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Retinal Tears and Vitreous Hemorrhage

Vitrectomy for Retinal Tear to Remove Vitreous HemorrhageA vitreous hemorrhage may be caused by a retinal tear.  Sometimes there is so much blood in the eye that direct examination is impossible and we can only guess at the most likely cause.  It is the most difficult situation for me to handle as a doctor.

Patients lose significant vision as the blood in the middle of the eye physically blocks all light from hitting the retina.  While this is usually not permanent visual loss, the blood makes it difficult to make a definitive diagnosis as it can be impossible to see the retina.

Normally, without blood in the eye, a retinal tear may be easily diagnosed and treated with laser.

While there are other causes of vitreous hemorrhage, such as diabetic retinopathy, retinal vascular disease and others.  Still, a retinal tear causing the vitreous bleeding is quite likely.

Retinal Tears Cause Retinal Detachments

A retinal tear can cause a retinal detachment.  A retinal detachment is potentially blinding.

In cases of vitreous hemorrhage, the patient cant’ see “out” and I can’t see “in.”  My ability to examine the eye is hindered.

Options at this point are to observe (i.e. do nothing).  Observing the eye is okay as the blood is doing no harm.  But what if there is a retinal tear?  A retinal detachment could occur if there is an undiagnosed retinal tear.

Other tests, such as an ultrasound can often detect a large tear, but it is not as good as directly examining the eye.  Operating to remove the blood to facilitate proper examination is an option, too.

What Does This Mean?

I am getting older, more aggressive, but smarter.

As I have aged, i.e. gained more experience, I have become more comfortable operating in these cases.  When I was younger, I would often hesitate because I was uncomfortable offering surgery in a situation where surgery might not be necessary, but I’ve learned (through experience) that watching a waiting can be more problematic.

Most of the time I recommend operating to at least remove the blood and confirm a diagnosis.  The risks of modern vitrectomy are quite low, while the risk of a retinal detachment occurring while we are waiting is quite possible.

Vitrectomy surgery is usually performed as an outpatient.  If a tear is indeed present, it can be treated simultaneously.

At the very least, a diagnosis can be made and a potentially blinding condition avoided.

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Your Eye Treatments

Eye drops are the most common form of medication for your eyes.  There are also ointments (aka salves), pills and injectable medicines.  The eye is unique in the many ways.  It can be treated directly with medicines.  Eye drops and ointments are the most common.  Medications given by mouth or intravenous usually don’t get into the eye well, due to the blood brain barrier.  Direct injection of medicine into the eye is probably the best for treating problems inside the eye (e.g. the retina).

Eye Drops

The skin is the only other organ in the body where the medication is placed directly upon it.  We use lotions and creams to treat ailments and diseases of the skin.

Eye drops, too, are placed right where we want them.  These drops commonly treat infections, fight glaucoma, lubricate, reduce inflammation, etc.  Eye drops are best suited for problems that develop outside, that is, on the surface, of the eye.  They aren’t so useful for treating diseases in side the eye as the drops do not penetrate the eye very well.

Each eye drop has a volume of about 32 microliters.  The volume of the surface of the eye is about 28 microliters.  These are approximations, but my point is that for most eye drop medications, the volume of one drop exceeds the amount of liquid that can be “held” by the surface of the eye.

This means that whatever the medication, never use more than one drop, or, the excess will roll down your cheek…it is a waste.  I have always recommended that if the directions recommend the use of more than one drop at a time, don’t buy it.  The manufacturer knowingly advises you waste a portion of the product.

A  more practical view?  Often patients are directed to use more than one different type of eye drop.  Separate the drops by a minute or two to prevent the first being washed away (and down your cheek) by the second drop.  Give the first drop time to be absorbed.


There are fewer medications available in ointment form.  The advantage of an ointment, or salve, is the effects may last a bit longer.  Once applied, the ointment heats up.  As it nears body temperature, the ointment melts and releases the medicine over the ocular surface.

Ointments; however, are somewhat greasy, difficult to apply and, most of all, generally blur the vision.  Patients don’t like to use them, they are messy and they can’t see.

