook that runs beneath Rainbow Bridge overflows
onto the edge of mossy banks and fins of treasured aquatic life quiver and jump high in the air in anticipation of this most joyous event.
Nestled in the midst of this happy choir of Bridgekids are the littlest one's who have just entered the Bridge staring in awe at the majestic Christmas tree adorned with flowing strands of angel hair.Twinkling
stars seesaw elegantly from the sky and land in glorious harmony upon the evergreen limbs of Heaven's most perfect Christmas tree.
Like magic the clock approaches midnight and a great stirring is heard in the distance. Each Bridgekid stops and listens,knowing the time is near, and they choose a fleecy cloud on which to snuggle.
The roar of purrs drops to barely an audible hum-the babbling brook ripples hypnotically and the flutter of downy feathered wings fall silent, amidst the warm glow of candlelight which rises from the earth below.
The arms of the Bridge Keeper envelopes the heavens and into the precious hands of each furbaby a holy gift is placed.
With grand exuberance the ribbons are removed and left to fly on a tender
breeze where they dissolve into showers of angel dust. As the golden lids of these heavenly gifts are raised, an amazing
aura fills the sky, reaching down to the very core of the earth. Ascending from each and every box is the greatest gift of all
unending, unconditional, all-encompassing LOVE.
This blessed love gently wraps itself around each and evey Bridgekid warming their hearts with beacons of radiant light
and bringing forth angels and their exquisite choir.
A huge sound is heard throughout Rainbow Bridge as the clock strikes midnight.
The distance between heaven
and earth is vanished. It is at this very moment on Christmas Eve that our blessed Bridgekids sends a message to their earthly loved ones on the wings of this unbridled love.
Listen carefully with an open heart. You will hear your own furchild or feathered friend whisper softly into your ear their Christmas message..
"
"Mommy, Daddy, when you need me know that I am there. I have not left you for I am in your heart where I belong. Our love is eternal, as is the brilliant glow of candlelight which illuminates the path to the heavens and Rainbow Bridge.I wait patiently as do you for our inevitable and glorious reunion. I send my gift of LOVE to you this Christmas Eve night and always. Take my LOVE and give back kindness and compassion to those on earth hurting in memory of my LOVE, until the day comes we greet eachother once more in ecstatic re-union. I love you, I love you."
I DIDNT WRITE THIS IT CAME FROM THE WWW.RAINBOWBRIDGE.COM WEBSITE.
The Rainbow Bridge by Lily Just this side of Heaven is a place called Rainbow Bridge
The lands here stretch far away, much more than just a smidge
When an animal dies that has been very close to someone here,
That animal goes to Rainbow Bridge, so the owner knows they're near
There is plenty of food and water, sunshine and cozy beds
On Earth, their owners are relieved that their pet is happy and fed
The animals who were ill and old are restored to health and youth
The animals who were hurt are made strong and free from abuse
The same way we remember them in our dreams of days gone by,
But sadly times passed all too quickly, the time came for goodbye
The animals are content and at peace, except for one small thing
They each miss someone very special, who has not yet gained their wings
They all run and play together, but then will come the day
Where the eyes are big, the ears are up, and it's time to stop the play
The animal flies away from the rest, jumping over the lush green grass
They know what they're about to find, their beloved is here at last
You have been spotted by your special friend, and when you both finally meet
You cling together the joyful reunion your pet has been waiting to greet
The happy kisses rain on your face, your hands caress the head
And you look once more into the trusting eyes, so glad for what's ahead
You missed each other for so many years since the very day you part,
So long gone from your life but never absent from your heart
But now you have finally reunited, you're here to stay forever,
It's time for you and your friend to cross the Rainbow Bridge together Comments would be appreciated by the author, Lily
THE MONDAY NIGHT PRAYER FOR ANIMALS FROM RAINBOW BRIDGE
14:33 Sep 08 2019 Times Read: 1,458
THIS PRAYER COMES FROM THE RAINBOW BRIDGE WEBSITE I DIDNT WRITE THIS.THIS PRAYER IS DONE WORLD WIDE EVERY MONDAY EVENING. THE WEBSITE IS WWW.RAINBOWBRIDGE.COM
PRAYER: God, Creator of all living things, we ask that as we light our candles, the healing warmth of love will flow into the brokenhearted who have lost a loved one. Give to them Your strength and comfort. We also pray that the soft glow of light will part the clouds of grief and sorrow to surround our furbabies at the Bridge.
May excitement reign supreme as wagging tails, ecstatic purrs and flapping feathers feel our gentle touch once again. May they know the gratitude we hold in our hearts for their faithfulness and gift of unconditional love as they are forever remembered. We are temporarily separated for only a short while. The gold cord that connects us through time and space can never be broken. AMEN.
Candle One CANDLE 1:
PERSONAL FURBABY I will not look back for there is sorrow. I will not look for today for there is longing. I will look forward for there is our tomorrow.
If you wish to add a personal message to this prayer please do so now.
Candle Two CANDLE 2:
FURBABIES OF FRIENDS AND FAMILY Read the names of those who have gone on before us as a tribute to them and their loving parents. As we all meet here, our Bridgekids will be meeting all newcomers, easing their way.
Candle Three CANDLE 3:
FOR ACKNOWLEDGMENT AND PEACE We light this candle in honor of all the homeless, forgotten, abandoned, abused animals. For the nameless furchildren who gave their lives for others, for research and as a result of humankind's inhumanity. May the Higher Powers that be forgive the cruelty. As our lights shine brightly through the galaxy, may the angels smile upon us, and know that for a brief moment, we have put aside worldly differences to bond as one.
CLOSING:
I have sent you on a journey to a land free from pain, not because I did not love you, but because I loved you too much to force you to stay.
MOMENT OF SILENCE:
"Blessed are they that mourn, for they will be comforted." Love, light and healing to all. Amen. The candles being lit tonight; Cast a soft and welcome flame. And draw our loved ones to the light as we call to them by name. Imagine spirits taking flight, For a moment our souls entwine. Say not Good Night, but in some Brighter Time bid them all ... Good Morning.
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Home » Eye Health Information » Retinal Detachment » Facts About Retinal Detachment
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Facts About Retinal Detachment
This information was developed by the National Eye Institute to help patients and their families search for general information about retinal detachment. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.
Retinal Detachment Defined
What is retinal detachment?
The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.
In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.
Frequently Asked Questions about Retinal Detachment
What are the different types of retinal detachment?
There are three different types of retinal detachment:
Rhegmatogenous [reg-ma-TAH-jenous]—A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.
Tractional—In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.
Exudative—Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.
Causes and Risk Factors
Who is at risk for retinal detachment?
A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans.
A retinal detachment is also more likely to occur in people who:
Are extremely nearsighted
Have had a retinal detachment in the other eye
Have a family history of retinal detachment
Have had cataract surgery
Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
Have had an eye injury
Symptoms and Detection
What are the symptoms of retinal detachment?
Symptoms include a sudden or gradual increase in either the number of floaters, which are little “cobwebs” or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.
Treatment
How is retinal detachment treated?
Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to “weld” the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.
Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to “weld” the retina back in place.
With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.
Current Research
What research is being done?
The NEI supported The Silicone Study, a nationwide clinical trial that compared the use of silicone oil with long-acting intraocular gas for repairing a retinal detachment caused by proliferative vitreoretinopathy (PVR). With PVR, cells grow on the surface of the retina causing it to detach. This is a serious complication that sometimes follows retinal detachment surgery and is difficult to treat. The results indicate that both treatments are effective and give the surgeons more options for treating these difficult cases.
Last Reviewed:
October 2009
The National Eye Institute (NEI) is part of the National Institutes of Health (NIH) and is the Federal government’s lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness.
Summary
The retina is the curved back layer of the eye and is covered in light-sensitive cells.
Retinal detachment means the retina has separated from the back of the eye.
Retinal detachment surgery involves reattaching the retina to the back of the eye and sealing any breaks or holes in the retina.
The treatment success rate is high, with around nine out of 10 retinas able to be reattached.
Older people are at higher risk of retinal detachment.
If left untreated, a detached retina can cause permanent damage to your eyesight.
On this page:Long term outlook for retinal detachment
On this page:
The retina
What is retinal detachment?
Causes of retinal detachment
Who is at risk of retinal detachment?
Symptoms of retinal detachment
Surgery for retinal detachment
Long term outlook for retinal detachment
Where to get help
The retina
The retina is the innermost layer of the wall of the eye and is made up of light sensitive cells known as rods and cones, which detect shape, colour and pattern. It is supported on the inside by the jelly-like vitreous, which fills the eyeball behind the lens.
On its outer side the retina is attached to the choroid, or middle layer, which is rich in blood vessels. Nerve fibres leaving the retina bundle together to form the optic nerve, which relays visual information to the brain.
What is retinal detachment?
Retinal detachment is when the retina pulls away from the tissue around it (the choroid), which supplies it with oxygen and nutrients.
When the retina is detached it can no longer function and vision is lost.
Causes of retinal detachment
The most common cause of retinal detachment is age-related shrinkage of the vitreous gel, which may lead to tearing at a weak point in the retina. Once such a tear or hole develops, fluid can collect beneath it and reduce the adhesion of the retina to the choroid, resulting in a detachment. Injury to the eye can also cause retinal detachment, although this is less common.
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Who is at risk of retinal detachment?
People at increased risk of retinal detachment include:
near-sighted people
people who have undergone cataract surgery
anyone who has had a severe eye injury.
Back to top
Symptoms of retinal detachment
Retinal detachment is painless. A retinal tear may be accompanied by the sensation of flashing lights in the affected eye or showers of dark floaters and blurred vision.
As the retina detaches it often causes a dark shadow, like a curtain or veil, in the peripheral vision, which usually progresses to complete vision loss.
