The main characteristic of this field is its multi-disciplinary nature, due to the diversity of systemic diseases that may be involved. It is also an area that touches on other specialisms, including maxillofacial surgery, ear, nose and throat, plastic surgery and neurosurgery.

Treatment in this field often involves inter-relation with other medical specialisms, including endocrinology, internal medicine, radiology and oncology. We also provide medical and surgical care for oculoplastic pathology at the Children’s and Women’s Hospital.

We are a benchmark centre (CSUR) for orbital tumours nationwide and have set up an Orbital Tumour Hospital Committee to provide our patients with the best care and treatment.

In this Section, we have access to all the testing required to diagnose and manage these conditions, from exclusively ocular tests, such as wide-field retinography, autofluorescence, optical coherence tomography, campimetry, etc., to extraocular testing in close relation with other specialties across the hospital.

Due to the huge amount of damage that ocular and extraocular tissues can undergo, these conditions are usually treated using powerful anti-inflammatory medicines, such as glucocorticoids. In many cases, inflammation is chronic and therefore requires medicines that allow us to bring it under control effectively and safely in the long term, such as immunosuppressant and biological therapies. These patients must therefore be treated using a multi-disciplinary approach, in collaboration with internal medicine specialists. Our Department benefits from professionals with a huge amount of experience and many years working in this field, who visit patients in appointments within the Department, together with the ophthalmologist.

Sometimes these conditions require surgery, which is performed in the Uveitis Department, whether for aetiological diagnosis (diagnostic vitrectomy, eye tissue biopsy...), or for treatment (cataract surgery, therapeutic vitrectomy...).

Activities

• Laser Service (Ophthalmology Department at Vall d'Hebron Hospital): Trabeculoplasty, iridoplasty, peripheral iridotomy, goniopuncture
• In the operating theatres at Parc Sanitari Pere Virgili, glaucoma surgery is performed in 4 to 5 modules per week, in line with surgeon capacity both in terms of availability and technical skills/accreditations
• Filtration surgery: Trabeculectomy, non-penetrating deep sclerectomy (NPDS), EXPRES P.50 implant, microincision glaucoma surgery (MIGS) techniques, iStent angle implants
• MIGS PLUS techniques: XEN implants
• Drainage devices: valve implants (Ahmed)
• Cycloablation techniques: transscleral diode laser cyclophotocoagulation (G-Probe TDLC), transscleral diode laser cyclophotocoagulation (MP3 TDLC)

Care services are currently conducted

• In outpatient clinics at Vall d'Hebron Hospital.
• In outpatient clinics at Parc Sanitari Pere Virgili.
• At the three clinics in our division: CAP Horta (Dr M. Castany), CAP Sant Andreu (Dr M. Amilburu), CAP Chafarinas (Dr J. Rigo and Dr O. Pujol).

 

Teaching

For the past 12 years, the Glaucoma Department has trained resident doctors in the medical and surgical techniques for glaucoma, in weekly sessions divided into three trimesters (1st, 2nd and 4th T). These sessions cover diagnosis and the medical and surgical treatment of the condition. Our aim is to continue this work, as it has had excellent results.

The Glaucoma Department is responsible for annual coordination of and participation in the course. We would like to deliver a yearly course related to the condition glaucoma in which speakers from different hospitals are invited to participate.

Scholarship course for a 4th year resident (R-4) interested in glaucoma as a sub-specialism so that they can take part in the annual European Glaucoma Society (EGS) residents' course.

Residents receive teaching during their rotation in the Glaucoma Unit. It is currently split into two periods of 3 or 4 months. Face-to-face sessions take place with residents on Monday mornings (PSPV). There are also annual refresher courses led by physicians from the Glaucoma Service and physicians external to our hospital.

 

Research

We are currently involved in several research studies. Scientific activity:

• We have collaborated in various monographs and events related to glaucoma.
• We have contributed to creating an open-angle glaucoma clinical practice guide, we have published articles in national and international journals and have attended a number of conferences as speakers.
• We formed part of a multi-centre clinical trial into two surgical techniques for glaucoma and we are interested in being able to take part in the near future (as discussed with the Allergan Lab.), in a multi-centre trial to evaluate the efficacy, the duration of hypotensive action and the tolerance of biodegradable implants (Brimatoprost) injected in the anterior chamber of the eye.

Within the Department, we have the most up-to-date complementary tests for diagnosing ocular surface pathologies: specular microscopy, pachymetry, state-of-the-art topography (Pentacam, Cassini), high-resolution anterior segment OCT, etc.

We maintain a close relationship with the departments involved in the diagnosis (Microbiology and Pathological Anatomy) and treatment (Blood and Tissue Bank) of ocular pathologies. This allows us to speed up the diagnostic processes (especially in infectious and tumour processes) and to improve the performance of the treatments applied (amniotic membrane, amniotic membrane extract eye drops, autologous serum eyedrops, cord blood plasma, platelet-rich plasma...)

