Surgical Retina

The Retina is a thin layer attached to the back wall of the eye. The Retina is one of the key components responsible for vision.

Retinal detachment is a sight threatening condition where the retina lifts away from the back of the eye.

Sudden onset of “floaters”, “flashing lights” or a “growing shadow/curtain” are symptoms compatible with retinal detachment.

These symptoms are caused by vitreous, the gel-like material in the eye, which shrinks and degenerates as we get older and detaches from the retina. Sometime the vitreous may pull stronger on the retina and create a retinal tear. Then fluid enters through the retinal tear and detaches the retina.

Retinal tear if not treated will lead to retinal detachment and loss of vision.

• Myopia (the need for glasses to see far away)
• Injury to the eye
• Family history of retinal detachment
• History of retinal tear or retinal detachment in the other eye
• History of eye surgery f.ex. cataract surgery

Laser treatment can be applied at early stages such as retinal tear and can prevent retinal detachment.

Vitrectomy is a procedure where the retina is re-attached to the wall of the eye from the inside. It involves the removal of vitreous (gel in the eye), treatment to the retinal tear and insertion of a gas or an oil bubble. The gas bubble will hold the retina as it heals. You cannot fly by plane until the gas bubble is reabsorbed. The eye naturally produces fluid over time. If an oil bubble is used, this will be removed a few months later. Vitrectomy is a c. 1 hour surgery done usually under local anaesthetic where the patient is awake.  This is a day surgery and the patient goes home an hour post-surgery.

Scleral Buckle is a treatment where the wall of the eye is pushed to the retina from outside with a silicone band. It is a procedure of choice in certain types of retinal detachments, predominantly in younger patients. This is c. 2 hours surgery done under general anaesthetic where the patient is asleep. This is a day surgery and the patient goes home a couple of hours after surgery.

If you are experiencing a sudden onset of floaters, flashing lights or a growing shadow, you must seek an urgent ophthalmological review.

Floaters are clumps and strands in the vitreous, the gel-like material, inside the eye. You can see floaters as black spots or shadows which move around as you move your eyes. They are formed as a result of an ageing process of the vitreous.

Most of the floaters are not a problem but they can be a sign of a serious condition such as the retinal detachment. Therefore, if you experience a sudden increase in new floaters, flashing lights and/or a growing shadow (curtain), you should see an ophthalmologist urgently.

Most of the floaters tend to disperse and they become less noticeable over time.

Severe floaters can be removed surgically via vitrectomy. Vitrectomy is a surgery that removes the vitreous via small incisions.  Risks of the surgery include loss of vision (very rare), haemorrhage, infection, retinal detachment and cataract. The surgery may not remove completely all the floaters and new floaters can appear after surgery.

Macular hole is a defect in the centre of the macula. The macula is a part of the retina (film at the back of the eye) which is responsible for central vision. Symptoms of macular hole include a dark or blind spot in the centre of the vision.

As we age, the vitreous pulls away from the retina. This is called a posterior vitreous detachment. In the majority of population, posterior vitreous detachment will occur with no problem, however, in certain people, it will pull stronger on the retina and form a macular hole.

Only macular holes occurring through all the layers of the retina (full thickness macular holes) will require treatment.

Macular hole can be repaired by surgery called vitrectomy. The surgery is performed usually under local anaesthetic and lasts c. 1 hour. Vitrectomy involves removal of the vitreous, gel-like material inside the eye, via small incisions. This is followed by the treatment to the macular hole and insertion of a gas bubble. You cannot travel by plane until the gas bubble is resolved which can be up to 6-8 weeks. You may also have to keep your head down during the day for a week (with breaks). The surgical success will depend on the size and duration of the macular hole. The vision improves but may not be perfect like before having a macular hole.

Epiretinal membrane (ERM) is a cellophane tissue that forms on the surface of the retina at the back wall of the eye. Over time, the membrane may pull on the retina leading to decreased vision.

Most of the ERMs are idiopathic and caused by an age-related condition called posterior vitreous detachment (vitreous gel inside the eye separated from the retina).

Other ERMs can be associated with certain conditions f.ex. previous retinal tear or retinal detachment, diabetic retinopathy, vascular occlusion.

Most of the patients with ERMs are asymptomatic. However, ERMs can progress slowly leading to distortion and blurriness. Distortion is a symptom in which normally straight objects will occur ‘wavy’.

Surgery may be recommended for ERMs which progress and cause decreased vision.

The surgical procedure to remove ERM is called ‘Vitrectomy’. Vitrectomy involves the removal of the vitreous gel and peeling the ERM from the surface of the retina. The surgery takes c. 1 hour and is usually done under local anaesthetic. Severe complications, such as loss of vision, are very rare. If gas bubble is used, you cannot travel by plane until the gas is gone and the visual recovery is longer.

Most of the patients will experience improved vision and decreased distortion after the surgery. The duration of the ERM and the degree of pulling on the retina may influence the final outcome. The maximum visual improvement is seen at 3 months post-surgery.

Diabetic retinopathy is an eye disease in people with diabetes. High blood sugar levels cause damage to the vessels in the retina. Abnormal blood vessels swell, leak, and stop passing blood. To compensate impaired circulation of blood in the eye, new vessels, which should not be there, may start growing. These may lead to bleed in the eye, retinal detachment and eventually loss of vision.

You may not have symptoms of diabetic retinopathy until more advanced changes.

Diabetic retinopathy has two main stages:

Non-proliferative diabetic retinopathy (NPDR): At this early stage, retinal vessels swell, leak and may close off. The main symptom of NPDR is blurry vision.

Proliferative diabetic retinopathy (PDR):  At this advanced stage, abnormal new vessels grow on the retina. These vessels use the vitreous gel as the scaffold. As the vitreous moves and shrinks, it may pull on these vessels and lead to bleed inside the eye and/or retinal detachment and loss of vision. The main symptoms of PDR are floaters and/or loss of vision.

If you have NPDR, your ophthalmologist may recommend laser treatment and/or injections in the eye.

If you have advanced Proliferative Diabetic Retinopathy, you may require surgery called vitrectomy.

Vitrectomy involves removing the vitreous gel, new abnormal vessels, scar tissues from the retinal surface and tractions. It aims to prevent future bleeds and retinal detachment. The surgery takes c. 1-2 hours and is done either under local or general anaesthetic. An injection is done in the eye a week before the surgery to reduce the risks of complications and bleed. The risks of surgery include loss of vision (rare), retinal detachment, cataract and the need for further surgery.