See your doctor or eye specialist straightaway if you experience any of the above visual disturbances, because a retinal detachment needs prompt corrective surgery to prevent permanent damage to your eyesight.
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Surgery for retinal detachment
Retinal detachment surgery involves reattaching the retina to the back of the eye and sealing any breaks or holes. Your retinal specialist will examine your eye to decide the most appropriate operation.
Operative procedures for retinal detachment
There are various methods available to reattach the retina, including:
pneumatic retinopexy – this is the simplest procedure for repair of a detachment, but is not suitable for all cases. The retinal surgeon injects a gas bubble into the vitreous cavity and treats the tear(s) with either laser or cryotherapy (freezing). The bubble presses the retina flat against the wall of the eye and the laser or freezing sticks the retina down. In order for the retina to remain in place after surgery it is important to follow the surgeon’s instructions on post-operative head positioning. The gas gradually disappears over the days or weeks following the surgery
scleral buckling – the retinal tear is treated with cryotherapy, the fluid under the retina drained and a specially-shaped piece of silicone rubber sutured to the sclera, or outer wall of the eye. The silicone creates an indent, which pushes the eye-wall back onto the retina. The scleral buckle remains in place indefinitely unless complications arise
vitrectomy surgery – under an operating microscope the vitreous is surgically removed using very fine instruments, any tears are treated with laser or cryotherapy and the eye is filled with gas or silicone oil. Once again it is important to follow instructions regarding post-operative head positioning in order to allow the retina to stick down. People who have had vitrectomy surgery will experience temporary poor vision while the eye is filled with gas, but if the surgery is successful the vision will improve as the gas reabsorbs and is replaced with the eye’s own clear fluid. If silicone oil is used it does not dissolve by itself, and further surgery is usually necessary after a few months.
After surgery for retinal detachment
Immediately after the operation, you can expect:
The eye will be covered with an eye pad and perhaps a protective eye shield.
You may need to stay in hospital overnight or, occasionally, longer.
During the post-operative period:
Your eye may be uncomfortable for several weeks, particularly if a scleral buckle has been used.
Your vision will be blurry – it may take some weeks or even three to six months for your vision to improve.
Your eye may water.
Expect a ‘gritty’ feeling on the surface of your eye if stitches have been used.
Avoid rubbing or pressing on the eye.
You may need to wear an eye pad for protection at night while your eye is healing.
Make sure to follow all directions for medications, such as eye drops.
Avoid vigorous activity for some weeks following surgery.
Obey all instructions on head positioning.
See your surgeon immediately if you experience severe pain.
If you have had gas inserted into your eye as part of your retinal re-attachment procedure, it is extremely important that you do not fly until it has completely reabsorbed. This may take up to four weeks
Possible complications of surgery for retinal detachment
Risks and complications depend on the procedure used, but can include:
cataract formation (loss of clarity of the lens of the eye)
glaucoma (raised pressure in the eye)
infection
haemorrhage (bleeding) into the vitreous cavity
vision loss
loss of the eye, although with modern surgical techniques this is a very unlikely outcome.
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Long term outlook for retinal detachment
In most specialist centres around nine out of ten retinal detachments are successfully repaired with a single operation. In the remaining cases, the retina re-detaches and needs another operation. The final success rate is over 95 per cent.
Whether or not your vision returns depends not only on the success or failure of the operation, but also on the duration, extent and location of the detachment. For example, if the macula (the part of the retina responsible for central vision) has detached, it is unlikely that full vision will ever return, even if the operation is successful.
Are there other forms of treatment for retinal detachment?
Retinal detachment can only be repaired with surgery. If left untreated, your vision will most likely worsen beyond repair. Seeing an eye specialist as soon as you experience symptoms leads to the best outcome.
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Where to get help
Your doctor
Eye specialist
Retinal surgeon
Royal Victorian Eye and Ear Hospital Tel. (03) 9929 8666
NOTE THAT PHONE NUMBER FOR AUSTRALIAN RESIDENTS IN VICTORIA ONLY.
Scleral Buckling
Medically reviewed by Drugs.com. Last updated on Jun 19, 2019.
Care Notes
Aftercare Instructions Discharge Care Inpatient Care Precare En Español
WHAT YOU SHOULD KNOW:
Scleral buckling is surgery to fix a detached retina. The retina is a thin layer of cells on the back of your eyeball. Your retina sends the images that you see from your eyes to your brain. A detached retina means that your retina has torn away from the tissue behind it. Your retina may become detached if it gets a hole in it and fluid builds up behind it. A detached retina also may be caused by inflammation (swelling) or an injury to your eye. A detached retina makes your vision worse, and you may lose sight in your eye.
Picture of a normal eye
During surgery, your caregiver reattaches your retina and stitches a small buckle onto your sclera (the white part of your eye). Scleral buckling surgery may help keep your eyesight from becoming worse. It also may decrease the risk of your retina detaching a second time. With scleral buckling, your eyesight may become clearer and it may be easier to do your daily activities.
INSTRUCTIONS:
Take your medicine as directed:
Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Eye drops: Ask your caregiver for information about putting drops into your eye. You may need one or more of the following eye medicines:
Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Always take your antibiotics exactly as ordered by your primary healthcare provider. Do not stop taking your medicine unless directed by your primary healthcare provider. Never save antibiotics or take leftover antibiotics that were given to you for another illness.
Steroids: This medicine may be given to decrease inflammation.
Pain medicine: You may be given medicine to take at home as eye drops or pills to help decrease pain. Your caregiver will tell you how much to take and how often to take it. Take the medicine exactly as directed by your caregiver. Do not wait until the pain is too bad before taking your medicine. The medicine may not work as well at controlling your pain if you wait too long to take it. Tell caregivers if the pain medicine does not help, or if your pain comes back too soon.
Picture of using eye drops correctly
Ask for information about where and when to go for follow-up visits:
For continuing care, treatments, or home services, ask for more information.
Tell your caregiver if you have any new symptoms, such as new problems seeing. Your caregiver will check how your eye is healing and if your retina has detached again.
Eye care:
Ask your caregiver for instructions about taking care of your eye after surgery. If you still have decreased vision after surgery, your caregiver may want you to see a vision rehabilitation therapist. This caregiver will teach you how to use tools that help you see better.
Activity:
Ask your caregiver if you should avoid driving and air travel. Do not drive or travel by air until your caregiver says it is okay.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Vitrectomy: Procedure, complications, and recovery
Last reviewed Fri 13 October 2017 By Jennifer Huizen Reviewed by Ann Marie Griff, OD
What is vitrectomy surgery? Why would you need a vitrectomy? Complications and risks What is the recovery process?
Vitrectomy surgeries involve the removal and replacement of some or all of the vitreous humor or fluid from the eye. The procedure is considered very successful and is often done as part of other eye surgeries.
Depending on the additional procedures involved, most people start to recover from vitrectomy surgeries after a few days, but a full recovery often takes several weeks.
Fast facts on vitrectomy surgery:
Vitreous humor is a gel-like substance made of at least 98 percent water.
Vitrectomy is an outpatient surgery, performed in hospital or dedicated ambulatory surgery center.
The vitreous cavity gives the eye its round shape and makes up at least two-thirds of the volume of the eye
After vitrectomy surgeries, most people can go home following a short monitoring period.
What is vitrectomy surgery?
Surgeons performing surgery on patients eye.
A vitrectomy surgery is when the vitreous humor or fluid surrounding the eye is surgically removed and replaced.
It is important for people to arrange to take a few days off work and to arrange for a ride home after the surgery.
Before the day of their surgery, an appointment will be scheduled to examine the eye that will be operated on.
Usually, people will have to avoid all food and water for at least 8 hours before the surgery is done.
An individual should discuss any current medications they are taking and medical conditions they have with the surgeon, ahead of time. Some medicines may need to be avoided on the day of surgery.
Common steps in vitrectomy surgery include:
1. The eye is anesthetized or numbed and dilated.
2. The eye is cleaned with an antiseptic solution and draped with a sterile covering.
3. An eyelid speculum is used to keep the eye open, and a protective covering is placed over the eye not being operated on.
4. The surgeon makes a small incision or cut, usually about the width of an eyelash or 0.5 millimeters, in the outer membrane of the eye.
5. The surgeon accesses the eye through the pars plana, a structure in the sclera or white part of the eye.
6. The surgeon uses forceps to open the cut.
7. The surgeon inserts a microscope, as well as a fiber-optic light to be able to see the eye.
8. The surgeon uses a vitrector or vitrectomy probe to cut the vitreous gel, and a suction tool to remove broken down fluid.
9. Depending on the individual case the surgeon will then:
use forceps, scissors, and cutters to peel back scar tissue from the retina
insert a silicone-tipped needle to drain infected, cloudy, or bloody fluid
use a laser probe, to treat abnormal blood vessels, clots, and seal off retinal injuries, such as tears or holes
10. The surgeon fills the eye with a vitreous substitute similar to saline solution, silicon oil, or a gas or air bubble.
11. An antibiotic ointment will be applied to the eye to prevent infection and the eye will be covered.
12. The individual may need to lay face down for a while to be monitored, and instructions will be given, depending on what other procedures are done on the eye.
Why would you need a vitrectomy?
Virectomy surgery may be performed to treat a range of eye problems, including cataracts.
Virectomy surgery may be performed to treat a range of eye problems, from eye injuries to cataracts.
Vitrectomy procedures are often done to allow surgeons access to the back of the eye, during operations for retinal conditions.
It is also commonly done to drain vitreous fluid that has become cloudy or bloody, or filled with floaters or clumps of tissue.
