- 1 Vitreoretinal Surgery
- 2 Understanding Vitreoretinal Diseases
- 3 Who Performs Vitreoretinal Surgery?
- 4 Surgical Approaches For Vitreoretinal Surgery
- 5 Complications of Vitreoretinal Surgery
As the name suggests, Vitreoretinal surgery is a type of eye surgery that is performed on the vitreous or retina. With advancements in modern technology, these surgeries have a high success rate and effectiveness. The eyes require minimum time for healing as they are less invasive.
This form of surgery is combined with a particular set of procedures that are performed in the depth of an eye, with the assistance of lasers or traditional surgical instruments. Vitreoretinal surgery is performed to conserve, augment and restore vision for several eye-related ailments, such as “age-related macular degeneration, diabetic retinopathy, diabetic vitreous hemorrhage, macular hole, a detached retina, epiretinal membrane, and CMV retinitis”, a diverse number of “Vitreoretinal surgical and laser” methods can be used. The conditions that need vitreoretinal surgery are commonly called vitreoretinal diseases.
Understanding Vitreoretinal Diseases
Vitreoretinal diseases are eye conditions that affect, the retina and vitreous fluid. The retina is the back layer of an eye. This layer sends the light that the eyes capture to the brain and optic nerve to recognize and form an image of what we see. Vitreous fluid is a gel-like substance present between the lens i.e. front layer of the eye, and the retina i.e. the back layer of the eye. Vitreous fluid helps the eye to keep its round shape. When vitreous fluid or retina is damaged because of many possible reasons, your vision gets abnormal. Therefore, it is important to get the diseases diagnosed for proper treatment.
Who Performs Vitreoretinal Surgery?
since the onset of the 90s, “Vitreoretinal Surgery” has been considered as a forward path of progression. Because up to that particular time period, the general opinion was “that the general Ophthalmologist possessed the skills of surgical treatment for retinal detachment”. The era of the 20th century saw numerous medical procedures for retinal reattachment which were comprised of a vast number of treatments, being performed from the scleral top of the eye. This form of surgery cannot be performed by a general eye surgeon, as only a “Vitreoretinal specialist” qualifies to perform such kinds of surgeries.
Surgical Approaches For Vitreoretinal Surgery
Only a certain number of conditions require vitreoretinal surgery. A particular number of surgical approaches have been mentioned below, which are in accordance with these conditions:
The purpose of a Vitrectomy is the eradication of the vitreous humor or gel-like substance, which is present in the eye. If a foreign matter invades the delicate area of an eye’s interior part, then a specific number of vision problems can occur because of it. However, with the assistance of this procedure, these vision problems can be addressed at their early stage itself. Once the eye surgeon has eradicated the vitreous humor and cleansed the area, a form of “saline liquid” is inserted, which acts as a replacement for the vitreous humor, which normally fills up the eye.
The precise reasons for a vitrectomy, have been mentioned below:-
- Diabetic vitreous haemorrhage
- Retinal detachment
- Epiretinal membrane
- Macular hole
- Proliferative vitreoretinopathy
In a large number of cases, only general anesthesia is given to patients, but in some special cases, “local anesthesia” is used. for instance, in the case of people who have complications in breathing.
Surgical Procedure of Vitrectomy
The surgeon will begin the procedure by performing three tiny incisions in the eye to create entrances for surgical instruments, which will be inserted for completion of the procedure. These specific incisions will be made in the pars plana of the eye which lies in front of the retina and just behind the iris. The surgical instruments, which will undergo through the incision include a light pipe, an infusion port, and a Vitrector (a cutting device)
And after the procedure has been performed, the eye specialist will prescribe certain antibiotic eye drops and some anti-inflammatory eye drop medications for a span, which go up to several weeks. This procedure has proven remarkable in both the vision’s restoration and its enhancement.
Vitrectomies have been found to have a high rate of success. Although certain complications, such as bleeding, infection, the advancement of cataracts, and retinal detachment can occur, the chances of these complications occurrences are rare.
Epiretinal Membrane Peeling (Membranectomy)
The epiretinal membrane (ERM) is consisting of a membrane’s growth. It has similarities to scar tissue, which lies across the macula. The growth of this type of membrane causes hindrances in the central vision. It also can further lead to distortion of the central retina.
The eye surgeon begins the procedure with a vitrectomy only. And after this procedure has been performed, the surgeon uses a specific set of forceps, to gently peel away the membrane from the retina. So, precision is the most important instrument for a surgeon during the whole procedure. As it is one of the most delicate operations, which is performed on a human eye.
A membranectomy is needed under two of the following circumstances:-
- A person who is facing either the problem of reduced vision or vision distortion, happening due to ERM.
- The appearance of the epiretinal membrane in a very clear and concise manner.
After the procedure has been performed, there will be an improvement in the person’s vision but in a slow manner. The time period for effective results can range from three to six months.
PVR is a very common impediment, which takes place after a rhegmatogenous retinal detachment (related to a retinal hole). Proliferative vitreoretinopathy (PVR) condition occurs when on the front and back surface areas of the retina, certain cellular membranes start to grow inside the vitreous cavity. These particular sets of membranes are fundamentally scar tissues, which release traction on the retina. They can cause multiple recurrences of “retinal detachment”, even though a successful reattachment procedure has been performed.
PVR can lead to the development of new retinal breaks or sudden reopening of retinal breaks, which were treated successfully in the past. Due to the shriveling membranes, the PVR can also be related to the “stiffness of the retina”. This can lead to unsatisfactory quality of vision. Even after the situation has been managed in a clear and precise manner.
When the procedure has been performed, the eye surgeon will instill special fluids or glasses inside the eye, to ensure that the retina becomes flattened and remains attached to the outer wall of the eye. In certain cases, laser treatment becomes a necessary option for the proper closure of the retinal breaks.
The duration of a patient’s recovery after the procedure has been performed can be for several months. Half of the patients can repossess useful vision, in the affected eye. But the probability of regaining an enhanced and clear vision becomes utterly low. After the PVR procedure has been performed, the patient can take the assistance of a low vision specialist for counseling.
Complications of Vitreoretinal Surgery
The techniques used in different types of Vitreoretinal Surgery, are challenging and require a high level of skill set. These kinds of surgeries are psychologically exhaustive for eye surgeons. As a high level of concentration, skill is required for successful completion of the surgeries. A small mistake can cause severe ramifications to the patient’s eye. The phenomenon is known as “retinal detachment” is mostly persisting in people over 40 years old.
The alarming symptoms of retinal detachment are specks or flashes being seen in the field of vision. One of the symptoms can be the development of a sudden blurry vision, by the person. There are different types of surgical procedures, which fall under the category of Vitreoretinal Surgery. These surgeries are used to treat the problem of “retinal detachment”.
over the past 10 years, new technologies have been introduced in the medical arena. Vitrectomy machines have seen a significant improvement level as well. So if a person chooses to go for Vitreoretinal Surgery, he must consult his eye surgeon. He should talk thoroughly about each kind of risk or benefit, associated with this form of surgery.
This form of surgery is a little expensive in comparison to traditional surgery. Expenses are lesser during the traditional mode of surgery because, in the case of Vitreoretinal Surgery, very high-tech medical instruments are used with an advanced level of precision. In return for the expenses, there is no margin of error.
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