Retinal Procedures

Description

A detached retina means the retina has separated from the back of the eye. When the retina is separated from the back of the eye, it is not able to function normally. Retinal detachments are often caused by a single hole or multiple holes in the retina. 

A detached retina can be an urgent issue. If left untreated, a retinal detachment can get larger and lead to permanent vision loss.

Treatment

The goal of treatment is to either prevent the retina detachment from getting larger or to reattach the retina to the back of the eye. Depending on the type of retinal detachment, there are several treatment options your retina doctor may offer you:

1. Laser or freezing treatment
2. Injection of a gas bubble along with laser or freezing treatment (pneumatic retinopexy)
3. Vitrectomy
4. Scleral buckle

The first two options are usually performed in the office, while the last two options are usually performed in the operating room.

If the retinal detachment is limited, your doctor may offer you laser or freezing treatment around the retinal detachment. The purpose of laser or freezing is to “weld” the retina to the back of the eye to prevent enlargening of the retinal detachment.

In other cases, your doctor may recommend injecting a gas bubble inside the eye in the office, along with either laser or freezing treatment. This is called a pneumatic retinopexy. With a gas bubble in the eye, you will have to position in a certain way per your doctor.

A vitrectomy is performed in the operating room. With a vitrectomy, a retina doctor uses small instruments inside the eye to remove the clear vitreous jelly inside the eye. Any holes in the retina are then lasered, and the eye is filled with a large gas or oil bubble to keep the retina in place while the laser treatment heals.

With a scleral buckle, a permanent piece of silicone is placed around the external surface of the eye. This scleral buckle causes a permanent indentation in the eye, which helps the retina reattach to the back of the eye. The scleral buckle is covered by the “skin” of the eye, and after time, the scleral buckle usually is not noticeable to other people. The scleral buckle stays in place permanently, unless it needs to be removed.

Your physician may choose to perform combinations of the above treatments, for example both a vitrectomy and a scleral buckle.

Outlook (Prognosis)

The vast majority of retinas can be reattached, although this may require more than one procedure or surgery. There is a small (~10%) chance that the retina does not reattach after surgery, or that the retina redetaches after surgery. If this happens, you will need further retina surgery.

The final vision is usually better than the vision before surgery, but the final vision may not be back to normal if the retinal detachment caused permanent damage to the retina.

Description

Patients with either Type 1 or Type 2 diabetes can develop abnormal blood vessels on the surface of the retina, also known as proliferative diabetic retinopathy. If caught early, these abnormal blood vessels can be treated with injections in the eye as well as laser. However, if not caught early and not treated, these abnormal blood vessels can cause bleeding inside the eye as well as retinal detachments. A retinal detachment means that the retina has come off of the back of the eye. If left untreated, proliferative diabetic retinopathy and retinal detachments can lead to permanent vision loss.

Treatment

If you have problems with your retina due to diabetes, the most important thing you can do for your eyes as well as your body is to work with your primary care doctor or diabetes doctor to make sure your diabetes is under good control. It is also important to make sure your blood pressure and blood cholesterol are as normal as possible.

Bleeding in the eye due to diabetes can sometimes be treated in the office with injections in the eye and laser. However, if there is no improvement in the bleeding, or if the proliferative diabetic retinopathy causes a severe retinal detachment, your doctor may offer you vitrectomy surgery. With vitrectomy surgery, your doctor uses small instruments to remove the vitreous jelly inside the eye. If there is a retinal detachment, this is fixed at the time of surgery. Laser is usually added, and the eye is filled with saline fluid, a gas bubble, or an oil bubble.

Outlook (Prognosis)

Problems in the retina due to diabetes can be very complicated and difficult to treat. The final vision can be difficult to predict, but it is very important to follow you doctor’s instructions and go to all of your appointments after surgery to try to improve your final vision.

Description

The macula is the center part of your retina that is responsible for your sharp, center vision. Sometimes, a hole can develop in the macula, which is known as a macular hole. Macular holes usually develop for unknown reasons, but can sometimes be due to a past eye injury.

Patients with macular holes usually notice blurred central vision, or a missing spot in their central vision.

Treatment

Macular holes can be treated with vitrectomy surgery, in which a doctor uses small instruments to remove the clear vitreous jelly in the eye, and replaces the jelly with a large gas bubble.

After vitrectomy surgery, most surgeons will want you to do “face-down” positioning, in which you spend a significant amount of time looking down at the floor. The purpose of the positioning is to maximize the chances for improved vision and surgical success. Depending on your doctor, the amount of face-down positioning may range between a few days to 3 weeks. Please let your doctor know about any problems you may have with positioning.

With a gas bubble in the eye, you will not be allowed to lay flat on your back, fly on an airplane, or go up to high altitudes as long as the gas bubble is in the eye. The gas bubble goes away by itself in 1-2 months.

Outlook (Prognosis)

Most macular holes will close with vitrectomy surgery, and the vision usually improves over a several month period after surgery. However, the vision is usually not completely back to normal after surgery.

Description

In some patients, a film of scar tissue can form over the central retina. The central retina is called the macula, and it is responsible for your sharp, central vision. The film is called an epiretinal membrane, and it can cause distortion of the macula, or a “macular pucker.”

It is unknown why epiretinal membranes form, but they can be related to changes in the vitreous jelly as well as inflammation in the eye.

Epiretinal membranes can have no symptoms, in which case they are watched. However, over time, some patients with epiretinal membranes can develop vision problems. These vision problems include distortion of vision (straight lines look wavy or curved), double vision, and changes in the size of objects between the two eyes. If these symptoms are bothersome, patients can consider surgery.

Treatment

Epiretinal membranes/macular pucker can be treated with vitrectomy surgery, in which a doctor uses small instruments to remove the clear vitreous jelly in the eye. The doctor then uses instruments to peel the epiretinal membrane off of the surface of the retina.

Outlook (Prognosis)

Most patients will notice some improvement in their vision after surgery, but it is difficult to say exactly how much improvement there will be. Rarely, some patients may notice double vision after surgery. This can be treated with glasses or further surgery.