How to avoid losing vision due to retinal detachment? What should not be done if the retina is detached? Postoperative period after retinal rupture.

Detachment of the retina of the eyeball is a disease that has become widespread today. In the first stages of the disease, it does not manifest itself in any way. The initial stage occurs without the manifestation of painful symptoms. In order to diagnose pathological changes in the visual organs, it is very important to visit an ophthalmologist in a timely manner and carry out diagnostics. Retinal detachment is a dangerous disease that can worsen with constant strain on the eyeball. The area of detachment begins to increase in size, which inevitably leads to loss of quality of vision. When the disease enters the final stages of development, myopia may increase, peripheral vision may disappear, and distortions in visual perception may appear.

Surgery for retinal detachment can be of two types: laser coagulation and extrascleral filling. In rare cases, when the disease has an advanced form, there is an urgent need for a vitrectomy procedure, that is, removal of the vitreous body.

Retinal detachment is a serious condition that requires immediate treatment.

Surgery on the retina is a necessary measure in case of retinal detachment. During this pathological process, the inner layers of the retina are separated. As a result of this separation, fluid begins to accumulate in the eyeball. Extrascleral filling procedure is designed to adhere the layers in order to return vision to its functionality.

For mechanical injuries to the head and visual organs directly, resulting in rupture, it is used laser coagulation technique. This method is also popular in the treatment of peripheral retinal detachment. As a result of the intervention, breaks in the shell remain, but their edges are sealed with special coagulants. This operation is of an emergency nature when there is an urgent need to stop the progression of the disease.

Vitrectomy– is carried out in cases where the doctor identifies pathologies in the vitreous body. The operation is usually performed in case of extensive damage to the retinal layer, changes in the structure of the vascular system and hemorrhages in the localization of the vitreous body.

Contraindications to surgery

Each of the above methods has its pros and cons. There is a special group of people for whom such treatment methods are contraindicated.

Contraindications to the vitrectomy procedure:

clouding of the cornea of the eyeball;
the appearance of white spots on the organs of vision;
severe changes in the structure of the retina and cornea.

If these symptoms are detected, the vitrectomy procedure will not bring positive effects.

Contraindications to the extrascleral filling procedure:

vitreous haze;
swelling on the sclera.

Contraindications to the laser coagulation procedure:

hemorrhage in the fundus;
pathological changes in the vascular system of the iris;
opacity of certain areas of the eyeball;
high risk of increasing the area of delamination.

Retinal detachment is the separation of the layer of photoreceptor cells - rods and cones - from the outermost layer - the retinal pigment epithelium

The procedure may also be refused if there is an allergic reaction to the anesthetic, or restrictions on anesthesia. Surgery for retinal detachment is not performed if the disease is in the stage of active inflammation. Before the procedure, it is necessary to conduct special tests, take X-ray photographs, and cure caries.

Carrying out the procedure

Laser coagulation

This operation does not require anesthesia, and its duration is up to 20 minutes. In specialized institutions, the operation is performed on an outpatient basis, and the patient goes home on the same day. The patient is observed in hospitals for one week.

During laser coagulation, instead of anesthesia, special eye drops and an anesthetic are used. After their application, the patient is injected with a drug that enlarges the pupil. As soon as the drug begins to act, the doctor installs a special optical lens that focuses the laser beams. With the help of such a device, individual rays are collected into a beam and directed to the area of detachment. As the operation progresses, areas appear where, as a result of protein breakdown, the retina is “soldered together.” Such “adhesions” will prevent further detachment.

The patient is placed in a special chair, in a sitting position. During exposure, slight discomfort may be felt due to the action of the laser, expressed in bright flashes of light. Some patients may experience dizziness or nausea as a result of these outbreaks. The process of complete adhesion of the detached areas takes about two weeks. After this period, the patient must visit a doctor to diagnose the results obtained.

Laser photocoagulation is used to limit the area of rupture and thinned areas of the retina

Extrascleral filling

Before performing this operation, the patient is prescribed bed rest. At rest, the liquid accumulated in the localization of the detachment forms a kind of bubble and acquires clear boundaries. This approach allows you to very accurately determine the areas that need to be affected.

The operation consists of several stages. First, the outer layer of the eyeball is cut. Using a special device, pressure is applied to the sclera of the eyeball. After the sclera is tightly pressed to the retina, the doctor marks all damaged areas and makes special fillings.

The main material for their manufacture is most often silicone. This filling is installed under the retina and adheres to the sclera. To prevent the filling from moving, it is secured with special threads. The liquid that accumulates at the rupture sites is absorbed by the pigment layer. In the later stages of the disease, when its amount is several times higher than normal, an incision of the sclera may be required in order to remove it.

Sometimes additional mesh fastening may be required. In such cases, a special mixture of gases is pumped into the vitreous body. In order for the gas to reach the required point, the patient must focus his vision on a certain point indicated by the doctor. In situations where it is necessary to restore the volume of the vitreous body, an isotonic solution is injected into it. After all the manipulations, the outer layer of the eyeball is sutured.

The extrascleral filling procedure is highly complex, and can only be entrusted to a true professional. In ninety-five percent of cases, specialists are able to succeed and stop retinal detachment. The main point in this issue is the timely detection of the disease.

