Retina | IOA Madrid
The most common treatment for retinas are surgical and are the following, depending on the pathology:
Once the retina has detached, the only solution is surgical. There are three ways of trying to solve a retinal detachment.
1- Pneumatic Retinoplexy – It is a technique used only in selected cases, mainly in superior retinal detachments with a single hole in the retina. It consists in introducing a bubble of special gas into the eye. Then, the patient is placed so that the gas bubble blocks the hole and impedes liquid passing through it. In this way the retina will stick and then the hole can be treated with laser.
2- Scleral surgery- The idea is that, if the retina has separated from the eye's wall, we can push the eye's wall inwards so that it makes contact with the retina again. This is done by placing implants in the ocular wall that push it until it enters into contact with the retina in the area of the detachment; so it blocks it, preventing more liquid from passing through and for the retina to stick.
3- Posterior vitrectomy- with this technique the surgery is performed from inside the eye. Consists in eliminating most of the vitreous and of the tractions that this exerts on the retina. Once the retina is freed, we stick it, the detachments are treated with laser or cryotherapy and a gas is inserted in the eye, so that it keeps the retina stuck for enough time for the laser to scar and seal the detachments. This technique requires for the patient to rest in the post-surgery and on many occasions facing downwards.
In a high percentage of patients, the vitreous detachments does not entail a serious problem, yet in some cases, as the vitreous detaches from the retina, it can pull it and break it, which entails a high risk of suffering a retina detachment.
Age-related macular degeneration
Dry form. It does not have a curative treatment, although vitamin and mineral supplements with antioxidant effect can be given to try and make the disease progress as slowly as possible.
Wet form. It is very important that in the case of having symptoms a fast loss of vision, sometimes even suddenly, and that may be accompanied by image deformity or a dark spot in the centre of the eye, the patient attends the ophthalmologist immediately, as he/she could be developing a wet form and must have treatment as soon as possible. The wet form does have treatment, which intends to improve the vision, or at least stop the loss of it. It consists in injecting certain drugs, known as anti-antigiogenetics, inside the eye. It does not work for all patients, although 80% of those affected improve with the treatment. The time passed from when the symptoms appear and the start of the treatment is essential. The sooner the treatment is started, the better the results will be.
The treatment will depend on the stage in which the diabetic retinopathy is in. The laser can be used to treat the macual oedema or the peripheral ischemia area; anti-giogenetic drugs for the macual oedema, in the same way as they are used for the AMD; the intraocular injection of slow corticosteroid releasing devices also to treat the macular oedema; or the performance of a vitrectomy to remove bleeding inside the eye or retinal detachments.
Despite the treatments available, treating an advanced retinopathy is often very difficult and ends in blindness. That is why it is important for diabetic people to have the back of their eye regularly checked to try and discover possible retinal alterations and treat them at an early stage.
It is easily diagnosed by performing an optic coherence tomography, known as OCT, which is a type of scan of the macula. If the vitreous adherence to the macula does not release spontaneously and the vision progressively decreases, a vitrectomy must be conducted to release it and for the macula to return to its original position.
The surgical result manages to close the hole in more than 90% of cases (somewhat less in the case of very short-sighted eyes) and the visual results are better if the operation is performed within the first six months from when the hole appeared. The treatment consists in performing a vitrectomy, filling the eye with gas and lay downwards for a few days.
The visual affectation depends on which vein thromboses. It is very serious if it affects the central vein of the retina and less serious if it affects one of the four single veins. The vascular involvement of the area affected is similar to that produced in the diabetic retinopathy and the treatment is also similar, as laser can be used, as well as anti-angiogenetic drugs or intraocular corticosteroids or even surgical treatment, in the case of serious intraocular bleeding.
Epimacular membranes are treated surgically, and it consists in removing that membrane by means of a vitrectomy.