Retinal Procedures

The retina is crucial to proper vision. It is the light-sensitive lining of the inner eye that collects information about visual stimuli before it is sent over the optic nerve to the brain to be processed into images.

If the retina becomes damaged or detached from its supporting tissue, loss of vision can occur. To prevent this, the retina must be reattached as quickly as possible with vitreoretinal surgery. This can be done using a variety of methods including lasers, silicone treatment, and scleral buckling.  

Conditions That May Require Vitreo-Retinal Surgery

• Vitreous floaters – deposits of various size, shape, consistency, refractive index, and motility within the eye’s normally transparent vitreous humour which can obstruct vision.
• Retinal detachment – a blinding condition where the lining of the eye peels loose and floats freely within the interior of the eye.
• Macular pucker – the formation of unhealthy tissue in the central retina (the macula) which can distort vision.  
• Diabetic retinopathy – the formation of new unhealthy blood vessels that freely bleed within the eye (called vitreal hemorrhage) and cause thick fibrous scar tissue to grow on the retina, creating a detachment.
• Macular holes – the normal, age-related shrinking of the vitreous can tear the central retina and cause a macular hole that creates a blind spot.
• Vitreous hemorrhage – bleeding in the eye from injuries, retinal tears, subarachnoidal bleedings, or blocked blood vessels. Once blood is removed, photocoagulation with a laser can shrink unhealthy blood vessels or seal retinal holes.

Types of Vitreo-Retinal Surgery

A vitrectomy is the surgical removal of some or all of the vitreous humor (the clear gel) from the eye. Anterior and pars plana vitrectomies are the most commonly performed. Anterior vitrectomy is the removal of small portions of the vitreous from the front structures of the eye. This is usually done because the vitreous is tangled in an intraocular lens or other structure. Pars plana vitrectomy refers to a group of operations performed in the deeper part of the eye that involve removing some or all of the vitreous.

Common Methods Used in Vitreoretinal Surgery

• Membranectomy is the removal of layers of unhealthy tissue from the retina with precision surgical instruments. These tools include forceps (small grasping tools), picks (miniature hooks), and visco-dissection (separating layers or tissue with concentrated jets of fluid).
• Fluid-air exchange is the injection of air into the eye to temporarily remove the intraocular fluid from the posterior segment of the eye while maintaining intraocular pressure to temporarily hold the retina in place or seal retinal holes.
• Air-gas exchange is the injection of a mixture of gas and air into the posterior segment of the eye. The gases are mixed with air to neutralize their expansive properties for enhanced performance. The gas creates a retinal tamponade which acts to hold the retina in place or temporarily seal off retinal holes. The mixed gases disappear spontaneously once they have accomplished their purpose and the posterior segment safely refills with fluid.
• A silicone oil injection fills the eye with liquid silicone to hold the retina in place.
• Photocoagulation is a laser treatment that seals off holes in the retina or shrinks unhealthy blood vessels that can cause damage and are associated with some diseases like diabetes.
• Scleral buckling is the placement of a support positioned like a belt around the walls of the eyeball to hold the retina in the proper attached position.
• Lensectomy is the removal of the lens in the eye.