Common reasons for a vitrectomy surgery, and other surgeries associated with it include:
bleeding inside of the eye
eye infections
major eye trauma or injury
problems after cataract (cloudy lens) surgery
vitreous floaters or tiny bits of tissue in the vitreous fluid
damaged retinal tissue or scar tissue on the retina
injury from a dislodged, misplaced, or infected intraocular lens (IOL)
detached retina where the retina becomes loose and moves around the eye
trauma or injury that occurs during cornea, cataract, or glaucoma surgery
diabetic retinopathy when the retina has been damaged by long periods of uncontrolled diabetes
macular degeneration or a macular hole where there is a small hole, tear, or defect in the macula or central tissue of the retina
swelling of the central retinal tissue
swelling of the eye
What you need to know about cataracts
What you need to know about cataracts
A common reason for vitrectomy surgery is bleeding inside the eye. Learn more about the condition here.
READ NOW
Complications and risks
Doctor speaking with patient.
Complications are rare for virectomy procedures, and the surgeons should explain the potential risks to the patient before performing the surgery.
Vitrectomy procedures are an effective surgery and severe complications are rare. According to the American Society of Retina Specialists, most surgeries have a 90 percent success rate.
In rare cases, however, complications can occur, especially in immune-compromised individuals and those with a history of eye conditions or surgery.
Possible side effects of vitrectomy procedures include:
inflammation or redness, swelling, and pain
bleeding inside the eye
infection
increased pressure (glaucoma) or reduced pressure in the eye
cataract formation or progression of existing cataracts
surgical injury, such as a wrong cut or tear, resulting in the need for further corrective surgery
swelling of the central part of the retina
change in vision, requiring the need for new eyeglasses
loss of night vision, blurriness, or depth perception
double vision
retinal detachment
dislocation or discoloration of the intraocular lens
macular pucker or a wrinkle in the retina
loss of vision
allergic reaction or over-reaction to anesthesia, which may risk stroke, heart attack, or pneumonia
What is the recovery process?
Vitrectomy procedures are often done alongside other eye surgeries, so individual recovery time and recommendations vary.
In general, activities like driving, reading, and exercise will need to be avoided for a few days after the procedure.
Some people will be required to lay face down for a period of time to help their eye heal properly. Often, eye drops will be prescribed to help prevent infection and to reduce inflammation.
In general, the full recovery process for vitrectomy surgeries takes between 4 to 6 weeks.
Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes mellitus. It is a leading cause of blindness.[1]
Diabetic retinopathy affects up to 80 percent of those who have had diabetes for 20 years or more.[2] At least 90% of new cases could be reduced with proper treatment and monitoring of the eyes.[3] The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.[4] Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness in people aged 20 to 64.[5]
Contents
1 Signs and symptoms
2 Risk factors
3 Pathogenesis
3.1 Proliferative diabetic retinopathy
4 Diagnosis
4.1 Screening
5 Management
5.1 Laser photocoagulation
5.2 Medications
5.3 Surgery
6 Research
6.1 Light treatment
6.2 C-peptide
6.3 Stem cell therapy
6.4 Blood pressure control
6.5 Fundoscopic image analyses
7 See also
8 References
9 Further reading
10 External links
Signs and symptoms[edit]
Normal vision
The same view with diabetic retinopathy.
Emptied retinal venules due to arterial branch occlusion in diabetic retinopathy (fluorescein angiography)
Diabetic retinopathy often has no early warning signs. Even macular edema, which can cause rapid vision loss, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day.
The first stage, called non-proliferative diabetic retinopathy (NPDR), has no symptoms. Patients may not notice the signs and have 20/20 vision. The only way to detect NPDR is by fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can show narrowing or blocked retinal blood vessels clearly (lack of blood flow or retinal ischemia).
Macular edema, in which blood vessels leak their contents into the macular region, can occur at any stage of NPDR. Its symptoms are blurred vision and darkened or distorted images that are not the same in both eyes. Ten percent (10%) of diabetic patients will have vision loss related to macular edema. Optical Coherence Tomography can show areas of retinal thickening due to fluid accumulation from macular edema.[6]
In the second stage, abnormal new blood vessels (neovascularisation) form at the back of the eye as part of proliferative diabetic retinopathy (PDR); these can burst and bleed (vitreous hemorrhage) and blur the vision, because these new blood vessels are fragile. The first time this bleeding occurs, it may not be very severe. In most cases, it will leave just a few specks of blood, or spots floating in a person's visual field, though the spots often go away after a few hours.
These spots are often followed within a few days or weeks by a much greater leakage of blood, which blurs the vision. In extreme cases, a person may only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of the eye, and in some cases the blood will not clear. These types of large hemorrhages tend to happen more than once, often during sleep.
On funduscopic exam, a doctor will see cotton wool spots, flame hemorrhages (similar lesions are also caused by the alpha-toxin of Clostridium novyi), and dot-blot hemorrhages.
Risk factors[edit]
All people with diabetes mellitus are at risk – those with Type I diabetes and those with Type II diabetes. The longer a person has had diabetes, the higher their risk of developing some ocular problem. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.[7] After 20 years of diabetes, nearly all patients with Type I diabetes and >60% of patients with Type II diabetes have some degree of retinopathy; however, these statistics were published in 2002 using data from four years earlier, limiting the usefulness of the research. The subjects would have been diagnosed with diabetes in the late 1970s, before modern fast-acting insulin and home glucose testing.
Prior studies had also assumed a clear glycemic threshold between people at high and low risk of diabetic retinopathy.[8][9]
Published rates vary between trials, the proposed explanation being differences in study methods and reporting of prevalence rather than incidence values.[10]
During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. NIH recommends[11] that all pregnant women with diabetes have dilated eye examinations each trimester.
People with Down syndrome, who have extra chromosome 21 material, almost never acquire diabetic retinopathy. This protection appears to be due to the elevated levels of endostatin,[12] an anti-angiogenic protein, derived from collagen XVIII. The collagen XVIII gene is located on chromosome 21.
Pathogenesis[edit]
Illustration depicting diabetic retinopathy
Diabetic retinopathy is the result of damage to the small blood vessels and neurons of the retina. The earliest changes leading to diabetic retinopathy include narrowing of the retinal arteries associated with reduced retinal blood flow; dysfunction of the neurons of the inner retina, followed in later stages by changes in the function of the outer retina, associated with subtle changes in visual function; dysfunction of the blood-retinal barrier, which protects the retina from many substances in the blood (including toxins and immune cells), leading to the leaking of blood constituents into the retinal neuropile.[13] Later, the basement membrane of the retinal blood vessels thickens, capillaries degenerate and lose cells, particularly pericytes and vascular smooth muscle cells. This leads to loss of blood flow and progressive ischemia, and microscopic aneurysms which appear as balloon-like structures jutting out from the capillary walls, which recruit inflammatory cells; and advanced dysfunction and degeneration of the neurons and glial cells of the retina.[13][14]
An experimental study suggests that pericyte death is caused by blood glucose persistently activating protein kinase C and mitogen-activated protein kinase (MAPK), which, through a series of intermediates, inhibits signaling through platelet-derived growth factor receptors — signaling that supports cellular survival, proliferation, and growth. The resulting withdrawal of this signaling leads to the programmed cell death (apoptosis) of the cells in this experimental model.[15]
Small blood vessels – such as those in the eye – are especially vulnerable to poor blood sugar (blood glucose) control. An overaccumulation of glucose damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most people do not notice any change in their vision. Early changes that are reversible and do not threaten central vision are sometimes termed simplex retinopathy or background retinopathy.[16]
Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.
Proliferative diabetic retinopathy[edit]
As the disease progresses, severe nonproliferative diabetic retinopathy enters an advanced or proliferative (PDR) stage, where blood vessels proliferate/grow. The lack of oxygen in the retina causes fragile, new, blood vessels to grow along the retina and in the clear, gel-like vitreous humour that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. Fibrovascular proliferation can also cause tractional retinal detachment. The new blood vessels can also grow into the angle of the anterior chamber of the eye and cause neovascular glaucoma.
Nonproliferative diabetic retinopathy shows up as cotton wool spots, or microvascular abnormalities or as superficial retinal hemorrhages. Even so, the advanced proliferative diabetic retinopathy (PDR) can remain asymptomatic for a very long time, and so should be monitored closely with regular checkups.
Diagnosis[edit]
Diabetic retinopathy is detected during an eye examination that includes:
Visual acuity test: Uses an eye chart to measure how well a person sees at various distances (i.e., visual acuity).
Pupil dilation: The eye care professional places drops into the eye to dilate the pupil. This allows him or her to see more of the retina and look for signs of diabetic retinopathy. After the examination, close-up vision may remain blurred for several hours.
Ophthalmoscopy or fundus photography: Ophthalmoscopy is an examination of the retina in which the eye care professional: (1) looks through a slit lamp biomicroscope with a special magnifying lens that provides a narrow view of the retina, or (2) wearing a headset (indirect ophthalmoscope) with a bright light, looks through a special magnifying glass and gains a wide view of the retina. Hand-held ophthalmoscopy is insufficient to rule out significant and treatable diabetic retinopathy. Fundus photography generally captures considerably larger areas of the fundus, and has the advantage of photo documentation for future reference, as well as availing the image to be examined by a specialist at another location and/or time.
Fundus Fluorescein angiography (FFA): This is an imaging technique which relies on the circulation of fluorescein dye to show staining, leakage, or non-perfusion of the retinal and choroidal vasculature.
Optical coherence tomography (OCT): This is an optical imaging modality based upon interference, and analogous to ultrasound. It produces cross-sectional images of the retina (B-scans) which can be used to measure the thickness of the retina and to resolve its major layers, allowing the observation of swelling.
