Retinal surgery is a key area of ophthalmology that focuses on the treatment of retinal diseases. The retina is a sensitive part of the eye and is crucial for visual acuity. Surgery is often necessary for severe retinal diseases such as retinal detachment. The goal of retinal surgery is to reattach the retina and preserve vision.
Modern procedures combine surgical techniques with laser treatment. The vitreous humor also plays an important role, as it is directly adjacent to the retina. Procedures such as vitrectomy allow for targeted treatment. An early diagnosis by an ophthalmologist significantly improves the chances of success.
Background Information on the Anatomy of the Eye
To help you better understand, here is an overview of the anatomy of the eye.
The Retina
The retina is part of the inner layer of the eye. It converts incoming light into electrical impulses.
The optic nerve transmits these impulses to the brain, where the signals are interpreted as images of the surroundings. Thus, the retina plays the first role in processing visual impressions.
As the innermost layer of tissue in the eyeball, the retina is directly adjacent to the vitreous humor on the inside. On the outside, it rests against the choroid, which supplies the retina with blood.
The highest density of photoreceptor cells is found in the center of the retina (macula). This is where the sharpest vision occurs.
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
The vitreous is a gel-like, transparent mass that fills the cavity between the lens and the retina. It plays an important role during childhood growth by helping to determine the shape of the eyeball.
In adults, the vitreous is no longer necessary. Doctors remove it via vitrectomy when necessary. The stability of the retina must then be maintained by an alternative, such as gas.
Incoming light passes through the vitreous before reaching the retina. Opacities in the vitreous therefore lead to impaired vision.
The structure of the human eye @ bilderzwerg /AdobeStock
Vitreous and Retinal Surgery
Depending on the condition and its progression, there are various procedures for vitreous and retinal surgery.
In vitreous and retinal surgery, the surgeon uses a minimally invasive approach. He uses small, lightweight instruments that are inserted into the eye via microcannulas. This method requires only small incisions in both the sclera and the cornea. These small wounds do not need to be sutured.
The risks associated with modern vitreous and retinal surgery are relatively low. Complications primarily take the form of infections. Accordingly, diligent follow-up care is very important.
This requires regular follow-up examinations and, if necessary, medication. If you experience any unusual symptoms related to the vitreous or retina after surgery, you should contact your ophthalmologist immediately.
Surgery for Vitreous and Retinal Disorders
Vitreous and retinal surgery treats various, often serious eye conditions.
These include, among others:
- Retinal detachments
- Diabetic retinopathy
- Retinal vascular occlusions
- Macular diseases
Retinal detachment
In cases of retinal detachment, doctors must perform vitreoretinal surgery quickly to prevent blindness.
In this condition, the retina detaches from the choroid and bulges into the interior of the eye. Doctors must reattach it to the choroid as quickly as possible to restore blood supply to the photoreceptor cells.
This can be caused by fluid that seeps under the retina and lifts it away. Tension from the vitreous humor pulling the retina away from the eye wall is also a possible cause.
Risk factors for retinal detachment include:
- Severe nearsightedness
- Metabolic disorders such as diabetes
- A family history of retinal detachment
- Injuries or eye surgeries
Only prompt surgical intervention can prevent damage to and the death of the sensory cells. If treatment is delayed or not provided at all, the damage is permanent and irreversible. This results in a significant deterioration of vision and blindness.
Vitreous and retinal surgery offers several procedures that can be used in this emergency:
Doctors suture a silicone patch to the wall of the eye. This patch presses the eye wall—including the choroid—inward, bringing it back into contact with the retina.
At the same time, they intentionally damage the affected area using a laser or cold to trigger the formation of insulating scar tissue. Additionally, they drain the fluid beneath the retina through a puncture.
If it is not possible to reattach the retina from the outside, the surgeon attempts to fix the retina from the inside. This can be achieved, for example, using fluids, lasers, or gas.
Diabetic Retinopathy
Diabetic retinopathy is a dangerous retinal disease for people with diabetes. Abnormal blood vessels gradually damage the retina at the back of the eye. This process initially goes unnoticed by those affected.
