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Vitreo-retinal surgery

As the name implies, this delicate surgery takes place where the gel-like vitreous and light-sensitive membrane (retina) are found.

Various vitreoretinal surgical and laser approaches can restore, preserve and enhance vision for many eye conditions such as certain types of age-related macular degeneration, diabetic retinopathy, diabetic vitreous hemorrhage, macular hole, a detached retina, epiretinal membrane and CMV retinitis.

Vitreo-retinal surgery includes the following:

  • Vitrectomy:

    Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.

    Reasons For A Vitrectomy:

    The most common reasons for a vitrectomy include:

    • Diabetic vitreous hemorrhage
    • Retinal detachment
    • Epiretinal membrane
    • Macular hole
    • Proliferative vitreoretinopathy
    • Endophthalmitis
    • Intraocular foreign body removal
    • Retrieval of lens nucleus following complicated cataract surgery
  • Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV):

    It is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments.

  • Pan retinal photocoagulation (PRP):

    Panretinal photocoagulation is used in the treatment of diabetic retinopathy. It involves using a laser (photocoagulator) to place laser spots in the peripheral retina for 360 degrees sparing the center of the retina. The central vision is in the macula which is roughly the center 20 degrees of the retina. Most panretinal photocoagulation treatments spare the center 30 degrees of the retina.

    Panretinal photocoagulation is used primarily for patients with proliferative diabetic retinopathy. It is also effective at reducing the risk of vision loss in patients with occlusive retinopathies like central retinal vein occlusion, branch retinal vein occlusion, sickle retinopathy, Eales disease and IRVAN (idiopathic retinal vasculitis, aneurysms, and neuroretinitis).

  • Ignipuncture:

    It is an obsolete procedure that involves surgical closing of a break in the retina due to retinal separation by cauterizing the site of the break with a hot needle. A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface. Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.

  • Pneumatic retinopexy:

    Pneumatic retinopexy is an effective surgery for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina. It is usually an outpatient procedure done with local anesthesia.

    During pneumatic retinopexy, the eye doctor (ophthalmologist) injects a gas bubble into the middle of the eyeball. Your head is positioned so that the gas bubble floats to the detached area and presses lightly against the detachment. The bubble flattens the retina so that the fluid can be pumped out from beneath it. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.

    The bubble remains for about 1 to 3 weeks to help flatten the retina, until a seal forms between the retina and the wall of the eye. The eye gradually absorbs the gas bubble.

  • Retinal cryopexy, or retinal cryotherapy:

    It is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue. The retina is the very thin membrane in the back of the eye that acts like the "film" in a camera. It is held against the inside back portion of the eye by pressure from fluid within the eye. In the front part of the eye, the retina is firmly attached at a ring just behind the lens called the pars plana. In the back part of the eye, the retina is continuous with the optic nerve. In between the pars plana and the optic nerve the retina has no fixed attachments. The retina collects information from the images projected on it from the eye lens and sends it along the optic nerve to the brain, where the information is interpreted and experienced as sight. Several disorders can affect the retina and retinal cryopexy is used to treat the following conditions: retinal breaks or detachments retinal ischemia (retinal tissue that lacks oxygen) neovascularization (proliferation of blood vessels in the retina) Coats' disease (abnormal retinal blood vessels that cause loss of vision) retinoblastoma (intraocular tumors)

  • Macular hole repair:

    A macular hole is a defect in the center of the macular area of the retina. The macula gives us sharp central vision and reading vision. The very center portion of the macula, called the fovea, is the thinnest portion of the entire retina. It is in this very delicate foveal area that a macular hole can develop. A macular hole can be treated with vitrectomy surgery. With current surgical techniques, most macular holes can be repaired with a success rate of about 95%. There is no non-surgical treatment for a macular hole.

  • Posterior sclerotomy:

    It is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body. It may be performed to extract an intraocular cyst, or to drain a choroidal haemorrhage.

  • Radial optic neurotomy:

    Radial optic neurotomy (RON) has been proposed as a surgical treatment to alleviate the neurovascular compression and to improve the venous outflow in patients with central retinal vein occlusion. In this treatment a microvitreoretinal blade is used to cut the cribriform plate, the scleral ring, and the adjacent sclera in a radial fashion, to alleviate the constriction of the scleral outlet, as a new surgical option for CRVO. In RON macular translocation surgery is done through 360 degree retinotomy and through scleral imbrication technique.