If you have a retinal detachment, your physician likely recommended a surgical procedure to repair it. There are several options for repair of retinal detachment, and the one we recommend changes based on factors such as your age, whether you have had cataract surgery, the location of the retinal detachment, and if any scar tissue is already present in your eye.
A retinal detachment occurs when the layers of the retina separate from the choroid, or inner lining of the eye. The goal of retinal detachment repair is to get the retina to "stick" to the back wall again. This can be accomplished with several different options.
The first option is a pneumatic retinopexy. This is an in office procedure where a gas bubble is placed in the eye. The gas bubble pushes against the detached retina and holds it in place, allowing the retina to scar down. The gas bubble is either preceded by cryo, which freezes around the tear causing the detachment, or followed later by laser, which seals around the tear that caused the detachment. Only certain people are candidates for pneumatic retinopexy. The tears causing the detachment must be close to one another, and must be near the top or the sides of the eye. This is so the bubble, which floats, can press against the tear. Also, the patient must be able to hold a specific position for 5-7 days which can be difficult for the elderly and patients with neck or back problems. The gas bubble dissolves over time leaving the retina attached in about 70- 75 % of cases.
The second option for repair is a scleral buckle. In a scleral buckle, the tear, or tears, are frozen with cryo, and a silicone band is placed around the eye and sutured in place. This is done in the operating room. The buckle stays in place for life in most cases. A gas bubble may be used as well that will dissolve over a 3-6 week period. Scleral buckles are excellent choices for young patients who have not yet had cataract surgery.
The third option for repair is a pars plana vitrectomy with oil or gas (the vitrectomy can be combined with a scleral buckle as well). This is the most common procedure to repair a retinal detachment today and is also performed in the operating room. In a pars plana vitrectomy, three small incisions are made in the eye. The vitreous gel is removed and laser or cryo is used to seal around the causative holes or tears. A gas bubble or oil bubble is then placed in the eye. The gas bubble will dissolve over time (3-6 weeks). The oil bubble will not dissolve and must be removed in the operating room at a later date. In some cases, the oil may remain in for life. The decision between gas and oil is made by your surgeon depending on the type of retinal detachment you have and whether you have scar tissue that requires a long term solution like oil. As mentioned, in some cases, we do a scleral buckle and vitrectomy in the same procedure.
Each person's retinal detachment requires a thorough evaluation before the decision is made as to which surgery is appropriate.
This blog is for informational purposes only and is not medical advice. Please seek the advice of a qualified medical personnel.
Showing posts with label retinal detachment. Show all posts
Showing posts with label retinal detachment. Show all posts
Monday, June 16, 2014
Monday, September 16, 2013
Your first visit with us: What to expect
If you have been referred to us by another eye care or other health professional, you might be wondering what to expect on your first visit. As retina specialists, we evaluate and treat diseases in the back part of the eye- the vitreous, retina, and choroid. There are many such diseases that we evaluate and treat, but some of the most common include macular degeneration, diabetic eye disease, macular hole, epiretinal membrane, vitreous hemorrhage, retinal tears or holes, and retinal detachments.
On your first visit, you will first have your vision checked, you intraocular pressure measured, and your eyes dilated. Often, people ask if it is necessary to dilate their pupils. The answer is yes, it is necessary. The way we see the retina is through the pupil, so it must be dilated for us to perform a complete exam.
Once your pupils are dilated, we will begin the testing process. Most patients will have an OCT, a test that looks at the layers of your macula, or center of your vision. And, most patients will have color photos taken of your retina. These tests are usually very quick and easy for the patient. Some patients will also require a fluorescein angiography. This is a dye test that looks at the circulation and structures of the retina and choroid. This dye is inserted into a vein in your arm or hand, and the photos are taken over a period of approximately 10 minutes. Fluorescein angiography is usually very well tolerated by the patient but can leave your vision blurry for a few minutes. Rarely, people have an allergic reaction to the dye, but before any test is done, the technician will discuss things that you should be aware of during the test.
After the testing is completed, you will then see the doctor. He or she will perform an examination as well as go over all of your testing with you. If treatment is necessary, you will receive a thorough description of the treatments available including risks, benefits, and alternatives to these treatments. Some of the various treatments that we perform include injections into the eye, lasers, and surgeries. Often, the first treatment is given or scheduled that day!
Overall, your first visit to any retina specialist will most likely be different than any eye examination you have had in the past due to the different tests that we perform. The first visit can last anywhere from 1-3 hours depending on your eye disease and treatment requirements.
This blog is for informational purposes only and is not intended to be medical advice. Please seek the advice of a health care professional.
