Retinal surgery

Retinal surgery is a serious eye condition that happens when your retina -a layer of tissue at the back of your eye that processes light - pulls away from the tissue around it. Doctors also call it a detached retina.

Retina-related conditions or retinal diseases could be due to damage to any part of the retina. They generally manifest as a hindrance to normal vision. 

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Causes of Retinal Surgery:

Retina is the thin tissue layer at the extreme back of the eye wall. Retina is important for us to see the world around. It receives the incoming light and communicates the visual information with the brain.

Retina related conditions or retinal diseases could be due to damage to any part of the retina. They generally manifest as a hindrance in normal vision. 

Types of common retinal conditions and diseases, and their respective causes are as follows:

  • Retinal tear: The eye centrally contains a gel-like clear substance called vitreous. This gel-like substance shrinks and creates a pull on the thin retina. Because of the traction, the retina tears. A sign of retinal tears is the onset of flashing lights and floaters.

  • Retinal detachment: This condition is characterized by the presence of fluid under the retina. It generally happens after a retinal tear, when fluid seeps in and enters the underlying tissue beneath the retina causing it to lift. 

  • Diabetic retinopathy: Diabetic patients are more prone to developing this condition. The capillaries (tiny blood vessels) located at the back of the eye degenerate and leak fluids under the retinal tissue. This may cause the retina to swell and distort vision. This condition could also be because of abnormally formed capillaries that break and bleed. This condition may worsen the vision further.

  • Epiretinal membrane: It is a thin, delicate and fibrous tissue covering the retina like a film on the inner surface of the retina. If this membrane draws up on the retina like a crinkled cling film, it distorts the vision. Objects begin to appear twisted, bent, or even blurred. 

  • Macular hole: The macula is the central region of the retina, and the most important portion. It is responsible for humans to see things in great detail. Anomalous traction when developed between the vitreous and retina of the eye or an injury to the eye could lead to the formation of a hole. This hole is a defect called the macular hole. 

  • Macular degeneration: The macula, which is located at the center of the retina, begins to deteriorate. This leads to blurring of central vision and some may experience a blind spot central to the visual field. Macular degeneration occurs in two forms: dry macular degeneration and wet macular degeneration. For most, dry macular degeneration precedes wet macular degeneration. It can happen in one or both eyes. 

  • Retinitis pigmentosa: It is a degenerative form of retinal disease. It is passed on from generation to generation. It affects the retinal and gradually leads to loss of vision at night and even peripheral vision.

Diagnosis of Retinal surgery:

The ophthalmologist conducts a thorough evaluation of the distortion reported by the patient to ascertain the exact cause impacting the retina for effective treatment subsequently.

Following are the techniques that the doctor may use:

  • Amsler grid test: It tests the clarity of the patient’s central vision. The patient is shown grid lines and asked to point where the blurring or deformity occurs along them to understand the degree of retinal damage. 

  • Optical Coherence Tomography (OCT): This technique captures exact images of the macular holes, macular edema (swelling), the extent of age-associated macular degeneration, and diagnoses epiretinal membranes. Starting the patient with a treatment regimen is an effective technique to record the response to it.

  • Fundus Autofluorescence (FAF): It is a protocol used to monitor the progression of certain retinal diseases such as macular degeneration. Increased retinal damage leads to an increase in a retinal pigment called lipofuscin. FAF highlights this pigment, thus underlining the extent of the damage.

  • Fluorescein angiography: This technique primarily evaluates the condition of the blood vessels supplying to the eye. It helps identify blocked, leaking, or abnormally developed blood vessels and other slight changes that may have occurred in the portion hind of the eye. Fluorescein is a dye that highlights the blood vessels in the eye in a special light. 

  • Indocyanine green angiography: It is a dye-based technique. It is to view blood vessels in the retina that are located deeper in a more difficult-to-view position. Especially the blood vessels behind the retina in the choroid tissue.

  • Ultrasound: It uses high-frequency sound waves to identify or treat tumors associated with the eye. 

  • MRI and CT scan: They are rarely used, only in cases where eye tumors or injuries may be involved.

Treatment for Retina Surgery:

In the case of retinal diseases, the main aim of the treatment is to slow the progression of the disease and protect the optimal vision of the affected patient.

The treatment regimen for retinal diseases is often complex and doctors resume a multifactorial approach to ensure the best possible solution.

Some conditions may need treatment under emergency. The approaches include:

  • Laser surgery: To restore a retinal hole or tear. When done immediately to a freshly diagnosed tear, it reduces the chances of retinal detachment. Laser scars the tissue under treatment and brings about welding actions that then bind the tissue under repair.

  • Scatter laser photocoagulation: It is to shrink anomalous blood vessels which may threaten bleeding in the eye. It could be an effective treatment for patients with diabetic retinopathy. 

  • Cryopexy (KRY-o-pek-see): The doctor applies an icy probe to the peripheral wall of the eye to freeze the inside of the eye, as well as the retina. The tear in the retina scars and attaches the retina back to the eyewall.

  • Pneumatic retinopexy (RET-ih-no-pek-see): This technique is performed by injecting gas or air into the eye. It is to treat specific types of retinal detachments. It could be combined with other techniques such as laser photocoagulation or cryopexy.

  • Scleral (SKLAIR-ul) buckling surgery: It is again used to treat retinal detachment. The surgeon patches a piece of silicone to the sclera (outside eye surface). This shifts the sclera and relieves the pulling pressure of the vitreous on the retina allowing the retina to heal. The procedure can be used with other protocols depending on the diagnosed condition/s.

  • Vitrectomy (vih-TREK-tuh-me): In VItrectomy, the vitreous (gel-like fluid filling the eye) is removed and replaced with liquid, air, or gas. This protocol is followed in case of bleeding or inflammation, which may hinder a clear view of the retina to be treated. This protocol is used in combination with various treatment protocols involved for retinal detachment, eye trauma, epiretinal membrane, retinal tear, diabetic retinopathy, or macular hole.

  • Injecting medicine into the eye: The medication is injected in the vitreous of the eye. Recommended for treatment of diabetic retinopathy, macular degeneration, or damaged blood vessels inside the eye.

  • Retinal prosthesis: It is a treatment modality for patients with extreme vision loss or even blindness. Here there is irreparable damage to the retina. A small chip is implanted in the retina. This chip receives signals from a video camera in the eyeglasses. The implanted electrode picks signals of visual information received from the camera and relays it further for the brain to interpret.

Depending on the type and extent of damage to the retina, the doctor advises the best treatment protocol for maximum benefit and optimized vision for the affected patient.

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