28 Apr Retinal Tears and Retinal Detachments
I just operated on a patient for a retinal detachment in his left eye. He had a previous retinal detachment repaired about 3 years ago. Three years ago, I repaired the retinal detachment by performing a vitrectomy in combination with a scleral buckle. When informed about the need for surgery in the left eye, due to the new retinal detachment, he asked if I had to perform a scleral buckle. He was elated when I said “no.”
How I explain retinal tears causing retinal detachments. Retinal detachments develop from a retinal tear (or retinal hole). The tear results from the vitreous pulling on the retina (Imagine your eye as a room, the wallpaper lines the room just as the retina lines the inside of your eye. If you put a piece of tape on the wallpaper of your room and pulled, you would tear the wallpaper). The tear allows fluid to get underneath the retina/wallpaper. This is a retinal detachment.
Scleral buckles have drawbacks. I am not going to Google “scleral buckle,” but it has been the mainstay of treatment for retinal detachments for over 100 years. Basically, it works well. The idea of the buckle is to narrow the diameter of the eye to relieve stresses in the vitreous. In effect, you cause slack to develop in the vitreous so that the vitreous can no longer pull on the tear or retina. Let’s say the success rate of scleral buckles is about 90%. These are very good odds at preventing blindness. There are, however, many drawbacks to the procedure including; lengthy surgery, lots of trauma to the tissues around the eye, possible double vision (the muscles around the eye get manipulated) and increased nearsightedness (myopia develops from increasing the anterior to posterior length of the eye, remember you are squeezing the eye making it skinnier, but making it longer, too). Read more about the mechanism of retinal detachment on my web page.
Vitrectomy only for retinal detachments. Most of the time these days, I perform a vitrectomy using 25 gauge instruments to repair a retinal detachment. In this scenario, the vitreous is simply removed from the eye. The same result occurs; relief of stresses in the vitreous. Instead of squeezing the eye, the vitreous strands are simply cut and removed. Gas is placed into the eye at the end of the operation. We estimate a 90-95% success rate! Best of all, there is much less trauma to the tissue, no chance of double vision, little or no pain and no change in the shape of the eye!
What does this mean? Technology has allowed us to change the way we treat a potentially blinding problem. The surgery is quicker, more comfortable and has fewer consequences.
Randall V. Wong, M.D.
Retina Specialist/ Ophthalmologist