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Oculoplastic and orbital surgery is a sub-specialism that treats the pathology related to the eye attachments, with four main fields of interest: orbital pathology, tear duct anomalies, anophthalmic cavity pathology and eyelid disorders.
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.
This Section treats conditions affecting the optic nerve and Strabismus, a loss of ocular alignment.
This Section treats conditions affecting the optic nerve, whether secondary to intracranial hypertension, inflammatory/demyelinating, ischemic, infiltration-related (such as sarcoidosis), compressive, autoimmune, due to nutritional/toxic deficits, paraneoplastic or genetic, those affecting the visual field due to involvement of the visual pathway, whether cranial tumours, stroke, traffic accidents, infections (meningitis, encephalitis…) and those affecting pupil shape, size or reactivity.
In short, all those systemic or neurological entities that can cause visual dysfunction.
It is a multidisciplinary sub-specialty in which we collaborate with other hospital services, such as Internal Medicine, Neurosurgery or Neurology. We work particularly closely with the Neurology department of the Multiple Sclerosis Centre of Catalonia (Cemcat).
Strabismus is a loss of ocular alignment.
In our Department, we offer treatment by means of glasses, with or without prism, botulinum toxin or surgery of the extraocular muscles.
We treat strabismus in patients who have presented it since childhood (whether they have been treated previously or not), as well as in patients who present it in an acute way due to paralysis, restrictions (severe myopia, thyroid pathology, orbital trauma, tumours), age-related strabismus (sagging eye) and sensory strabismus (secondary to visual deficit).
The main reason for treatment is diplopia (double vision), improving eye mobility or compensatory torticollis and also for aesthetic reasons.
Uveitis is an inflammation of the middle layer of the eye, the uvea, and can affect only the ocular and periocular region or it may be associated with systemic diseases. The aetiology of this clinical picture is very varied and includes trauma, infection, previous eye surgery, systemic inflammatory disease and others.
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...).
The retina sub-specialism is a branch of ophthalmology concerned with studying, diagnosing and treating retina, uvea and vitreous conditions.
Among the pathologies tackled by this sub-specialism are pathologies of the retina that require medical treatment, including: diabetic retinopathy, retinal vascular disorder, such as venous thrombosis or arterial occlusions, age-associated macular degeneration or severe myopia.
The Department has the most advanced technology for the surgical treatment of various retina conditions:
The Department also has the technology required for correct differential diagnosis of tumour pathologies of the eye and to conduct multi-disciplinary exams to diagnose and monitor patients. With regard to treating choroidal melanoma, the Department performs treatment through vitrectomy, acquiring tumour samples, and through tumour endoresection, as well as plaque brachytherapy implant (local radiotherapy).
The Retina Department at Vall d'Hebron Hospital constantly works on implementing and updating protocols of action on the different diseases of the retina and vitreous. The Retina Department is highly committed to research and teaching. It stands out for its long tradition of publications and for publishing chapters in books, as well as for taking part in various national and international studies on the latest scientific advances and technological innovation, allowing us to offer our patients the latest therapeutic advances.
The clinical and basic research activity of the ophthalmology research group focuses on finding new treatments for blindness. We have a research programme in developing new therapeutic strategies based on: a) gene and cell therapies to regenerate or halt the retina degeneration process in pre-clinical models; b) eyewash formulae to discover new anti-inflammatory and anti-oxidant compounds to treat retina conditions; and c) 3D retinal organoids derived from hiPSC and bioscaffolds used as models of retinal disease, both for genome editing and drug screening.
Integrated monitoring of patients with glaucoma, from diagnosis at the GP surgery/hospital to surgical treatment, where required.
Care services are currently conducted
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.
We are currently involved in several research studies. Scientific activity:
Our Section deals with the diagnosis and treatment of all pathologies affecting the ocular surface, whether inflammatory, infectious, dystrophic, traumatic, tumour-related or degenerative.
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.
The Ophthalmology Department at Vall d’Hebron University Hospital offers integrated care to all those with conditions that affect eyes and eye attachments. We act as a national reference in various ophthalmological pathologies, attending patients from both Catalonia and the rest of Spain. This care work is complemented by important teaching and research activity, which allows us to remain at the forefront of our specialty.
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:
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:
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).
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:
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.
The Ophthalmology Teaching Unit at Vall d'Hebron Hospital has several decades of experience in academic training, both formal and continuous, in the subject of Ophthalmology in the degree in Medicine and in the training, via MIR (internal residency), of doctors specialised in ophthalmology.
Ophthalmology training itinerary
"Ophthalmology is defined as the medical and surgical specialty related to the diagnosis and treatment of eye disorders and diseases".
"Ophthalmology specialists attend to patients with ocular pathology. Their competencies include the study, prevention, diagnosis, treatment and rehabilitation of eye conditions".
he training of resident specialists in ophthalmology requires a special mention in this section, as it is one of our Department's priorities. To this end, we have a teaching structure based on each resident having a tutor, who is responsible for accompanying the resident during the four years of training. The ratio is one tutor for every 3-4 residents. They are responsible for ensuring the resident integrates into the Department, resolving any problems that may arise during the residency and acting as a means of communication between the various attending physicians, the Department Head and the resident. Tutors meet periodically with the residents they tutor, the other tutors in the Department and ultimate teaching leads (the Department Head and the Teaching Director). This is all geared towards achieving the best training profiles for our residents, so that by the end of the residency they are prepared to perform their professional role within the specialty with the utmost professionalism.
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