THE BEST RETINA SURGEONS IN THE REGION
When your retina is affected by disease or trauma, it is imperative that you get the best care possible. Both your color perception and focus can be affected when the thin layer of the retina is damaged, because the light-sensitive nerve cells at the back of the eye are unable to send signals to the optic nerve. And this is not something we take lightly at Sabates Eye Centers. Our commitment to researching the latest treatments and procedures means you and your eyes get the highest quality of care available.
Sabates Eye Centers Approach to Retinal Surgery
Our retina ophthalmologists have performed hundreds of retinal surgeries. These surgeries vary depending on which condition you have and how serious it is. While surgery is not always the answer, it is an option for more severe cases. The two conditions we operate on regularly are macular holes and retina detachment.
For more information about the types of retina conditions we treat at Sabates Eye Centers, please visit our Retina page.
DID YOU KNOW?
There are two types of photoreceptor cells in the retina: rods and cones.
RETINAL DETACHMENT: OVERVIEW
Dr. Nelson R. Sabates, M.D. – Dr. Sabates sees patients at the Independence, Leawood, Northland, Plaza, and St. Joseph Eye Centers, and Truman Medical Center – Lakewood location.
The central portion of the retina is called the macula. This area provides all of the sharp central vision for activities such as reading and driving. If this area is damaged, the central vision can be severely affected. A macular hole may develop in the area of central vision. Macular holes occur in a number of ways.
Although macular holes may occur from trauma or inflammation, the most common cause of macular hole formation is from traction. The eye contains a special gel known as the vitreous. The vitreous provides structure within the eye. As we age, the vitreous liquefies and no longer exists as a gel. As the vitreous liquefies, it exerts traction on the macula, stretching the center and causing a hole to develop. This results in progressive loss of the central vision, but does not usually affect the peripheral vision.
Symptoms and Treatment of Macular Holes
Patients who develop macular holes initially notice distortion and waviness in the central vision, especially while reading. This may slowly or abruptly worsen. In some cases, the other eye compensates well enough that the patient notices no vision loss until they cover the good eye. The peripheral or side vision remains unchanged.
Macular holes resulting from vitreous traction can be closed with an operation called vitrectomy. In this procedure, the eye is anesthetized and the vitreous gel is removed. The macula is freed from traction. The eye is then filled with a gas mixture. The surface of the gas bubble presses against the macula, closing the hole. The surgery is usually done as an outpatient and eye drops will be needed after surgery.
Gas floats, and in order for surgery to be effective, the bubble must press upon the macula, which is at the very back of the eye. Therefore, it is critically important that the patient look straight down continuously for two weeks. This is by far the most important factor for success. Patients may utilize special chairs, beds and other equipment to make this easier.
This surgery, and especially the gas bubble, may result in more rapid cataract formation than normal. This is treatable with routine cataract surgery. In some cases, cataract surgery is combined with vitrectomy surgery for macular holes. Your doctor will fully discuss these issues with you and answer any questions you may have.
Surgery succeeds in closing the hole in 80-90 percent of cases. In 60-70 percent of cases, this results in vision improvement. If there is too much damage from the hole, vision may not improve. Complications are unusual but include bleeding, infection and retinal detachment. Your doctor will discuss this with you and watch very closely for problems in the postoperative period.
When the vitreous gel peels away from the back of the eye, strands clump together and cast shadows, referred to as floaters. When the gel pulls or tears the retina, this stimulates the retina and may cause flashes of light. Flashes and floaters do not always signify a retinal tear or detachment, but may be a warning sign of an impending tear or detachment. Prompt evaluation by an ophthalmologist may find a retinal tear before it causes a retinal detachment. Laser surgery may prevent the retina from detaching and save the patient from needing to have a more serious procedure.
A progressively enlarging dark curtain or shadow in one eye often signifies a developing retinal detachment. The curtain usually starts in the peripheral or side vision and eventually may spread to the central vision. At this point, laser treatment is not likely to be helpful and an operation is usually necessary.
Retinal Detachment Treatment
There are several types of surgery that can repair a detached retina. The surgery usually consists of one or more of the following procedures:
1. Scleral Buckle: A plastic band is often placed around the eye to indent and support the area of the tear. It may extend all the way around the eye, like a belt, or it may be fixed to only one area. The patient cannot see or feel the band once the eye has healed. The scleral buckle is meant to stay in place for your entire life.
2. Pneumatic Retinopexy: If the tear causing the retinal detachment is in the top half of the eye, it may be possible to seal it with a gas bubble injected into the eye. This is combined with special head positioning to push the bubble against the tear, and laser or freezing technique to “spot-weld” the tear. If the bubble does not work, scleral buckling and/or vitrectomy may be recommended.
3. Vitrectomy: In more complicated retinal detachments, vitrectomy surgery may be necessary. This operation removes the vitreous jelly, as well as any scar tissue or blood that may have accumulated. The vitreous is replaced with special fluid or sometimes a gas bubble. The fluid or gas is replaced by the eye’s own fluid over time without any further surgery. Occasionally, oil replaces the vitreous and a second surgery is needed to remove the oil.
4. Combinations: Occasionally physicians will combine a scleral buckle with a vitrectomy to treat more complicated detachments.
Before, During and After Retinal Detachment Surgery
A general physical examination is part of the preoperative routine. In some cases, other laboratory testing is necessary, depending on your age and physical condition. We will consult with your primary care physician to discuss your case and secure clearance for your surgery. An anesthesiologist will interview you and assist your doctor with preoperative medications.
An intravenous line will be placed into an arm or hand vein. If you are having general anesthesia, you will not be aware of the operation. You will be in the recovery room when you wake up. If you are having local anesthesia, a tranquilizer will be injected in the intravenous line. You will be relaxed and sleepy. You may or may not fall asleep. A local anesthetic will be injected around, but not into, your eye. You should feel no pain.
Local, monitored anesthesia is also an option. The patient is given an injection to numb the eye. The patient is kept semi-awake or in a “twilight” state. Patients require very little in terms of recovery from local anesthesia.
Following surgery you will remain in the recovery room for a short period under special supervision. You will have a patch on your eye. Some pain is to be expected, which is controllable by oral or injected medication. Some nausea is not uncommon and will also be treated with medication. If vomiting should occur after surgery, this will not harm the eye. The intravenous line may be discontinued once you are fully awake. Most retinal surgery can be done as an outpatient.
Retinal Detachment Recovery
You need to be examined the day after surgery and usually again within a week. You will be placed on a regime of eye drops. Your eye may feel scratchy or sore, and you may have a stuffy nose for a few days after surgery. If a gas bubble is placed in your eye during the surgical procedure, you should not fly in an airplane or receive anesthetic gases. Either can cause the bubble to expand, causing pain and possible damage to the eye. Your doctor can determine when it is safe to fly or have anesthetics. Your physician will tell you if special positioning or activity limitations are necessary.
Patients ultimately return to their referring doctor for their continued care. If you wear glasses or contact lenses, the power of the lens may change as a result of your surgery. We usually do not recommend changing your glasses or contact lenses for about two months following surgery to allow the new prescription to stabilize.
If your vision was good before surgery, the chances are excellent that you will maintain normal or near-normal vision following surgery. If the vision was poor before surgery, the visual return may be slow and incomplete. A single operation successfully reattaches the retina in more than 90 percent of cases. In a few cases, scar tissue may begin to form inside the eye and may cause a secondary detachment. If the retina should detach again, it usually does so within several months of surgery and can often be repaired with another operation. Surgery may also result in cataract formation and glaucoma, which also have to be carefully managed.