The eye care professional will look at the retina for early signs of the disease, such as:
leaking blood vessels,
retinal swelling, such as macular edema,
pale, fatty deposits on the retina (exudates) – signs of leaking blood vessels,
damaged nerve tissue (neuropathy), and
any changes in the blood vessels.
If macular edema is suspected, FFA and sometimes OCT may be performed.
Diabetic retinopathy also affects microcirculation thorough the body. A recent study[17] showed assessment of conjunctival microvascular hemodynamics such as vessel diameter, red blood cell velocity and wall shear stress can be useful for diagnosis and screening of diabetic retinopathy. Furthermore, the pattern of conjunctival microvessels was shown to be useful for rapid monitoring and diagnosis of different stages of diabetic retinopathy.[18]
In April 2018 the FDA approved a similar device called IDx-DR.[19] IDx-DR is an AI diagnostic system that autonomously analyzes images of the retina for signs of diabetic retinopathy. As an autonomous, AI-based system, IDx-DR is unique in that it makes an assessment without the need for a clinician to also interpret the image or results, making it usable by health care providers who may not normally be involved in eye care.
Google is testing a cloud algorithm that scans photos of the eye for signs of retinopathy. The algorithm still requires FDA approval.[19]
According to a DRSS user manual, poor quality images (which may apply to other methods) may be caused by cataract, poor dilation, ptosis, external ocular condition, or learning difficulties. There may be artefacts caused by dust, dirt, condensation, or smudge.[20]
Screening[edit]
In the UK, screening for diabetic retinopathy is part of the standard of care for people with diabetes.[21] After one normal screening in people with diabetes, further screening is recommended every two years.[22] In the UK, this is recommended every year.[23] Teleophthalmology has been employed in these programs.[24]
Management[edit]
There are three major treatments for diabetic retinopathy, which are very effective in reducing vision loss from this disease.[25] In fact, even people with advanced retinopathy have a 95 percent chance of keeping their vision when they get treatment before the retina is severely damaged.[26] These three treatments are laser surgery, injection of corticosteroids or anti-VEGF agents into the eye, and vitrectomy.
Although these treatments are very successful (in slowing or stopping further vision loss), they do not cure diabetic retinopathy. Caution should be exercised in treatment with laser surgery since it causes a loss of retinal tissue. It is often more prudent to inject triamcinolone or anti-VEGF drugs. In some patients it results in a marked increase of vision, especially if there is an edema of the macula.[25]
Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy.[27]
Obstructive sleep apnea (OSA) has been associated with a higher incidence of diabetic eye disease due to blood desaturation caused by intermittent upper airway obstructions. Treatment for OSA can help reduce the risk of diabetic complications.[28]
The best way of preventing the onset and delaying the progression of diabetic retinopathy is to monitor it vigilantly and achieve optimal glycemic control.[29]
Since 2008 there have been other therapies (e.g. kinase inhibitors and anti-VEGF) drugs available.[30]
Laser photocoagulation[edit]
Laser photocoagulation can be used in two scenarios for the treatment of diabetic retinopathy. It can be used to treat macular edema by creating a Modified Grid at the posterior pole and it can be used for panretinal coagulation for controlling neovascularization. It is widely used for early stages of proliferative retinopathy.
Modified grid[edit]
A 'C' shaped area around the macula is treated with low intensity small burns. This helps in clearing the macular edema.
Panretinal[edit]
Panretinal photocoagulation, or PRP (also called scatter laser treatment), is used to treat proliferative diabetic retinopathy (PDR). The goal is to create 1,600 – 2,000 burns in the retina with the hope of reducing the retina's oxygen demand, and hence the possibility of ischemia. It is done in multiple sittings.
In treating advanced diabetic retinopathy, the burns are used to destroy the abnormal blood vessels that form in the retina. This has been shown to reduce the risk of severe vision loss for eyes at risk by 50%.[2]
Before using the laser, the ophthalmologist dilates the pupil and applies anaesthetic drops to numb the eye. In some cases, the doctor also may numb the area behind the eye to reduce discomfort. The patient sits facing the laser machine while the doctor holds a special lens on the eye. The physician can use a single spot laser or a pattern scan laser for two dimensional patterns such as squares, rings and arcs. During the procedure, the patient will see flashes of light. These flashes often create an uncomfortable stinging sensation for the patient. After the laser treatment, patients should be advised not to drive for a few hours while the pupils are still dilated. Vision will most likely remain blurry for the rest of the day. Though there should not be much pain in the eye itself, an ice-cream headache like pain may last for hours afterwards.
Patients will lose some of their peripheral vision after this surgery although it may be barely noticeable by the patient. The procedure does however save the center of the patient's sight. Laser surgery may also slightly reduce colour and night vision.
A person with proliferative retinopathy will always be at risk for new bleeding, as well as glaucoma, a complication from the new blood vessels. This means that multiple treatments may be required to protect vision.
Medications[edit]
Intravitreal triamcinolone acetonide[edit]
Triamcinolone is a long acting steroid preparation. When injected in the vitreous cavity, it decreases the macular edema (thickening of the retina at the macula) caused due to diabetic maculopathy, and results in an increase in visual acuity. The effect of triamcinolone is transient, lasting up to three months, which necessitates repeated injections for maintaining the beneficial effect. Best results of intravitreal Triamcinolone have been found in eyes that have already undergone cataract surgery. Complications of intravitreal injection of triamcinolone include cataract, steroid-induced glaucoma and endophthalmitis. A systematic review found evidence that eyes treated with the intravitreal injection of triamcinolone had better visual acuity outcomes compared to eyes treated with macular laser grid photocoagulation, or sham injections.[31]
Intravitreal anti-VEGF[edit]
There are good results from multiple doses of intravitreal injections of anti-VEGF drugs such as bevacizumab.[32] A 2017 systematic review update found moderate evidence that aflibercept may have advantages in improving visual outcomes over bevacizumab and ranibizumab, after one year.[33][needs update] Present recommended treatment for diabetic macular edema is Modified Grid laser photocoagulation combined with multiple injections of anti-VEGF drugs.
Surgery[edit]
Instead of laser surgery, some people require a vitrectomy to restore vision. A vitrectomy is performed when there is a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a saline solution.
Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation. Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.
Vitrectomy is often done under local anesthesia. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye to remove the vitreous and insert the saline solution into the eye.
Patients may be able to return home soon after the vitrectomy, or may be asked to stay in the hospital overnight. After the operation, the eye will be red and sensitive, and patients usually need to wear an eyepatch for a few days or weeks to protect the eye. Medicated eye drops are also prescribed to protect against infection.
Vitrectomy is frequently combined with other modalities of treatment.
Research[edit]
Light treatment[edit]
A medical device comprising a mask that delivers green light through the eyelids while a person sleeps was under development in 2016.[34][35] The light from the mask stops rod cells in the retina from dark adapting, which is thought to reduce their oxygen requirement, which in turn diminishes new blood vessel formation and thus prevents diabetic retinopathy.[34] As of 2016 a large clinical trial was underway.[34]
C-peptide[edit]
C-peptide had shown promising results in treatment of diabetic complications incidental to vascular degeneration.[36] Creative Peptides,[37] Eli Lilly,[38] and Cebix[39] all had drug development programs for a C-peptide product. Cebix had the only ongoing program until it completed a Phase IIb trial in December 2014 that showed no difference between C-peptide and placebo, and it terminated its program and went out of business.[40][41]
Stem cell therapy[edit]
Clinical trials are under way or are being populated in preparation for study at medical centers in Brazil, Iran and the United States. Current trials involve using the patients' own stem cells derived from bone marrow and injected into the degenerated areas in an effort to regenerate the vascular system.[42]
Blood pressure control[edit]
A Cochrane review examined 15 randomized controlled trials to determine whether interventions that sought to control or reduce blood pressure in diabetics had any effects of diabetic retinopathy.[43] While the results showed that interventions to control or reduce blood pressure prevented diabetic retinopathy for up to 4–5 years in diabetics, there was no evidence of any effect of these interventions on progression of diabetic retinopathy, preservation of visual acuity, adverse events, quality of life, and costs.[43]
Fundoscopic image analyses[edit]
Distribution in percentage of pre-processing techniques from 2011–2014 [44]
Diabetic retinopathy is diagnosed entirely by recognizing abnormalities on retinal images taken by fundoscopy. Color fundus photography is mainly used for staging the disease. Fluorescein angiography is used to assess the extent of retinopathy that aids in treatment plan development. Optical coherence tomography (OCT) is used to determine the severity of edema and treatment response.[45]
Because fundoscopic images are the main sources for diagnosis of diabetic retinopathy, manually analyzing those images can be time-consuming and unreliable, as the ability of detecting abnormalities varies by years of experience.[46] Therefore, scientists have explored developing computer-aided diagnosis approaches to automate the process, which involves extracting information about the blood vessels and any abnormal patterns from the rest of the fundoscopic image and analyzing them.[44]
See also[edit]
Diabetic diet
Purtscher's retinopathy, a disease with similar abnormalities in the eye, usually caused by trauma.
Retinal regeneration[47]
HEART MURMOUR INFORMATION FROM THE MAYO CLINIC WEBSITE
14:13 Sep 03 2019 Times Read: 1,502
Heart murmurs
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Overview
Heart murmurs are sounds during your heartbeat cycle — such as whooshing or swishing — made by turbulent blood in or near your heart. These sounds can be heard with a stethoscope. A normal heartbeat makes two sounds like "lubb-dupp" (sometimes described as "lub-DUP"), which are the sounds of your heart valves closing.
Heart murmurs can be present at birth (congenital) or develop later in life. A heart murmur isn't a disease — but murmurs may indicate an underlying heart problem.
