Retinal detachment
Retinal detachment is a separation of the sensory retina from the pigment epithelium by subretinal fluid. The most common cause of retinal detachment is the creation of a hole in the retina through which the fluid from the diluted vitreous gets to the subretinal area. Other causes are: pulling the retina by the shrinking glassy-retinal membrane such as diabetes, or getting the fluid under the retina as a result of inflammatory changes of the retina and choroid of the eye.
Treatment:
In the case of fresh holes in the retina, when it had not yet reached its detachment, the laser treatment is safe and effective.
However, in the case of fully symptomatic retinal detachment, the surgery consists of putting the seal sinking the eyeball wall and closing the retinal hole from the outside, or putting a silicone bracelet that causes sinking the retina in its full periphery.
In the case of ineffectiveness of the treatment presented above, or if the location of the hole has little chance of hope for closing it by using these methods, the surgery performed then is called vitrectomy. Posterior vitrectomy is a procedure involving the removal of the vitreous, and release of all traction from the retinal surface. The treatment ends with the so-called internal endotamponada, that is, giving a substance holding the retina to the interior of the eye, which may be silicone oil or gas.
Macular hole
Macular hole is a disease of the place of retina responsible for central vision. The mechanism of the hole lies in the forces pulling the vitreous, detatching it from the retina and leading to the formation of the hole. The first symptoms include image distortion, blurring in the center of vision and deterioration of visual acuity.
Treatment:
The only effective treatment for this is the performance of vitrectomy surgery, or removal of the vitreous and retinal internal limiting membrane in order to liquidate the macular traction, followed by gas filling the eye. The application of gas causes transient deterioration of vision lasting until the absorption of the gas. It is also related to the recommendation of maintaining the head in position with the face pointing down at least for 3 days.
In addition, until the complete absorption of the gas, travel by plane is cotraindicated, due to the risk of large increases in intraocular pressure.
Foretinal membrane
They are membranes of different thickness and different degrees of transparency formed on the surface of the retina that can cause image distortion and deterioration of visual acuity. The membranes are formed as a process of spontaneous or secondary to trauma of the eye, retinal detachment surgery, cryotherapy of the retina, choroid, or inflammation of the eye.
Treatment:
In the case of thin, translucent and causing minor symptoms membranes, the clinical treatment is not necessary. However, the periodic check-up of the eye is necessary, best with the OCT test (optical coherence tomography) of the retina. In cases of clear deterioration of sight, posterior vitrecomy with the removal of existing membranes is indicated. The treatment often reduces image distortion and may lead to an improvement in visual acuity.
Diabetic retinopathy
The risk of diabetic retinopathy depends on the duration of diabetes and its types. There are 2 types of diabetes: insulin dependent (type I) and insulin independent (type II). It is estimated that type I diabetic retinopathy occurs after 15 years of disease duration at 97% of patients, whereas type II at 80%. Diabetic retinopathy is the leading cause of blindness in the world. Diabetes leads, among others, to damage of small vessels, causing their obstruction, leakage and, in result, their swelling and retinal hypoxia.
Treatment:
The treatment is dependent on the stage of the disease. The primary treatment of diabetic retinopathy is the retinal laser therapy, which aims to bring to the disappearance of the newly formed, abnormal blood vessels and to protect against loss of vision caused by bleeding into the vitreous and retinal detachment. In the case of inefficiency of the laser treatment and when it fails to stop the disease progression, posterior vitrectomy is necessary. The most serious, threatening the loss of vision, complications of diabetes, such as vitreous hemorrhage, traction retinal detachment or retinal macular swelling are treated with this method. It involves removal the vitreous, removal of the effects of haemorrhage, removal of fibro-vascular membranes, application of the retina and retinal laser treatment performed in order to stop further development of the disease.
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