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How to Prepare for Your Eye Surgery

Pre-operative directions for Dr. Randall Wong's retina patients.There is only one requirement I have before your retinal eye surgery, “Do NOT eat before Surgery!”

Eating anything after midnight the night before surgery is certain to cancel your surgery.  By the way, the following rules apply to my personal patients who are having surgery at INOVA Woodburn Surgical center.  These guidelines may be similar to your own doctor’s, in your own state/country and your hospital, but you should contact your own doctor if you have any questions.

By the way, while I am A boss, I am not THE boss of the operating room.  There is usually an anesthesiologist who heads every operating room.  They are responsible to make sure patients are medically sound, and to their own specifications, to undergo the rigors of anesthesia and, therefore, surgery.  Not me.

Don’t Eat Anything the Night Before Surgery

“NPO after midnight” means nothing to eat after 12 AM the night before surgery.

This rule really means, nothing to eat 8 hours prior to surgery.  This rule ensures an empty stomach for surgery.  This is for your safety and health.  Although unlikely, it is possible you could regurgitate and then aspirate something into your lungs.

While clear fluids such as water, coffee or tea are usually okay, coffee with cream is NOT acceptable.  The cream curdles in your stomach…and takes much longer to leave your stomach than clear liquids.

Be prepared, don’t eat.

Aspirin and Blood Thinners

I personally do not want you to stop any of your medicines that are used to “thin” your blood.  You are on these medications to prevent stroke, heart attack or preserve circulation.  Quite frankly, I’d rather keep you alive and well at the remote risk of jeopardizing your vision.

Our equipment makes retinal surgery unique in that we operate in a “closed” system.  I have complete control over the pressure inside your eye at all times.  Bleeding can NOT get out of hand.  This is NOT true of other eye surgeries and explains why many other eye surgeons do request you stopping blood thinners in anticipation of eye surgery.

Aspirin “thins” blood by effecting the platelets in your blood.  The effects of aspirin last a good two weeks after stopping the oral blood thinner.  Many times, retinal surgery is performed soon after the initial exam.

My colleagues who perform cataract surgery often insist on no aspirin.

No Drops Before Eye Surgery

Many cataract surgeons prescribe antibiotic drops to use prior to eye surgery.  Most retinal surgeons do not.  Again, the chance of infection inside the eye is greater with cataract surgery than with most retinal surgery…again, due to the ‘positive” intraocular pressure during the operation.

Take Your Medications

At my surgical center, we encourage you to take your oral medications with sips of water.  If you have diabetes, ask your diabetic doctor about specific instructions regarding your medicines.

What Does this Mean?

Where I work, these guidelines ensure that each and every patient be treated as if undergoing general anesthesia.  Though most of our procedures are indeed performed under sedation, you will be scrutinized as if general anesthesia is going to be performed.

 

Randy

Randall V. Wong, M.D. 
Ophthalmologist, Retina Specialist
Fairfax, Virginia

 


Your First "Post-Operative" Eye Exam After Retinal Surgery

Eye Examination after your retinal surgery, Randall V. Wong, M.D., Retinal Specialist, Fairfax, VirginiaI routinely examine patients the first day after retinal surgery. It’s the shortest visit you’ll ever have at my office.  Surprisingly, there are very, very few things for me to check the first day after surgery.

Whether you have had retinal surgery for removal of an ERM (macular pucker), repair of a macular hole, a vitrectomy for vitreous hemorrhage, floater only vitrectomy (FOV) or retinal detachment surgery; the post-operative exam is brief.

Removal of the Eye Patch

Removing the eye patch can be intimidating.  The cotton patch, affixed with paper tape (my favorite due to its’ stickiness), comes off the next morning and stays off.  It is usually a bit moist and bloody.

Though a little unsightly, the blood is expected, but insignificant.  Also, the eye patch has little therapeutic value.

Especially in cases of a scleral buckle, I like to use a “pressure patch” as it eliminates any lid swelling the next day and facilitates a nice easy exam (sometimes it’s difficult to examine an eye with the lids swollen shut).