On your first visit, you will first have your vision checked, you intraocular pressure measured, and your eyes dilated. Often, people ask if it is necessary to dilate their pupils. The answer is yes, it is necessary. The way we see the retina is through the pupil, so it must be dilated for us to perform a complete exam.
Once your pupils are dilated, we will begin the testing process. Most patients will have an OCT, a test that looks at the layers of your macula, or center of your vision. And, most patients will have color photos taken of your retina. These tests are usually very quick and easy for the patient. Some patients will also require a fluorescein angiography. This is a dye test that looks at the circulation and structures of the retina and choroid. This dye is inserted into a vein in your arm or hand, and the photos are taken over a period of approximately 10 minutes. Fluorescein angiography is usually very well tolerated by the patient but can leave your vision blurry for a few minutes. Rarely, people have an allergic reaction to the dye, but before any test is done, the technician will discuss things that you should be aware of during the test.
After the testing is completed, you will then see the doctor. He or she will perform an examination as well as go over all of your testing with you. If treatment is necessary, you will receive a thorough description of the treatments available including risks, benefits, and alternatives to these treatments. Some of the various treatments that we perform include injections into the eye, lasers, and surgeries. Often, the first treatment is given or scheduled that day!
Overall, your first visit to any retina specialist will most likely be different than any eye examination you have had in the past due to the different tests that we perform. The first visit can last anywhere from 1-3 hours depending on your eye disease and treatment requirements.
This blog is for informational purposes only and is not intended to be medical advice. Please seek the advice of a health care professional.
Monday, April 22, 2013
Retinal tears
Retinal tears are a common diagnosis that we see in our practice. Patients often wonder when they have flashes and floaters whether they have a retinal tear or detachment. Many have researched these symptoms on the internet and see the words "retinal tear" and "retinal detachment" and, understandably, become concerned.
The retina is the inner lining of the back wall of the eye. It is a 9 layered structure that "takes the picture" and sends it to the brain by way of the optic nerve. The vitreous is a gel layer made up of collagen and other proteins as well as water that is between the lens, the focusing system of the eye, and the retina. The vitreous is attached at the optic nerve, the macula, and the entire peripheral retina. As we age, our vitreous becomes less gel-like and more liquid. When this occurs, it begins to separate from the retina in stages. When it separates from the peripheral retina, it can cause a retinal tear or hole.
Retinal holes and tears can have many symptoms. Flashes and floaters are common with a benign vitreous detachment as well as a more serious retinal tear. That is why we recommend patients with new flashes and floaters be evaluated by an eye care professional. Some retinal tears have no symptoms and are discovered on routine exam.
A retinal tear is a serious condition because it can lead to a retinal detachment. A retinal detachment occurs when the fluid of the vitreous tracks underneath the layers of the retina through the tear.
If a retinal tear is discovered, often it can be treated before it leads to a detachment. The treatment involves a "welding" process where either laser or freezing is placed around the tear to "glue" it in place. This is not a guaranteed fix because the tear can sometimes pull through the treatment and evolve into a detachment, but is often very successful.
If you have symptoms of a retinal tear please consult an eye care professional.
This blog is for informational purposes only and is not intended to be medical advice. Please consult an eye care professional for medical advice.
The retina is the inner lining of the back wall of the eye. It is a 9 layered structure that "takes the picture" and sends it to the brain by way of the optic nerve. The vitreous is a gel layer made up of collagen and other proteins as well as water that is between the lens, the focusing system of the eye, and the retina. The vitreous is attached at the optic nerve, the macula, and the entire peripheral retina. As we age, our vitreous becomes less gel-like and more liquid. When this occurs, it begins to separate from the retina in stages. When it separates from the peripheral retina, it can cause a retinal tear or hole.
Retinal holes and tears can have many symptoms. Flashes and floaters are common with a benign vitreous detachment as well as a more serious retinal tear. That is why we recommend patients with new flashes and floaters be evaluated by an eye care professional. Some retinal tears have no symptoms and are discovered on routine exam.
A retinal tear is a serious condition because it can lead to a retinal detachment. A retinal detachment occurs when the fluid of the vitreous tracks underneath the layers of the retina through the tear.
If a retinal tear is discovered, often it can be treated before it leads to a detachment. The treatment involves a "welding" process where either laser or freezing is placed around the tear to "glue" it in place. This is not a guaranteed fix because the tear can sometimes pull through the treatment and evolve into a detachment, but is often very successful.
If you have symptoms of a retinal tear please consult an eye care professional.
This blog is for informational purposes only and is not intended to be medical advice. Please consult an eye care professional for medical advice.
Wednesday, October 24, 2012
Fluoroquinolones and retinal detachment?
