Macular Hole Surgery

Posts Tagged ‘posterior vitreous detachment’

This video shows 20-gauge vitreous surgery for macular hole. Posterior vitreous detachment is induced using cutter. Internal limiting membrane is peeled around the hole using Tanos diamond dusted membrane scrature scraper. This is followed by FGE and C3F8 gas injection.

The Good News and the Bad News About Eye Floaters
By Jeffrey Guild

The Good News

I’ve always been a good news first type of guy. Well, here it is: If the vitreous humor has already pulled off of the back of the eye safely, it won’t be under tension and will not pull the retina off the back of the eye. So, no retinal detachment. This is called a PVD (posterior vitreous detachment).

You can think of the interface between the vitreous and retina like plastic wrap: it’s clingy. If it’s already pulled away from its normal position where it pushes the retina flat, it won’t rip or tear holes at it starts to shrink. This type of pulling causes a common condition in the ERM, or epi-retinal membrane, which can tear in the center of the retina’s vision, creating a ‘Macular hole.’ I’m sure you realize you don’t want a hole in the middle of your vision. It is possible to self-monitor for this by using an Amsler Grid. The wrinkling that occurs where the retina and vitreous interface causes scar tissue to form. To get an idea of how this occurs mechanically in the eye, just lift up your sleeve and notice how it wrinkles.

The Bad News

Now we’re on to the bad news. That is, if you have a posterior vitreous detachment (PVD), the floaters in your eyes are more noticeable. In general, eye floaters are more visible in a bright background which has a lot of contrast.

The most common posterior vitreous detachments form a ring over the head of the optic nerve. This is called a Weiss’s ring. The shape of the ring is caused by the release of attachments at the rim of the optic nerve head. This ring is often significant visually, and is far larger and more condensed than your classic floaters. The more classic type of eye floaters are stringy with undefined shapes. Also, a typical eye floater is more often mobile than the ring-shaped one. In general, a person who has a posterior vitreous detachment has greater risk for retinal detachment (RD) – this is because they are experiencing changes in vitreous humor already.

Doctor Jeffrey Guild graduated from the New England College of Optometry, Boston. He has practiced optometry for twelve years in several states including Massachusetts, Texas, Oregon, California, and Hawaii. Currently, he lives and practices on Maui at the multi-disciplinary Center for Sight clinic. Dr. Guild has also practiced internationally, including one year in Jamaica and missions in Mexico, Guatemala, and Thailand with Gift of Sight and the Lions Club. Dr. Guild has experience in all modes of practice: private, with an ophthalmologist, corporate, and HMO. As an active orthokeratology practitioner and specialty contact lens fitter, his current area of interest is within the vitreous and retina. Dr. Jeffrey Guild graduated from the University of California at Santa Barbara as a Biology major. He played lacrosse for UCSB and became a founding father of the Alpha Tau Omega campus fraternity. His interests include scuba diving, golf, paddling, tennis, and running. Dr. Guild believes that an integrated, holistic approach to treatment is best for his patients. See: http://www.fixeyefloaters.com for more info.

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Flashes and Floaters – Signs of a Retinal Detachment?
By Randall Wong, M.D.

The most common symptoms preceding a retinal detachment are flashes and floaters. These symptoms may be a sign of a retinal tear. Retinal tears can lead to retinal detachments. A detachment of the retina is potentially blinding.

Flashes and floaters are the most common symptoms of a tear in the retina. Though usually benign, there is no way of telling if a tear is associated with new onset of symptoms. Only an eye doctor can properly diagnose a retinal tear. They can also be asymptomatic.

Commonly, a posterior vitreous detachment occurs causing the symptoms of flashes and floaters. A posterior vitreous detachment is a normal physiologic event and happens, eventually, to everyone. The incidence of a “PVD” increases with age and nearsightedness, that is, it is more likely to occur as you age and with increasing myopia (nearsightedness).

Rarely, trauma may cause a retinal tear. In my experience as a retinal surgeon, severe blunt trauma, severe enough to cause loss of consciousness, can sometimes cause a retinal tear.

The retina is the light sensitive tissue that lines the inside of your eye. It is analogous to wall paper. A tear in the retina (or a retinal hole) allows vitreous fluid to travel underneath the retina, causing this delicate tissue to “detach.”

If a tear is identified, but before a retinal detachment has developed, laser treatment may possibly “fix” the tear and prevent a retinal detachment. If a retinal detachment has developed, surgery is required. There are various ways to repair a retinal detachment.

Pneumatic retinopexy, vitrectomy and scleral buckles are different methods to repair this potentially blinding problem. Often, they are successfully repaired, but permanent loss of vision is still possible.

It is recommended by the American Academy of Ophthalmology that new flashes and floaters be examined with 48-72 hours after initial onset. If a posterior vitreous detachment is present, but no tear, re-examination is recommended at 6 weeks. Additional flashes and floaters should be re-examined if they develop.

Retinal surgery can be an emergency. The key is to diagnose a retinal tear before a retinal detachment develops. If a detachment has occurred, operating to preserve the central vision is of utmost importance.

Randall V. Wong, M.D. is an ophthalmologist and retina specialist. He writes on his own blog http://RetinaEyeDoctor.com providing health information on the two leading causes of blindness; macular degeneration and diabetic retinopathy. http://TotalRetina.com is a comprehensive site that covers most other diseases of the retina.

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