Checking the Vision

I expect your vision to be lousy immediately after removing the patch.  There are so many reasons why you shouldn’t see, I don’t bother wasting time having you read the eye chart.  Simply seeing a strong light is sufficient.

What causes the vision to be so bad?

The cornea is warped from the patch, there might be post-operative bleeding, you might have air or gas in your eye…etc.  Therefore, careful measurement is meaningless as it has no bearing on the actual function of your retina (i.e. how well your retina can “read.”)

Checking Your Eye Pressure

This is somewhat important to ensure that the eye is neither too low (not uncommon after 25 gauge sutureless vitrectomy) nor too high (especially with gas injected).

Dilated Exam

At the end of each operation, I prefer to use stronger dilating drops to keep your eye dilated for a few days following surgery.  While it may add to the blurriness after surgery, you will already be dilated for the next morning’s exam…avoiding the need to dilate your eyes again!  It may also keep your eye more comfortable for the first few days.

Once the patch is removed, therefore, I can examine your retina immediately, looking for complications of surgery including retinal detachment or infection.

What Does This Mean?

Checking your vision, pressure and looking at your retina is all that I need to examine you after your retinal surgery.  Most of the time is spent going over your instructions on how to use your drops and…if needed (it is usually not!), any special head positioning.

Complications immediately following retinal surgery are uncommon, but include;  retinal detachment, bleeding, infection and problems with eye pressure.  All can be assessed quickly, and comfortably, after your retinal eye surgery!

 

 

 


Vitrectomy Eye Surgery for Macular Pucker

This is my first patient education video.  I uploaded this last evening to YouTube.  It is one of the best I’ve seen for a super niche like eye surgery.

Vitrectomy Surgery

As I state in the video, vitrectomy surgery is performed by retina specialists.  I completed extra training to specialize and to perform retinal surgery.

A vitrectomy is the core operation for many of the surgical diseases we treat.  For instance, a vitrectomy is used to remove an epiretinal membrane (ERM), fix a macular hole or repair a retinal detachment.  A vitrectomy can remove floaters.

It is very similar to arthroscopic surgery or laparoscopic surgery in that all the systems are “closed.”

Patient is Awake and Comfortable

Most of my procedures are performed while the patient is awake.  Before surgery, the patient receives a sedative, putting them to sleep for a few minutes while the entire eye is numbed.

This “IV sedation” or “twilight” form of anesthesia is quite popular in most outpatient surgical settings.  It avoids the rigors of general anesthesia.

By the way, the operation is completely painless!  I am usually able to talk to my patients while operating.

25 Gauge Instrumentation:  No Stitches!

The instruments used have revolutionized vitrectomy surgery.  The instruments are so thin, that we no longer have to take time to stitch the eye.  This improves efficiency (shortens operating times), but also causes less tissue damage and greatly speeds up healing time (fewer office visits).

What Does This Mean?

You’ve probably noticed that you see more and more video.  It’s a great medium, it captures your attention via audio and video, the costs of equipment are miniscule and the video quality is exeptional.

I produced this entire video at home using iMovie (Apple).  The operation took about 16 minutes in real time.  Many thanks to Meredith Maclauchlan for her skill in adding the special effects and background!

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Anesthesia For Eye Surgery

Retina surgery is painless, you remain awake and is performed on an outpatient basis.  Advances in technology have decreased the length of surgery making outpatient eye surgery possible.

There are two basic methods of anesthesia; awake (aka local) and asleep (aka general).

Local Anesthesia with Sedation

Most of my operations, either vitrectomy or scleral buckle, are all completed in less than an hour.  Some cases can take longer, but not often.  These relatively short operating times make it possible to operate with simple local anesthesia.

“Local” means that you are awake and numbing medicine (e.g. Lidocaine) is injected around the eye to provide sufficient numbing.  This also inhibits eye movement.

Prior to the injection, to avoid the discomfort of the injection around the eye, a heavy sedative is given to make you sleepy for a few minutes.  You are completely unaware of the injection that numbs the eye.  When you awake, the eye is numb and can’t move.  You don’t remember a thing.

