Vitreous and retinal surgery refers to surgical procedures on the eye. As the vitreous body and retina are adjacent to each other, both parts are often affected by disease and treatment.
You can find all the important information and qualified retinal surgeons here.
For a better understanding, here is an overview of the anatomy of the eye.
The retina
The retina is part of the inner skin of the eye. It converts incoming light into electrical impulses.
The optic nerve transmits these impulses to the brain, where it interprets the signals as images of the environment . The retina thus takes the first step in processing visual impressions.
As the innermost tissue layer of the eyeball, the retina is directly adjacent to the vitreous humor on the inside. On the outside, it lies on the choroid, which supplies the retina with blood.
The highest density of sensory cells is found in the center of the retina (macula). This is where the sharpest vision is located.
Various diseases can affect individual layers of the retina, the entire retina or the choroid and vitreous body. Such diseases require surgical intervention on the eye.
The vitreous body
The vitreous body is a gelatinous, transparent mass that fills the cavity between the lens of the eye and the retina. It plays an important role in childhood growth by determining the shape of the eyeball.
In adults, the vitreous body is no longer necessary. If necessary, doctors remove it by means of vitrectomy. The stability of the retina must then be provided by an alternative, such as gas.
The incident light passes through the vitreous body before it reaches the retina. Clouding of the vitreous therefore leads to poorer vision.
.jpg "Anatomie des Auges")
The structure of the human eye @ bilderzwerg /AdobeStock
There are different vitreous and retinal surgery procedures depending on the disease and its progression.
In vitreous and retinal surgery, the surgeon works in a minimally invasive manner. He uses small, lightweight instruments which he inserts into the eye via microcannulas. In this way, only small incisions are required in both the conjunctiva and the sclera. It is not necessary to suture these small wounds.
The risks associated with modern vitreous and retinal surgery are relatively low. Complications occur mainly in the form of infections. Accordingly, conscientious aftercare is very important.
This requires regular check-ups and, if necessary, medical treatment. If unusual symptoms occur after surgery on the vitreous body and/or retina, you should consult your ophthalmologist immediately.
Vitreous and retinal surgery treats various, often serious eye diseases.
These include, among others
In the case of retinal detachment, doctors must operate quickly as part of vitreous and retinal surgery in order to avoid blindness.
In this case, the retina detaches from the choroid and bulges into the inside of the eye. Doctors must reattach it to the choroid as quickly as possible in order to restore the supply to the sensory cells.
This can be caused by fluid that gets under the retina and lifts it off. A pull through the vitreous body, which pulls the retina away from the eye wall, is also possible.
Risk factors for retinal detachment are
Only prompt intervention can prevent the sensory cells from being damaged and dying. If treatment is carried out too late or not at all, the damage is permanent and irreversible. The consequences are a significant deterioration in vision and blindness.
There are several procedures in vitreous and retinal surgery that can be used in this emergency:
Doctors sew a silicone seal onto the eye wall. This compresses the eye wall together with the choroid and brings it back into contact with the retina.
At the same time, they deliberately damage the affected area with laser or cold so that an insulating scarring occurs as a reaction. They also aspirate the fluid under the retina through a puncture.
If it is not possible to attach the retina from the outside, the surgeon attempts to fix the retina from the inside. This can be achieved with the help of liquids, lasers or gas.
Diabetic retinopathy is a dangerous disease of the retina for diabetics. Defective blood vessels gradually damage the retina at the back of the eye. This process initially goes unnoticed by those affected.
40,000 diabetics go blind from this diseaseevery year.
Vitreous and retinal surgery cannot always prevent blindness. It is more helpful to treat diabetes consistently in the early stages. This prevents the disease from progressing.
Illustration of a healthy eye (above) and a retina affected by diabetic retinopathy
If the disease progresses, various methods of vitreous and retinal surgery can be considered:
A laser scars the surface of the retina over a large area, with the exception of the macula. The sensory cells remain unaffected, but color vision may be impaired. The procedure reduces the need for oxygen and improves the supply to the macula.
In the case of macular oedema, the laser scars the blood vessels responsible for the oedema. This treatment leads to a stabilization of visual acuity, but not to an improvement.
If an unstoppable hemorrhage occurs in the vitreous, the doctor can remove the vitreous (vitrectomy).
Medicine distinguishes between arterial occlusion and occlusion of a vein. Arteries supply the organs with oxygen, while veins transport the deoxygenated blood back to the heart.
Occlusions of blood vessels that supply the optic nerve or retina are particularly acute. For example, small blood clots can block a vessel, cutting off the supply within a very short time.
If the central arteries of the retina are blocked, vision is severely affected from one moment to the next. Those affected can often only vaguely distinguish between light and dark.
The progression of retinal vein occlusion is slower and gradual. Usually over many weeks.
If certain arterial branches in the retina are blocked, doctors can surgically remove the causative blood clot. However, this procedure is only possible if the blood clot is visible and has only existed for a few hours.
Surgical alternatives still exist for arterial occlusions in the retina.
Vein occlusions in the retina can be treated surgically in different ways.
Traditionally, laser or cold treatment is used. This method scars certain areas of the retina so that they require less oxygen. This method has a stabilizing effect and does not significantly improve visual performance.
Newer retinal surgeryprocedures, on the other hand, aim to restore blood circulation. The surgeon makes a small incision in the optic nerve to improve blood flow (so-called radial optic neurotomy).
If branch vein thrombosis is present, the surrounding connective tissue is removed. This procedure is called adventitia splitting. It can also be performed in combination with laser treatment. In addition to adventitia splitting, it is also possible to remove membranes in front of the macula.
A vitrectomy is part of the treatment for a macular pucker. Here, a membrane develops on the point of the central retina, the macula, which causes small wrinkles.
This causes a shift in the photoreceptors, so that those affected see vertical and horizontal lines as wavy lines.
If vision is severely impaired, only surgery can help. After a vitrectomy, doctors remove the membrane and strands of scar tissue in the center of vision.
A macular hole is a hole at the point of sharpest vision. It is caused by a defect in the retina in the area of the center of the macula. For the patient, this means a significant deterioration in vision. The disease is characterized by distortions in the visual field and requires removal of the vitreous body.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
