PNEUMATIC RETINOPEXY
What is the retina?
The retina is the nerve tissue that lines the back wall of the eye. Much like
the film in a camera, the retina is sensitive to light. It transforms light
energy to nerve stimuli, and “sends a picture” through the optic
nerve to the brain.
What causes a retinal
detachment?
The eye is filled with a clear jelly-like substance called vitreous gel. Normally,
the retina receives support form this gel. A normal aging change of the vitreous
gel causes it to liquefy and separate into two portions: a gel portion and
a watery portion. This change occurs earlier in nearsighted eyes and following
inflammation or eye surgery. Sometimes the gel portion can rapidly shift
forward and tug on the retina. In some areas, the vitreous attachment to
the retina may be strong. In these areas of vitreoretinal traction the bond
may be so strong that the pulling away of the vitreous gel from the retina
causes a tear a the point of adherence. Fluid from the vitreous cavity can
then pass through the hole and allow the retina to separate form the choroids,
much like wallpaper peels from the wall.
Why does a retinal detachment cause visual loss?
The retina normally rests against the choroid, a layer of blood vessels which
supplies the retina with nourishment. When the retina becomes separated (detached)
from the choroid, it no longer receives its normal blood supply and is unable
to function properly. The result is visual loss. The amount of visual loss
depends on the location and extent of the detachment. If the center of the
retina, the macula, is detached, patients usually report significant decrease
in visual acuity and loss of the ability to read. If the detachment is occurring
in the peripheral retina, the patient may be unaware of its presence except
for noticing a black curtain, veil or shadow in some portion of side vision
of the affected eye.
TREATMENT
What is the treatment for retinal detachment?
Repair of retinal detachments had traditionally required an operation performed
in the hospital called scleral buckling surgery. A newer technique is now used
to repair some detachments. This technique, called pneumatic retinopexy, can
be performed in the office under local anesthesia with much less discomfort
and shorter recovery time than traditional surgery.
What is involved in scleral buckling surgery?
Scleral buckling surgery is a three part procedure:
1) The holes and tears are treated with a freezing technique (cryotherapy)
to produce a localized scar.
2) The subretinal fluid may be drained from the eye or, depending on the individual
case, may be left to absorb slowly by itself.
3) A silicone material is sutured to the outside of the eye wall overlying
the hole in the retina. This creates an indentation or buckle which supports
the retina.
This surgery is performed in a hospital or surgery center and takes 1 to 3 hours to complete. The success rate for uncomplicated detachments (without inflammation, hemorrhage or scar tissue) is 90% to 95%.
What is involved in pneumatic retinopexy?
This technique to repair some forms of retinal detachment employs many of the
same principals as scleral buckling surgery. After local anesthesia with
xylocaine, the retinal holes or tears are treated with cryotherapy. Then
a small bubble of expanding gas is injected into the eye. With the head properly
positioned, the bubble will push the retina into position. The procedure
is performed in the office and takes 15 to 30 minutes to perform. The bubble
will expand over the first two days following injection. It remains in the
eye for 2 to 4 weeks and then is slowly reabsorbed by the body. The bubble
will be visible as a dark circle which moves as the eye moves. It often breaks
into smaller bubbles as it begins to disappear.
What are the risks of this procedure?
The major risks of the procedure are the same as scleral buckling surgery:
Hemorrhage, infection, increased Intraocular pressure and failure to reattach
the retina. The success rate for this procedure is somewhat lower than the
more extensive scleral buckling operation. Most recent surgical results show
the rate of retinal reattachment is 84% with pneumatic retinopexy as opposed
to 90% to 95% with scleral buckling surgery. In approximately 16% of patients,
pneumatic retinopexy fails and a scleral buckling operation is then required.
The scleral buckling procedure following unsuccessful pneumatic retinopexy
is successful in 90% to 95% of cases. Thus, there appears to be no deleterious
effect on the overall success rate even if the pneumatic procedure fails.
What level of vision can be expected following surgery?
Following surgery, vision will be quite blurred at first but gradually improve
over many months. The final level of vision depends upon the complexity of
damage before surgery. Be patient with your eyes and don’t expect too
much too soon!
POST OPERATIVE CARE
Head Position
Following the procedure, the head must be positioned for several days, such
that the bubble pushes on the retinal hole or tear. For example, if the hole
is in the 3:00 position in the right eye, the patient should lie on his right
side so the bubble pushes on the tear. In the upright position, a hole in
the 3:00 position is not covered by the bubble and the retina will remain
detached. Proper positioning is absolutely essential to the success of the
procedure. Your doctor will instruct you as to your proper head positioning.
Medications
Eye drops will be prescribed. The typical drops are:
Atropine-Used to keep the pupil dilated-helpful while the eye is healing.
Pred Forte-A steroid used to decrease inflammation.
Zymar-An antibiotic used to prevent infection in the the post-op period.
You may need additional drops or ointments depending on you individual case.
Patch
Unless instructed otherwise, they eye should remain patched until you return
for your post-operative visit the day after the procedure.
Infection
Your eye will be red, watery and uncomfortable immediately following surgery.
This will clear up. If the redness worsens, the discharge becomes yellow
or green, and/or the eye becomes very painful, you should contact the office
immediately.
Travel
While the bubble is in the eye, air travel is not permitted. (The change in
pressure can cause the bubble to expand too much.)
Please do not hesitate to call with any further questions or concerns. A nurse is always available to answer your questions.
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