I prefer this method for almost all my patients.  The recovery after surgery is usually quite short as there is no need to recover from the systemic effects of general anesthesia.  You are usually able to leave in less than 30 minutes after surgery.

Requirements for having local anesthesia with sedation; your doctor must clear you medically for surgery, you can lie still and you are not claustrophic (there is a surgical drape place over you during the operation).

(By the way, most adult eye surgery, including cataracts are performed in similar fashion.  There are a few centers, that use only topical numbing medication for the cataract surgery.  This is not recommended for retinal surgery.)

General Anesthesia

General anesthesia is rarely needed for my patients.  The recovery period is usually longer and more complicated as it takes a long time for the body to metabolize the drugs used to keep you asleep.  Nausea is more common than with local anesthesia.

There are times, however, when this is preferable.  In young children, patients with dementia, patients with high anxiety, etc., it is safer to use general anesthesia.  Sudden movements of the head can ruin surgery and cause permanent damage.

I also like to place patients under general anesthesia with patients that talk too much.  Though this usually reflects a level of anxiety, talking causes the head to move, and thus the eye.  It makes it more difficult, and more dangerous, to operate.

Compromise

Many patients fear being awake during surgery.  Rest assured, if you can not tolerate being fully awake, we can also give you some sedation through the intravenous during the operation.  If needed, we can always “convert” to general anesthesia.

What Does This Mean? There are a variety of ways to provide safe and effective anesthesia for retina surgery.  The goal is to provide safe, yet effective means to complete the surgery.

By safe, I mean two things.  I don’t want to jeopardize your eye, and second, we don’t want to jeopardize your health.  We try to avoid general anesthesia, but balance your eye safety to make that decision.

Regardless, you should not be afraid of your eye surgery.  While many fear the whole process, there are several ways to keep you comfortable, safe…and calm.

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Eye Patches After Surgery

Patching the eye after surgery is a matter of routine.  The eye patch is usually worn only overnight and then removed for the rest of the post-operative period.  It can offer protection, reduce discomfort, but really has no “healing” attributes.

The Lid Should be Closed Against the Eye

A properly placed eye patch, for any reason, should be a “pressure patch,” meaning that the taped patch should exert enough pressure on the eye to keep the lid closed.  This also ensures that the eye can not rub against the patch itself.

Pain Reduced

Whatever “discomfort” (doctor language for pain) there might be after the operation is decreased by blocking light.  While the eye is still able to move underneath the closed lid, there is some additional comfort created by decreased blinking.

The cornea is a very sensitive tissue.  Small abrasions can cause great sensitivity to light.  Corneal abrasions, even those unrelated to surgery, usually heal rapidly, with or without patching.

Protection?

The eye is dirty, so there is no protective effect from the patch, unlike, say, a true bandage.  Remember that the eye, nose and mouth are all connected.

In the old days, when cataract surgery required a “large” incision to be made into the eye, a shield was placed on top of the patch.  This shield would offer physical protection until the incision healed and became stronger.

Special Situations

There are a few special situations where patching is important after eye surgery.  Occasionally the surgical wounds are not tightly sealed (i.e. the eye is leaking) and an additional day or two of patching is required.  If patching doesn’t suffice, then a short trip back to the operating room might be warranted.

What Does This Mean? As surgical techniques have advanced, there is less tissue damage from surgery, that is, there is less cutting that causes trauma to the eye.  Hence, there is really little discomfort after surgery.

Many cataract surgeons often have the patch removed later in the day so post-operative eye drops can be started right away.  I’ve even heard of a few surgeons that forget the patch all together.

I still prefer to patch.  I find it very useful to help limit swelling after placing a scleral buckle for retinal detachment, but I don’t find it mandatory for the reasons above.

An eye patch does serve as a reminder that an operation was performed and, I believe, are expected.

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Eye Drops to Help You Heal

After eye surgery, there are several eye drops to help you recuperate, and heal, quickly.  These eye drops usually include an antibiotic, anti-inflammatory, and sometimes, an eye drop to keep  you dilated for comfort.

