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Retinal detachment repair
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Indications for
retinal detachment repair
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Retinal detachment
repair procedures
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After Your Retinal
Detachment Repair
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How
do I get more information?
The
retina, which
lines the inside of the
posterior wall
of the eye, may occasionally become detached for various reasons. Most
commonly,
retinal detachment
occurs as a result of a tear or hole in the retina, which develops as a
result of a
posterior vitreous
detachment or separation (PVD). The retinal tear or hole allows
fluid to enter the subretinal space, thus detaching the retina.
The retina receives oxygen and nutrients from the underlying choroid
(vascular layer) of the eye. When a retinal detachment occurs, the detached
retina begins to dysfunction, and ultimately, necrosis (death) ensues as a
result if the retina is not reattached to the underlying choroid. As such, a
retinal detachment is an urgent condition. The detached retina should be
recognized and treated promptly.
Indications for Retinal
Detachment Repair
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Rhegmatogenous retinal detachment (secondary to retinal hole or tear)
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Tractional retinal detachment (secondary to vitreous membranes, such as
that which may occur in proliferative diabetic retinopathy)
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Proliferative vitreoretinopathy (PVR), secondary to long-standing retinal
detachment
Retinal Detachment Surgical
Procedures
The surgical management of retinal detachment may include several different
procedures, depending on the circumstances. These procedures include
pneumatic retinopexy, scleral buckling, and vitrectomy. Each of these
procedures is discussed below.
Pneumatic Retinopexy
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. Ophthalmologists sometimes use the
phrase, "put the bubble on the trouble" to describe this aspect of the
procedure to patients. Since the positioning of the bubble is dependent on
positioning of the patient, pneumatic retinopexy is usually only appropriate
for retinal detachments (with holes) in the superior (top) part of the eye.
Scleral Buckling
Scleral buckling surgery is probably the most commonly required procedure
for repair of retinal detachment. In this procedure, a soft silicone band is
placed around the eye, which indents the outside of the eye towards the
detached retina, thereby relieving vitreous traction on the retinal hole.
The buckle is much like a belt around one's waist. It is kept in place with
tiny sutures to the
sclera of the
eye. In many cases, the vitreo-retinal surgeon drains the fluid under the
retina at the site of the retinal detachment, and then seals the hole (or
holes) with laser or cryotherapy.
Vitrectomy
In some cases, a vitrectomy is also necessary for repair of a retinal
detachment. In this procedure, the vitreous humor is removed from the eye
with an instrument known as a vitrector. This instrument utilizes a tiny
guillotine cutting device to safely remove the vitreous while replacing it
with saline.
Laser photocoagulation or cryotherapy are still typically used if a retinal
hole or tear is present. A scleral buckling procedure may also be combined
with the vitrectomy for certain types of retinal detachment.
Retinal detachment can be successfully repaired in about 90% of cases with a
single surgical procedure. However, anatomical success does not always mean
functional success. Those patients with retinal detachments that do not
involve the
macula (central
retina) have the best prognosis. Fortunately, the great majority of patients
will have a successful outcome, especially if they seek attention as soon as
vision is lost.
After Your Retinal Detachment
Repair
Following retinal detachment surgery, you will likely be required to use
antibiotic and anti-inflammatory eye drop medications, perhaps for a few
weeks or more following surgery. Your surgeon will prescribe a regimen of
medication and follow-up, which you should carefully follow.
Recovery following retinal detachment repair will depend largely on the
location and extent of retinal detachment prior to repair. Patients who have
had only a peripheral retinal detachment will likely have faster recovery
and a better outcome than patients who had a retinal detachment involving
the macula (central retina). Patients who had a total retinal detachment,
which had been present for a few weeks or more, have a much worse prognosis
for a favorable visual result. In any case, the final visual result may not
be known for up to several months following surgery. Your surgeon will be
the best judge of what individual results you should expect.
Please call your local eye care professional for more
information about vitrectomy. To arrange for an appointment with the
Ophthalmic Consultants Philippines Co., call the Eye Republic™ Manila +(632)
536-2398 or Eye Republic™ Alabang +(632) 771-9253. Our vitreoretinal surgeon
is Dr. Michael Santos.
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