Scleral filling is the bringing together of the layers of the retina by creating an area of scleral depression from the outside.

Vitrectomy

This method of surgical intervention is performed in a hospital, and most often has the nature of additional treatment after extrasleral filling. The procedure is performed under anesthesia.

The doctor makes holes in certain areas of the sclera. Special tools are inserted into these holes. After this, the specialist begins to directly influence the vitreous body, partially or completely removing it. Instead, a special mixture of gas or silicone oil is installed.

Complications and their consequences

The following complications often occur after surgery:

Inflammation. It manifests itself as redness of the eyeball, severe itching and lacrimation. As a preventive measure, eye drops containing an antiseptic can be prescribed.
Changes in visual perception. After the procedures, vision may temporarily lose its sharpness. Ophthalmologists recommend wearing special glasses during the postoperative period. The recovery period can take up to three months.
Strabismus. This side effect was found in almost fifty percent of patients who underwent extrascleral filling procedures. Usually caused by damage or improper fusion of muscles.
Increased pressure in the visual organs. Such consequences after surgery develop very rarely. Sometimes they cause glaucoma. Given the complexity of the disease, there may be a possibility of a repeat procedure in order to remove the filling.
Narrowing of visual perception. This side effect is the result of improper laser coagulation of the retina. In rare cases, the pathology is associated with a progressive stage of the disease.

The likelihood that the disease will spread to other areas of the retina is about twenty percent. In order to avoid this, it is sometimes necessary to re-correct.

If you know the primary symptoms of detachment, then recognizing it will not be so difficult

Recovery period

Restoring vision after surgery for retinal detachment takes a fairly short time. During laser treatment, the patient is not subject to certain restrictions. The only requirement from the doctor may be to avoid strenuous physical activity. Most experts recommend performing special exercises during the recovery period to strengthen the muscle tissue of the eyeball.

After extrascleral filling, retinal detachment of the eye, the postoperative period takes much longer.

Experts announce the following list of restrictions:

For three days after the operation, the patient must wear a special blindfold.
For the first month after surgery, you are prohibited from lifting anything that weighs more than five kilograms.
It is necessary to avoid getting liquid into the eyes while bathing and washing.
In the first weeks, it is strictly forbidden to strain the visual organs (reading, working on the computer, watching TV).
In summer it is necessary to wear sunglasses.

After the vitrectomy procedure, patients are contraindicated in the following:

visiting baths, saunas, places with sudden temperature changes;
washing hair in hot water.

The duration of the recovery period is strictly individual for each person, as it depends on the speed of the healing process. The size of the affected area, the degree of surgical intervention - these factors play a huge role in this period. The average speed of rehabilitation can range from two weeks to three months. To avoid serious consequences for the body and the development of unpleasant diseases, it is necessary to seek the help of specialists in time. High-quality medical services, in-depth diagnostics and the right choice of treatment methods are the key to visual health.

You have undergone a major operation and after treatment in the hospital you are being discharged home. The early postoperative period has been completed and restorative treatment and rehabilitation are required under the supervision of an ophthalmologist at the place of residence for 1-1.5 months after surgery.

Continue instilling the eye drops indicated in the discharge summary. You can bury the drops yourself, or relatives and neighbors can help with this.
How to instill eye drops correctly:

It is necessary to wash your hands with soap;
Lie on your back and look up at the ceiling. When you gain experience, you will be able to dig in while sitting or standing in front of a mirror, tilting your head back a little;
Take a pipette in your hand, or if you have a bottle of drops, turn the bottle upside down and place it above the eye at the inner corner of the palpebral fissure. Gently pull down the lower eyelid of the operated eye and apply drops. After instillation, you should not squeeze your eyelids too much, otherwise the medicine will be squeezed out of the eyes and the therapeutic effect will be less. It is advisable to press the inner corner of the eye with your finger, then the drops will not go into the nasolacrimal duct and their effect will be maximum. Between instillation of drops, you need to take a break of 5-10 minutes for the medicine to take effect, and then instill the next drops as prescribed. If you use pipettes, you should have an individual pipette for each type of drop. Before use, pipettes should be boiled for several minutes and inserted into each bottle of drops.

