Conditions
Retinal Conditions & Surgery
The retina detects light coming into the eye and converts the energy to electrical impulses. These are sent via the optic nerve to the brain where they are turned into clear, bright, colourful pictures. To reach the retina, light passes through the cornea, the lens and vitreous, which fills the globe. At birth, the vitreous is a transparent gel-like fluid but, as we age, it opacifies. This change causes visual problems, ranging from mild floaters to serious pathology, such as macular holes. Optegra is at the forefront of treatment to repair retinal damage, using the latest vitrectomy procedures.
The Optegra treatment
The following treatments are variations on the technique of vitrectomy. In this procedure, three tiny holes are made through the white of the eye, allowing removal of the vitreous gel, safe access to the surface of the retina and, where necessary, filling of the eye with a bubble of oil or gas. This procedure is performed under local anaesthesia (which may be combined with intravenous sedation) and can usually be done in a sutureless fashion, minimising post-operative discomfort. Other treatments, such as cataract extraction with intra-ocular lens implantation, may be performed in conjunction. Your Optegra Consultant will discuss all aspects of your individual treatment with you.
Floaters
As we age the vitreous opacifies, causing small specks or a generalised mistiness to appear in the field of vision. When visual function is compromised vitrectomy can eliminate these troublesome symptoms. Vitreous is replaced with saline solution, following which the eye manufactures its own 'aqueous'. When floaters and cataracts co-exist, it is routine to combine vitrectomy with cataract extraction. This gives the additional benefit of minimising the need for spectacles post-operatively.
Macular pucker
This is a slowly progressing condition in which the vitreous shrinks and pulls away from the macula - the central area of retina - causing scarring. This superficial scar tissue is known as epiretinal membrane. As the scar tissue contracts it 'puckers' the underlying macular retina, causing swelling and distortion. Macular pucker causes a central visual disturbance with straight lines looking wavy and objects appearing too big or too small. At surgery, a vitrectomy procedure is followed by peeling of the scar tissue membrane from the surface of the macula. This allows the retinal tissue to return to a more normal position and vision to improve.
Macular hole
Many patients have heard of the need to 'posture' following surgery with the insertion of a gas bubble, but using modern techniques and combining vitrectomy with phacoemulsification makes this unnecessary. The only requirement post-operatively is that patients refrain from lying flat on their back for the first couple of weeks. In this position the bubble floats up, away from the macula and loses its effect.
Frequently asked questions
I am diabetic. Am I at risk of retinal disease?
All diabetic patients should undergo annual retinal screening. Different approaches have been used in different parts of the country (for example, examination by an Optometrist or photography with a mobile retinal camera), but digital retinal photography and evaluation of the images by an approved screener is now considered best practice. The early detection of diabetic retinopathy is the key to the maintenance of good sight.
Is vitrectomy surgery painful?
No. Surgery is performed with local anaesthetic, which completely numbs the eye and surrounding tissues. For those feeling particularly apprehensive, intravenous sedation is offered. The procedure may take anything between 30 minutes and an hour, but patients rarely find the experience unpleasant. With sutureless vitrectomy, post-operative discomfort is unusual, although patients frequently suffer some aching around the eye during the first 24 hours.
Will my eye sight be affected after vitrectomy surgery?
This depends upon whether or not a gas bubble is used as it is impossible to see clearly through gas. With macular hole surgery, vision is extremely poor for the first two or three weeks - the time it takes for the bubble to shrink sufficiently for central vision to return. If gas is not used, vision returns quite quickly over the first few days, although the macula may remain 'bruised' for some time after the peeling of scar tissue.
Are there any complications following vitrectomy surgery?
The most common complication is the development of post-operative cataract. This can occur as quickly as a few months after surgery, or may take several years. It is now common to combine phacoemulsification with vitrectomy, which also offers the additional benefits of refractive correction to minimise the need for spectacles. There is a small risk of retinal detachment at the time of vitrectomy, but this can usually be detected and prevented with laser gluing during the initial procedure. If detachment does occur, a second vitrectomy operation is required using a gas bubble to push the detached retina back into position.
Are there any particular restrictions with vitrectomy surgery?
If a gas bubble has been used, you must not fly until the bubble has completely disappeared. Problems can also occur if a general anaesthetic is given when a gas bubble is present in the eye. It is, therefore, important that you tell your doctor should hospital admission be required in the first few weeks after vitrectomy surgery with gas.
