Vitreoretinal

Vitreoretinal surgery refers to any operation to treat eye problems involving the retina, macula, and vitreous fluid. These include retinal detachment, macular hole, epiretinal membrane and complications related to diabetic retinopathy. Retinal diseases vary widely, but most of them cause visual symptoms. Retinal diseases can affect any part of your retina, a thin layer of tissue on the inside back wall of your eye.

OVERVIEW
Vitreoretinal surgery refers to any operation to treat eye problems involving the retina, macula, and vitreous fluid. These include retinal detachment, macular hole, epiretinal membrane and complications related to diabetic retinopathy.

Retinal diseases vary widely, but most of them cause visual symptoms. Retinal diseases can affect any part of your retina, a thin layer of tissue on the inside back wall of your eye.

The retina contains millions of light-sensitive cells (rods and cones) and other nerve cells that receive and organize visual information. Your retina sends this information to your brain through your optic nerve, enabling you to see.

Treatment is available for some retinal diseases. Depending on your condition, treatment goals may be to stop or slow the disease and preserve, improve or restore your vision. Untreated, some retinal diseases can cause severe vision loss or blindness
SYMPTOMS
Many retinal diseases share some common signs and symptoms.

These may include:

·        Seeing floating specks or cobwebs
·        Blurred or distorted (straight lines look wavy) vision
·        Defects in the side vision
·        Lost vision You may need to try looking with each eye alone to notice these.
WHAT TO EXPECT AFTER A VITRECTOMY
Because so many variables are involved, only your eye surgeon familiar with your condition can give you a realistic idea of what to expect following a vitrectomy. But the underlying reason for the procedure usually is a major factor in determining how fast you will recover as well as the ultimate outcome.

After a procedure, you likely will use antibiotic eye drops for about the first week and anti-inflammatory eye drop medications for several weeks. Follow your surgeon's advice carefully. In general, don't expect to know your final visual outcome for at least a few weeks. Again, your surgeon or attending ophthalmologist will be the best judge of your individual recovery.

Vitrectomies have a very high success rate. Bleeding, infection, progression of cataract and retinal detachment are potential problems, but these complications are relatively unusual. For most patients who undergo a vitrectomy, sight is restored or significantly improved. The procedure is a marvel of modern medicine for people with conditions that might be blinding otherwise.
TYPES
Common retinal diseases and conditions include:

·        Retinal tear. A retinal tear occurs when the clear, gel-like substance in the center of your eye (vitreous) shrinks and tugs on the thin layer of tissue lining the back of your eye (retina) with enough traction to cause a break in the tissue. It's often accompanied by the sudden onset of symptoms such as floaters and flashing lights.

·        Retinal detachment. A retinal detachment is defined by the presence of fluid under the retina. This usually occurs when fluid passes through a retinal tear, causing the retina to lift away from the underlying tissue layers.

·        Diabetic retinopathy. If you have diabetes, the tiny blood vessels (capillaries) in the back of your eye can deteriorate and leak fluid into and under the retina. This causes the retina to swell, which may blur or distort your vision. Or you may develop new, abnormal capillaries that break and bleed. This also worsens your vision. ·        Epiretinal membrane.

. Epiretinal membrane. is a delicate tissue-like scar or membrane that looks like crinkled cellophane lying on top of the retina. This membrane pulls up on the retina, which distorts your vision. Objects may appear blurred or crooked.

·        Macular hole. A macular hole is a small defect in the center of the retina at the back of your eye (macula). The hole may develop from abnormal traction between the retina and the vitreous, or it may follow an injury to the eye.

·        Macular degeneration. In macular degeneration, the center of your retina begins to deteriorate. This causes symptoms such as blurred central vision or a blind spot in the center of the visual field. There are two types — wet macular degeneration and dry macular degeneration. Many people will first have the dry form, which can progress to the wet form in one or both eyes.

·        Retinitis pigmentosa. Retinitis pigmentosa is a degenerative disease that affects the retina.
DIAGNOSIS
Retinal diseases can be related to aging, diabetes or other diseases, trauma to the eye, or family history. To make a diagnosis, your ophthalmologist conducts a thorough eye exam and looks for abnormalities anywhere in the eye.

The following tests may be done to determine the location and extent of the disease:

·        Amsler grid test. Your doctor may use an Amsler grid to test the clarity of your central vision. He or she will ask you if the lines of the grid seem faded, broken or distorted and will note where the distortion occurs on the grid to better understand the extent of retinal damage. If you have macular degeneration, he or she might also ask you to use this test to self-monitor your condition at home.
·        Optical coherence tomography (OCT). This test is an excellent technique for capturing precise images of the retina to diagnose epiretinal membranes, macular holes and macular swelling (edema), to monitor the extent of age-related wet macular degeneration, and to monitor responses to treatment.
·        Fluorescein angiography. This test uses a dye that causes blood vessels in the retina to stand out under a special light. This helps to exactly identify closed blood vessels, leaking blood vessels, new abnormal blood vessels and subtle changes in the back of the eye.
·        Indocyanine green angiography. This test uses a dye that lights up when exposed to infrared light. The resulting images show retinal blood vessels and the deeper, harder-to-see blood vessels behind the retina in a tissue called the choroid.
·        Ultrasound. This test uses high-frequency sound waves (ultrasonography) to help view the retina and other structures in the eye. It can also identify certain tissue characteristics that can help in the diagnosis and treatment of eye tumors.
·        CT and MRI. In rare instances, these imaging methods can be used to help evaluate eye injuries or tumors.