You do not need to wear a bandage indoors. On the street, it is better to cover the eye with a bandage for 1-2 weeks after discharge. Depending on the condition of the eye, your doctor may allow you to remove the bandage earlier.
Food should be complete and easily digestible, contain vitamins (A, B, C, E), elements (zinc, selenium) and antioxidants (betacarotene). The diet should contain sufficient quantities of vegetables, fruits, vegetable oil, and wholemeal bread. The amount of liquid should be no more than 1.5 liters per day, including first courses. A large amount of fluid can lead to edema and increased blood pressure, stress on the cardiovascular system. Avoid foods that cause thirst and fluid retention (salinity, smoked foods, spices, etc.). Strong tea and coffee are contraindicated for you, as they can cause vasospasm and an increase in blood pressure. Alcoholic drinks such as cognac and fortified wines are unacceptable; their use causes dilation and then constriction of blood vessels.
Daily walks in the fresh air are required, at least 60 minutes a day, as a lack of oxygen causes the vessels of the retina and optic nerve to suffer. You need to sleep at least 8 hours a day.
You should limit your visual load, reading, watching TV, and working on a computer. It is advisable to watch TV no more than 2-3 hours a day with breaks.
Avoid physical activity, work in hot shops and in the sun, activities associated with tension, vibration, body shaking, and bending of the body. You cannot move furniture in the apartment, carry bags of potatoes, full buckets of water, or work in an inclined position for a long time in the country and at home. This causes an excessive rush of blood to the head, and therefore to the eyes. You can only do light gymnastics and breathing exercises. For 2 months, the maximum weight that can be carried in your hands should not exceed 8-10 kg. During this time, a chorioretinal adhesion is formed after cryo and laser coagulation. Avoid constipation and coughing, as during straining, blood vessels may burst and tears may appear in the retina.
Wash your face very carefully without touching the operated eye. You can touch the eyelids in the projection of the bony edge of the orbit. You can take a bath not hot, the same goes for a shower. The operated eye must be covered with a bandage for the first time. After the water procedure, you need to apply eye drops. You can visit a bathhouse or sauna no earlier than 6 months after surgery. Entering the steam room should not exceed 2 minutes. It is necessary to avoid sharp contrasting water procedures.
In addition to instillation, drugs are prescribed that improve metabolism in the organ of vision, strengthen blood vessels, and antioxidants. The course of postoperative treatment includes:

"Strix" 1 drop 2 times a day, 15 days.
Simultaneously with Strix, you need to take Triovit, 1 drop 2 times a day for 2 months, then (after Triovit), Duovit, 1 tablet of each color 1 time a day for a month.
After 6 months, it is advisable to repeat the course. If you are 40 years or older and there are no contraindications, then treatment can be enhanced by taking the drug “Bilobil”, 1 capsule 3 times a day for 3 months. A good multivitamin complex is Multitabs Intensive. Take 1 capsule per day for 1 month; after six months, the drug must be taken again.

Your treatment should be monitored by an ophthalmologist.

30-45 days after the operation, if the eye has become calm and there is no discomfort, you can return to your work. Visual stress during the work process should be carried out in good lighting conditions.

REMEMBER! If you experience pain, a feeling of heaviness in the eye, headaches on the side of the eye, photophobia, lacrimation, or blurred vision, you should immediately contact your doctor or ophthalmologist at your place of residence.

Proper outpatient treatment and follow-up, as well as compliance with our recommendations, will help you avoid complications and preserve your vision.

Retinal surgery is performed when the neurosensory membrane is detached or ruptured. The pathological process refers to severe diseases of the organ of vision. If left untreated, it can lead to complete blindness.

To prevent the development of complications, it is necessary to undergo a timely examination by an ophthalmologist. Depending on the diagnostic results, the doctor may prescribe surgery. Based on the data obtained, the ophthalmologist will prescribe a technique for performing the procedure.

Indications for the procedure

Surgery on the retinal layer is a surgical procedure during which the morphological structure of the inner lining of the eyeball is restored. There are 2 types of procedures: extrascleral and endovitreal. In the latter case, the surgeon performs manipulations inside the organ of vision. With extrascleral intervention, the operation is performed on the surface of the sclera.

The procedure is indicated in the following cases:

Indications for the procedure depend on the etiology of the disease and the severity of the pathological process in the retina. The decision to perform surgery is made by the doctor. The specialist takes into account the patient’s condition, his individual characteristics and the presence of concomitant pathologies.

The video describes the most modern methods of laser treatment for retinal detachment:

Types of surgical intervention

Many patients are interested in what operations are performed for damage to the retina. Surgery can be performed inside the eye cavity or outside. Endovitreal methods are used to eliminate extensive damage to the retina. The extrascleral technique involves fixing the retina by applying pressure to the outer wall of the eye.

Vitrectomy

Vitrectomy is the complete or partial removal of a gel-like concentrate from the cavity of the eyeball. The technique allows easy access to the retina. The operation is indicated for epiretinal membrane, extensive ruptures, and tissue transplantation. After the procedure is completed, the vitreous is replaced with saline, silicone or gas. The duration of the procedure is from 1 to 2 hours. Patients with gas are not recommended to sleep on their backs, so as not to provoke the substance to enter the anterior chamber of the eye.

IMPORTANT. An air bubble is often placed in front of the retina to help fix the tissue in its normal position.

Laser coagulation

Laser surgery is based on the action of thermal radiation. During the procedure, the ruptures and detachments of the inner membrane are cauterized. Laser coagulation can be carried out regardless of the pathological process - the method is equally effective in cases of damage to the peripheral and central zones of the reticular layer. The technique helps prevent tissue degeneration. The duration of the procedure is 20-40 minutes. After surgery, it is not recommended to fall asleep on your back to avoid increased intraocular pressure.

Extrascleral filling

During extrascleral filling, the distance between the retina and the pigment layer, which was formed during the process of delamination of the membranes, decreases. The surgical technique allows preserving the vitreous body compared to vitrectomy.

