Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye. This type of retina surgery may be done because removing the vitreous gel gives the doctor better access to the retina, or the back of the eye. It may also be removed if blood in the vitreous gel (vitreous hemorrhage) does not clear on its own.
During a vitrectomy, the surgeon suctions out the vitreous gel. After removing the gel, the surgeon may treat the retina with a laser (photocoagulation), peel fibrous or scar tissue from the retina, flatten areas where the retina had become detached, or repair tears or holes in the retina. At the end of the surgery, silicone oil or a gas is injected into the eye to replace the vitreous gel and restore normal pressure in the eye.
Additional surgical steps involved as part of modern vitrectomy surgery may include membranectomy, fluid/air exchange, air/gas exchange, photocoagulation and scleral buckling.
Retinal cryopexy, also called retinal cryotherapy, is a procedure that uses intense cold to induce a scar to destroy retinal or choroidal tissue. Several disorders can affect the retina and retinal cryopexy is used to treat the following 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)
The procedure involves placing a metal probe against the eye. The tip of the cryopexy probe becomes very cold as a result of the rapid expansion of very cold gases within the probe tip. When the probe is placed on the eye, the formation of water crystals followed by rapid thawing results in tissue destruction. This is followed by healing and scar tissue formation.
In the case of retinal detachment, treatment calls for irritating the tissue around each of the retinal tears. Cryopexy stimulates scar formation, sealing the edges of the tear. By using multiple small freezes, each of the tears is surrounded. Irritated tissue forms a scar, which brings the retina back into contact with the tissue underneath it.
After the procedure, vision may be blurred briefly and the operated eye is usually red and swollen for a while. Cold compresses applied to the eyelids relieve some of the discomfort.
Scleral buckling surgery is a common way to treat retinal detachment. It is a method of closing breaks and flattening the retina. A scleral buckle is a piece of silicone sponge, rubber, or semi-hard plastic that is placed on the sclera, or outside white layer of the eye. The band is sewn to the eye to keep it in place. The element pushes in, or “buckles,” the sclera toward the middle of the eye. This buckling effect on the sclera relieves the pull on the retina, allowing the retinal tear to settle against the wall of the eye. The buckle may cover only the area behind the detachment, or it may encircle the eyeball like a ring.
By itself, the buckle does not prevent a retinal break from opening again. Usually, extreme cold (cryopexy) or light (laser photocoagulation) is used to scar the retina and hold it in place until a seal forms between the retina and the layer beneath it. The seal holds the layers of the eye together and keeps fluid from getting between them. You may have some discomfort for a few days following surgery. Your eye may also be swollen, red, or tender.
Wolfe Eye Clinic has expertise in several retinal surgery techniques including vitrectomy, laser photocoagulation, retinal cryopexy and scleral buckle surgery. Wolfe Eye Clinic offers complete retina services throughout our Iowa locations, including Ames, Cedar Falls, Cedar Rapids, Des Moines, Fort Dodge, Iowa City, Marshalltown, Ottumwa, Spencer, Waterloo, and Pleasant Hill.
Please contact Wolfe Eye Clinic at 1-800-542-7956 to ask any questions about retina surgery options or to schedule an appointment with one of our retina specialists: Dr. David Saggau, Dr. Charles Barnes, Dr. Jared Nielsen, Dr. Kyle Alliman, Dr. Alex Kartvelishvili, and Dr. Paul Boeke.