Treatments

VITREORETINAL
The main goals of treatment are to stop or slow disease progression and preserve, improve or restore your vision. In many cases, damage that has already occurred can't be reversed, making early detection important. Your doctor will work with you to determine the best treatment. Treatment of retinal disease may be complex and sometimes urgent. Options include: • Using a laser. Laser surgery can repair a retinal tear or hole. Your surgeon uses a laser to heat small pinpoints on the retina. This creates scarring that usually binds (welds) the retina to the underlying tissue. Immediate laser treatment of a new retinal tear can decrease the chance of it causing a retinal detachment. • Shrinking abnormal blood vessels. Your doctor may use a technique called scatter laser photocoagulation to shrink abnormal new blood vessels that are bleeding or threatening to bleed into the eye. This treatment may help people with diabetic retinopathy. Extensive use of this treatment may cause the loss of some side (peripheral) or night vision. • Freezing. In this process, called cryopexy (KRY-o-pek-see), your surgeon applies a freezing probe to the external wall of the eye to treat a retinal tear. Intense cold reaches the inside of the eye and freezes the retina. The treated area will later scar and secure the retina to the eye wall. • Injecting air or gas into your eye. This technique, called pneumatic retinopexy (RET-ih-no-pek-see), is used to help repair certain types of retinal detachment. It can be used in combination with cryopexy or laser photocoagulation. • Indenting the surface of your eye. This surgery, called scleral (SKLEER-ul) buckling, is used to repair a retinal detachment. Your surgeon sews a small piece of silicone material to the outside eye surface (sclera). This indents the sclera and relieves some of the force caused by the vitreous tugging on the retina. This technique may be used with other treatments. • Evacuating and replacing the fluid in the eye. In this procedure, called vitrectomy (vih-TREK-tuh-me), your surgeon removes the gel-like fluid that fills the inside of your eye (vitreous). He or she then injects air, gas or liquid into the space. Vitrectomy may be used if bleeding or inflammation clouds the vitreous and obstructs the surgeon's view of the retina. This technique may be part of the treatment for people with a retinal tear, diabetic retinopathy, a macular hole, an infection, eye trauma or a retinal detachment. • Injecting medicine into the eye. Your doctor may suggest injecting medication into the vitreous in the eye. This technique may be effective in treating people with wet macular degeneration, diabetic retinopathy or broken blood vessels within the eye. • Implanting a retinal prosthesis. People who have severe vision loss or blindness owing to retinal disease may be a candidate for surgery. One surgical option not widely available is called retinal prosthesis. View

VITREORETINAL

The main goals of treatment are to stop or slow disease progression and preserve, improve or restore your vision. In many cases, damage that has already occurred can't be reversed, making early detection important. Your doctor will work with you to determine the best treatment.

Treatment of retinal disease may be complex and sometimes urgent. Options include:

• Using a laser. Laser surgery can repair a retinal tear or hole. Your surgeon uses a laser to heat small pinpoints on the retina. This creates scarring that usually binds (welds) the retina to the underlying tissue. Immediate laser treatment of a new retinal tear can decrease the chance of it causing a retinal detachment.

• Shrinking abnormal blood vessels. Your doctor may use a technique called scatter laser photocoagulation to shrink abnormal new blood vessels that are bleeding or threatening to bleed into the eye. This treatment may help people with diabetic retinopathy. Extensive use of this treatment may cause the loss of some side (peripheral) or night vision.

• Freezing. In this process, called cryopexy (KRY-o-pek-see), your surgeon applies a freezing probe to the external wall of the eye to treat a retinal tear. Intense cold reaches the inside of the eye and freezes the retina. The treated area will later scar and secure the retina to the eye wall.

• Injecting air or gas into your eye. This technique, called pneumatic retinopexy (RET-ih-no-pek-see), is used to help repair certain types of retinal detachment. It can be used in combination with cryopexy or laser photocoagulation.

• Indenting the surface of your eye. This surgery, called scleral (SKLEER-ul) buckling, is used to repair a retinal detachment. Your surgeon sews a small piece of silicone material to the outside eye surface (sclera). This indents the sclera and relieves some of the force caused by the vitreous tugging on the retina. This technique may be used with other treatments.

• Evacuating and replacing the fluid in the eye. In this procedure, called vitrectomy (vih-TREK-tuh-me), your surgeon removes the gel-like fluid that fills the inside of your eye (vitreous). He or she then injects air, gas or liquid into the space.

Vitrectomy may be used if bleeding or inflammation clouds the vitreous and obstructs the surgeon's view of the retina. This technique may be part of the treatment for people with a retinal tear, diabetic retinopathy, a macular hole, an infection, eye trauma or a retinal detachment.

• Injecting medicine into the eye. Your doctor may suggest injecting medication into the vitreous in the eye. This technique may be effective in treating people with wet macular degeneration, diabetic retinopathy or broken blood vessels within the eye.

• Implanting a retinal prosthesis. People who have severe vision loss or blindness owing to retinal disease may be a candidate for surgery. One surgical option not widely available is called retinal prosthesis.

View