The new standard in Vitreoretinal surgery

The minimally invasive vitrectomy is the latest in the field of retinal surgery and the macula.

It seems to be the future for any intervention and surgery on the retina. Dr. Panico is one of the first few in Europe who has been using it since 2011. Click here for more information on Vitrectomy

Retinal detachment

It refers to the separation of the retina from the underlying tissue, the choroid.

It is manifested by the appearance of a tent or a dark shadow in the field, because of the detached portion of the retina that is no longer working. It is often preceded by the sudden appearance of light flashes called photopsias or floaters in the visual field.

What is retinal detachment?

The retina is a thin layer of nervous tissue that is sensitive to light. Attached to its underlying layer, is the choroid which is a vascular spongy tissue that acts as a placenta nourishing the retina and separates it from the white outer shell, the sclera.

If you compare the eye to a camera, the retina is the film that is exposed to light.

The images from the outside world pass through the cornea and crystalline lens, with the focus on the retina. Its function is to transform the light into electrical impulses, transmitted via the optic nerve to the cerebral cortex. Here they are transformed into images.

Why does retinal detachment occur?

Under normal conditions, the retina is attached on one side to its underlying layer, the choroid, while internally, it is tenaciously attached to the vitreous in some points.

Over the years, the vitreous gel undergoes a progressive degeneration that either dehydrates or melts over time. This phenomenon is perceived by the patient as floaters or cobwebs in field.

Gradually, this process makes the vitreous detach from the retina remaining connected only in increased adhesion points. It is a physiological event that can happen in substance to anyone.

 Retinal detachment surgery

With the sudden movements of the head and the body, the vitreous tends to produce tractions in these areas. This sometimes results in a rupture. At this point the aqueous component of the vitreous gel can creep behind the retina detaching more or less extensively, depending on the position of the break.

Exactly as it can occur in a pool in which there is a crack along a wall. The water enters through the continuous solution and by gravity tends to move downwards accentuating the retinal detachment.

In this case the retina is no longer able to provide an adequate image to the brain and vision becomes blurred and reduced.

Who is most affected by retinal detachment?

Retinal detachment occurs most frequently in people in their middle age with medium to high myopia. It affects about 1 in 10,000 people each year.

The most common cause of retinal detachment is the appearance of a retinal tear. There are other risk factors which include high myopia, surgery for cataract extraction and trauma.

What are the symptoms of retinal detachment?

-The most common symptom is the vision of a tent or a dark shadow in the field, due to a detached retina portion which no longer works.

-A retinal detachment is usually preceded by the sudden appearance of light flashes, with the vitreous causing traction on the retina leading to a retinal break.

-You may sense floaters in the visual field.

- It is not painful hence, we may not even realize what has happened unless we pay close attention. 

In the presence of these symptoms, you need an urgent eye examination as it could be very harmful in the long run.

An immediate treatment, in fact, can minimize the damage to the eye.

What is the treatment of retinal detachment?

If the problem is diagnosed early, a laser treatment may suffice. This applies when the retinal tear has not yet raised the retina or when there is a small retinal detachment, limited, around the break.

Through the surgery, it is necessary to repair the retinal hole. Usually the surgery is done by giving the patient local anesthesia and 80-90% of cases are completed in just a single operation.

It is based on the release of the vitreous traction on the retina and in the closure of the break due to the detachment.

There are two types of action:

-Traditional ab-outside

-with vitrectomy

The traditional intervention consists of the attachment of a belt outside the eye, which is narrow so as to reconnect the outer wall of the eye to the detached retina and this in turn to the vitreous, in order to release traction of the gel on the break. The break no longer subjected to traction can then be closed and, at this point, it is possible to use a cold laser treatment or a cryopexy treatment around it against unauthorized opening. The sub-retinal fluid is drained through a small hole on the outer wall of the eye.

The advantage of this technique is that there are lesser chances of infectious complications and cataract. However, not all types of retinal detachments can be treated in this way.