Eye ointments are great for eye lid problems and for cases where lubricating the eye requires more than just drops (e.g. just before you go to bed).

Intravenous Medications

Rarely used in the office setting, intravenous medications can be used when there are eye and systemic complications that need to be treated.  Beyond the scope of this article, intravenous medications may be used to treat certain infections, bacterial and viral, that are out of control (e.g. herpes, CMV, syphilis).  Still not much drug finds its way into the eye even whe given I.V.  The “blood-brain-barrier” prevents many drugs from getting inside the eye.  This is a unique problem of the eye and the brain.


Tablets and pills are sometimes used to treat certain types of inflammation, occasionally eye pressure and only a few types of infections.  This route, too, fails to get large quantities of medicine inside the eye, again, due to the blood brain barrier.

Intravitreal Eye  Injections

Most of the advances in treatment for macular degeneration and diabetic retinopathy involve intravitreal injections.  Injecting anti-VEGF medications and steroids have given us new ways to treat these two common retinal diseases.  This circumvents the the “blood brain barrier.”

Sustained Release Drug Delivery

This category is really a subset of intravitreal injections.  These devices will be injected into the eye and release drug over many months (bypasses the blood brain barrier).  Right now, Ozurdex, is the only FDA approved system.  It releases steroid for the treatment of retinal vascular occlusions.  Other sustained release systems are in the pipeline.

What Does This Mean?

Depending on the malady, topical eye drops and ointments are probably best suited to treat disease outside the eye.  They have the advantage of being applied directly to the target tissue.

Similarly, by directly injecting medicine into the eye to treat retinal disease, intravitreal injections share the same advantage; namely, directly applying the medication to the target.

While the main thrust of this web site focuses on retinal disease, don’t forget that eye drops were really the first time we could apply medicine directly to the eye.  History has taught us that this is a very effective method.  This makes for an exciting future for the treatment of retinal disease.

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When a Cataract Comes Back

While not a retinal problem, cataracts can “return” and can mimic the symptoms of the original cataract; blurred vision, glare and distortion.  This can usually be remedied by a simple painless laser procedure called a YAG capsulotomy.

Cataract Surgery with Implant

Like grey hair, everyone gets cataracts.  With time, the natural lens of the eye clouds with time.  This clouding decreases vision.  The lens is similar to an “M&M” piece of candy both in size and shape.  An M&M is a core of milk chocolate surrounded by a candy coated shell.

Cataracts Cause Decreased Vision

When cataract surgery is performed, the cataract surgeon cuts a hole in the outside candy coating.  The “chocolate”  (core of the lens) is then sucked out leaving the empty candy coated shell.  In the real eye, this shell is actually a clear tissue very similar to plastic wrap used to cover food.  This shell is called the “capsular bag.”

Once the cloudy natural lens material is removed, a clear plastic implant is used to replace the natural lens.  Vision is restored.

Plastic Wrap Gets Dirty

With time, from weeks to years, this clear plastic wrap-like material can get cloudy.  The original symptoms of blurry vision and glare return.  Decreased vision from “posterior capsule opacification” occurs in almost every cataract patient.

Using a “laser” to Restore Vision

A YAG laser is a type of laser that uses its energy to cut.  By focusing the laser beam on the back portion of the candy coating shell, just behind the implant, a small hole is created.  This removes the cloudy/hazy tissue out of the line of sight and vision is restored.

YAG Laser Used for Posterior Capsulotomy
Laser Cut Hole in Posterior Portion of Shell (Capsule)

Does the Implant Fall

Properly performed, a YAG capsulotomy will not cause the implant to move.  While it has happened (and to me!), it is unusual as the implant is usually scarred in place.

In theory, there may be a slight increased risk of a retinal tear that could lead to a retinal detachment.

What Does This Mean?

Many of my patients have had cataract surgery.  It is a relief when we find the cause of the decreased vision is only due to PCO (posterior capsule opacification) and not due to diabetic retinopathy or macular degeneration.

Many people erroneously believe (and perpetuated by some docs) that cataracts “come back.”  They don’t.

This is also why many people believe cataract surgery is performed with laser.  It isn’t, but now you know why, and how, the rumor started.