Often, heart murmurs are harmless (innocent) and don't need treatment. Some heart murmurs may require follow-up tests to be sure the murmur isn't caused by a serious underlying heart condition. Treatment, if needed, is directed at the cause of your heart murmur.
Symptoms
If you have a harmless heart murmur, more commonly known as an innocent heart murmur, you likely won't have any other signs or symptoms.
An abnormal heart murmur may cause no obvious other signs or symptoms, aside from the unusual sound your doctor hears when listening to your heart with a stethoscope. But if you have these signs or symptoms, they may indicate a heart problem:
Skin that appears blue, especially on your fingertips and lips
Swelling or sudden weight gain
Shortness of breath
Chronic cough
Enlarged liver
Enlarged neck veins
Poor appetite and failure to grow normally (in infants)
Heavy sweating with minimal or no exertion
Chest pain
Dizziness
Fainting
When to see a doctor
Most heart murmurs aren't serious, but if you think you or your child has a heart murmur, make an appointment to see your family doctor. Your doctor can tell you if your heart murmur is innocent and doesn't require any further treatment or if an underlying heart problem needs to be further examined.
Causes
There are two types of heart murmurs: innocent murmurs and abnormal murmurs. A person with an innocent murmur has a normal heart. This type of heart murmur is common in newborns and children.
An abnormal heart murmur is more serious. In children, abnormal murmurs are usually caused by congenital heart disease. In adults, abnormal murmurs are most often due to acquired heart valve problems.
Innocent heart murmurs
An innocent murmur can occur when blood flows more rapidly than normal through the heart. Conditions that may cause rapid blood flow through your heart, resulting in an innocent heart murmur, include:
Physical activity or exercise
Pregnancy
Fever
Not having enough healthy red blood cells to carry adequate oxygen to your body tissues (anemia)
An excessive amount of thyroid hormone in your body (hyperthyroidism)
Phases of rapid growth, such as adolescence
Innocent heart murmurs may disappear over time, or they may last your entire life without ever causing further health problems.
Abnormal heart murmurs
The most common cause of abnormal murmurs in children is when babies are born with structural problems of the heart (congenital heart defects).
Common congenital defects that cause heart murmurs include:
Holes in the heart or cardiac shunts. Known as septal defects, holes in the heart may or may not be serious, depending on the size of the hole and its location.
Cardiac shunts occur when there's an abnormal blood flow between the heart chambers or blood vessels, which may lead to a heart murmur.
Heart valve abnormalities. Congenital heart valve abnormalities are present at birth, but sometimes aren't discovered until much later in life. Examples include valves that don't allow enough blood through them (stenosis) or those that don't close properly and leak (regurgitation).
Other causes of abnormal heart murmurs include infections and conditions that damage the structures of the heart and are more common in older children or adults. For example:
Valve calcification. This hardening or thickening of valves, as in mitral stenosis or aortic valve stenosis, can occur as you age. Valves may become narrowed (stenotic), making it harder for blood to flow through your heart, resulting in murmurs.
Endocarditis. This infection of the inner lining of your heart and valves typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and lodge in your heart.
Left untreated, endocarditis can damage or destroy your heart valves. This condition usually occurs in people who already have heart valve abnormalities.
Rheumatic fever. Although now rare in the United States, rheumatic fever is a serious condition that can occur when you don't receive prompt or complete treatment for a strep throat infection. It can permanently affect the heart valves and interfere with normal blood flow through your heart.
Risk factors
There are risk factors that increase your chances of developing a heart murmur, including:
Family history of a heart defect. If blood relatives have had a heart defect, that increases the likelihood you or your child may also have a heart defect and heart murmur.
Certain medical conditions, including uncontrolled high blood pressure (hypertension), hyperthyroidism, an infection of the lining of the heart (endocarditis), high blood pressure in the lungs (pulmonary hypertension), carcinoid syndrome, hypereosinophilic syndrome, systemic lupus erythematosus, rheumatoid arthritis, a weakened heart muscle or a history of rheumatic fever, can increase your risk of a heart murmur later in life.
Factors that increase your baby's risk of developing a heart murmur include:
Illnesses during pregnancy. Having some conditions during pregnancy, such as uncontrolled diabetes or a rubella infection, increases your baby's risk of developing heart defects and a heart murmur.
Taking certain medications or illegal drugs during pregnancy. Use of certain medications, alcohol or drugs can harm a developing baby, leading to heart defects.
Prevention
While there's not much you can do to prevent a heart murmur, it is reassuring to know that heart murmurs are not a disease and are often harmless. For children, many murmurs go away on their own as children grow. For adults, murmurs may disappear as the underlying condition causing them improves.
Diagnosis
Heart murmurs are usually detected when your doctor listens to your heart using a stethoscope during a physical exam.
To check whether the murmur is innocent or abnormal, your doctor will consider:
How loud is it? This is rated on a scale from 1 to 6, with 6 being the loudest.
Where in your heart is it? And can it be heard in your neck or back?
What pitch is it? Is it high-, medium- or low-pitched?
What affects the sound? If you change your body position or exercise, does it affect the sound?
When does it occur, and for how long? Murmurs that happen when the heart is filling with blood (diastolic murmur) or throughout the heartbeat (continuous murmur) may indicate a heart problem. You or your child will need more tests to find out what the problem is. Murmurs that occur when the heart is emptying (systolic) generally are innocent heart murmurs that don't cause health issues, but sometimes they may reflect a heart condition.
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Your doctor will also look for other signs and symptoms of heart problems and ask about your medical history and whether other family members have had heart murmurs or other heart conditions.
Additional tests
If the doctor thinks the heart murmur is abnormal, you or your child may need additional tests, including:
Chest X-ray. A chest X-ray shows an image of your heart, lungs and blood vessels. It can reveal if your heart is enlarged, which may mean an underlying condition is causing your heart murmur.
Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor look for heart rhythm and structure problems.
Echocardiogram. This type of testing uses ultrasound waves to show detailed images of your heart's structure and function. Echocardiography can help identify abnormal heart valves, such as those that are hardened (calcified) or leaking, and can also detect most heart defects.
Cardiac catheterization. In this test, a catheter is inserted into a vein or artery in your leg or arm until it reaches your heart. The pressures in your heart chambers can be measured, and dye can be injected.
The dye can be seen on an X-ray, which helps your doctor see the blood flow through your heart, blood vessels and valves to check for problems. This test is generally used when other tests have been inconclusive.
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Treatment
An innocent heart murmur generally doesn't require treatment because the heart is normal. If innocent murmurs are the result of an illness, such as fever or hyperthyroidism, the murmurs will go away once that condition is treated.
If you or your child has an abnormal heart murmur, treatment may not be necessary. Your doctor may want to monitor the condition over time. If treatment is necessary, it depends on what heart problem is causing the murmur and may include medications or surgery.
Medications
The medication your doctor prescribes depends on the specific heart problem you have. Some medications your doctor might give you include:
Medications that prevent blood clots (anticoagulants). Your doctor may prescribe anticoagulants, such as aspirin, warfarin (Coumadin, Jantoven) or clopidogrel (Plavix). An anticoagulant prevents blood clots from forming in your heart and causing a heart attack or stroke.
Water pills (diuretics). Diuretics remove excess fluid from your body, which can help treat other conditions that might worsen a heart murmur, such as high blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors lower your blood pressure. High blood pressure can worsen underlying conditions that cause heart murmurs.
Statins. Statins help lower your cholesterol. Having high cholesterol seems to worsen some heart valve problems, including some heart murmurs.
Beta blockers. These drugs lower your heart rate and blood pressure. They're used for some types of heart valve problems.
Surgery
Many valve conditions can't be treated with medications alone. Depending on your heart condition, your doctor may recommend one of these options to treat a damaged or leaky valve:
Valve repair
To repair a valve, your doctor may recommend one of the following procedures:
Balloon valvuloplasty. This procedure is performed to relieve a narrowed valve. During a balloon valvuloplasty, a small catheter containing an expandable balloon is threaded into your heart, placed into the valve and then expanded to help widen the narrowed valve.
Annuloplasty. In this procedure, your surgeon tightens the tissue around the valve by implanting an artificial ring. This allows the leaflets to come together and close the abnormal opening through the valve.
Repair of structural support. In this procedure, your surgeon replaces or shortens the cords that support the valves (chordae tendineae and papillary muscles) to repair the structural support. When the cords and muscles are the right length, the valve leaflet edges meet and eliminate the leak.
Valve leaflet repair. In valve leaflet repair, your surgeon surgically separates, cuts or pleats a valve flap (leaflet).
Valve replacement
In many cases, the valve has to be replaced. Options include:
Open-heart surgery. This is the primary surgical treatment for severe valve stenosis. Your surgeon removes the narrowed valve and replaces it with a mechanical valve or a tissue valve.
Mechanical valves, made from metal, are durable, but carry the risk of blood clots forming. If you receive a mechanical valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin, Jantoven), for life to prevent blood clots.
Tissue valves — which may come from a pig, cow or human deceased donor — often eventually need replacement. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible.
Transcatheter aortic valve replacement (TAVR). A less invasive approach, TAVR involves replacing the aortic valve with a prosthetic valve via an artery in your leg or in a small incision in your chest.
In some cases, a valve can be inserted via a catheter into a tissue replacement valve that needs to be replaced (valve-in-valve procedure).
TAVR is usually reserved for individuals with severe aortic valve stenosis who are at increased risk of complications from aortic valve surgery.
Doctors used to recommend that most people with abnormal heart murmurs take antibiotics before visiting the dentist or having surgery due to possible complications from a bacterial infection that affects the lining of your heart (infective endocarditis).
Doctors no longer recommend antibiotics before procedures, except for people at highest risk of complications of infective endocarditis, such as those who have an artificial heart valve or people with certain congenital heart defects.