We have three weekly sub-specialty operating room sessions, which gives us a very short waiting list for ocular surface and keratoplasty techniques. We are a centre especially involved in performing corneal transplants, and in recent years we have remained among the public centres that have performed the most transplants, both in Catalonia and nationally. In the last few years, we have been incorporating lamellar techniques into our transplants (anterior lamellar, DALK type, and posterior endothelial lamellar, DSAEK and DMEK type), so that currently only 30% are penetrating. We thus achieve a lower rate of intraoperative complications, better and earlier sight recovery and a reduction in the incidence of rejection and/or endothelial failure in the medium and long term.

Like the other sections in our Department, we actively participate in training residents in the specialty, as well as in Ophthalmology classes and in placements for fourth-year students of Medicine at the UAB.

As far as research is concerned, the members of the Department conduct work as principal investigators or collaborators in different projects, both in the Ophthalmology Department and in other hospital departments (Oncology). One of these projects allows us to have access to topical treatment of our patients with umbilical cord blood plasma eye drops, which is far superior to other therapeutic options in ocular surface pathologies.

We are a benchmark national unit of expertise (CSUR) for surgical techniques involving complex reconstruction of the ocular surface, especially those using amniotic membrane and temporary or permanent keratoprosthetics.

 

Care activity

The aim of the Ophthalmology Department is to put all the material and human resources at our disposal into improving the eye health and quality of life of our patients.

The Ophthalmology Department's activity is conducted at various locations, depending on the different care activities, all of which are coordinated and directed by Dr José García-Arumí, Head of Department:

• Ophthalmology Department as such, located in the annexe on the third floor of the General Hospital.
• Ophthalmology Emergency Department: integrated into the Emergency Department of the General Hospital.
• Paediatric Ophthalmology Unit: located in the Maternity and Children's Hospital.
• Day Surgery Unit: located in the Parque Sanitario Pere Virgili. Also includes care activities and complementary ophthalmology tests.
• Outpatient Ophthalmology Units: spread across the Horta, Chafarinas and Sant Andreu outpatient clinics.

In turn, the Department's care work is structured into different sections, corresponding to each of the ophthalmology sub-specialties. In order to be able to offer more specialised care, in the context of a tertiary level hospital, we have a large team of professionals who are experts in the different sub-specialties:

• Corneal and Ocular Surface Section
• Glaucoma Section
• Retina Section
• Uveitis and Eye Inflammation Section
• Neuro-ophthalmology and Strabismus Section
• Oculoplastics and Orbital Surgery 
• Paediatric Ophthalmology Unit

All the above sections interact with other departments or units at Vall d'Hebron Hospital in order to coordinate and agree on diagnostic and therapeutic decisions for patients who present pathologies involving different medical specialties. This is the case of the multi-disciplinary committees (Tumour Committee, Transplant Committee...), direct contact with other care services in specific cases (maxillofacial surgery, traumatology, plastic surgery, neurology, paediatric specialties, etc.), close contact with services involved in diagnostic (microbiology, pathological anatomy) or therapeutic (Blood and Tissue Bank) tasks and the participation of a doctor specialised in internal medicine in the tasks of diagnosis and treatment of ocular inflammatory processes (Dr Antonio Segura).

 

Teaching

The Ophthalmology Department is a Teaching Unit of the Autonomous University of Barcelona (UAB). The academic chair is Dr José García-Arumí, Head of the Ophthalmology Department. In turn, several members of the Department are professors (Dr Tirso Alonso Alonso), associate professors or interns at the UAB.

The teaching activity of the Ophthalmology Department includes:

• Undergraduate teaching: theory classes, seminars and practical work completed by fourth-year students from the UAB Faculty of Medicine in our Department.
• Postgraduate teaching: resident interns learning their specialty in our Department, rotations of resident interns from other national and international hospitals, organisation and development of doctoral courses and management and tutoring of various doctoral theses.
• Continuous training of the different professionals that make up the Ophthalmology Department: clinical sessions, organisation of conferences within our Department and active participation in various national and international conferences in our specialty.

 

Research

The protocolisation of clinical measures, patient follow-up and collecting the corresponding data has led to the publication of various works in high-prestige national and international journals and the participation in clinical trials and research studies on the most recent therapeutic techniques in the different sub-specialties.

 The basic research group in Ophthalmology, made up of an interdisciplinary team of clinicians and basic researchers, focuses its activity on research into new therapies for the treatment of the main neurodegenerative diseases of the retina (such as diabetic retinopathy, age-related macular degeneration and retinitis pigmentosa), ocular surface pathologies (dry eye syndrome, herpes keratitis and neurotrophic ulcers) and the repercussions at eye level of different systemic treatments.

The projects currently being conducted deal with studying different therapeutic strategies, such as cell therapy using stem cells, gene therapy for the expression of curative genes and pharmacological therapies with antiangiogenic factors and antioxidants. These research projects mainly involve basic research, conducted at the Ophthalmology Laboratory located at Vall d'Hebron Research Institute (VHIR), as well as the development of preclinical trials, using animal models for experimentation, which are conducted at the VHIR Animal Facility. All these products have led to multiple presentations and publications in high-impact journals.