There are many types of eye surgery; cataract, glaucoma, corneal, retina, etc.  In general, the post-operative medications/drops that we use are about the same.

Antibiotics

These usually come packaged in a bottle with a tan colored top.  It may be used 4 times a day.  The drop is clear and may be prescribed to be used 4 times per day.

Remember that eye drops do not penetrate the eye very well, so it is probable that the antibiotics really help the outside of the eye and the actual incision (i.e. place where your surgeon “cut” into your eye) from becoming infected.

One of the unfortunate complications of any intraocular surgery is endophthalmitis, an infection of the contents of the eye.  I doubt the topical drops actually fight any infection inside the eye per se.

Anti-Inflammatory Drops

These usually come in a white or pink capped bottle.  I prefer a steroid called prednisolone acetate 1% (e.g. Pred Forte, Omni Pred).  It is milky white.  This drop must be shaken prior to instillation.  It is really a suspension, that is, the drop contains microscopic particles of drug that settle out.

Other anti-inflammatories included Xibrom or Acular.  These are not steroids and probably not as strong.

Anti-inflammatory drops help the eye keep comfortable during the healing.  If we limit the post-operative inflammation, there should be less discomfort.

Dilating Drops

Some operations and some docs require dilating drops after the operation.  These are in a bright red topped dropper.  These are very similar to what is used in the office to dilate your eyes for examination.

Occasionally, it is helpful to keep the pupil dilated during the recovery period.  I like to use these drops at the end of an operation.  The drops I use will keep the pupil dilated for a day or two, but I don’t have to wait for dilation the next day for the follow-up exam.

Certain dilating drops can also cause “cycloplegia” in addition to simple pupillary dilation.  One of muscles inside the eye, the ciliary muscle, can sometimes spasm, causing severe pain and discomfort.  “Cycloplegia” prevents this from occurring and helps keep the eye comfortable.  The ciliary muscle also helps focus, so vision become blurry.

What Does This Mean? Most of the post-operative medicines we use are topical drops.  Oral medicines usually aren’t necessary.   Most of the drops are really used to promote smooth, comfortable healing, the antibiotics being the exception.

Oral pain relievers generally are not required.  I rarely have to prescribe anything by mouth regardless of the procedures I performed.  The operation I perform requiring the most tissue manipulation is a scleral buckle.  Even with this procedure, oral pain relievers are not necessary.  (Of course, this is surgeon dependent and reflects the way I practice only.)

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Retina Surgery is "Same Day" Surgery

Retinal eye surgery, either vitrectomy or scleral buckle, is usually performed while the patient is awake and as an outpatient, allowing you to go home the “same day.”  Usually, there is absolutely no pain with retina surgery and recovery takes place in the comfort of your own home.

In most cases, operations are performed under “local sedation.”  This term varies, but at our surgical center local sedation involves giving a sedative through the intravenous (I.V.).  This puts the patient in “la la land” for a few minutes during which the eye is then numbed using an injection.  When the patient awakes, the eye is numb and can’t move.

Pain is transmitted via nerves.  The anesthetic prevents the perception of pain by blocking nerve conduction.  The nerves that control the eye muscles are also blocked, thus, the eye can not move.  Both pain and movement are controlled.

The eye remains in the eye socket during the operation.  The eye lids are held wide open with a wire clamp, or speculum, to allow maximum exposure of the eye for the surgery.

The time for surgery depends on the retinal procedure and the amount of work required, but the anesthesia will work for several hours.

Vitrectomy eye surgery involves minimal cutting on the eye.  The use of 25-gauge instruments for vitrectomy eliminates cutting tissue on the outside of the eye, thus, there isn’t much discomfort any way.  Scleral buckle surgery for retinal detachments creates the most discomfort due to increased cutting on the outside of the eye, but this method of anesthesia is still very effective.

Most of the time, my patients are completely awake…and comfortable.  We can talk and listen to music.  On occasion, patients will report they are able to see the instruments moving inside the eye!