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Preparing for your appointment
If you think you or your child has a heart murmur, make an appointment to see your family doctor. Although most heart murmurs are harmless, it's a good idea to rule out any underlying heart problems that could be serious.
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready and know what to expect from your doctor.
What you can do
Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there are any advance preparations. For example, if you're having a certain type of echocardiogram, you may need to fast for several hours before your appointment.
Write down any symptoms you or your child is experiencing, including any that may seem unrelated to heart murmurs.
Write down key personal information, including a family history of heart murmurs, heart rhythm problems, heart defects, coronary artery disease, genetic disorders, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
Make a list of all medications, vitamins or supplements that you or your child is taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who comes along with you may remember something that you missed or forgot.
Be prepared to discuss diet and exercise habits. If you or your child doesn't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
Write down questions to ask the doctor.
Your time with the doctor is limited, so preparing a list of questions can help you make the most of your time together. For heart murmurs, some basic questions to ask your doctor include:
What's the most likely cause of the heart murmur?
What are other possible causes for the heart murmur?
What kinds of tests are necessary?
What's the best treatment or follow-up care?
What are the alternatives to the primary approach that you're suggesting?
How should health conditions other than the heart murmur be managed?
Are there any dietary or exercise restrictions that I need to follow?
Should I see a specialist?
If surgery is necessary, which surgeon do you recommend?
Is there a generic alternative to the medicine you're prescribing?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from the doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When did you or your child first have symptoms?
Have the symptoms been continuous or occasional?
How severe are the symptoms?
What, if anything, seems to make your symptoms better?
Does anything make the symptoms worse?
Have you ever noticed a bluish discoloration of the skin?
Do you have shortness of breath? When does this happen?
Have you ever fainted?
Have you had chest pain?
Have you had swelling in your legs?
How do you feel when you exercise?
Have you ever used illicit drugs?
Have you ever had rheumatic fever?
Does anyone else in the family have a heart murmur or a heart valve problem?
HEART ARRHYTHMIA INFORMATION FROM THE MAYO CLINIC WEBSITE
13:32 Sep 03 2019 Times Read: 1,504
Heart arrhythmia
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Overview
Heart rhythm problems (heart arrhythmias) occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too fast, too slow or irregularly.
Heart arrhythmias (uh-RITH-me-uhs) may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.
Heart arrhythmia treatment can often control or eliminate fast, slow or irregular heartbeats. In addition, because troublesome heart arrhythmias are often made worse — or are even caused — by a weak or damaged heart, you may be able to reduce your arrhythmia risk by adopting a heart-healthy lifestyle.
Symptoms
Arrhythmias may not cause any signs or symptoms. In fact, your doctor might find you have an arrhythmia before you do, during a routine examination. Noticeable signs and symptoms don't necessarily mean you have a serious problem, however.
Noticeable arrhythmia symptoms may include:
A fluttering in your chest
A racing heartbeat (tachycardia)
A slow heartbeat (bradycardia)
Chest pain
Shortness of breath
Lightheadedness or dizziness
Sweating
Fainting (syncope) or near fainting
When to see a doctor
Arrhythmias may cause you to feel premature or extra heartbeats, or you may feel that your heart is racing or beating too slowly. Other signs and symptoms may be related to your heart not pumping effectively due to the fast or slow heartbeat. These include shortness of breath, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort.
Seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you wouldn't expect to feel them.
Ventricular fibrillation is one type of arrhythmia that can be deadly. It occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly instead of pumping blood. Without an effective heartbeat, blood pressure plummets, cutting off blood supply to your vital organs.
A person with ventricular fibrillation will collapse within seconds and soon won't be breathing or have a pulse. If this occurs, follow these steps:
Call 911 or the emergency number in your area.
If there's no one nearby trained in cardiopulmonary resuscitation (CPR), provide hands-only CPR. That means uninterrupted chest compressions at a rate of 100 to 120 a minute until paramedics arrive. To do chest compressions, push hard and fast in the center of the chest. You don't need to do rescue breathing.
If you or someone nearby knows CPR, begin providing it if it's needed. CPR can help maintain blood flow to the organs until an electrical shock (defibrillation) can be given.
Find out if an automated external defibrillator (AED) is available nearby. These portable defibrillators, which can deliver an electric shock that may restart heartbeats, are available in an increasing number of places, such as in airplanes, police cars and shopping malls. They can even be purchased for your home.
No training is required. The AED will tell you what to do. It's programmed to allow a shock only when appropriate.
Causes
Normal heartbeat
Normal heartbeat
Many things can lead to, or cause, an arrhythmia, including:
A heart attack that's occurring right now
Scarring of heart tissue from a prior heart attack
Changes to your heart's structure, such as from cardiomyopathy
Blocked arteries in your heart (coronary artery disease)
High blood pressure
Overactive thyroid gland (hyperthyroidism)
Underactive thyroid gland (hypothyroidism)
Smoking
Drinking too much alcohol or caffeine
Drug abuse
Stress
Certain medications and supplements, including over-the-counter cold and allergy drugs and nutritional supplements
Diabetes
Sleep apnea
Genetics
What's a normal heartbeat?
Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by a natural pacemaker (the sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat.
From the sinus node, electrical impulses travel across the atria, causing the atria muscles to contract and pump blood into the ventricles.
The electrical impulses then arrive at a cluster of cells called the atrioventricular node (AV node) — usually the only pathway for signals to travel from the atria to the ventricles.
The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body.
In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute.
Types of arrhythmias
Doctors classify arrhythmias not only by where they originate (atria or ventricles) but also by the speed of heart rate they cause:
Tachycardia (tak-ih-KAHR-dee-uh). This refers to a fast heartbeat — a resting heart rate greater than 100 beats a minute.
Bradycardia (brad-e-KAHR-dee-uh). This refers to a slow heartbeat — a resting heart rate less than 60 beats a minute.
Not all tachycardias or bradycardias mean you have heart disease. For example, during exercise it's normal to develop a fast heartbeat as the heart speeds up to provide your tissues with more oxygen-rich blood. During sleep or times of deep relaxation, it's not unusual for the heartbeat to be slower.
Tachycardias in the atria
Tachycardias originating in the atria include:
Atrial fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated, weak contractions of the atria.
The chaotic electrical signals bombard the AV node, usually resulting in an irregular, rapid rhythm of the ventricles. Atrial fibrillation may be temporary, but some episodes won't end unless treated.
Atrial fibrillation may lead to serious complications such as stroke.
Atrial flutter. Atrial flutter is similar to atrial fibrillation. The heartbeats in atrial flutter are more-organized and more-rhythmic electrical impulses than in atrial fibrillation. Atrial flutter may also lead to serious complications such as stroke.
Supraventricular tachycardia. Supraventricular tachycardia is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular) in the atria or AV node.
Wolff-Parkinson-White syndrome. In Wolff-Parkinson-White syndrome, a type of supraventricular tachycardia, there is an extra electrical pathway between the atria and the ventricles, which is present at birth. However, you may not experience symptoms until you're an adult. This pathway may allow electrical signals to pass between the atria and the ventricles without passing through the AV node, leading to short circuits and rapid heartbeats.
Tachycardias in the ventricles
Tachycardias occurring in the ventricles include:
Ventricular tachycardia. Ventricular tachycardia is a rapid, regular heart rate that originates with abnormal electrical signals in the ventricles. The rapid heart rate doesn't allow the ventricles to fill and contract efficiently to pump enough blood to the body. Ventricular tachycardia can often be a medical emergency. Without prompt medical treatment, ventricular tachycardia may worsen into ventricular fibrillation.
Ventricular fibrillation. Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This serious problem is fatal if the heart isn't restored to a normal rhythm within minutes.
Most people who experience ventricular fibrillation have an underlying heart disease or have experienced serious trauma, such as being struck by lightning.
Long QT syndrome. Long QT syndrome is a heart disorder that carries an increased risk of fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the electrical system of your heart, may lead to fainting, and can be life-threatening. In some cases, your heart's rhythm may be so erratic that it can cause sudden death.
You can be born with a genetic mutation that puts you at risk of long QT syndrome. In addition, several medications may cause long QT syndrome. Some medical conditions, such as congenital heart defects, may also cause long QT syndrome.
Bradycardia — A slow heartbeat
Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low resting heart rate doesn't always signal a problem. If you're physically fit, you may have an efficient heart capable of pumping an adequate supply of blood with fewer than 60 beats a minute at rest.
In addition, certain medications used to treat other conditions, such as high blood pressure, may lower your heart rate. However, if you have a slow heart rate and your heart isn't pumping enough blood, you may have one of several bradycardias, including:
Sick sinus syndrome. If your sinus node, which is responsible for setting the pace of your heart, isn't sending impulses properly, your heart rate may be too slow (bradycardia), or it may speed up (tachycardia) and slow down intermittently. Sick sinus syndrome can also be caused by scarring near the sinus node that's slowing, disrupting or blocking the travel of impulses.
Conduction block. A block of your heart's electrical pathways can occur in or near the AV node, which lies on the pathway between your atria and your ventricles. A block can also occur along other pathways to each ventricle.
Depending on the location and type of block, the impulses between the upper and lower halves of your heart may be slowed or blocked. If the signal is completely blocked, certain cells in the AV node or ventricles can make a steady, although usually slower, heartbeat.
Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia.
Premature heartbeats
Although it often feels like a skipped heartbeat, a premature heartbeat is actually an extra beat. Even though you may feel an occasional premature beat, it seldom means you have a more serious problem. Still, a premature beat can trigger a longer lasting arrhythmia — especially in people with heart disease.
Premature heartbeats are commonly caused by stress, strenuous exercise or stimulants, such as caffeine or nicotine.
