Vitreo-retina surgery uses various treatments to treat a variety of diseases that affect the retina, which can lead to blindness or severe vision loss if not treated on time. Depending on which pathology is involved, there are treatments by laser, with medicines, or surgery.
What are the retina and the vitreous?
The retina is the thin inner layer of the eye formed by cells that receive light and in charge of capturing the images that are sent to the brain. The central area of the retina is called macula and is where most of the vision is collected, of it depends the central vision that allows us to identify details, which is necessary for reading, recognizing faces, etc…
The interior of the eyeball is occupied by a transparent and gelatinous substance known as vitreous or vitreous humour, which among other functions maintains the shape of the eyeball while being transparent allows the passage of light from the lens to the retina.
What pathologies can affect the retina?
There are several pathologies and diseases related to the retina, here are the most common:
Retinal detachment, as its name suggests, occurs when the retina separates from the inner wall of the eye, specifically the pigment epithelium, resulting in loss of vision. This is a serious problem that must be treated urgently, since if it is not detected and treated within a few days, vision loss can be severe and permanent.
The amount of vision recovered after treatment depends to a large extent on the time that has elapsed, as well as the area of the retina that has detached (being the macula the area of the retina that causes greater loss of vision if it is detached) and the size of the detachment.
Some of the symptoms that may indicate the appearance of a retinal detachment are:
- Appearance of a “black curtain” in the visual field.
- Perception of inexistent light flashes (photopsies).
- Appearance of dark spots in the visual field that move spontaneously, known as floaters. Their appearance is not always due to a retinal detachment, although when they are caused by a detachment they usually appear in great quantity and abruptly, accompanied by the other symptoms indicated above.
In any case, if these symptoms appear it is advisable to go to the ophthalmologist for an ocular revision.
You will find more information about retinal detachments in our blog.
The epiretinal membrane consists of the development of a transparent membrane over the central area of the retina or macula. When this membrane wrinkles and contracts, it causes a deformation of the retina and distortion in the central vision. In milder cases it may not be necessary to intervene, only to monitor them in periodic check-ups, but if it worsens it is necessary to perform surgery to correct the problem before the vision deteriorates too much.
Macular holes are ruptures in the central area of the retina called the macula, which causes significant loss of vision. They should be treated as soon as possible to avoid further loss of vision.
The vitreous (the clear gel that occupies the inside of the eye) is firmly attached, on the back, to the retina. With age, the vitreous degenerates and can detach from the retina. Normally it does not cause problems, but sometimes when the vitreous collapses can “traction” the retina (that is, pulling the retina, dragging it), causing tears that can lead to a retinal detachment.
Vitreous floating bodies
Also known as floaters, its technical name is myodesopsias. They are opacities that are formed in the vitreous, which are perceived as floating bodies or spots in the vision, that move with the movements of the eye.
In most cases they appear with age and if they are mild they do not require treatment, only in severe cases that interfere significantly in the vision may be necessary a vitrectomy to eliminate them. They can also be a symptom of other serious pathologies, such as retinal detachment, so if they appear it is recommended to go to the ophthalmologist for a review.
It is an ocular complication derived from diabetes, caused by the deterioration of the blood vessels that supply the cells of the retina. When the disease progresses and the lack of blood and oxygen supply is prolonged, new vessels are formed and the vision is severely affected. In the early stages of this pathology there are no symptoms, so to be able to detect and treat it in time and to avoid as far as possible loss of vision, is recommended eye fund revisions at least once a year for diabetics.
Age-related Macular Degeneration (AMD) is a disease of the eye that causes macular degeneration, resulting in loss of vision, usually in people over 60 years of age. It usually produces a spot in the center of the vision and deformation of the images. There are two types of AMD:
- Dry (or atrophic): it is the most frequent and its evolution is slow, causing gradual loss of vision. It is because of this gradual and slow loss of vision that its symptoms may not be noticeable until a significant amount of vision has been lost. Until now there is no treatment for this variety of AMD, it is only possible to slow the progression of the disease, through vitamin supplements, antioxidants, etc…
- Wet (or exudative): it is less frequent and more aggressive, causing a rapid decrease of vision in a few days. This variety has treatment, but should be treated as soon as possible to minimize vision loss.
Treatments and surgeries of the retina
To treat the pathologies of the retina, there are various techniques and treatments. The use of one or the other technique will depend on the problem to be treated, and depending on the case it may even be necessary to combine the use of several of these techniques:
It is the most frequent microsurgery to treat diseases of the retina. In it, the vitreous humor is extracted (which is later replaced by a saline solution), in order to be able to access the retina from the inside of the eye with other surgical instruments and to be able to treat it. It is used to treat complex retinal detachments, macular holes, epiretinal membranes, vitreous hemorrhages, severe cases of floaters…
In retinal detachments an argon laser is used to perform small controlled burns, thus sealing the holes and tears in the retina. It is also used in diabetic retinopathy, to prevent the onset of neovessels and to treat microaneurysms that cause macular edema (inflammation in the center of the retina).
Like laser photocoagulation, it is used to heal tears in the retina, but in this case by freezing.
It is used to treat very specific cases of retinal detachments. A gas bubble is introduced into the interior of the eye which exerts continuous pressure on the detached area, which will allow laser to be applied in the tear or tears to heal and prevent the detachment from spreading. The gas disappears after several weeks.
Band or scleral ring
It is used in some cases of retinal detachment, and consists of placing a band of silicone around the outermost layer of the eye to exert an external pressure that occludes the tear causing the detachment.
Vitreous and retinal surgery in Vithas Xanit
In the ophthalmology unit of Vithas Xanit International Hospital we have the best ophthalmologists specialists in vitreous and retinal surgery, which together with the latest advances in technology allow us to offer our patients the best solutions for each case.