Prof Matthew Simunovic
MB BChir PhD FRANZCO |
Eye Surgeon
MB BChir PhD FRANZCO |
Eye Surgeon
Services
Professor Simunovic is experienced in providing routine and emergency care for patients with retinal disease. Click below for information about some of the services he offers.
Cataract surgery
Why choose Prof Simunovic?
- Matthew Simunovic has extensive experience of routine and complex cataract surgery.
- His undergraduate training in optometry, combined with his surgical experience enables him to select the appropriate lens and refractive outcome for his patients.
- He trains the next generation of ophthalmologists and retinal surgeons in routine and complex cataract surgery.
What are cataracts?
- A cataract is a cloudy crystalline lens. The crystalline lens of the eye is normally highly transparent and helps to focus light on the retina.
- Loss of transparency of the crystalline lens degrades the image formed by the eye, leading to loss of clarity, glare and sometimes distortion.
Procedure information
- Cataract surgery is a day procedure, taking approximately 15-20 minutes to complete.
- Cataract surgery is undertaken in accredited hospitals and is generally conducted using local anaesthesia under sedation.
- Cataract surgery is performed as a day procedure and patients are discharged home following surgery, though you will be unable to drive yourself home and it is recommended that you have a friend or relative with you to help with the journey home. Your first post-operative visit will be the day after surgery.
- During cataract surgery, small incisions are made into the eye and the cloudy lens is emulsified (broken up) in the eye using ultrasound energy. A replacement plastic intraocular lens is then inserted into the eye and permanently fixed in place.
- 95% of patients have improved vision following cataract surgery.
- More information can be found at https://www.aao.org/eye-health/diseases/what-are-cataracts.
Complicated cataract surgery and secondary intraocular lenses
Why choose Prof Simunovic?
- Matthew Simunovic routinely manages patients referred by other eye surgeons for the management of the complications of cataract surgery.
- He has extensive experience in vitrectomy surgery for retained cataract and subluxed lenses. He is able to provide a range of secondary intraocular lens fixation techniques, including sutured and sutureless scleral fixation.
- He trains the next generation of vitreoretinal surgeons in the management of patients requiring complex cataract surgery.
What are cataracts?
- A cataract is a cloudy crystalline lens. The crystalline lens of the eye is normally highly transparent and helps to focus light on the retina.
- Loss of transparency of the crystalline lens degrades the image formed by the eye, leading to loss of clarity, glare and sometimes distortion.
Procedure information
- In cases where an intact lens must be removed, a vitrectomy performed and a secondary lens sutured, surgery takes up to 90 minutes.
- Surgery is performed in an accredited hospital and is usually performed under local anaesthetic with sedation.
- Patients requiring vitrectomy are generally admitted overnight and discharged home on the following day.
Retinal detachment surgery
Why choose Prof Simunovic?
- Matthew Simunovic has extensive experience in the management of patients with routine and complex retinal detachment.
- As a consultant vitreoretinal surgeon at Sydney Eye Hospital, he performs high volume vitreoretinal surgery. He will select the appropriate surgical technique tailored to the patient and their eye: options available include scleral buckling, vitrectomy, combined scleral buckle/vitrectomy and pneumatic retinopexy.
- He trains the next generation of vitreoretinal surgeons in the management of retinal detachment.
What is retinal detachment?
- Retinal detachments affect about 1 in 10,000 people per year and occur when the light sensitive retina, which normally lines the inside of the eye, separates from the underlying layers.
- Most retinal detachments occur as the result of tears or holes in the retina and are managed surgically.
Procedure information
- Two principal methods of retinal reattachment can be employed separately or in combination: these are scleral buckling and pars plana vitrectomy.
- Scleral buckling involves suturing a silicone tire or sponge onto the white of the eye (sclera). Buckles are placed underneath the conjunctiva (the “skin” covering the white of the eye) and are not visible externally. Buckles maintain retinal attachment by changing the flow of fluid within the eye. Retinal holes or tears are treated during surgery with cryotherapy (freezing).
- Vitrectomy is a micro-keyhole surgery in which the vitreous gel is removed, causative retinal tears are identified and treated and in which fluid is removed from under the retina. At the completion of surgery gas or (rarely) oil is injected into the eye to maintain retinal attachment. Gas is reabsorbed by the eye, however oil must be removed at a second surgery. Patients are generally advised to posture for up to 7 days following the surgery – this will be discussed on a case-by-case basis.