The operation is carried out according to the following algorithm:

The duration of the procedure is 40-90 minutes. Visual function is restored within 2-3 months. However, complete rehabilitation does not occur. The degree of restoration of the functional activity of the organ of vision depends on which area of the retina is detached. The severity of the pathological process plays an important role. The postoperative period after applying a filling increases in old age.

Cryocoagulation

Cryocoagulation helps prevent the detachment from spreading to the macula. Cryopexy prevents divergence of the edges of the retinal tear. The operation is performed on an outpatient basis with local anesthesia. A tube is inserted into the eye, delivering a stream of liquid nitrogen. The substance freezes the tissue, pressing the retina to the vascular layer. As a result, the neurosensory membrane fuses with the choriocapillaris. The duration of the procedure is no more than 40 minutes. The procedure does not impose restrictions on lifestyle during the rehabilitation period.

Extrascleral ballooning

This type of surgery is performed for retinal detachment, which is not accompanied by the development of complications.

Extrascleral ballooning cannot restore extensive tissue damage and does not help with hemorrhages in the intraocular cavity.

Patients wonder how surgery works. During the procedure, a special balloon is inserted into the organ of vision through a catheter. It is left inside the vitreous. After installation, liquid begins to flow into the cylinder, causing the device to increase in size. In this state, the instrument creates pressure on the sclera, which allows the retina to be fixed in its normal position. To strengthen the retina after removing the catheter, the doctor may perform laser coagulation.

On the 5-7th day of the postoperative period, the balloon is removed, because during this time the tissues are completely regenerated. The effectiveness of extrascleral treatment is 98%. The duration of the procedure is about 2 hours.

Preparation

Preoperative preparation consists of conducting a thorough examination of the organ of vision by an ophthalmologist. The specialist must assess the general condition of both eyeballs, identify or deny the presence of diseases of the visual apparatus. The doctor may perform the following diagnostic procedures:

Ophthalmoscopy with a dilated pupil. Fundus examination is performed using a slit lamp. The ophthalmologist identifies visible damage to the retina and, if necessary, prescribes more accurate studies of the organ.
Optical coherence tomography. The procedure uses a special scanner to capture images of the various layers of the retina. High clarity photos allow you to accurately diagnose pathology.
Electrophysiological study. During the procedure, the device registers changes during electrical stimulation of the eyeball. Allows you to identify defects in the structure of the retina and determine the path of the signal to the cerebral cortex.
Fluorescein angiography. A test with the introduction of a contrast agent allows you to assess the condition of the retinal vessels. With high permeability of the choriocapillaris, the location of fluid accumulation under the neurosensory membrane is determined.
Ultrasound examination of the retina. Ultrasound helps to localize damage and provides detailed information about the condition of the visual organ.

IMPORTANT. Ultrasound is prescribed as an additional study if during the operation it is planned to affect the anterior chamber of the eye: the lens, sclera and cornea. This need arises with deep penetrating trauma.

After the examination, the doctor determines the type of operation, explains to the patient how it is performed and how long the procedure lasts. After becoming familiar with the possible consequences of surgical intervention, the patient must sign an informed consent.

Before the operation, you must pass the following tests and undergo some studies:

8 hours before surgery, it is recommended to refrain from eating and drinking. This is necessary during general anesthesia in order to minimize the risk of asphyxia with vomit in the event of an inadequate response to anesthesia. When taking any medications, you must discuss their use in advance with your doctor, anesthesiologist and surgeon.

Rehabilitation

To quickly restore tissue during rehabilitation, you should adhere to the following recommendations:

do not lift heavy objects weighing more than 3 kg;
avoid colds, strengthen the immune system;
do not stay in the sun for a long time, use sunglasses when going outside;
Avoid temperature changes: visiting saunas, going out into the cold from a warm room.

Visual functions are restored slowly. On average, the process takes from 2 to 6 months. The visual acuity of patients who have silicone placed into the intraocular cavity may deteriorate. The negative effect goes away on its own within a week.

If the position of the retina was fixed using gas during surgery, you should avoid flying or taking the subway. Changes in atmospheric pressure can cause the gas to expand or contract, which can cause destruction of the optic nerve.

The first 48 hours - features

In the first 2 days after the operation, the body is in a state of stress. Therefore, any negative impact on the affected area can provoke the development of complications.

To avoid unpleasant consequences, you should follow several rules:

The patient experiences discomfort for 48 hours. A person feels the false presence of a foreign body in the operated area. In some cases, the unpleasant feeling is accompanied by tingling pain. The bandage is removed from the eye the next day after the procedure. In this case, there is irritation and redness of the eyes, and swelling of the eyelids.

The first 2 weeks of the postoperative period

The rate of restoration of the visual system in the postoperative period depends on the surgical technique, the type of retinal dissection and the individual characteristics of the patient. During tissue regeneration, the activity of the immune system decreases, so you need to take antibiotics for the first 2 weeks after the procedure.

The dosage and duration of use of the drugs should be prescribed by an ophthalmologist. Antimicrobial agents prevent the development of infection and accelerate tissue regeneration. Anti-inflammatory eye drops will help relieve swelling. During 2 weeks of rehabilitation, the patient must observe semi-bed rest, avoid stressful situations and physical activity. During this period, you can take sick leave so as not to put strain on your vision. The patient should be observed by an ophthalmologist and promptly inform the doctor about the occurrence of discomfort or complications.