On rare occasion general anesthesia is required.  This may be due to the age of the patient (i.e. child), anxiety, claustrophobia, etc.  We usually prefer the patient fully awake or slightly sedated.  The recovery is much faster, easier and safer without general anesthesia.

What Does This Mean? In most cases, technology has improved retina surgery to be completed much faster, and safer, than even 10 years ago.  The reduction in operating times, the time it requires to perform an operation, has allowed “local” anesthesia to become preferred by many doctors.

Along with shorter operating times, and less general anesthesia, most surgery is easily performed as an outpatient as the time it takes to recover from “anesthesia” is much shorter.

Many practices choose to operate in a surgical center, a freestanding outpatient surgical site,  – usually maximizing efficiency…and time.

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Gas Injection for Retinal Detachments

Injecting gas into the eye, called pneumatic retinopexy, is the fourth way to fix retinal detachments.  Other methods include

Gas Injection

This procedure is performed in the office.  Similar to other intraocular injections, except gas is introduced into the eye instead of anti-VEGF medications or steroids.

The gas is usually injected at 100% concentration and will expand a bit over the first day or so.  This allows us to inject a small amount of gas that will enlarge and cover more retinal surface area.

Gases used are usually SF6 (sulfur hexafluoride), C2F6 (hexafluoroethane) and C3F8 (octafluoropropane).  These are large molecules, are inert (don’t react with tissue) and can expand at given concentrations.

Their large size means that they will be slowly absorbed after injection, giving us plenty of time to use them as a tool.  In comparison, air, if injected into the eye, does not expand and will be absorbed within 24 hours.

Advantages of Gas Injection

No “operation” is the biggest advantage.  The procedure can be completed within hours of diagnosis.  There are no issues with scheduling an operation at the hospital, pre-operative clearance and coordinating schedules.

Quick Healing – no actual cutting, so tissue healing is very quick.

No Change in Glasses – as the eye remains the same shape (in contrast to scleral buckle), there is no change in glasses prescription.

Disadvantages to Pneumatic Retinopexy

Lower Success Rate – not all retinal detachments can be treated with gas injection.  The forces within the vitreous are NOT changed.

After gas is injected, the head must be positioned so that the gas abuts the retinal tear.  For instance, if the tear is at the “12 o’clock” position of the eye, the head must be held upright, or erect.  Similaryly, if the retinal tear is located at “9 o’clock” as you are looking at the patient, the head must be tilted over to the left to position the gas “bubble” appropriately.

Retinal Detachments and Retinal Tear
A Retinal Tear Can Lead to a Retinal Detachment

For example, in the illustration above, the tear is located at 10 o’clock.  The head should be tilted to the patient’s left, so the gas, as it rises in the eye, will abut the retinal tear.

Usually, only retinal detachments with tears from 8-4 o’clock can be treated with gas.  It is not possible to treat tears occurring at 6 o’clock.

In both scleral buckle surgery and vitrectomy eye surgery, forces are reduced in the vitreous.  This does not occur with pneumatic retinopexy (gas injection).  Therefore, redetachment occurs more often.  The success rate is lower, perhaps around 85% for this procedure.  Scleral buckle and/or vitrectomy procedures are slightly more successful.

Whenever gas is used, there is a higher rate of cataract formation after the operation.  As with any procedure, there is a chance of infection that can cause blindness.

How the Gas Bubble Works

Basically, the gas, when positioned properly, blocks the transmission of fluid through the retinal tear or retinal hole.  The retina reattaches.  By using either laser or freezing (cryotherapy), the tear is treated to induce scarring that will eventually “seal” the retina and prevent re-detachment.  It does NOT “push” the retina back per se.

What Does This Mean? Depending upon the circumstances, there are a variety of ways to operate to fix a retinal detachment.  Gas injection has many advantages, and is a successful way to proceed.

My personal feeling is that gas injection used to be a great time saver, however, the success rate is lower.  As technology as advanced (e.g. 25  gauge vitrectomy), operating room procedures have become easier, and quicker, to perform.  The advantages to pneumatic retinopexy, or gas injection, have become…well, er, “blurry.”

