What is vitreous haemorrhage?
Vitreous hemorrhage is leakage of blood into the areas in and around the vitreous humor, the clear gel that fills the space between the lens and the retina of the eye. This can cause impaired vision, floaters, and photopsia.
How is retinal detachment diagnosed?
The doctor will check your eyes and examine your retina. To help make the diagnosis, the doctor should be told about any symptoms you experience.
Types of surgery
Vitrectomy/Retina surgery: The vitreous is a normally clear, gel-like substance that fills the center of the eye, giving it form and shape. Certain problems affecting the back of the eye may require a vitrectomy, or surgical removal of the vitreous, especially retinal detachment, where vitreous pulling the retina may exaggerate or cause it.
Vitrectomy is a very delicate surgery performed with an operating microscope and special needle-sized instruments where the vitreous gel, which is pulling on the retina, is removed from the eye and is usually replaced with silicone oil or gas bubble. Endo laser is carried out to seal the breaks causing the detachment. This procedure is done using the state-of-the-art Micro Incision Vitrectomy System (MIVS).
Scleral buckling surgery: A flexible band, sclera buckle, is placed around the eye to counteract the force pulling the retina out of place. Fluid under the detached retina is drained, pulling the retina to its normal position against the back of the wall of the eye.
Sometimes a combination of the above two procedures could also be done if the surgeon finds it necessary.
Difference between traditional and MIVS surgery
What is traditional retinal surgery?
Several incisions are made on the sclera for inserting Fiber optic illumination, Infusing Solution and other instruments to cut and suck the vitreous. These incisions are relatively bigger and hence need to be stitched. This is traditional surgery.
How is MIVS surgery different from traditional surgery?
During MIVS surgery, the incisions made are very tiny, using special trocar cannulas and trocar blades. This eliminates the need to put stitches at the end of the surgery. However in case of thick membranes and other complications during surgery, it may become necessary to convert it to the traditional surgery, where stitch will be required.
What are the benefits of MIVS surgery?
- Less pain as it is stitch-less surgery
- More comfort during the post operation recovery time.
- Quicker healing of the incision
- The wound is undetectable in 2 weeks time
- The procedure is quicker
What is involved in retinal surgery?
The surgery involves removal of the vitreous and repairing the retina. The aim is to prevent your vision from getting worse. Surgery may not result in your vision returning to normal. This depends on whether the macula (most central and sensitive part of the retina) is damaged and for how long it has been detached.
When you visit our OPD, our doctor will test your eyes to check how well you can see. The doctor will dilate your pupil in order to examine the condition of the lens and other parts of the eye and suggest the treatment accordingly. While you can bring your glasses or lenses along, it is advisable not to come for the surgery with your contact lens on. .
The counseling department will then brief you about the surgery and run fitness & safety tests to ensure you are fit for the operation. You will be given a surgery date by the healthcare team. .
The healthcare team at PRASAN NETHRALAYA will carry out a number of checks to make sure you have the operation you came in for and on the correct side. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having. .
Can cataract surgery be combined with it?
Vitrectomy increases the rate of cataract progression postoperatively. Hence, in coexistent cases, and to avoid a second surgery, cataract surgery is planned with vitrectomy. This just adds 15 minutes to the total surgical time.
What will happen if you decide not to go for operation?
More of the retina will usually detach, causing your vision to get worse. If the macula becomes detached and you leave it untreated for too long, you are likely to permanently lose the vision in your eye.
What other conditions require retinal surgery?
- Macular hole
- Epiretinal membrane (ERM)
- Vitreomacular traction(VMT)
These conditions can lead to disturbances in the central vision, reading, writing and in worse conditions ñloss of central vision. These conditions can exist alone or in combination with retinal detachment and can be treated with the help of retinal surgery such as vitrectomy.
What technology and procedures are used at PRASAN NETHRALAYA?