Risk factors
Certain factors may increase your risk of developing an arrhythmia. These include:
Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, a heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
High blood pressure. This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to become stiff and thick, which can change how electrical impulses travel through your heart.
Congenital heart disease. Being born with a heart abnormality may affect your heart's rhythm.
Thyroid problems. Having an overactive or underactive thyroid gland can raise your risk of arrhythmias.
Drugs and supplements. Certain over-the-counter cough and cold medicines and certain prescription drugs may contribute to arrhythmia development.
Diabetes. Your risk of developing coronary artery disease and high blood pressure greatly increases with uncontrolled diabetes.
Obstructive sleep apnea. This disorder, in which your breathing is interrupted during sleep, can increase your risk of bradycardia, atrial fibrillation and other arrhythmias.
Electrolyte imbalance. Substances in your blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development.
Drinking too much alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing atrial fibrillation.
Caffeine or nicotine use. Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.
Complications
Certain arrhythmias may increase your risk of developing conditions such as:
Stroke. When your heart quivers, it's unable to pump blood effectively, which can cause blood to pool. This can cause blood clots to form. If a clot breaks loose, it can travel from your heart to your brain. There it might block blood flow, causing a stroke.
Certain medications, such as blood thinners, can greatly lower your risk of stroke or damage to other organs caused by blood clots. Your doctor will determine if a blood-thinning medication is appropriate for you, depending on your type of arrhythmia and your risk of blood clots.
Heart failure. Heart failure can result if your heart is pumping ineffectively for a prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation. Sometimes controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.
Prevention
To prevent heart arrhythmia, it's important to live a heart-healthy lifestyle to reduce your risk of heart disease. A heart-healthy lifestyle may include:
Eating a heart-healthy diet
Increasing your physical activity
Avoiding smoking
Keeping a healthy weight
Limiting or avoiding caffeine and alcohol
Reducing stress, as intense stress and anger can cause heart rhythm problems
Using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat
Diagnosis
To diagnose a heart arrhythmia, your doctor will review your symptoms and your medical history and conduct a physical examination. Your doctor may ask about — or test for — conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Your doctor may also perform heart-monitoring tests specific to arrhythmias. These may include:
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Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
Event monitor. For sporadic arrhythmias, you keep this portable ECG device available, attaching it to your body and pressing a button when you have symptoms. This lets your doctor check your heart rhythm at the time of your symptoms.
Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion.
Implantable loop recorder. This device detects abnormal heart rhythms and is implanted under the skin in the chest area.
If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:
Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If doctors are evaluating you to determine if coronary artery disease may be causing the arrhythmia, and you have difficulty exercising, then your doctor may use a drug to stimulate your heart in a way that's similar to exercise.
Tilt table test. Your doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your doctor observes how your heart and the nervous system that controls it respond to the change in angle.
Electrophysiological testing and mapping. In this test, doctors thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart.
In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger — or halt — an arrhythmia. This allows your doctor to see the location of the arrhythmia and what may be causing it.
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Treatment
If you have an arrhythmia, treatment may or may not be necessary. Usually, it's required only if the arrhythmia is causing significant symptoms or if it's putting you at risk of a more serious arrhythmia or arrhythmia complication.
Treating slow heartbeats
If slow heartbeats (bradycardias) don't have a cause that can be corrected, doctors often treat them with a pacemaker because there aren't any medications that can reliably speed up your heart.
A pacemaker is a small device that's usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady rate.
Treating fast heartbeats
Cardiac catheter ablation
Cardiac catheter ablation
For fast heartbeats (tachycardias), treatments may include one or more of the following:
Vagal maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing.
These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. However, vagal maneuvers don't work for all types of arrhythmias.
Medications. For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm. It's very important to take any anti-arrhythmic medication exactly as directed by your doctor in order to minimize complications.
If you have atrial fibrillation, your doctor may prescribe blood-thinning medications to help keep dangerous blood clots from forming.
Cardioversion. If you have a certain type of arrhythmia, such as atrial fibrillation, your doctor may use cardioversion, which can be conducted as a procedure or by using medications.
In the procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.
Catheter ablation. In this procedure, your doctor threads one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips can use heat, extreme cold or radiofrequency energy to damage (ablate) a small spot of heart tissue and create an electrical block along the pathway that's causing your arrhythmia.
Implantable devices
Illustration showing pacemakers, defibrillator
Pacemakers, defibrillator
Treatment for heart arrhythmias also may involve use of an implantable device:
Pacemaker. A pacemaker is an implantable device that helps control abnormal heart rhythms. A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it's permanently anchored.
If a pacemaker detects a heart rate that's abnormal, it emits electrical impulses that stimulate your heart to beat at a normal rate.
Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your doctor may also recommend an ICD.
An ICD is a battery-powered unit that's implanted under the skin near the collarbone — similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm.
If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD doesn't prevent an abnormal heart rhythm from occurring, but it treats it if it occurs.
Surgical treatments
In some cases, surgery may be the recommended treatment for heart arrhythmias:
Maze procedure. In the maze procedure, a surgeon makes a series of surgical incisions in the heart tissue in the upper half of your heart (atria) to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia.
The procedure is effective, but because it requires surgery, it's usually reserved for people who don't respond to other treatments or for those who are having heart surgery for other reasons.
Coronary bypass surgery. If you have severe coronary artery disease in addition to arrhythmias, your doctor may perform coronary bypass surgery. This procedure may improve the blood flow to your heart.
CARRY OUT A RANDOM ACT OF KINDNESS WITH NO EXPECTATION OF
REWARD,SAFE IN THE KNOWLEDGE THAT ONE DAY- SOMEONE MIGHT DO THE SAME FOR YOU.
THIS STATEMENT WAS BOTH SPOKEN AND WRITTEN BY HRH PRINCESS DIANA, I DIDNT WRITE THIS QUOTE ABOVE. I ONLY WROTE MY THOUGHTS ABOUT THIS UNDERNEATH HER QUOTE.
AFTER READING THIS, I HAVE DECIDED TO DO SOMETHING KIND FOR SOME PERSON OR ANIMAL PER DAY. THE WORLD NEEDS MORE POSITIVE AND KIND PEOPLE IN IT, SO I AM GOING TO TRY MY BEST TO BE A KINDER MORE POSITIVE PERSON. WE ARE ONLY HERE FOR A SHORT TIME, AND NONE OF US KNOWS WHEN THEIR DEATH WILL COME. PRINCESS DIANA WAS LOVED SO MUCH BY PEOPLE, BECAUSE SHE LOVED AND SHOWED KINDNESS AND COMPASSION FOR ALL WHO CAME INTO HER LIFE WITHOUT JUDGEMENT OR CONDITION.THEY DAY SHE PASSED HOME TO SPIRIT, THE WORLD LOST A VERY KIND SWEET AND COMPASSIONATE PERSON. SHE PROVED THAT A SIMPLE ACT OF KINDNESS DOESNT NEED TO COST MONEY, AND THAT A SIMPLE ACT OF A KIND WORD OR ACTION CAN CHANGE A PERSON'S LIFE FOR THE BETTER.
Pituitary tumors
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Overview
Pituitary tumor
Pituitary tumor
Pituitary tumors are abnormal growths that develop in your pituitary gland. Some pituitary tumors result in too many of the hormones that regulate important functions of your body. Some pituitary tumors can cause your pituitary gland to produce lower levels of hormones.
Most pituitary tumors are noncancerous (benign) growths (adenomas). Adenomas remain in your pituitary gland or surrounding tissues and don't spread to other parts of your body.
There are various options for treating pituitary tumors, including removing the tumor, controlling its growth and managing your hormone levels with medications. Your doctor may recommend observation — or a ''wait and see'' approach.
Symptoms
Not all pituitary tumors cause symptoms. Pituitary tumors that make hormones (functioning) can cause a variety of signs and symptoms depending on the hormone they produce. The signs and symptoms of pituitary tumors that don't make hormones (nonfunctioning) are related to their growth and the pressure they put on other structures.
Large pituitary tumors — those measuring about 1 centimeter (slightly less than a half-inch) or larger — are known as macroadenomas. Smaller tumors are called microadenomas. Because of the size of macroadenomas, they can put pressure on the normal pituitary gland and nearby structures.
Signs and symptoms related to tumor pressure
Signs and symptoms of pressure from a pituitary tumor may include:
Headache
Vision loss, particularly loss of peripheral vision
Symptoms related to hormone level changes
Overfunctioning
Functioning pituitary tumors cause an overproduction of hormones. Different types of functioning tumors in your pituitary gland cause specific signs and symptoms and sometimes a combination of them.
Deficiency
Large tumors could cause hormonal deficiencies. Signs and symptoms include:
Nausea and vomiting
Weakness
Feeling cold
Less frequent or no menstrual periods
Sexual dysfunction
Increased amount of urine
Unintended weight loss or gain
Adrenocorticotropic hormone-secreting (ACTH) tumors
ACTH tumors produce the hormone adrenocorticotropin, which stimulates your adrenal glands to make the hormone cortisol. Cushing's syndrome results from your adrenal glands producing too much cortisol. Possible signs and symptoms of Cushing's syndrome include:
Fat accumulation around your midsection and upper back
Exaggerated facial roundness
Thinning of the arms and legs with muscle weakness
High blood pressure
High blood sugar
Acne
Bone weakening
Bruising
Stretch marks
Anxiety, irritability or depression
Growth hormone-secreting tumors
These tumors produce excess growth hormone (acromegaly), which can cause:
Coarsened facial features
Enlarged hands and feet
Excess sweating
High blood sugar
Heart problems
Joint pain
Misaligned teeth
Increased body hair
Children and adolescents might grow too fast or too tall.