IMPORTANT. It is necessary to protect the operated eye from contact with irritating agents: detergents, dirt, small particles.

When will vision be restored?

During the recovery period after surgery, the patient may see fog before the eyes. The negative effect goes away on its own within 3-5 days. It should be remembered that everyone’s body has individual characteristics. The duration of tissue regeneration will depend on age, metabolic rate, vascular condition or other internal factors. The stage of retinal dissection and the degree of damage to neurosensory cells have a great influence on the rehabilitation process.

If the pathology has not affected the central area, then recovery will take about six months. Otherwise, destruction of the macular zone can lead to an irreversible decrease in visual acuity. To speed up rehabilitation, it is necessary to lead a measured lifestyle, not overstrain your eyes and eat right for a month.

Possible complications

Before performing the operation, the ophthalmologist is obliged to warn the patient about a number of complications that may arise during the procedure. After completion of surgical treatment, there is a risk of developing the following negative consequences:

Negligence of surgeons can lead to various defects of the organ of vision: strabismus, dislocation of the lens, increased intraocular pressure. Severe damage requires replacement of the retina with donor tissue.

IMPORTANT. In some cases, eye pain may occur in bright light. It should be remembered that the operated retina has increased sensitivity, and wear sunglasses.

To avoid the risk of relapse of the disease during pregnancy, it is necessary to coordinate the operation with a gynecologist. If the procedure was performed before childbirth, then a cesarean section is performed during labor. Natural birth of a child can lead to increased intraocular pressure and the development of angle-closure glaucoma.

Retina surgery is performed to restore the integrity of the neurosensory layer of the eye. There are several techniques for performing the procedure. The type of surgical intervention is determined by the ophthalmologist who diagnosed the organ of vision. Before starting treatment, the specialist must explain to the patient how the operation is performed, what risks exist and how to behave during rehabilitation.

If the retina is torn or detached, surgical treatment is prescribed to restore the integrity of the eye tissue. The operations are performed under the control of a microscope; they are considered highly accurate and quite complex. Despite this, almost all patients achieve positive results when performed early. The duration of restoration of intraocular structures depends on the type of damage, the age of the patient, and the method of intervention.

All surgical methods of treatment on the retina of the eye are carried out through punctures using microsurgical instruments. Under the control of a microscope, a gas mixture is injected into the eyeball, abnormal films are excised, the vitreous body is removed, the retina is cauterized with a laser or exposed to cold. Most often, operations in case of rupture of the membrane have to be performed on an emergency basis to prevent loss of vision.

If the operation is planned, then it is preceded by an ophthalmological examination (diagnostics of visual acuity, perimetry, electroretinography) and general clinical diagnostics (blood tests, urine tests, biochemistry, coagulogram, and fluorography). Many procedures require general anesthesia. The anesthesiologist measures basic hemodynamic parameters, administers anesthetics, sedatives and hemostatic drugs.

The first stage of operations in most cases is the destruction and removal of the vitreous body - vitrectomy. In case of slight clouding of the ocular media, vitreolysis is prescribed - evaporation of abnormal inclusions with laser radiation. After this, the treatment begins directly. For this purpose they use:

“soldering” of the retina to the epithelial layer using laser coagulation;
freezing to connect the retina and choroid (cryopexy);
installation of a silicone filling (extrascleral filling);
pressing the retina with a balloon (extrascleral ballooning);

To improve tissue nutrition, implantation of eye muscle fibers and episclera is used, which stimulate the formation of new vessels to nourish the membranes and nerve structures. If there are membranes that reduce vision, they are excised.

Operation extrascleral filling for retinal detachment

The final stage is the introduction of silicone oil, a gas mixture or a perfluoroorganic substance into the location of the vitreous body (during vitrectomy).

Injections of antibiotics or anti-inflammatory medications are made under the conjunctival membrane, the eye is covered with a bandage, and the patient is transferred to a ward for further observation. The maximum duration of operations is 3 hours; with laser coagulation or cryopexy it lasts about half an hour.

What is used for detachment, rupture

Retinal detachment is considered one of the most dangerous eye diseases. This shell is the first to perceive the image of an object and sends signals to the visual centers of the brain. Normally, it is tightly fused to the choroid, which provides it with nutrition. Detachment can occur when:

physical stress,
concussion,
tumor development,
severe myopia,
inflammatory process,
vascular thrombosis,

When the retina is torn off, blood stops flowing into it and gradual destruction of cells occurs. If help is provided late, complete loss of vision develops. In such situations, the time is counted on the clock.

Watch the video about retinal detachment and rupture:

Treatment requires operations: ballooning or filling with an extrascleral (external) method, vitrectomy.

Sealing

The purpose of the operation is to reduce the distance between the membranes of the eye using a silicone sponge. This filling compresses the sclera, prevents tissue rupture, and ensures gradual resorption of accumulated fluid under the retina. Filling is carried out using the radial, sectoral or circular method, depending on the zone and area of detachment. Stages of surgery:

identifying the area of detachment and making a silicone filling;
incision of the conjunctival membrane;
sponge implantation, suture fixation;
fluid removal, drainage;
introduction of an expanding gas mixture for strong fixation (if necessary);
stitching.

