Surgical Management of Retinal Diseases

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Dr Lee Mun Wai

‘Eye Chat’ – from a Retinal Surgeon’s Perspective

World Sight Day is upon us again and this annual advocacy event for “The Right to Sight” marks the coming together of all ophthalmic care providers to increase public awareness of blinding eye diseases. Retinal diseases make up a significant portion of the blinding diseases and with this article, I hope to provide an overview of the surgical management of these diseases.

Retinal Surgery

Schematic diagram of Vitrectomy

Vitrectomy is a specialized microsurgical procedure which is used to treat retinal disorders. The surgeon uses an operating microscope with a specialized viewing system and a highly sophisticated vitrectomy machine together with very fine instruments to perform the surgery. This is usually performed under local anaesthesia and is often a day case procedure.

RETINAL DISEASES WHICH REQUIRE SURGERY

Diabetic eye disease

Diabetes is a fast growing worldwide ‘epidemic’ and eye complications from diabetes are the leading cause of blindness in the working age group. Diabetes causes leakage of blood and protein from the blood vessels of the retina (retinopathy). Advanced diabetic retinopathy requires aggressive laser treatment to prevent progression to blindness but in severe cases, surgery is often required.

Symptoms of eye problems from diabetes may not be obvious until a very late stage. It is therefore very important for diabetics to have regular eye checkups to monitor for retinopathy. The longer the duration of diabetes, the higher the risk of developing retinopathy.

Retinal detachment

This refers to a separation of the retina from the back wall of the eye. The retina will degenerate and lose its ability to function when detached. The most common form of retinal detachment occurs following a break or tear in the retina.

Symptoms of retinal detachment include floaters, flashing lights or blurred vision particularly described by patients as ‘a curtain hanging over their vision’. The prognosis for retinal detachment depends a lot on the extent and duration of detachment. Therefore, it is important that patients present early when they have visual disturbances as described above.

Macular diseases

The macula is the most sensitive part of the retina responsible for high quality vision necessary for tasks such as reading, driving or watching television. In the aging eye, abnormal changes in the macula can lead to formation of scar tissue known as macular pucker or epiretinal membrane. In some cases, a hole in the macula can form. Typically, patients will describe ‘straight lines appearing crooked’ or even a ‘missing portion’ in their central vision. A vitrectomy combined with peeling of this scar tissue would be required to close this hole and restore vision.

Other conditions

Cataract surgery can sometimes be complicated when the cataract dislocates to the back of the eye or in other cases where the intraocular lens implant itself dislocates. Vitrectomy would then be required to retrieve the dislocated lens material.

Other serious conditions which require vitrectomy would include endophthalmitis (intraocular infections) and serious injuries to the eye including intraocular foreign bodies.

Conclusion

Vitrectomy has been a major advance for ophthalmology as retinal specialists are now able to treat certain retinal diseases and prevent significant visual loss in patients where previously they may have gone blind. There have been further improvements made in the instrumentation for modern vitrectomy and the advantages to the patient include shorter operating times, less discomfort and quicker healing.

For more information, contact:  Lee Eye Centre Ipoh Tel: 05-254 0095 or email: enquiry@lec.com.my. Website: www.lec.com.my