Introduction
The retina is a light-sensitive tissue at the backside of the eyeball. It receives images and converts them into electrical signals. Finally, these signals are carried to the brain via the optic nerve. Various diseases can affect the retina. A retinal detachment happens when the retina is not in the normal position. It is a serious condition. The vision becomes blurred. If treatment is not done, it may lead to blindness. Other conditions are retinal tears, diabetic retinopathy, macular holes, and age-related macular degeneration. The macula is the central part of the retina involved in clear vision.
What Is Retinal Surgery?
Retinal surgery involves the correction of the mentioned retinal conditions. Retinal detachment is an emergency. There are no signs and symptoms if a small part of the retina has detached. However, after a certain degree of detachment, sudden symptoms include dark spots or lines across the vision, flashes of light, blurred vision, reduced side vision, and a dark shadow in the middle of the vision.
How Is Retinal Surgery Performed?
Different types of retinal surgeries are performed for different eye conditions. The conditions are described along with the procedures. Before surgery, a complete medical history and physical examination are essential. The examination includes a retinal check-up and ultrasound imaging (if there is bleeding in the eye).
1. Freezing: It is also called cryopexy or retinal cryotherapy. After local anesthesia (LA), the ophthalmologist views the eye through an ophthalmoscope. Then, a small metal probe is used to deliver the freezing gas after determining the treatment location. The freezing damages the target tissue with a resultant scar formation. The scar forces the retina back to its place. Cryopexy is used to treat retinal tears, early stages of retinal detachment, diabetic retinopathy, and age-related macular degeneration.
2. Laser Surgery: It is also called photocoagulation. The laser delivers amplified light energy to the retinal tissues. As a result, retinal damage occurs, which leads to scarring. The scars are helpful in sealing tears, closing leaking blood vessels, and disintegrating abnormal tissue. Therefore, laser surgery is used in retinal tears, age-related macular degeneration, macular hole (break in the macula due to which central vision is affected), diabetic retinopathy, and retinal detachment. Laser is used more than cryopexy.
3. Pneumatic Retinopexy: Pneumatic retinopexy is done in minor retinal detachment. It involves the injection of a small air bubble into the eye. The bubble forces the retina back into its original position. Topical anesthesia (numbing eye drops) is usually given before the procedure. Cryopexy or laser treatment is also done to repair retinal tears. Head position after surgery is important to hold the bubble in its place. The air bubble becomes a part of the side vision. However, it reabsorbs after some time. Therefore, patients should avoid heavy activities for some days. Pneumatic retinopexy is an outpatient procedure.
4. Scleral Buckle Surgery: Sclera is the white of the eye. Scleral buckle surgery is usually done under LA. General anesthesia (GA) can be used in young and uncooperative patients. The surgical placement of a silicone band around the eye is done. As a result, the band acts as a belt pushing the eye inwards, leading to retinal reattachment. The band insertion is permanent, and it does not impair vision. Cryopexy and laser surgery can also be performed along with the procedure. Patients should wear an eye patch following the surgery. Scleral buckle surgery is indicated in young patients, myopia (near-sightedness), and complex retinal detachments. However, it is contraindicated in severe scleral thinning, advanced cataracts, and previous glaucoma surgery.
5. Vitrectomy: Vitrectomy is done in the hospital or on an outpatient basis. It is used in diabetic retinopathy and severe retinal detachment. This procedure has gained popularity due to technological advancements. Vitrectomy means the removal of vitreous humor from the eye. Vitreous humor is a gel-like substance made mostly of water. After LA or GA, the eye is cleaned. First, a speculum keeps the eye open. Next, the surgeon makes a small cut on the eye's outer covering, followed by eye-opening using forceps. A vitrectomy probe is used to cut the vitreous humor. Finally, a suction tool removes the vitreous humor from the eye. Vitrectomy is sometimes done with scleral buckle surgery. It is indicated in retinal detachment, diabetic retinopathy, vitreous hemorrhage, eye infection, severe eye injury, retinal bleeding, and macular hole patients.
What Are the Risks and Complications Associated With Retinal Surgery?
A retinal surgery should not be delayed. It is especially correct in retinal detachment cases. Complications are rare. Still, some of the associated risk factors with retinal surgery are:
1. Glaucoma: Increased pressure inside the eye sometimes leads to glaucoma. Glaucoma is a chronic progressive disease resulting from a problem with the eye’s drainage.
2. Cataract: A cataract is a clouding of the lens. It can happen due to retina surgery. Cataract progression has also been reported in some patients.
3. Recurrence: The surgery is not successful in all cases. Some patients have a chance of retinal detachment, prompting a second surgery. Moreover, the retina does not reattach properly, sometimes leading to vision disturbances. A surgical injury also necessitates the need for follow-up surgery.
4. Vision-Related: In some patients, vision is affected. Hence, they require prescription eyeglasses for vision correction. Loss of night vision and depth perception is reported. Double vision also occurs.
5. Anesthesia-Related: Allergy to anesthesia happens in some patients. It includes reactions to medicines and breathing problems. However, it is uncommon.
6. Others: Eye inflammation, pain, redness, and infection.
What Is the Prognosis of Retina Surgery?
The prognosis depends upon the disease extent. If the detachment is extensive, complete vision recovery is difficult. However, in 9 out of 10 patients, the procedure is successful. The quality of vision depends on the area of detachment. Following a retinal detachment, rods, and cones (type of photoreceptors) start degenerating. Their recovery depends on how soon the surgery is done. But, it is difficult in case of a complete retinal detachment. If the macula were spared, the vision would be good. If macular involvement is less than a week, some vision will improve. But, the involvement of the macula for a long time restores only a part of the vision.
Conclusion
Retinal conditions should be treated with the utmost attention. Preventive care is essential to avoid surgery. Still, after retinal surgery, recovery takes different times for different patients. A full recovery takes place after about a month of the procedure.