The advantage of the operation is the preservation of the vitreous body; the disadvantage is the incomplete restoration of visual functions. Complications may include infection, weakening of the oculomotor muscle fibers, and increased pressure inside the eye. In the later period, the development of cataracts and myopia is possible.

Ballooning

It is used only for uncomplicated retinal detachment, absence of rupture or hemorrhage into the internal media of the eye. Using a catheter, a balloon is passed behind the eyeball, into which liquid flows after it has reached the desired location. Pressure on the sclera leads to fixation of the retina in its normal position.

Extrascleral retinal ballooning

Typically, after removing the catheter, additional laser coagulation is performed. The method gives positive results in almost all patients, but after ballooning, hematomas, hypertension inside the eye, and cataracts often occur.

Vitrectomy

This operation involves removing the vitreous body and replacing it with artificial polymer compounds, oils, and gases. The method is contraindicated in cases of reduced corneal transparency, severe retinopathy or optic nerve pathology. Through several thin punctures, a jelly-like substance is removed, which fills the space between the lens and the retina.

Laser beams cauterize the remaining tissues of the retina, compact the areas of detachment, and restore the lost integrity.

Microinvasive vitrectomy surgery of the eye

The duration of the surgical intervention is about 3 hours. If the ophthalmologist is sufficiently qualified, postoperative complications (glaucoma, corneal edema, infection of the membranes of the eye, hemorrhage, recurrence of membrane detachment) are rare.

Retinal replacement surgery

As an option that provides partial restoration of vision, an artificial retina can be implanted - a plate with photodiodes. This method is usually indicated for untimely treatment of diseases of the eyes and nervous system with the development of complete blindness. The transplantation technique is still in the clinical trial stage. Currently, the study of its effectiveness is based on three types of operations:

the implant is installed on the retina;
prosthesis behind the shell;
artificial retina is located above the vascular tissue.

Implants allow electrical stimulation of the remaining retinal cells; after surgery, it is possible to achieve the eye’s response to light and the perception of the contours of objects. A new treatment method is to grow new tissue from stem cells. Japanese doctors performed a retinal transplant using the patient's cells as the material.

The next step will be the use of donor cells. They are taken from the skin and reprogrammed. Bioprostheses have a resolution 5 times better than that of a mechanical retina.

Strengthening intervention

Cryopexy, pneumoretinopexy and laser coagulation are the main methods of strengthening the membrane of the eye when it is detached.

Exposure to liquid nitrogen

Cryopexy is indicated for damage to one eye due to a high degree of myopia, for patients with connective tissue pathology (Marfan and Stickler syndromes). The operation can be performed on an outpatient basis.

Under local anesthesia, a special tip is inserted into which liquid nitrogen is supplied. It causes local pressing of the retina to the choroid for subsequent fusion of these tissues. The technique is effective for fresh defects of a small area.

Laser coagulation

A special lens is placed on the patient's eye to fix the eyeball and limit involuntary movements. After directing the beam, point effects are applied to the damaged area, which are perceived as light flashes. At the end of the procedure, the lens is removed, and anti-inflammatory solutions are dripped into the eye. The application of points can be of the following types:

Species	Description
Barrier	small coagulates in a circle around the center in several rows;
Panretinal	covers the entire surface except the center, used for extensive detachment;
Peripheral	coagulation takes place in distant sectors and is used for prevention at an increased risk of detachment;
Focal	Only the affected area is cauterized

Pneumoretinopexy

A mixture of fluorine gas and air is injected into the syringe. Under the control of an ophthalmoscope, this mixture enters the retina, and the liquid is pumped out with the same syringe. These steps are repeated, and 3 hours after the procedure, laser coagulation is performed. The points are applied as close as possible to the detachment zone. If the rupture area is on the periphery, then liquid nitrogen can be used instead of laser light.

Recovery after eye surgery

As a rule, the patient's hospital stay does not exceed a week for operations that involve penetration into the eyeball. With laser coagulation, the patient is discharged on the same day after a follow-up examination by an ophthalmologist. During the recovery period, a scheduled visit to the doctor is required to examine the fundus and determine visual acuity.

You may need to wear an eye patch and sunglasses for several days to protect yourself from the sun's rays. Also, until tissue restoration is complete, the following are prohibited:

If the vitreous body has been removed, then you need to avoid air travel and hiking in the mountains for six months. Patients are advised to take medications to accelerate healing, injections of metabolic activators, and eye drops:

disinfectant drops with gentamicin, ciprofloxacin, miramistin, decamethoxin;
anti-inflammatory drugs - Indocollir, Naklof;
combined solutions - Tobradex, Maxitrol, Garazon.

In the first week, instillations (instillations) are carried out 4 times a day, then three times, and after a month of prophylaxis, you need to drip the prescribed drug once a day. The total duration of rehabilitation (on average) is:

laser coagulation – two weeks;
cryopexy – 10 days;
pneumoretinopexy – 15 – 20 days;
extrascleral filling and vitrectomy – up to 6 months.

