Sarit Lesnik Oberstein
Consultant Ophthalmologist
Lesnik Eye Consultancy
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+44 (0) 020 30965843
SURGERY OF THE RETINA
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Surgery of the retina is almost always done by a procedure called a vitrectomy. To reach the retina 3 tiny openings are made to see into the eye. This way the retina can be reached to treat retinal detachment, macular hole, epiretinal membrane and floaters.
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The surgery is usually done under local anesthetic using a sub tenon anesthetic (a small cannula along the side of the eye). If you prefer the surgery can be done with a general anesthetic. Eye surgery usually causes minimal discomfort to the eye in the period after surgery. The recovery time for the operation itself is short (2 weeks, depending on the surgery) and you will have 4 weeks of eye drops. Vision can take variable times to recover, depending on the underlying retina problem.
RETINA
Causes: Floaters are caused by thick bits in the normal jelly that fills the inside of the eye. This can get in the way of normal vision. Most people do not notice their floaters or only see them against a white wall or blue sky. However, there are people who are very troubled by their floaters. This may be because the floaters are large, or because they are in the center of vision.
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Symptoms: Large or small disturbances, like little flies or black dots, floating in the field of vision that have usually existed for a long time. These tend to move with movement of the eyes or head and can be very troublesome if they are visible constantly.
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Surgery: If floaters are very large or affecting daily life they can be removed by surgery with an operation called a vitrectomy. Three tiny holes are made in the eye and the jelly and the floaters are carefully removed. The eye is then filled with water or gas (this disappears after a few weeks). The vitrectomy is often combined with a cataract operation.
Describe your image.
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A retinal detachment is when the retina (the layer at the back of the eye that perceives light and lets us see) comes off the back wall of the eye.
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Causes: A retinal detachment is usually caused by a small tear in the retina, where the jelly of the eye (the vitreous) is too firmly attached to the retina and has been pulling and caused a small break in the retina. As the jelly continues to pull on the retina, the retina can come loose ( a bit like pulling on wet wall paper).
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This is an EMERGENCY and the retina needs to be attached as soon as possible to avoid loss of vision.
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Symptoms of a retinal detachment or retinal tear are sudden floaters or one big, new floater. Lots of flashing lights in your vision or a grey/black curtain in your field of vision. Should you have any of these symptoms then please have yourself checked urgently.
Surgery: To fix the detachment we usually do a vitrectomy. The jelly of the eye is removed to stop it pulling on the retina and the tear is treated with laser of freezing to close the break in the retina. There will be gas left in the eye to support the healing process (like a splint inside the eye). The gas is usually gone after 2 weeks. After 3 months the eye is considered “healed”. If you have had a retinal detachment in one eye there is a 10% risk of having a retinal detachment in your other eye.
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Describe your image.
An epiretinal membrane is a thin layer of scar tissue over the macula (the center of vision). This scar tissue often occurs with aging. It only needs surgery if it is causing problems in vision.
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Causes: The scar tissue often occurs with aging. It only needs surgery if it is causing problems in vision. Sometimes an epiretinal membrane can be caused by inflammation of the eye or other eye diseases.
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Symptoms: distortion (straight lines wobble) and blurring of vision because the scar tissue is pulling on the retina.
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Surgery: In surgery the layer of scar tissue is carefully removed after doing a vitrectomy so the retina can relax into its normal flat configuration.
RETINAL DETACHMENT
Retinal tears are “rips” in the retina.
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Causes: Retinal tears occur when the jelly of the eye (the vitreous) is too firmly attached to the retina and can pull on the retina causing it to tear. As the jelly stays attached to the edge of the tear, eye and head movement can cause the retina to be pulled loose.
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Symptoms: The first symptoms of a retinal tear can be flashing lights in one eye or lots of new floaters in the eye. Sometimes one or two big, new floaters are seen. Should you notice new floaters in your vision or see lots of flashing lights, please see an eye specialist urgently.
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Treatment: If the retinal tear has occurred without causing a retinal detachment it can be treated by laser or freezing of the tear. This causes a scar to form in the area of the tear, so that the retina cannot detach. If the tear does progress and the retina comes loose it is a retinal detachment.
A macular hole is a small defect pulled in the center of the macula (the central vision).
Causes: Macular hole is caused by the jelly of the eye pulling on this small area. Macular holes almost always need surgery, as otherwise the eye will lose vision permanently.
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Symptoms: Blurring of central vision and often missing letters whilst reading, or seeing a small “gap” in central vision.
Surgery: The surgery involves a vitrectomy and removal of any abnormal pulling tissue around the hole. The eye is filled with gas to close the hole. This gas lasts between 2-10 weeks depending on the size of the hole. During the first week you will be asked to not lie on your back and/or to look at the floor.
Diabetes can cause many eye problems, some which might need surgery.
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Bleeding in the eye: Sometimes in diabetes, new, small blood vessels can grow from the retina. These vessels bleed easily and can cause bleeding in the inside of the eye making vision poor and causing the diabetic eye disease to progress.
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Treatment: Often, when a bleed occurs, laser treatment is given is given to the retina to try and stop the new vessels from progressing and to stabilise the diabetic eye disease. However, if the retina is not visible due to the blood, then an operation to remove the blood is performed. Laser to the retina can then be done during the surgery.
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Retinal detachment from diabetes: If the diabetes in the eye has progressed then there may be a layer of scar tissue over the retina. This scar tissue may pull on the retina and cause it to lift. When this happens vision may deteriorate. The scar tissue can be removed, if necessary, relaxing the retina back in place.
FLOATERS
EPIRETINAL MEMBRANE
RETINAL TEARS
MACULAR HOLE
DIABETES
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