- Retinal detachment surgery is performed in accredited hospitals. Surgery is usually performed under local anaesthesia with sedation.
- Success rates for detachment surgery are dependent upon the characteristics of the detachment, however, more than 90% of detachments can be repaired successfully with a single operation.
Macular surgery
Why choose Prof Simunovic?
- Matthew Simunovic routinely performs macular surgery for the management of epiretinal membrane and macular hole and is experienced in performing sub-retinal injections.
- He trains the next generation of ophthalmologists and retinal surgeons in macular surgery.
- He uses the latest small gauge technology to maximise patient comfort post-operatively.
- In the case of most macular hole patients, he is able to offer “non-posturing” post-operatively.
Procedure information
- Macular surgery is performed in accredited hospitals.
- Surgery is usually performed under local anaesthesia with sedation.
- Patients are normally admitted overnight following surgery and discharged the following morning.
Epiretinal membrane
- Epiretinal membranes are common, affecting about 5% of individuals.
- Whilst most epiretinal membranes do not cause significant problems, some patients may experience decreased vision, loss of depth perception and distortion.
- Patients with significant changes in visual function may benefit from vitrectomy and membrane peeling surgery.
- Vitrectomy is a micro-keyhole surgery in which the vitreous gel is removed.
- Following removal of the vitreous, fine forceps are used to peel the epiretinal membrane from the retinal surface.
- More than 90% of patients notice an improvement in vision following epiretinal membrane surgery.
Macular hole
- Macular holes occur when traction (pulling) on the central retina results in a “gap” in the retina at its most sensitive location.
- This results in decreased vision and distortion.
- Spontaneous closure is uncommon.
- Surgery for macular hole is highly successful, with more than 95% of holes achieving closure following intervention.
- Surgery involves vitrectomy, peeling of the innermost layer of the retina (the ILM) and injection of a gas bubble.
- Vitrectomy is a micro-keyhole surgery in which the vitreous gel is removed.
- Following removal of the vitreous, fine forceps are used to peel the internal limiting membrane (ILM). Visualisation of the ILM is enhanced with vital dyes such as ILM blue.
- Gas is injected into the eye at the completion of surgery and is reabsorbed over a 2 week period (although long-acting gas may be used).
Sub-macular injections
- Sub-macular haemorrhage may result in catastrophic vision loss and is most commonly caused by either macular degeneration or retinal arteriolar macroaneurysm.
- Appropriate management varies from careful observation through to sub-retinal injection of a “clot-busting” agent (tissue plasminogen activator) and gas injection.
- Sub-retinal injections take place following vitrectomy.
- Vitrectomy is a micro-keyhole surgery in which the vitreous gel is removed.
- The sub-retinal space is accessed via a small gauge Teflon tipped cannula.
- At the completion of surgery, a gas bubble is injected into the eye.
- Patients are generally advised to posture following the surgery – this will be discussed on a case-by-case basis.
- The prognosis of patients presenting with sub-macular haemorrhage depends on many factors and can be discussed following a comprehensive examination.
Intraocular trauma
Why choose Prof Simunovic?
- Matthew Simunovic regularly manages patients with intraocular trauma and intra-ocular foreign bodies. He is experienced in the short- and long-term management of such patients.
- In his role as a consultant vitreoretinal surgeon at Sydney Eye Hospital, he is responsible for training the next generation of retinal surgeons in the management of intraocular trauma.
Procedure information
- Trauma surgery is performed in accredited hospitals and requires overnight admission. Depending on the nature of the injury, either local anaesthetic with sedation or general anaesthesia may be used.
- The prognosis of patients presenting with intraocular trauma depends upon the nature of the injuries and can be discussed following a comprehensive examination.
Intravitreal injections for macular degeneration, retinal vascular disease and diabetic retinopathy
Why choose Prof Simunovic?
- Matthew Simunovic has extensive experience in performing intra-vitreal injections for the management of a variety of conditions including macular degeneration, retinal vein occlusions and diabetic eye disease.
Procedure information
- Intravitreal injections are performed in rooms and a variety of anaesthetic options are available to patients in order to minimise any discomfort experienced during the procedure.
Macular degeneration
- Macular degeneration is the commonest cause of irreversible sight loss and occurs when the central retina undergoes degenerative changes.
- Macular degeneration is divided into two forms: exudative (“wet”) and non-exudative (“dry”).
- Wet macular degeneration may lead to sudden and drastic loss of vision, whilst dry macular degeneration is generally associated with gradual decline.