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Vitrectomy Surgery for Retinal Detachments

Vitrectomy eye surgery for repair of a retinal detachment can be an alternative or adjunct to scleral buckle.  Vitrectomy surgery involves the removal of the vitreous from the eye.  This procedure was introduced (i.e. invented) in the mid-1970’s and enhanced our ability to treat retinal detachments.

Retinal Tears Cause Retinal Detachments

Remember that the culprit in “rhegmatogenous” retinal detachments is the formation of a hole or retinal tear in the retina.  The vitreous can exert “pulling,” or traction, on the retina and cause a retinal tear. 

Using a scleral buckle surgery, we introduced “slack” in the vitreous to release some of the traction.

Vitrectomy surgery, too, is focused (no pun intended) on relieving stress in the vitreous.  By cutting and removing the vitreous, the vitreous can no longer “pull” on the retina and cause additional tears and keep the detached retina elevated.

Remove the Vitreous, Replace with Gas

After removing the vitreous, the next step usually involves exchanging the vitreous and fluid with intraocular gas.  The purpose of the gas is to stop the migration of fluid to the space underneath the retina (by definition, a retinal detachment). 

Many people are told (incorrectly) that the purpose of the gas is to “push” the retina back into position, but this is not so.  The surface tension of the gas bubble actually acts as a cork, stopping migration of fluid from the vitreous cavity to the subretinal space.

A Vitrectomy Can Fix a Retinal Detachment
A Vitrectomy to Repair Retinal Detachment

In this way, the retina is reattached, and kept attached, until significant scarring takes place to keep the retina attached by itself.

The gas will absorb, but the length of time required depends upon the type and concentration of the gas (I use 16% SF6, sulfahexafluoride).  It does not stay in the eye as long as the gas others use as I believe this to minimize the amount of post-operative complications.

During the time gas is actually in the eye, patients are warned against experiencing large changes in atmospheric pressure.  Going to the mountains or airplane travel is usually prohibited as the decreased atmospheric pressure can cause a rapid increase in the volume of the intraocular gas.  This could cause the pressure in the eye to increase too fast.

In short, the gas is used as a tool to help reattach the retina.  Depending upon the location of the tear in the retina, a patient may be required to keep his/her head in a certain position following surgery.  This positioning is as crucial as the operation itself. 

For instance, if the tear is located at the top of the eye, the patient may need to sit up in a chair for days following surgery.  If the thear is located at the bottom of the retina, face-down positioning may be needed.

Advantages of Vitrectomy

There are a few advantages to vitrectomy for repair of a retinal detachment.  There is no worry about becoming more near-sighted as there is no scleral buckle placed.  Similarly, there is no chance of causing double vision as there is no manipulation of the eye muscles as in the case of a scleral buckle.

Basically, for the patient, there is less operating outside the eye.  Discomfort (“doctor-speak” for pain) is minimized.

There is, however, the chance of infection, as there is with any intraocular surgery, that can lead to blindness.  “Endophthalmitis,” the fancy clinical term for this type of infection, is less common in retinal surgery than cataract surgery.  The chance of infection occurring is small, somewhere around 1:5,000-10,000.

Vitrectomy with Scleral Buckle

Many times both a scleral buckle and a vitrectomy are utilized for a retinal detachment.  There are no clearcut reasons when to use vitrectomy or scleral buckle or both.  As I said last post, placing a scleral buckle can be time consuming in certain instances…thus affecting the decision.

What Does This Mean?  There are several ways to fix a retinal detachment.  Vitrectomy surgery fixes the retinal detachment from the inside, requires less tissue manipulation (i.e. operating) and is more comfortable than a scleral buckle. 

Using both modalities, in the right situation, can lead to a higher success rate as we are fixing a retinal detachment from both the inside (vitrectomy) and the outside of the eye (scleral buckle).

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Scleral Buckle Surgery for Retinal Detachment

A scleral buckle is one of several ways to “fix” a retinal detachment. Other ways include vitrectomy eye surgery as well as a combination of scleral buckle and vitrectomy.  An office procedure, called pneumatic retinopexy, is sometimes used as well.

