Retrina and Vitreous
Age related Macular Degeneration
Dislocated lens (natural or pseudophakic)
Hereditary retinal disorders
A&B-scan standardized echography
Ocular Coherence Tomography
Lasers- 532 nm & 690 nm
Silicone oil implantation
What is retinal detachment?
When the retina detaches, it separates from the back wall of the eye and is removed from its blood supply and source of nutrition. The retina will degenerate and lose its ability to function if it remains detached. Central vision will be lost if the macula remains detached. The causes of retinal detachment can be divided into three main categories:
Rhegmatogenous retinal detachment: due to a retinal break or tear that allows the liquid vitreous which fills the center of the eye ball to pass through the break and detach the retina. This is the most common type of detachment.
Exudative retinal detachment: due to leakage from under the retina which creates fluid (exudate) that detaches the retina. Tumours and inflammatory disorders can create exudative detachments.
Traction retinal detachments: due to pulling on the retina usually from fibro-vascular tissue within the vitreous cavity.
Anyone can develop a retinal detachment at any time, but certain people are at higher risk than others. These include people who are short sighted, those who have had cataract surgery in the past and those who have recently suffered a severe direct blow to the eye. Some types of retinal detachments can run in families, but these are rare.
The types of Surgery
Scleral buckle: The procedure involves localizing the position of all the retinal breaks, treating all retinal breaks with the cryotherapy and supporting all the retinal breaks with a scleral buckle. The buckle is usually a piece of silicone sponge or solid silicone. The buckle is sewn onto the outer wall of the eyeball (sclera). The buckle is positioned so that it pushes in on the retinal break and effectively closes the break. Once the break is closed, the fluid under the retina (sub retinal fluid) will usually spontaneously resolve over 1-2 days. Postoperatively, there are usually no positioning requirements and one can resume most activities within several days (except for anything that would jar the head).
Vitrectomy: This procedure involves making small incisions into the wall of the eye to allow the introduction of instruments into the vitreous cavity (the middle of the eyeball). The first part of the procedure usually is the removal of the vitreous using a vitreous cutter. Then, depending on the type and cause of the detachment, a variety of instruments (scissors, forceps, pics, lasers) and techniques (excision of tractional bands, air-fluid exchange, gas or silicone oil fill) are used to reattach the retina. It is sometimes important to maintain a specific head position after surgery to keep the retina attached. Mr. Georgiou will give you specific advice.
Pneumatic retinopexy is a procedure in which a gas bubble is placed inside the vitreous cavity, either before or after, the retinal hole is treated with laser or cryotherapy (freezing) to help seal the hole permanently. The gas bubble, which must be positioned over the hole, prevents fluid from entering the hole while the retina heals.
The visual prognosis depends mainly on the pre-existing status of the retina before it is detached. If the macula has not detached, the pre-existing vision will usually be retained following successful repair. However if the macula is detached and central vision is impaired by the detachment, there may be permanent loss of central vision even if the retina is successfully repaired. The longer the macula is detached, the more likely there will be loss of vision due to irreversible damage to the photoreceptor cells.
Vitrectomy surgery is a major medical advance which allows treating retinal diseases and prevent vision loss for patients who, in previous years, may have gone blind without this technique. A vitrectomy procedure usually takes about 1-2 hours but may take longer in complex cases or when combined with a scleral buckle or lensectomy. Risks of surgery include infection, bleeding, cataract, glaucoma, and detachment or re-detachment of the retina. Any of these complications can result in severe visual loss or even loss of the eye itself. It is important that you discuss the potential risks and benefits of this procedure with Mr. Georgiou before making a decision regarding treatment.
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