Prolactin-secreting tumors
Overproduction of prolactin from a pituitary tumor (prolactinoma) can cause a decrease in normal levels of sex hormones — estrogen in women and testosterone in men. Excessive prolactin in the blood affects men and women differently.
In women, prolactinoma might cause:
Irregular menstrual periods
Lack of menstrual periods
Milky discharge from the breasts
In men, a prolactin-producing tumor may cause male hypogonadism. Signs and symptoms can include:
Erectile dysfunction
Lowered sperm count
Loss of sex drive
Breast growth
Thyroid-stimulating hormone-secreting tumors
When a pituitary tumor overproduces thyroid-stimulating hormone, your thyroid gland makes too much of the hormone thyroxine. This is a rare cause of hyperthyroidism or overactive thyroid disease. Hyperthyroidism can accelerate your body's metabolism, causing:
Weight loss
Rapid or irregular heartbeat
Nervousness or irritability
Frequent bowel movements
Excessive sweating
When to see a doctor
If you develop signs and symptoms that might be associated with a pituitary tumor, see your doctor. Pituitary tumors often can be treated to return your hormone levels to normal and alleviate your signs and symptoms.
If you know that multiple endocrine neoplasia, type 1 (MEN 1) runs in your family, talk to your doctor about periodic tests that may help detect a pituitary tumor early.
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Causes
Pituitary gland and hypothalamus
Pituitary gland and hypothalamus
The cause of uncontrolled cell growth in the pituitary gland, which creates a tumor, remains unknown.
The pituitary gland is a small, bean-shaped gland situated at the base of your brain, somewhat behind your nose and between your ears. Despite its small size, the gland influences nearly every part of your body. The hormones it produces help regulate important functions, such as growth, blood pressure and reproduction.
A small percentage of pituitary tumor cases run in families, but most have no apparent hereditary factor. Still, scientists suspect that genetic alterations play an important role in how pituitary tumors develop.
Risk factors
People with a family history of certain hereditary conditions, such as multiple endocrine neoplasia, type 1 (MEN 1), have an increased risk of pituitary tumors. In MEN I, multiple tumors occur in various glands of the endocrine system. Genetic testing is available for this disorder.
Complications
Pituitary tumors usually don't grow or spread extensively. However, they can affect your health, possibly causing:
Vision loss. A pituitary tumor can put pressure on the optic nerves.
Permanent hormone deficiency. The presence of a pituitary tumor or the removal of one may permanently alter your hormone supply, which may need to be replaced with hormone medications.
A rare but potentially serious complication of a pituitary tumor is pituitary apoplexy, when sudden bleeding into the tumor occurs. It feels like the most severe headache you've ever had. Pituitary apoplexy requires emergency treatment, usually with corticosteroids and possibly surgery.
Pituitary tumors
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Diagnosis
Pituitary tumors often go undiagnosed because their symptoms resemble those of other conditions. And some pituitary tumors are found because of medical tests for other conditions.
To diagnose a pituitary tumor, your doctor will likely take a detailed history and perform a physical exam. He or she might order:
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Blood and urine tests. These tests can determine whether you have an overproduction or deficiency of hormones.
Brain imaging. A CT scan or MRI scan of your brain can help your doctor judge the location and size of a pituitary tumor.
Vision testing.This can determine if a pituitary tumor has impaired your sight or peripheral vision.
In addition, your doctor might refer you to an endocrinologist for more-extensive testing.
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Treatment
Many pituitary tumors don't require treatment. Treatment for those that do depends on the type of tumor, its size and how far it has grown into your brain. Your age and overall health also are factors.
Treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a radiation oncologist. Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.
Surgery
Transnasal transsphenoidal surgery
Endoscopic transnasal transsphenoidal surgery
Surgical removal of a pituitary tumor usually is necessary if the tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones. The success of surgery depends on the tumor type, its location, its size and whether the tumor has invaded surrounding tissues. The two main surgical techniques for treating pituitary tumors are:
Endoscopic transnasal transsphenoidal approach. This usually enables your doctor to remove the tumor through your nose and sinuses without an external incision. No other part of your brain is affected, and there's no visible scar. Large tumors may be difficult to remove this way, especially if a tumor has invaded nearby nerves or brain tissue.
Transcranial approach (craniotomy). The tumor is removed through the upper part of your skull via an incision in your scalp. It's easier to reach large or more-complicated tumors using this procedure.
Radiation therapy
Radiation therapy uses high-energy sources of radiation to destroy tumors. It can be used after surgery or alone if surgery isn't an option. Radiation therapy can be beneficial if a tumor persists or returns after surgery and causes signs and symptoms that medications don't relieve. Methods of radiation therapy include:
Stereotactic radiosurgery. Often delivered as a single high dose, this focuses radiation beams on the tumor without an incision. It delivers radiation beams the size and shape of the tumor into the tumor with the aid of special brain-imaging techniques. Minimal radiation comes in contact with healthy tissue surrounding the tumor, decreasing the risk of damage to normal tissue.
External beam radiation. This delivers radiation in small increments over time. A series of treatments, usually five times a week over a four- to six-week period, is performed on an outpatient basis. While this therapy is often effective, it may take years to fully control the tumor growth and hormone production. Radiation therapy may also damage remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland.
Intensity modulated radiation therapy (IMRT). This type of radiation therapy uses a computer that allows the doctor to shape the beams and surround the tumor from many different angles. The strength of the beams can also be limited, which means surrounding tissues will receive less radiation.
Proton beam therapy. Another radiation option, this type uses positively charged ions (protons) rather than X-rays. Unlike X-rays, proton beams stop after releasing their energy within their target. The beams can be finely controlled and can be used on tumors with less risk to healthy tissues. This type of therapy requires special equipment and isn't widely available.
The benefits and complications of these forms of radiation therapy often aren't immediate and may take months or years to be fully effective. A radiation oncologist will evaluate your condition and discuss the pros and cons of each option with you.
Medications
Treatment with medications may help to block excess hormone secretion and sometimes shrink certain types of pituitary tumors:
Prolactin-secreting tumors (prolactinomas). The drugs cabergoline and bromocriptine (Parlodel) decrease prolactin secretion and often reduce tumor size. Possible side effects include drowsiness, dizziness, nausea, nasal stuffiness, vomiting, diarrhea or constipation, confusion, and depression. Some people develop compulsive behaviors, such as gambling, while taking these medications.
ACTH-producing tumors (Cushing syndrome). Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or glucose intolerance. Mifepristone does not decrease cortisol production, but it blocks the effects of cortisol on your tissues. Side effects may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium and swelling.
The newest medication for Cushing syndrome is pasireotide (Signifor), and it works by decreasing ACTH production from a pituitary tumor. This medication is given as an injection twice daily. It is recommended if pituitary surgery is unsuccessful or cannot be done. Side effects are fairly common, and may include diarrhea, nausea, high blood sugar, headache, abdominal pain and fatigue.
Growth hormone-secreting tumors. Two types of drugs are available for these types of pituitary tumors and are especially useful if surgery has been unsuccessful in normalizing growth hormone production. One type of drugs known as somatostatin analogs, which includes drugs such as octreotide (Sandostatin) and lanreotide (Somatuline Depot), causes a decrease in growth hormone production and may shrink the tumor. These are given by injections, usually every four weeks.
These drugs can cause side effects such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache and pain at the site of injection. Many of these side effects improve or even go away with time. They can also cause gallstones and may worsen diabetes mellitus.
The second type of drugs, pegvisomant (Somavert), blocks the effect of excess growth hormone on the body. This drug, given by daily injections, may cause liver damage in some people.
Replacement of pituitary hormones
If a pituitary tumor or surgery to remove it decreases hormone production, you'll likely need to take replacement hormones to maintain normal hormone levels. Some people who have radiation treatment also need pituitary hormone replacement.
Watchful waiting
In watchful waiting — also known as observation, expectant therapy or deferred therapy — you might need regular follow-up tests to determine if your tumor grows. This might be an option if your tumor isn't causing signs or symptoms.
Many people with pituitary tumors function normally without treatment if the tumor isn't causing other problems. If you're younger, watchful waiting can be an option as long as you accept the possibility of your tumor changing or growing during the observation period, possibly requiring treatment. You and your doctor can weigh the risk of symptoms developing versus treatment.
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Coping and support
It's natural for you and your family to have questions throughout the diagnosis and treatment of a pituitary tumor. The process can be overwhelming — and frightening. That's why it's important to learn as much as you can about your condition. The more you and your family know and understand about each aspect of your care, the better.
You might also find it helpful to share your feelings with others in similar situations. Check to see if support groups for people with pituitary tumors and their families are available in your area. Hospitals often sponsor these groups. Your medical team also may be able to help you find the emotional support you might need.
Preparing for your appointment
You're likely to start by seeing your primary care provider. If your doctor finds evidence of a pituitary tumor, he or she might recommend you see several specialists, such as a brain surgeon (neurosurgeon) or a doctor who specializes in disorders of the endocrine system (endocrinologist).
Here's some information to help you prepare for your appointment.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
Your symptoms, including any that may seem unrelated to the reason for your appointment
Key personal information, including major stresses or recent life changes and family medical history
Medications, vitamins or supplements you take, including doses
Questions to ask your doctor
Take a family member or friend along, if possible, to help you retain the information you receive.
For a pituitary tumor, questions to ask your doctor include:
What is likely causing my symptoms or condition?
What are other possible causes?
What specialists should I see?
What tests do I need?
What is the best course of action?
What are alternatives to the primary approach you're suggesting?
I have these other health conditions. How can I manage them together?
Are there restrictions I need to follow?
Are there brochures or other printed materials I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
When did your symptoms begin?
Have they been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Have you had previous imaging of your head for any reason in the past?
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