Vitrectomy and treatment of retinal diseases
It is difficult to mention all the diseases of the retina and the vitreous body which can be treated, due to their increasing number. These diseases affect both adults and children.
Diseases of the retina and the vitreous body are among those eye disorders which now have a significantly better chance of treatment, particularly surgically. Just a few years ago, vitreoretinal surgery accounted for a negligible amount of all the operations carried out related to ophthalmology. This technique was only used in extreme cases, on people with only rudimentary visual acuity left, as a last chance to save their sight. Currently, though, the introduction of new operating techniques, modern equipment and diagnostic methods has led to the number of conditions treatable by vitreoretinal surgery increasing significantly, thus giving hope for the recovery or maintenance of sight in many cases of eye diseases which until recently had been considered incurable.
Treatment of diseases of the retina and the vitreous body includes
- conservative treatmentThis involves the patient taking medicines (e.g. anti-inflammatory or antihaemorrhagic), and also diet supplements, and enriching meals to include ingredients with high levels of antioxidants (e.g. in the case of degenerative changes – AMD)
- laser techniquesThis includes retinal laserotherapy. This can be a single-stage operation, or repeated several times.
- surgical techniquesThese cover a range of surgical measures carried out from outside the eye (e.g. cryotherapy – treatment using low temperatures, applying materials to indent the wall of the eyeball) and direct manipulation inside the eyeball using various micro-surgery tools (incl. vitreoretinal operations).
During the operation, 4 trocars are fixated to the sclera (the layer which forms the wall of the eyeball), through which the surgical tools and substances necessary to carry out the procedure are introduced.
After the vitreous body is removed, depending on the reason for the operation, the local condition of the eye being operated on and the post-operative forecasts, the eyeball is filled with one of the following substances: A sterile fluid of the appropriate chemical composition, which is gradually replaced by the fluid produced by the eye’s secretion structures; Sterile air or a mixture of expanding gas (SF6, C3F8 etc.), which will also be gradually replaced by the intraocular fluid. Applying the mixture of expanding gas causes a high degree of visual impairment (even to the extent of distinguishing hand movements in front of the eye), which may last from several days to several weeks, depending on the mixture of gases used. The visual impairment is temporary. The use of gas or air sometimes involves the necessity for the patient to stay in the appropriate position (walking or sitting face down, sleeping on the stomach). Failure to follow these instructions may result in the treatment having no medical effects. While the expanding gas is present in the eye, patients may not travel by aeroplane, due to the risk of the gas expanding excessively and thus causing a severe increase in the intraocular pressure, which could even lead to loss of the eye which was operated on; Silicone oil (which is not replaced by fluid). Applying silicone oil to the interior of the eye causes a change to the refraction of the eye’s optical system, which means the patient requires additional correction. Sometimes the difference between the correction in both eyes is so great that no appropriate corrective glasses can be selected for the period when the silicone oil is present in the eye. In some cases a contact lens can be applied to the eye being operated on. The silicone oil usually has to be removed from the eye, which entails further surgical intervention. When deciding on an operation, remember that like any surgery the anterior vitrectomy may be complicated by various undesirable consequences. The frequency of these consequences depends to a great degree on the condition being treated and the pre-operative condition of the eye. A vitrectomy is often a last-chance operation. Vitreoretinal procedures are used to stabilise, restore or improve the functioning of the retina. The technique involves the mechanical removal of the vitreous body – a gelatinous structure which fills the larger, anterior chamber of the eye.
- detachment of the retina
- inflammation of the eye
- increase of internal pressure in eye
- haemorrhage into the eye
- progressive opacity of the lens (in the case of operations involving expanding gas or silicone oil, opacity of the lens is observed to proceed more rapidly in each operated case)
- others (post-operative wound not airtight, etc.)
In certain complicated cases (especially detached retina or diabetes), the vitrectomy sometimes has to be repeated.
In some cases, to achieve the desired improvement the vitrectomy is carried out simultaneously with other operations, e.g. cataract removal, bandaging or applying a filling to indent the wall of the eyeball.
Vitrectomy can provide the following benefits:
- improvement in acuity of sight
- stabilisation of acuity of sight
- slowing down the condition which is damaging the sight
- recreating the anatomical conditions of the eyeball (injury)
- not allowing the eyeball to atrophy