Scleral Buckles are “Oldies But Goodies”

The scleral buckle has been employed for about 75 years.  The principle behind a scleral buckle is to cause the shell of the eye, or sclera (the white “wall” of the eyeball) to indent, or “buckle.”  The most common way to achieve “buckling” is by oversewing a thick piece of silicone rubber or sponge around the eye or encircling the eye with a silicone band and pulling it tight (same as a belt “buckle”).

The longevity of the scleral buckle implies, at least to me, that it is inherently very good surgery.  It corrects the principal problem – relieving “pulling” on the retina.

A Scleral Buckle is Placed to Repair a Retinal Detachment
The Scleral Buckle Reduces the Diameter of the Eye (Yellow Arrows)

Pretend You Are Sitting inside Your Eye

The result of any scleral buckle  is to reduce the internal diameter of the eye.  In doing so, the vitreous can no longer pull on the retina.  The cause of a retinal detachment is a retinal tear (or retinal hole).

For example, suppose the room in which you are sitting is the eye and you are the vitreous.  The wallpaper of the room is the retina.  Stretch your arms apart and pretend you can reach from one wall to the other.  Your fingertips are glued to the wallpaper.  This is how the vitreous adheres to the retina.

If you move to the left, your right arm now pulls on the wallpaper (or the retina) and you cause a tear on the right side.  Similarly, if you move to the right, you create pulling, or traction, on the left wall and cause a tear.

By placing a scleral buckle around the eye, the internal diameter is reduced.  This would be the same as moving the walls of the room closer and, as a result, your arms would bend and create slack in the “vitreous.”  You could move left or right with less pulling on the wallpaper, and less likely to cause a retinal tear.

Same with the retina!

“Side Effects” of a Scleral Buckle

Side effects, or possible complications, of scleral buckle surgery include;

  • increased myopia (you will be more nearsighted) – due to the increased length of the eye.  There may also be a large change in the refraction due to astigmatism.
  • double vision – uncommon, but the buckle is placed outside of the eye and underneath the eye muscles.  By manipulating the eye muscles, double vision is possible.
  • pain – usually not an issue and is usually (in my experience) amenable to Tylenol/Advil.

Fun Facts About Scleral Buckles

  1. The eye is not taken out.  We wouldn’t be able to put it back in.
  2. The “buckle” is usually made of silicone rubber (different than silicone oil) and has no known systemic side effects.  It can also be made of a silicone sponge material.  These, too, are safe.
  3. The “buckle” is intended to be permanent.  At times, it may extrude, but it is very uncommon.  The buckle only really needs to be in place for a couple of months, but we usually never plan on removing them.
  4. Some surgeons use metal clips to help fasten the buckle around the eye.  This can be a problem if future MRI’s are needed.

What Does This Mean?

Though “old,” scleral buckles are not obsolete.

There has been a shift in practice patterns among retina surgeons over the past 15 years.  About 15 – 20 years ago, pneumatic retinopexy was first described (aka invented).  Scleral buckles with vitrectomy became popular in certain areas of the country and, more recently, vitrectomy alone has  become popular.

As I’ll explain in the next few posts, vitrectomy surgery has become instrumental for the repair of retinal detachment, but there is still a role for scleral buckling.

I believe it to be a very valuable tool for retinal detachment surgery, but their use is sometimes based upon the length of time a surgeon takes to perform that part of the operation.  It can take a matter of minutes…to hours.

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offices

A detached retina is potentially blinding. The retina is the light sensitive tissue that lines the inside of the eye. A retinal tear or hole usually leads to a retinal detachment. Floaters can sometimes be the earliest, and only, symptom. Many times there is little warning and a retinal detachment usually occurs without trauma.

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Randall V. Wong, M.D.
Contact: Brigitte O’Brien

A: 3025 Hamaker Court, Suite 101 • Fair fax, Virginia 22031
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Randall V. Wong, M.D.
Contact: Andrea Armstrong (Surgery/Web)
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