Retinal surgery is considered microsurgery and is performed with the use of a powerful microscope and sophisticated microsurgical instruments. Surgical procedures rarely require hospitalization and are nearly always performed at the ambulatory surgical center. Patients are able to go home a short time after completion of the surgery. Monitored local anesthesia is used in nearly all cases, with general anesthesia only required for children or under unusual conditions.
Pars Plana Vitrectomy
Pars plana simply refers to an area of the eye that may safely be entered to perform surgery in the posterior segment of the eye, where the retina is located. Vitrectomy (removal of the vitreous) is performed as a primary component of the surgical repair of most retinal disorders. Once the vitreous has been removed, additional procedures can be performed to treat specific retinal problems. As the vitreous is removed, it is automatically replaced by a specially developed solution to maintain consistent ocular volume. Following surgery, the eye produces natural fluid that fills the vitreous cavity.
Scar tissue or epiretinal membranes may form on the surface of the retina in many situations, including macular pucker, macular hole, and complicated retinal detachment. After completion of vitrectomy, the epiretinal membranes are delicately peeled from the surface of the retina and removed from the eye using micro-forceps. If the membrane is particularly dense, micro-scissors may be used to release it from the retina.
In certain situations, such as macular hole and retinal detachment, a gas bubble is placed in the eye towards the end of surgery. In retinal surgery, a gas bubble performs a similar function to the cast placed on a broken arm after the bone is set. As with a cast, the gas bubble holds the tissue in position for proper healing. Fortunately, the intraocular gas bubble goes away and does not need removal. The various forms of gas may last from 2-8 weeks and are selected by the surgeon depending on the situation.
Laser is simply an intense form of light of a certain wavelength or color, usually green. It is used by the surgeon to produce a minute, controlled thermal burn of the retina. The spot produced by the laser makes an adhesion between the retina and underlying tissue. This adhesion prevents the retina from detaching and is often used to treat retinal tears or weak areas of the retina that might tear in the future.
Laser is also commonly used to treat diabetic retinopathy. Often laser for diabetic retinopathy is applied in the office setting; however, if vitrectomy is being performed for another reason, such as vitreous hemorrhage, laser will usually be completed during surgery.
A scleral buckle is a band that is placed around the outside of the eye near the equator of the globe. In a general way, it is somewhat similar to a belt cinched around a person’s waist. The scleral buckle gently indents the eye wall and supports the retina. This surgery is usually performed in combination with vitrectomy in patients with more complex forms of retinal detachment or trauma.