By admin | Jun 25, 2018
The retina is very thin, light sensitive tissue that lines the back of the eye. When light enters our eyes through the cornea and lens, the image is focused on the retina. The retina is made up of several regions — the macula which is responsible for detailed pin- point central vision and the peripheral retina which is responsible for your peripheral vision.
Often, retinal detachments occur after a retinal break or tear. The most common way retinal tears occur is through a normal aging change where the vitreous – a clear jelly like substance – pulls loose and separates from the retina. This pull can cause traction on the retina, resulting in a retinal tear. The liquefied vitreous goes under the retinal tear and accumulates behind the retina causing a retinal detachment. If not treated in a timely manner a retinal detachment may lead to permanent vision loss.
There are many ways to successfully repair a retinal detachment. The choice in procedure will be picked based on the type of retinal detachment you have and your specific situation. Proper reattachment of the retina is important in order best preserve your vision.
Vitrectomy: A detachment may be repaired by several different surgical procedures. One method is called a vitrectomy. During this procedure, a surgeon makes small openings in the sclera through which instruments can be inserted into the eye. The vitreous gel is removed, taking care that any traction on the existing tear is released. The fluid is then removed from under the retina. Once the retina is flattened, 360-degree laser is performed to ensure the peripheral retina is well tacked down. Care is taken to completely encircle any existing breaks. Lastly, either gas or oil is placed in the middle of the eye, allowing the retina to be pressed up against the back of the eye until the laser heals.
Scleral Buckle: A scleral buckle surgery is performed from the outside of the eye, in contrast with the previous vitrectomy surgery where instruments were introduced in the middle of the eye. The point of the scleral buckle surgery is to try to relieve the traction placed on the retinal break by moving the wall of the eye inwards. This is done by placing an encircling buckle around the eye and tightening it. The fluid under the retina is drained from the outside, and freezing treatment is applied to the break to seal it.
Laser/ Freezing treatment: Your surgeon will perform laser to make small burns around the tear. The burns result in scarring that aids in sealing of the tissue around the tear, which prevents fluid from progressing and leading to a full blown retinal detachment. Freezing is used with a special probe that applies intense cold to freeze the retina resulting in scar tissue that will help encircle and fully seal the tear. Allow 4-6 weeks for proper healing time following these treatments.
Pneumatic retinopexy: A gas bubble is injected into the vitreous along with a combination of laser or freezing around the tear. The gas is used to hold the retina in place while either the laser or freezing can work.
In order to have the best possible outcome after surgery there are several things to keep in mind. For those who have been treated with a gas bubble, proper face down positioning is imperative to reinforce the retina and help it heal properly. Patients are encouraged to rent the face down apparatus that will help with face down positioning. All patients must take postoperative drops. They are important for preventing inflammation and bacterial infections. Activity must be restricted, and patients should refrain bending and heavy lifting (2-10 lb. limit). Protective shield should be worn for at least a week and guidelines should be followed closely to ensure incisions heal properly without disruption. Flying must be avoided due to the ability of gas expansion in the eye that will lead to other serious problems including blindness. Be sure to always wear the green bracelet provided until gas has completely dissipated. The green bracelet is used to prevent certain anesthetics from being administered to a patient with a gas bubble in their eye. Lastly, be patient. While the gas bubble is still in the eye vision will be minimal to none — don’t panic. As gas begins to dissipate vision will be regained slowly. Proper healing of the retina is imperative to try and restore your best possible sight. We will work closely with you in order to choose the proper surgery for your particular retinal detachment and will educate you on your postoperative care to give you the greatest chance of preserving your sight.
In the interest of maintaining further transparency and providing a wide breadth of information to our patients and providers, this blog will serve as an educational and informative resource on interesting happenings within Retina Consultants of Boston and in the greater field of Ophthalmology.
Here at Retina Consultants of Boston, Dr. John J. Weiter and Dr. Namrata Nandakumar are on the forefront of diagnostic techniques, treatment and micro-surgical techniques for macular degeneration, diabetic retinopathy, retinal detachments, macular holes, and a number of other issues affecting the vitreous and retina. Check back here frequently for news and updates on our practice and all things retina!