A recent patient brought to mind the possible link between fluorquinolone antibiotics (ciprofloxacin, moxifloxacin, levofloxacin, etc) and the risk of retinal tears or detachments. Fluoroquinolones are one of the most often prescribed antibiotics, and if there is such a risk, could affect a large number of people.
An article posted in JAMA in April 2012 revealed a possible link between these antibiotics and retinal detachments. The article was a case control study of 989,591 patients who took the antibiotic between 2000-2007. 4384 patients had experienced a retinal detachment. Statistically, current use of fluoroquinolones carried a higher risk of retinal detachment but recent use and past use did not.
This article does not prove that fluorquinolones were the cause of the detachments, but merely suggests that there might be a correlation. The proposed mechanism is that the drug may have a destructive effect on collagen and connective tissue. In fact, there is a known risk between fluoroquinolone use and tendon rupture. Since the vitreous contains collagen, this could be the mechanism that leads to the increased risk of retinal detachment or tears.
So, what is the take home message of this possible risk? As a patient, be aware that there is a theoretical risk of retinal detachments with the use of this drug. If you are a prescriber, educate your patients about the signs of retinal tears and detachment such as flashes and floaters. If you are currently using a fluorquinolone antibiotic and experience flashes, floaters, or other symptoms of a retinal detachment, you should contact your physician and an eye care professional. They will perform an dilated exam to look for retinal pathology.
This blog post is for informational purposes only. It is not intended to medical advice. Please seek the advice of a qualified professional.
An article posted in JAMA in April 2012 revealed a possible link between these antibiotics and retinal detachments. The article was a case control study of 989,591 patients who took the antibiotic between 2000-2007. 4384 patients had experienced a retinal detachment. Statistically, current use of fluoroquinolones carried a higher risk of retinal detachment but recent use and past use did not.
This article does not prove that fluorquinolones were the cause of the detachments, but merely suggests that there might be a correlation. The proposed mechanism is that the drug may have a destructive effect on collagen and connective tissue. In fact, there is a known risk between fluoroquinolone use and tendon rupture. Since the vitreous contains collagen, this could be the mechanism that leads to the increased risk of retinal detachment or tears.
So, what is the take home message of this possible risk? As a patient, be aware that there is a theoretical risk of retinal detachments with the use of this drug. If you are a prescriber, educate your patients about the signs of retinal tears and detachment such as flashes and floaters. If you are currently using a fluorquinolone antibiotic and experience flashes, floaters, or other symptoms of a retinal detachment, you should contact your physician and an eye care professional. They will perform an dilated exam to look for retinal pathology.
This blog post is for informational purposes only. It is not intended to medical advice. Please seek the advice of a qualified professional.
Saturday, September 22, 2012
Flashes and Floaters
One of the most common complaints our patients have is flashes and/or floaters. There are many reasons for these symptoms, but the most common is a posterior vitreous detachment or PVD.
The vitreous humor lies between the lens and the retina. Early in life, the vitreous is a jelly-like substance. With age, the jelly-like substance begins to liquefy. This causes vitreous syneresis, one cause of vitreous floaters.
The vitreous is attached to the retina at the optic nerve, the macula, and the peripheral retina. During the liquefication process, the vitreous begins to pull on the retina. The pulling, or traction, on the retina creates flashing which is usually seen by the patient as a bright arc in the temporal visual field.
When the vitreous pulls away from the retina, it is known as a posterior vitreous detachment. Usually this occurs without any consequences for the patient except for pesky floaters. However, it can lead to a retinal tear or detachment. Retinal tears and detachments can be treated but should be addressed quickly. Therefore, we recommend that all patients with new floaters should be seen by an Optometrist or Ophthalmologist.
This post is for informational purposes. It does not constitute medical advice. Please seek the advice of a qualified medical professional.
Please visit us at www.ncretina.com
The vitreous humor lies between the lens and the retina. Early in life, the vitreous is a jelly-like substance. With age, the jelly-like substance begins to liquefy. This causes vitreous syneresis, one cause of vitreous floaters.
The vitreous is attached to the retina at the optic nerve, the macula, and the peripheral retina. During the liquefication process, the vitreous begins to pull on the retina. The pulling, or traction, on the retina creates flashing which is usually seen by the patient as a bright arc in the temporal visual field.
When the vitreous pulls away from the retina, it is known as a posterior vitreous detachment. Usually this occurs without any consequences for the patient except for pesky floaters. However, it can lead to a retinal tear or detachment. Retinal tears and detachments can be treated but should be addressed quickly. Therefore, we recommend that all patients with new floaters should be seen by an Optometrist or Ophthalmologist.
This post is for informational purposes. It does not constitute medical advice. Please seek the advice of a qualified medical professional.
Please visit us at www.ncretina.com
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