Summarized below are different laser treatments, intraocular injections and surgical procedures applied for a variety of retinal problems.
Diabetic Retinopathy Treatments
Three laser treatments have been developed for the treatment of diabetic retinopathy at different stages of the disease. Intraocular injections have recently gained traction in the treatment of significant diabetic macular edema. It is important to understand that the goal for each of these procedures is to stabilize the vision; they cannot correct the damage already done.
Focal Laser Treatment is an in-office procedure used to treat macular edema, or swelling in the anterior part of the eye. Patients undergo a dilated eye examination and a flouroscein angiograph prior to the treatment in order to identify the location of leaky blood vessels that cause the swelling. During the procedure, a laser is used to seal off the leaky blood vessels and prevent further leakage. As the existing blood dissipates, the swelling is reduced. The sooner the problem is diagnosed and the earlier treatment is applied, the higher the likelihood of a successful outcome.
Grid Laser Treatment also an outpatient procedure that is used to seal off a wider array of leaky blood vessels over a diffuse area. Because there are more leaks, there is also more swelling in the eye. The laser treatment is similar to focal laser treatment except that more leaks are sealed in the eye. Again, the object of this treatment is to reduce swelling in the eye.
Macular Edema may sometimes be somewhat resistant to focal laser treatments, there might be a contraindication to treatment with laser, or your surgeon might feel that laser is not the best option for you. This is when the use of intravitreal injections come in handy. The technique is quite simple and it only takes a matter of minutes. Your doctor will first carefully apply an anesthetic to the eye. After the eye is completely numb he will then deliver the medicine intraocularly. Rarely do patients complain of pain with our technique. An improvement in vision is usually noticed days after the injection. The type of injection that your surgeon will decide to use depends entirely on the characteristics of your particular condition.
Pan Retinal Photocoagulation (PRP)
As the severity of diabetic retinopathy progresses, swelling causes ischemic tissue (oxygen-deprived tissue) that sends signals to the body to produce new blood vessels. These new vessels tend to be abnormal and often break open and bleed, making the situation worse. With PRP, tissue is selectively destroyed using a laser in order to force the new blood vessels to shut down. When successful, this technique reduces the eye's demand for oxygen and stops the signal for more new blood vessels.
PRP is a same day, outpatient procedure. Patients must have a clinical examination as well as a flouroscein angiograph prior to the treatment. There are no sutures and no patching or eye drops are required afterwards.
Vitrectomy is a surgical alternative for the treatment of severe diabetic retinopathy. In this procedure, the damaged tissue, blood vessels and any accumulated blood are removed from the middle of the eye with the help of a laser and replaced with saline solution to keep the globe formed. Vitrectomy is a same day, outpatient procedure.
A retinal detachment occurs when the retinal tissue detaches from the eye wall in the back of the eye. There are many possible causes for retinal detachment, such as blunt trauma, weakness in the tissue or holes. Retinal detachment is often marked by the sudden loss of half or all of the vision in one eye. It may also be accompanied by light flashes. Retinal detachments are easily diagnosed in a dilated eye examination.
The specific treatment used to re-attach the retina to the eye wall depends on where the detachment occurred. The options include injecting a gas bubble (pneumatic retinopexy) to support the retina while new tissue builds to connect it to the wall of the eye; cryosurgery that creates scar tissue that allows the retina to reattach to the eye wall; or sclera buckle, in which a device is inserted permanently into the eye to reduce tension on the retinal surface.
Patients generally go home the same day as the procedure. Depending on the treatment used, patients may have to maintain a head down position for a few days. The full recovery period can take several months. Retinal re-attachment surgery is usually very successful, although in some cases a second surgery is required.