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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.


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.


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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Eye Surgery Removes Floaters

Persistent floaters that decrease vision can be removed.  A vitrectomy, a retinal eye operation, can be used to successfully remove the vitreous and the “floaters” located within this gel-like tissue.

Most Floaters are From a PVD

Most new “spots” or “cob-webs” are due a posterior vitreous detachment (PVD).  A vitreous detachment increases the risk of a retinal tear and/or retinal detachment.  As we have discussed previously, a PVD is a common occurrence (especially as we get older).  Patients should be examined when the symptoms of a PVD first appear and then 6 weeks after the symptoms started.

From a medical point of view, if a retinal tear has not occurred at the 6 week point, the patient may not need to return for another exam.

These Spots Can Be Annoying

Sometimes, the floaters are so numerous or so large that they are annoying, prevent normal function and may decrease vision.  There is hope and there is help.

A Vitrectomy is the Only Solution

A vitrectomy can remove most of the vitreous, and thus, remove the vitreous opacities.  The vision returns to “normal.”

Vitrectomy eye surgery is routinely performed by retinal specialists.  The operation is usually performed for other reasons rather than just opacification or cloudiness of the vitreous.  It can be used to repair retinal detachments, macular holes or remove epiretinal membranes, for instance.

Of course, there are risks of vitrectomy surgery.  Though very rare, the biggest risks are blindness from infection or retinal detachment.

Some doctors advocate the use of a special laser (YAG laser) to reposition the vitreous within the eye.  I personally don’t feel this is a wise choice as there is a chance of causing retinal tears, and possibly, retinal detachment.

What Does This Mean? It is true that most people learn to tolerate small changes in vision.  In my practice, I rarely performed a vitrectomy for just floaters while I was in Baltimore.  I operate on floaters much more often at my present locations.

Perhaps our tolerance for visual changes is different here.

The point is that, if needed, the surgery can be helpful.  It is not a fancy operation, but rather a routine procedure and does not involve new technology.

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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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Vision Saved by Web Site

Vision saved by reading a web site?  Yes, my patient saved his own vision after reading about retinal detachments on this blog.  Learning from a credible health information source (this blog)  about his condition initiated a cascade of events leading to saving his vision.

A retinal tear or retinal hole can cause a retinal detachment.  Flashes and floaters sometimes precede the formation of a retinal tear, or, there may not be any symptoms at all.  Retinal holes are usually associated with a condition called lattice degeneration, a natural thinning of the retina.

Web Site Saves Vision

Last week a patient came to the office with decreased vision in the right eye.  He lost most of his vision in the right eye.   I diagnosed a retinal detachment and scheduled him for surgery.  His visual prognosis, despite successful surgery,  is not great as the retinal detachment is of unknown duration and the macula is also detached.

I suggested he read this blog specifically about retinal detachment and “PVD and Floaters.”

Several days later, floaters developed in the left eye (the “good” eye).  Now educated about retinal detachments, he emailed, concerned about a possible retinal detachment developing in the remaining eye.

I was able to successfully laser the tear and thereby prevent a retinal detachment!

What Does This Mean?

I will be operating on his “bad” in the next week or so.  Due to the length of time of the detachment, there is an urgency, but no real emergency.  Still, he has learned the significance of a long standing retinal detachment.

Using this web site as a tool for patient education, he was able to learn much more about retinal detachments, especially warning signs of a retinal tear!

Another advantage of learning through a web site is you can go at your own pace.  You can re-read and research.  This is a huge advantage over a doctor visit or reading a printed flyer.

“Unlearning” something takes more time and energy than initial “learning.”  Clearly, since the original cause of vision loss was “missed,” it took additional time for my patient to “unlearn” and then “relearn.”

A web site affords time to “unlearn.”

Lastly, armed with new information, specifically warning signs of a retinal detachment, my patient emailed me about his new “learned” concerns.

Email is easier than a phone call.  No answering machines, recordings and leaving messages.  Email is a form of communication that is convenient and less intimidating than a phone call.

Regardless, this new “system” worked well and in favor of my patient last weekend.

The Internet can work for improving health care!

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Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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