40,000 people with diabetes go blind each year as a result of this condition.
Vitreous and retinal surgery cannot always prevent blindness. It is more helpful to consistently treat diabetes in its early stages. This prevents the disease from progressing.
Blausen 0312 DiabeticRetinopathy
: Illustration of a healthy eye (top) and a retina affected by diabetic retinopathy
As the disease progresses, various methods of vitreous and retinal surgery may be considered:
- Laser therapy:
A laser causes extensive superficial scarring of the retina, with the exception of the macula. The photoreceptor cells remain unaffected, but color vision may be impaired. The procedure reduces oxygen demand and improves blood supply to the macula.
In cases of macular edema, the laser causes scarring of the blood vessels responsible for the edema. This treatment stabilizes visual acuity but does not improve it.
- Surgery:
If uncontrollable bleeding occurs in the vitreous body, the doctor may remove the vitreous body (vitrectomy).
Vascular occlusions in the retina
Medicine distinguishes between arterial occlusion and venous occlusion. Arteries supply the organs with oxygen, while veins transport oxygen-poor blood back to the heart.
- Retinal artery occlusion:
Occlusions of blood vessels that supply the optic nerve or the retina are particularly acute. For example, small blood clots can block a vessel, cutting off blood flow within a very short time.
When the central retinal arteries are occluded, vision is severely affected from one moment to the next. Often, those affected can only vaguely distinguish between light and dark.
The progression of retinal vein occlusions is slower and more insidious, usually taking many weeks.
If certain arterial branches in the retina are blocked, doctors can surgically remove the blood clot causing the blockage. However, this procedure is only possible if the blood clot is visible and has been present for only a few hours.
To date, surgical alternatives exist for arterial occlusions in the retina.
- Venous occlusion:
Venous occlusions in the retina can be treated surgically in various ways.
Traditionally, laser or cryotherapy is used. This method causes scarring in certain areas of the retina, reducing their oxygen requirements. This method has a stabilizing effect but does not significantly improve visual acuity.
Newer retinal surgery techniques, on the other hand, aim to restore blood flow. In this procedure, the surgeon makes a small incision in the optic nerve to improve blood flow (known as radial optic neurotomy).
If a venous branch thrombosis is present, the surrounding connective tissue is removed. This procedure is called adventitial dissection. It can also be performed in combination with laser treatment. In addition to adventitial dissection, it is also possible to remove membranes in front of the macula.
Macular Diseases
- Macular Pucker:
A vitrectomy is part of the treatment for macular pucker (a condition characterized by folds in the macula). In this condition, a membrane forms over the central part of the retina—the macula—causing small folds there.
This causes the photoreceptor cells to shift, so that those affected see vertical and horizontal lines as wavy lines.
In cases of severely impaired vision, surgery is the only effective treatment. After a vitrectomy, doctors remove the membrane and scar tissue strands in the center of the retina.
- Macular hole:
A macular hole is a hole at the site of sharpest vision. It results from a defect in the retina in the center of the macula. For the patient, this means a significant deterioration in visual acuity. The condition is characterized by distortions in the visual field and requires vitrectomy.
FAQ
What is retinal surgery?
Retinal surgery encompasses all surgical procedures used to treat diseases of the retina in the eye. This includes surgeries for retinal detachment, macular changes, and other retinal diseases.
When is retinal surgery necessary?
Surgery becomes necessary when the retina detaches or severe changes occur. Without treatment, this can lead to a significant deterioration in vision or even blindness.
What procedures are used in retinal surgery?
The most important procedures include vitrectomy, laser treatment, and laser coagulation. Depending on the condition, gas or silicone oil may also be used to stabilize the retina.
How is retinal surgery performed?
The surgery is performed under local or general anesthesia. The surgeon uses special instruments to work within the vitreous cavity to reattach the retina or treat abnormalities.
What are the chances of success?
The chances of success depend on the extent of the retinal detachment and the underlying condition. With early treatment, the chances of preserving or improving vision are good.