- Constellation vision system:
The CONSTELLATIONÆ Vision System delivers an exceptional level of performance through its advanced technologies like ULTRAVITÆ High Speed Vitrectomy Probes with Duty Cycle Control, Integrated Pressurized Infusion & IOP Compensation, Advanced Xenon Illumination, and V-LOCITY.
EIBOS wide angle lens system is used in association as it provides wider and better viewing of the surgical field.
- MIVS Surgery
MIVS is stitch less surgery. It has patient related benefits like less pain & comfort to the patient during the post recovery time. It has faster healing of the incision. The wound is undetectable in 2 weeks time. Also it takes lesser time for the surgeon to complete the surgery.
- Total Plus Pro Pack
All the instruments required for the surgery are available in one pack called the Total Plus Pak. Surgery done with this pack is retinal surgery with TPP. A new pack will be opened for your surgery. As the instruments are all fresh and used for the first time, the performance will be more predictable and also cross contamination will be eliminated & risk of infection will reduce.
- Endolaser (Endophotocoagulation)
It is a procedure where laser is done by a probe put in the eye during vitreous surgery. It is used to treat retinal tears in retinal detachment and to do panretinal photocoagulation in proliferative retinopathies.
- Retinal cryotherapy
Several disorders can affect the retina and retinal cryopexy is
used to treat the following conditions:
- Retinal Conditions:
- Retinal breaks or detachments
- Retinal ischemia (retinal tissue that lacks oxygen)
- Neovascularization (proliferation of blood vessels in the retina)
- Coats’ disease (abnormal retinal blood vessels that cause loss of vision)
- Retinoblastoma (intraocular tumors)
- Heine Wireless Indirect Ophthalmoscope:
- Built on the latest wireless technology
- Offers one-of-a-kind mobility without restriction or hindrance caused by cables, cords, or similar connections
- Chandelier System:
- Provides a stationary and diffuse form of endoillumination from an anterior location
- Enables bimanual surgery for enhanced versatility
- Ideal for complex cases such as:
- Proliferative vitreoretinopathy
- Giant retinal tears
- Intraocular foreign body
- Pars plana lensectomy for dropped nucleus
- Tractional retinal detachments
- Wide Angle Viewing System – EIBOS:
- Allows simultaneous observation of fundus and incision areas in the eye
- Comes with spring-leaded suspension
- Offers superior safety to the patient’s eyes
What complications can occur during and after surgery?
The healthcare team at PRASAN NETHRALAYA will try to make the operation as safe as possible however complications can happen.
- General Complications of Any Operation:
- Pain:
- Usually mild and easily controlled with simple painkillers such as paracetamol.
- In case of severe pain, inform your surgeon immediately.
- Slight Bleeding or Mild Redness:
- Mild redness on the outside of your eye may be seen.
- If your eye is very red and painful, inform your surgeon immediately.
- Infection:
- Can result in blurred vision or even permanent loss of vision.
- Risk: 1 in 1,000.
- Complications of Anaesthesia:
- Your anaesthetist or surgeon will discuss possible complications with you.
- Perforation of Eyeball (very rare)
- Needle Damage to the Optic Nerve:
- Could destroy vision (very rare).
- Retrobulbar Hemorrhage (very rare)
- Possible Drooping of Eyelid:
- Double Vision (if a silicone buckle is used):
- Usually improves but may require another operation (risk: 1 in 100).
- Permanent double vision is rare (risk: 1 in 500).
- Need for Low Vision Devices:
- Some patients may require thick glasses or contact lenses to improve vision in specific cases.
- Inflammation in the Other Eye (Sympathetic Ophthalmia):
- Occurs in specific cases (Risk: 1 in 10,000).
- A potentially serious complication that may be treatable.
- Inform your surgeon if you develop pain or blurred vision in your other eye.
Surgical Treatments
Vitrectomy/Retina Surgery
This procedure removes the vitreous gel and replaces it with silicone oil or gas bubbles. The retina is sealed using laser treatment.
Scleral Buckling Surgery
A flexible band is placed around the eye to counteract pulling forces and restore the retina's position.