Retinal detachment occurs mainly in older people. Signs: flies, spots, loss of parts of the species. The pathology threatens blindness, so treatment should be started immediately. These can be injections, ointments, surgery, as well as traditional medicine.

A disease called hypertensive retinopathy affects the retina of the eye and can lead to vision loss. Only noticed symptoms will help to start treatment in a timely manner.

The disease angiopathy of the retina or both eyes is a serious pathology that occurs as a result of other diseases. Most often hypertension or diabetes. What are the symptoms of angiopathy of the retina, blood vessels, and fundus? How to treat angiopathy?

Retinal detachment is the separation of the inner retinal layers from the underlying pigment epithelium and choroid. Thus, the normal functioning and light perception of the retina is disrupted. Without appropriate treatment, this condition can lead to complete or partial irreversible vision loss.

A similar diagnosis was first made by de Saint-Yves in the early 1700s, but people began to talk about the disease reliably in 1851, when Helmholtz first invented the ophthalmoscope. Unfortunately, until the 1920s. Retinal detachment always resulted in blindness until Jules Gonin, MD performed the first retinal detachment surgery. In subsequent years, there has been a rapid growth in methods and technologies for surgical treatment of retinal detachment, and modern capabilities of ophthalmic microsurgery make it possible to successfully combat the described condition through various types of surgical intervention. They will be discussed in this article.

Indications for surgical intervention for detachment depend on the etiology, duration of the disease, the patient’s condition and the presence of concomitant ophthalmological pathology.

Let's consider various clinical situations:

Rhegmatogenous retinal detachment is undoubtedly an emergency condition requiring emergency surgical intervention. The optimal timing of surgery is 1-2 days after the onset of the disease. The sooner the integrity of the layers is restored, the greater the patient’s chances of regaining good vision. If the macula is involved in the process, treatment should begin within 24 hours. If the macula remains intact, the operation can be waited for several days, provided that strict bed rest is observed. Regardless of the patient’s age, surgical treatment should consist of two main components – closing the defect (tear) and eliminating the traction effects that led to the formation of the tear.

Surgery for tractional retinal detachment may not be so urgent - the patient can be monitored dynamically, especially if there is no significant progression. But when the macular area is involved in the process, microsurgical intervention is often indicated. If there is a significant traction component, vitrectomy is indicated, and sometimes there is a need for episcleral filling.

Exudative retinal detachment rarely requires emergency intervention. The exception is submacular hemorrhages, delay in which leads to irreversible changes. The type of intervention mainly depends on the etiology of the disease. For example, inflammatory conditions require topical or systemic corticosteroids, and bacterial infections require appropriate antimicrobial therapy. For patients with diabetes mellitus, an integral part of treatment is the selection of an insulin therapy regimen for glycemic control and adequate antihypertensive therapy.

Indications for surgery, as well as treatment tactics, are determined individually by the attending physician, depending on the clinical situation and the patient’s condition.

Despite the fact that interventions for detachment are often carried out for emergency reasons, there are certain limitations. Surgical treatment of detachment is contraindicated in the following situations:

The presence of a pronounced irreversible violation of the transparency of the cornea.

Irreversible pathological changes in the retina.

Ectasia of the sclera and a significant decrease in the transparency of the vitreous body (relevant for episcleral filling).

Inflammatory processes of the eyeball requiring treatment.

General condition of the patient, severe concomitant diseases in the acute phase.

Since there are several types of operations to treat detachment, specialists always try to help the patient as much as possible and choose the optimal treatment tactics for him.

Operation technology

Regardless of the surgical method chosen, the goal is to identify and close the retinal tear or tears while minimizing iatrogenic damage. It is retinal tears that in the vast majority of cases are the cause of detachment. Also, during manipulation with the patient, it is necessary to eliminate the traction effect on the retina from the vitreous body.

All types of operations for retinal detachment can be divided into extrascleral and endovitreal methods. Extrascleral retinal filling is performed outside the eyeball on the surface of the sclera, and the detached retina is brought closer to the underlying pigment epithelium by indenting the outer wall of the eye. Endovitreal methods involve pressing the retina from inside the eye. Sealing of defects is carried out through the formation of strong chorioretinal adhesions due to temperature or energy effects on the eye tissue in the area of the retinal tear. The most widely used methods are:

To carry out episcleral filling of the retina, fillings made of solid silicone or silicone sponges are used, which allows for radial, sectoral or circular extrascleral filling, depending on the number and location of breaks, and on the volume of the detached retina. The essence of the operation is as follows: a conjunctival peritomy is performed with the release of the rectus muscles. To localize all ruptures, indirect ophthalmoscopy is performed. Once the defects are identified, they are closed using transscleral cryopexy.

The filling element is prepared and sewn on the outside of the eyeball, pressing the sclera in the projection of the retinal break so that the break is completely located on the seal depression shaft. If there is a significant amount of fluid under the retina, the surgeon decides on the need to drain the subretinal space to ensure a tight fit of the detached retina on the filling without a significant increase in intraocular pressure. A circular continuous suture or interrupted sutures are placed on the conjunctival incision, which are removed 10-14 days after surgery.

