Retinal holes or tears may be treated with cryotherapy (freezing) or laser treatment in an effort to prevent them from becoming full detachments, depending on the type and location of the hole or tear, as well as whether it is pulling on the retina or if bleeding is involved. For full detachments, scleral buckling, pneumatic retinopexy, and/or vitrectomy may be done. Scleral buckling is performed in a hospital operating room where the surgeon will heat or freeze the tissue or use a laser to seal the hole or tear. Scar tissue is formed which will keep the tear sealed. A scleral buckle is then sewn to the outer part of the eye, compressing it so the tear pushes against the outer part of the eye. The buckle is typically not visible.
With pneumatic retinopexy, cryotherapy or laser treatment is used to seal the hole or tear. The surgeon then injects a gas bubble inside the eye to push the detachment against the outer part of the eye. The bubble dissipates within 2-6 weeks. After the procedure, special positioning of the patient’s head is required. Pneumatic retinopexy is an outpatient procedure, typically performed under local anesthesia.
Vitrectomy surgery is a fairly routine outpatient procedure in which the vitreous gel is removed from the middle part of the eye. It is frequently done when a patient has a retinal detachment because removing the vitreous will give the surgeon better access to the back of the eye. It may also be done if blood in the vitreous (vitreous hemorrhage) is present and does not clear on its own. After removing the vitreous gel, the retina may be treated with a laser, fibrous or scar tissue removed from the retina, detached areas flattened, or repairing any tears or holes in the retina or macula. After surgery, silicone or gas is injected into the eye to replace the gel and restore normal pressure in the eye.
While there are many types of lasers used to treat eye disease, only a few are used to treat retinal disease. Typically, a thermal laser is used to seal retinal tears and destroy abnormal or leaking blood vessels. A laser may also be used to control macular edema, a swelling in the central part of retina, often due to diabetes and vein occlusions. Laser treatments are oftentimes aimed at preventing further loss of vision, not to restore or improve vision. Most laser treatments are done under local anesthesia in our office.
In recent years, tremendous advances have been made in the treatment of age-related macular degeneration (AMD), diabetic retinopathy, and vein occlusions. One such advance is called an intravitreal injection, in which medicine is injected in or around the eye. The medication may be a steroidal or an anti-vascular endothelial growth factor agent, aimed at stopping vision loss due to swelling or bleeding in the center of the retina (called the macula). Intravitreal injections are done in the office under local anesthesia. After the procedure, you may notice floaters in your vision for a few days up to a few weeks. Some patients may also experience mild eye discomfort, a foreign-body sensation, and/or redness in the eye. These are normal and do not pose a threat to vision. Excessive pain or decreased vision is not normal – if you experience these symptoms, you should call our office immediately.