Surgical Procedures
Victrectomy
Vitrectomy is a surgical procedure used in the treatment of many different types of retinal problems. This is the most common surgical procedure performed by a retinal specialist. Some of the most common disorders for which vitrectomy is used include: Retinal Detachment, Macular Pucker (epiretinal membrane), Macular Hole, Vitreous Hemorrhage, and Endophthalmitis (infection).
Vitrectomy is performed in the operating room. In most cases, it is done with suture-less instrumentation under local anesthesia and the patient goes home the same day. Most patients have little to no discomfort
Vitrectomy instruments in the eye
Intravitreal
Injections
Intravitreal injection is the procedure of injecting a medication into the vitreous cavity, the large chamber in the back of the eye. This is the most common office procedure performed by a retinal specialist. There are many different medications that are injected to treat many retinal conditions including: Diabetic Macular Edema, Cystoid Macular Edema, Branch Retinal Vein Occlusion, Central Retinal Vein Occlusion, Wet AMD, Uveitis (inflammation), and Endophthalmitis (infection). The procedure is performed in-office under local anesthesia. Most patients feel only a light pressure or pinch as the medication is injected. The greatest risk for this procedure is infection, which fortunately is very rare, approximately 1/5000 injections. Other risks such as retinal detachment, bleeding, and loss of vision are also very rare.
Laser Application to Retina
Lasers has many applications in the treatment of retinal disorders. In simplest terms the laser cauterizes the tissue onto which it shines. Most laser procedures are performed in-office under topical anesthesia. The laser is applied in the treatment of many conditions including: retinal tears, wet AMD, Diabetic macular edema, Proliferative diabetic retinopathy, Retinal vein occlusions, Retinopathy of prematurity, and other diseases which cause abnormal blood vessel growth within the eye.
Usually a special lens is placed on the eye to help focus the laser to the desired tretment area. Depending on the situation the treatment may be performed in one or several sessions. Occasionally the patient may experience
Scleral Buckle
Scleral Buckling is the traditional method for repairing retinal detachment but is used much less frequently now. The buckle is a band made of silicone. It is secured to the eye and presses the wall of the eye towards the middle of the eye. This brings the wall of the eye (the sclera) closer to the retina and combined with freezing treatment (cryo-therapy) or laser treatment helps the retina re-attach. Sometimes scleral buckling is combined with vitrectomy. Also, special gases are sometimes placed in the eye at the time of surgery. The buckle usually remains on the eye forever unless a problem develops and it needs to be removed. Buckles are rarely removed unless infected or exposed. These occur in less than 1 in 100 cases.
Your surgeon will decide based on the type and appearance of your retinal detachment whether scleral buckling is the appropriate procedure.
Diagram of detached retina (left) and reattached after buckling (right)
Pneumatic Retinopexy
Pneumatic retinopexy is a procedure used to repair certain types of retinal detachment. A special gas (C3F8 or SF6) is placed in the eye. The gas serves to tamponade the tear, preventing more fluid from going under the retina. It also helps push the retina back onto the wall of the eye. The tear is then sealed with either laser treatment or freezing treatment (Cryo-therapy). If the retina fails to reattach further procedures such as scleral buckling or vitrectomy may be needed.