Initially, it was the operation of choice for complicated conditions, such as giant retinal tears or diabetic tractional detachments. Today, microinvasive vitrectomy is successfully used by many vitreoretinal surgeons for uncomplicated primary conditions.

The most popular is the 3-port technique using 23- and 25G instrumentation. If axial opacities are present (for example, vitreous hemorrhage), they are removed. In phakic patients, pars plana vitrectomy has a higher risk of cataract formation compared to scleral buckling, so the vitreoretinal surgeon takes necessary precautions to avoid damaging the lens. According to some experts, it is almost impossible to completely eliminate vitreoretinal traction without damaging the lens. In this regard, there is an opinion that vitrectomy is the operation of choice for retinal detachment in pseudophakic and aphakic patients. Or a combined intervention is required, when the lens is replaced before vitrectomy.

Standard transciliary vitrectomy is performed as follows. Using a vitreotome instrument, the vitreous humor is removed - a transparent gel-like substance that fills the eyeball from the inside and is the cause of the formation of a retinal tear due to its traction effect. Subretinal fluid is aspirated through the existing retinal defects, and the edges of the retinal tear are then treated with cryotherapy or laser photocoagulation to form a chorioretinal adhesion. In order to securely fix the retina, intraocular tamponade with a long-absorbable gas-air mixture or silicone oil is used. The advantage of gas is the large area of pressure on the defect compared to silicone. Also, the gas bubble gradually resolves on its own, while the silicone is removed during a second operation after 2-4 months. After vitrectomy, postoperative positioning is required for the first 10-14 days.

Vitrectomy is performed on an outpatient basis or in a hospital setting. Anesthesia can be either local (eye drops with anesthetic), regional (retrobulbar injections of anesthetic) or general, depending on the indications, the patient’s condition and the standards of ophthalmological care adopted in a particular medical institution.

Pneumatic retinopexy

Pneumoretinopexy involves intravitreal injection of an expanding gas bubble to press the retina from inside the eye in the area of the tear to the pigment epithelium and choroid. Pneumoretinopexy is extremely rarely used as a separate independent operation for retinal detachment. In the vast majority of cases of surgical treatment, cryopexy is performed simultaneously in the area of ruptures.

Possible complications and consequences

Any surgical intervention carries a risk of complications. Experts always warn patients in advance about the likelihood of an undesirable scenario, after which informed consent is signed. After surgery for retinal detachment, the following complications are possible:

Infectious processes. The addition of a bacterial infection can cause serious endophthalmitis. For prevention, eye drops with an antibacterial drug are usually prescribed.

Hemorrhages are possible during any operation. Before surgery, it is necessary to carefully review all regularly taken medications, paying special attention to anticoagulants and antiplatelet agents.

Damage to the lens and development of cataracts after vitrectomy.

Development after episcleral filling.

Intraocular hypertension.

Recurrence of retinal detachment, which requires repeated surgery.

All described complications can be successfully corrected with timely diagnosis. After the operation, the specialist determines a schedule for visiting the clinic for follow-up examinations. If there is a sudden deterioration in your condition, the appearance of pain or a sharp deterioration in vision, you must visit your doctor on the same day.

Recovery period

Standard postoperative prescriptions include topical antibiotic eye drops (7-10 days), and corticosteroids also in the form of eye drops for a month. Constant monitoring of intraocular pressure and, if necessary, its correction is necessary. The patient is also given certain recommendations that he must adhere to for a speedy recovery and restoration of vision, the main ones of which are the following:

Postoperative positioning to better compress the retina with a gas bubble or silicone oil in the area of the tear.

It is forbidden to rub your eyes, apply external pressure to them, or use cosmetic makeup products for 2 weeks.

For the first few days, it is optimal to follow a gentle regimen; subsequently, avoid intense physical activity and heavy lifting.

It is undesirable to carry out activities associated with eye strain for a long time, including reading, watching TV, using a computer, tablet or smartphone.

There are restrictions on visiting baths and saunas.

When performing gas-air tamponade during vitrectomy or pneumatic retinopexy, air travel is prohibited until the gas is completely absorbed, since when atmospheric pressure changes at flight altitude, gas expands and an uncontrolled increase in intraocular pressure occurs, which can lead to the death of the optic nerve. Silicone tamponade does not have this drawback, and air travel is not prohibited.

Operation under compulsory medical insurance, price in private medical centers

It is possible to perform free surgery for retinal detachment. State health care institutions have quotas for such treatment. That is, after waiting in line, the patient can undergo vitrectomy or extrascleral retinal filling free of charge. Laser coagulation is also performed free of charge as prescribed by the attending physician. In the hospital, after examination, the patient is registered for surgery. However, timely, as soon as possible, surgery for retinal detachment is the main factor in restoring vision lost as a result of the disease.

There are practically no queues at private ophthalmology clinics. The cost of the operation varies depending on the status of the clinic, the availability of this or that equipment, and the choice of surgical method. The price of laser coagulation of the retina varies between 10,000-15,000 rubles, the cost of episcleral filling is in the price range of 35-60 thousand rubles, the price of vitrectomy is 50-100 thousand rubles.