- At present, active treatment is available for wet macular degeneration: the most common intervention is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents.
- Intravitreal injection involves numbing the eye with anesthetic, thorough cleaning of the surface of the eye and surrounding skin with an antiseptic solution followed by an injection into the eye using a fine needle. Patients are advised not to drive themselves home after their procedure.
- More than 90% of patients undergoing injections maintain their vision and between 40 and 50% make significant gains in their ability to discern objects.
- For further information on macular degeneration go to https://www.aao.org/eye-health/diseases/amd-macular-degeneration.
Retinal vein occlusion
- Retinal vein occlusions occur when there is blockage in the blood vessels carrying blood out of the retina. Blockage may occur either to the main vein (“central retinal vein occlusion”) or one of the smaller branches of this vein (“branch retinal vein occlusion”).
- Vision loss can be due to subsequent swelling (oedema) of the macula or due to a resulting loss of blood supply (ischemia).
- Patients with vision loss due to retinal vein occlusion may benefit from active treatment in the form of intra-vitreal injection, LASER or vitrectomy.
- For patients with macular oedema, intravitreal injection has been demonstrated to be superior to “traditional” management (LASER in branch vein occlusion and observation in central vein occlusion). Intravitreal injection increases the chance of significant improvement by a factor of 2 to 3 times over “traditional” management.
- Occasionally, growth of new blood vessels onto the retinal surface may occur: this may cause haemorrhage in the vitreous gel or mechanical detachment of the retina from pulling on the retinal surface - such patients may benefit from intravitreal injection and LASER or vitrectomy surgery.
- Rarely, new blood vessels may clog up the drainage mechanism of the eye. This causes an increase in pressure inside the eye and is known as neovascular glaucoma. Depending on the stage and severity of blood vessel growth, a number of treatment options are available. Intravitreal injection may be used in the short term to “buy time” by temporarily shutting down these new vessels; however, further treatment is also required. This may include LASER or surgery.
Diabetic eye disease
- Diabetic eye disease has been the principal cause of vision loss in those of working age. However, the rates of vision loss are decreasing as the result of improved detection and management.
- Diabetes affects the eye in many ways and can affect both the blood vessels in the retina as well as the nerve cells contained in the retina.
- Treatment is generally reserved for patients who develop swelling of the macular (diabetic macular oedema) or for those in whom new blood vessels have grown into the eye (neovascularization).
- Depending upon the nature of the changes, treatment may consist of intravitreal therapy with an anti-vascular endothelial growth factor (anti-VEGF) agent, LASER or vitrectomy surgery.
- Intravitreal injection involves numbing the eye with anesthetic, thoroughly cleaning the surface of the eye and surrounding skin with an antiseptic solution followed by an injection into the eye using a fine needle. Patients are advised not to drive themselves home after their procedure.
- LASER is generally conducted in rooms and involves focussing a green LASER light onto the retina. This results in heating of the retinal tissue. Although topical anaesthesia is used, many patients experience ache at the time of LASER application, though for the majority the discomfort is minimal. Patients who experience significant discomfort, or in whom extensive LASER is required, may benefit from undergoing the procedure in hospital with local anaesthesia and sedation.
- Vitrectomy is a micro-keyhole surgery in which the vitreous gel is removed. In the context of diabetes, scar tissue may also need to be removed from the eye at the same time. Vitrectomy is performed in accredited hospitals and requires overnight admission.
- For further information on diabetic eye disease go to https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy.
Retinopexy (LASER/cryopexy), LASER and photodynamic therapy (PDT)
Why choose Prof Simunovic?
- Matthew Simunovic has extensive experience in performing LASER retinopexy and cryopexy for the management of retinal tears and limited retinal detachment.
- He has extensive experience in LASER for the management of diabetic eye disease, retinal vascular occlusion and other retinal diseases.
- He is experienced in the use of photodynamic therapy (PDT) in the management of retinal disease.
- Matthew Simunovic trains the next generation of ophthalmologists and retinal specialists in these procedures.
Procedure information
- Depending upon the nature of the condition to be treated, LASER is carried out in rooms or occasionally in theatre; cryotherapy is generally reserved for theatre but occasionally may be performed in rooms.
- Patients undergoing PDT are required to avoid exposure to sunlight for a few days following the procedure.
All surgical procedures carry some risk. The information provided here is for general educational purposes only. Please contact Professor Matthew Simunovic to discuss the options that are appropriate for your individual situation.
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APPOINTMENTS
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