Dr. Panico practices an innovative and minimally invasive surgery technique called VITRECTOMY 27G, consisting of three small incisions introduced in the white part of the eye of the size of an insulin needle (400 microns), within which flow micropinze, microforbici, light fibers and a tool that cuts and longs, the vitreous. This microprobe allows the removal of the vitreous using vitrectomy, eliminating the traction on the break, which can then be welded with a laser treatment.

At the end, the sub-retinal fluid is actively sucked out by the surgeon while air or gases are injected into the eye so as to keep the break dry for one or two weeks. The patient will therefore assume a particular position for a few days so as to allow the bubble of air or gas to remain in contact with the break as long as possible.

The eye itself will fill up a secondary vitreous. 

Post- operative procedure for retinal detachment?

The surgery can be ambulatory, or you may need a hospital stay of a few days.

The very next day the patient can get out of bed. Sometimes we ask the patient to keep the head in a certain position to facilitate the healing process, especially when a vitrectomy is performed.

During the weeks in which the eye is still filled with air or gas, the vision will be low, and will improve only when these will melt.

If instead the surgeon decides to inject silicone oil, you will then need a second small operation to remove it from the eye with the times and variable mode from case to case (on average 3 months).

In place of the fracture, in both interventions, there will be a scar, which will not affect the view because it is located in the periphery of the retina, and thus of the visual field.

The postoperative process usually is not painful but the eye is inflamed for a few days. Normal activities can be resumed within a few weeks.

How are the results of the intervention of retinal detachment?

Retinal detachment surgeries are known to be very successful. 

90% cases with only one operation are successful while 95% of cases with two operations are successful. 

Unfortunately, more than one surgery is required, as a result of abnormal wound leading to the vitreoretinal proliferation (PVR). In this case, cicatricial membranes are formed on the retina, inducing the detachment again. The treatment usually required is a vitrectomy with removal of the membranes, and replacement of the vitreous gel with silicone oil, instead of with air or gas. The silicone oil, keeps the retina attached for an appropriate time to heal, but requires another operation to be removed. In certain cases it may also decide to leave it in place indefinitely.

In cases complicated by vitreoretinal proliferation it is also possible to do a surgery three or four times.

Will the vision improve after intervention of retinal detachment?

Visual recovery depends on the extent of retinal detachment and its duration. The shadow caused by the detachment usually disappears in all cases. Visual recovery after retinal detachment surgery is variable and basically depends on the involvement or lack of it of the macula. At the center of the retina, it is home to the end vision and, when it is involved in the detachment, it causes more serious harm.

The so-called macula-on detachments (macula attached) are surgical emergencies to be dealt with as quickly as possible. The outcome of such surgeries is potentially very good. Patients with retinal detachment but with attached macula, if successfully operated, can continue to see very well. The macula-off detachments (macula detached) represent on the contrary a deferrable surgery and can be operated within a few days after symptom onset, without the prognosis changes. However, visual recovery is subjective and reading skills will be impaired to varying degrees. Statistically, a recovery of 50% of the visual capacity is reached in 80% of cases.

Can it prevent retinal detachment?

In cases of trauma, cataract surgery, nearsightedness and previous cases of retinal detachment in the other eye or with someone in the family, you need to trust the eye doctor. He will schedule periodic checks based on the risk profile of each.

The prevention of retinal detachment is based on how aware the patient is about the symptoms of a retinal detachment. It also depends on timely laser treatment of symptomatic retinal breaks accompanied by flashes and floaters, which still did not lead to detachment.

Asymptomatic retinal tears or degeneration devices, discovered by chance during a check, do not usually require treatment, unless a retinal detachment has occurred in the other eye.

 Can retinal detachment be bilateral?

If a patient has had a detachment in one eye, the risk of having it in the other eye is 5% higher than average.

What if the retinal detachment has not been treated?

On not undergoing treatment, one can lose eyesight. In some cases, about 3 or more surgeries are required to restore the anatomical situation and to prevent bulbar atrophy wherein the eyeball becomes small and sore.

Retina schematic
Retinal detachment

Patients who do not get it operated can completely lose their sight. Sometimes it is necessary to perform 3 or more interventions in order to restore the anatomical situation, in order to prevent that the eyeball becomes small (bulbar atrophy) and sore.

Share by: