How not to lose sight with retinal detachment? What should not be done in case of retinal detachment? 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 proceeds 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 be aggravated by constant eyeball strain. The detachment area begins to increase in size, which inevitably leads to a loss in the quality of vision. When the disease enters the last stages of development, myopia may increase, peripheral vision may be lost, and distortions of visual perception may also appear.

The operation 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, the removal of the vitreous body.

Retinal detachment is a serious disease that requires immediate treatment.

Retinal surgery is a necessary measure in case of retinal detachment. During this pathological process, the inner layers of the retina separate. As a result of this separation, fluid begins to accumulate in the eyeball. Extrascleral filling procedure is designed to carry out the adhesion of layers in order to restore its functionality to vision.

With mechanical injuries of the head and directly the organs of vision, as a result of which a rupture occurs, it is used laser coagulation technique. Also, this method is popular in the treatment of peripheral retinal detachment. As a result of the intervention, gaps in the shell remain, but their edges are sealed with special coagulants. This operation is in the nature of emergency care when there is an urgent need to stop the progression of the disease.

Vitrectomy- is carried out in cases where the doctor reveals pathologies in the vitreous body. It is customary to carry out the operation with abundant damage to the reticular layer, changes in the structure of the vascular system and hemorrhages in the localization of the vitreous body.

Contraindications for surgery

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

Contraindications to the vitrectomy procedure:

clouding of the cornea of the eyeball;
the appearance of white spots on the organs of vision;
strong 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:

cloudiness of the vitreous body;
swelling on the sclera.

Contraindications to the procedure of laser coagulation:

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

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

The procedure can also be refused if there is an allergic reaction to the anesthetic, or if anesthesia is limited. 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 photography, and cure caries.

Carrying out the procedure

Laser coagulation

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

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

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

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

Extrascleral filling

Before performing this operation, the patient is assigned to bed rest. At rest, the fluid 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. With the help of a special apparatus, pressure is applied to the sclera of the eyeball. After the sclera is firmly pressed against the retina, the doctor marks all the damaged areas and makes special fillings.

The main material for their manufacture is most often silicone. Such a seal is placed under the mesh and is coupled to the sclera. In order for the seal not to move, it is fixed with special threads. The liquid accumulating in the places of rupture is absorbed by the pigment layer. In the later stages of the disease, when its amount is several times higher than normal, an incision in the sclera may be required in order to remove it.

Sometimes additional mesh reinforcement 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 desired 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 introduced 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 manage to succeed and stop retinal detachment. The main point in this matter is the timely detection of the disease.

Sealing of the sclera is the convergence of the layers of the retina by creating an area of depression of the sclera from the outside.

Vitrectomy

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

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

Complications and their consequences

Often after surgery, the following complications appear:

Inflammation. It is manifested by redness of the eyeball, severe itching and lacrimation. As a preventive measure, eye drops containing an antiseptic can be prescribed.
Change 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 an extrascleral filling procedure. It is 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 is a possibility of a second procedure in order to remove the filling.
Narrowing of visual perception. This side effect is the result of improper laser photocoagulation of the retina. In rare cases, 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 the manifestation of detachment, then it will not be so difficult to recognize it.

Recovery period

Recovery of vision after retinal detachment surgery takes quite a short time. With laser exposure, the patient is not subject to certain restrictions. The only requirement of the doctor may be the avoidance of strong physical exertion. Most experts recommend during the recovery period to carry out special exercises to strengthen the muscle tissue of the eyeball.

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

Experts announce the following list of restrictions:

Three days after the operation, the patient must wear a special bandage over his eyes.
The first month after the operation, it is forbidden to lift weights, whose weight is more than five kilograms.
It is necessary to avoid getting liquid in the eyes while bathing and washing.
In the first weeks it is strictly forbidden to strain the visual organs (read, work at a computer, watch TV).
Sunglasses must be worn during the summer.

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

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

The duration of the recovery period for each person is strictly individual, as it depends on the speed of the healing processes. The size of the affected area, the degree of surgical intervention - these factors play a huge role in this period. The average recovery time 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 the health of the organs of vision.

In contact with

You have undergone major surgery and are discharged home after treatment in the hospital. 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 within 1-1.5 months after the operation.

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

Hands must be washed with soap;
Get into a supine position and look up at the ceiling. When you gain experience, you will be able to bury sitting or standing in front of a mirror, throwing your head back a little;
Take a pipette in your hand, or if you have a bottle of drops, then turn the bottle upside down, place it above the eye at the inner corner of the palpebral fissure. Gently pull down the lower eyelid of the operated eye and drip drops. After instillation, it is impossible to squeeze the eyelids strongly, while the medicine is 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 lacrimal-nasal passage and their impact will be maximum. Between instillation of drops, you need to take a break of 5-10 minutes for the medicine to work, and then instill the next drops as directed. If you use pipettes, then you should have an individual pipette for each type of drop. Pipettes before use should be boiled for several minutes and inserted into each vial with drops.

The bandage may not be worn indoors. On the street, it is better to close the eye with a bandage for 1-2 weeks after discharge. Depending on the condition of the eye, the 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 enough vegetables, fruits, vegetable oil, 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 an increase in blood pressure, stress on the cardiovascular system. Eliminate foods that cause thirst and fluid retention (salinity, smoked meats, spices, etc.). Strong tea and coffee are contraindicated for you, as they can cause vasospasm, rise in blood pressure. Alcoholic drinks such as cognac, fortified wines are unacceptable, their use causes expansion and then narrowing of blood vessels.
Mandatory daily walks in the fresh air, 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 visual load, reading, watching TV, working on a computer. TV is desirable to watch no more than 2-3 hours a day with breaks.
Exclude physical activity, work in hot shops and in the sun, activities associated with stress, vibration, body shaking, torso tilts. You can’t move furniture in the apartment, carry sacks of potatoes, full buckets of water, 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 do only light gymnastics, breathing exercises. Within 2 months, the maximum weight that can be carried in the 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, the vessels may burst, and breaks may occur on 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. The bath can be taken not hot, the same applies to the shower. The operated eye should be covered with a bandage at first. After the water procedure, it is necessary to drip eye drops. Bath or sauna can be visited no earlier than 6 months after the operation. Entering the steam room should not exceed 2 minutes. Sharp contrasting water procedures should be avoided.
In addition to instillation, drugs are prescribed that improve the metabolism in the organ of vision, strengthen blood vessels, and antioxidants. The course of postoperative treatment includes:

"Strix" 1 cap 2 times a day, 15 days.
Simultaneously with Strix, it is necessary to take Triovit 1 cap 2 times a day for 2 months, then (after Triovit), Duovit 1 tablet of each color 1 time per day for a month.
After 6 months, it is desirable to repeat the course. If you are 40 years old or more and there are no contraindications, then the treatment can be enhanced by taking Bilobil, 1 capsule 3 times a day for 3 months. A good multivitamin complex is Multitabs Intensive. It is taken 1 capsule per day for 1 month, after six months the drug should be repeated.

An ophthalmologist should supervise your treatment.

30-45 days after the operation, if the eye has become calm, there are no signs of discomfort, you can return to your work. Visual non-loading in the process of work should be carried out in conditions of good lighting.

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

Properly conducted outpatient treatment and dispensary observation, as well as following our recommendations, will help to avoid complications and preserve your vision.

An operation on the retina 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 total blindness.

To prevent the development of complications, it is necessary to undergo a timely examination by an ophthalmologist. Depending on the results of the diagnosis, the doctor may prescribe an operation. Based on the data received, the ophthalmologist prescribes the technique for the procedure.

Indications for the procedure

The operation on the mesh layer is a surgical intervention during which the morphological structure of the inner shell of the eyeball is restored. There are 2 types of the procedure: 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 on 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 tells about the most modern methods of laser treatment of retinal detachment:

Types of surgery

Many patients are interested in what kind of operations are performed in case of 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. Extrascleral technique involves fixation of the retina due to pressure on 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 you to freely get to the retina. The operation is indicated for the epiretinal membrane, extensive ruptures, tissue transplantation. After the end of the procedure, the vitreous body 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 entry of the substance into the anterior chamber of the eye.

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

Laser coagulation

Laser surgery is based on the action of thermal radiation. During the procedure, cauterization of tears and detachments of the inner shell occurs. Laser coagulation can be carried out regardless of the pathological process - the method is equally effective in the defeat of the peripheral and central zones of the reticular layer. The technique helps to prevent tissue dystrophy. The duration of the procedure is 20-40 minutes. After the operation, it is not recommended to fall asleep on your back to avoid an increase in intraocular pressure.

Extrascleral filling

In the course of extrascleral filling, the distance between the retina and the pigment layer, which was formed during the separation of the membranes, decreases. The technique of performing surgical intervention compared with vitrectomy allows you to save the vitreous body.

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. In this case, full recovery does not occur. The degree of restoration of the functional activity of the organ of vision depends on which area of the retina has detached. An important role is played by the severity of the pathological process. The postoperative period after applying the filling increases in old age.

cryocoagulation

Cryocoagulation helps prevent the spread of the detachment to the macula. Cryopexy prevents the divergence of the edges of the rupture of the retina. The operation is performed on an outpatient basis with local anesthesia. A tube is inserted into the eye, supplying a jet of liquid nitrogen. The substance freezes tissues, pressing the retina against the vascular layer. As a result, the neurosensory sheath fuses with the choriocapillaries. The duration of the procedure is no more than 40 minutes. The procedure does not impose restrictions on the lifestyle during the rehabilitation period.

Extrascleral ballooning

This type of surgical intervention is carried out with 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 the surgery goes. During the procedure, a special balloon is introduced into the organ of vision through a catheter. It is left inside the vitreous. After installation, liquid begins to flow into the cylinder, due to which the device increases in size. In this state, the instrument creates pressure on the sclera, which allows fixing the retina in its normal position. To strengthen the retina after removing the catheter, the doctor may perform laser photocoagulation.

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

Training

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

Ophthalmoscopy with dilated pupil. Examination of the fundus is carried out using a slit lamp. The ophthalmologist detects visible damage to the retina and, if necessary, prescribes more accurate studies of the organ.
Optical coherence tomography. The procedure takes place using a special scanner to capture images of the various layers of the retina. High definition photo allows you to accurately diagnose the 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. The test with the introduction of a contrast agent allows you to assess the condition of the vessels of the retina. With high permeability of the choriocapillaries, the place of fluid accumulation under the neurosensory membrane is determined.
Ultrasound examination of the retina. Ultrasound helps to establish the localization of damage and provides detailed information about the state 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. Such a need arises with deep penetrating trauma.

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

Before the operation, it is necessary to pass the following tests and undergo some research:

It is recommended to stop eating and drinking 8 hours before surgery. This is necessary during general anesthesia in order to minimize the risk of developing asphyxia with vomit in case of an inadequate response to anesthesia. When taking any medications, it is necessary to discuss their use with the attending physician, anesthetist and surgeon in advance.

Rehabilitation

For quick tissue repair during rehabilitation, the following recommendations should be followed:

do not lift heavy objects weighing more than 3 kg;
avoid colds, strengthen immunity;
do not stay in the sun for a long time, use sunglasses when going outside;
avoid temperature differences: 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 in whom silicone is placed in the intraocular cavity may deteriorate. The negative effect disappears on its own within a week.

If during the operation the position of the retina was fixed with gas, it is necessary to avoid flying or taking the subway. Changes in atmospheric pressure can cause the gas to expand or contract, which can cause damage to the optic nerve.

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 a few rules:

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

The first 2 weeks of the postoperative period

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

The dosage and duration of the use of drugs should be prescribed by an ophthalmologist. Antimicrobial agents prevent the development of infection and accelerate tissue regeneration. Puffiness will help relieve anti-inflammatory eye drops. Within 2 weeks of rehabilitation, the patient must observe a half-bed rest, avoid stressful situations and physical exertion. For this period, you can take sick leave so as not to create a load on your eyesight. The patient should be observed by an ophthalmologist, in time to inform the doctor about the occurrence of discomfort or complications.

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

When will vision be restored?

During the recovery period after surgery, the patient may see a fog before his eyes. The negative effect disappears on its own within 3-5 days. It should be remembered that the body of each has individual characteristics. The period of tissue regeneration will depend on age, the rate of metabolic processes, the state of blood vessels or other internal factors. The stage of retinal stratification and the degree of damage to neurosensory cells have a great influence on the rehabilitation process.

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

Possible Complications

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

The 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 is highly sensitive, and wear sunglasses.

To avoid the risk of recurrence of the disease during pregnancy, it is necessary to coordinate the operation with a gynecologist. If the procedure was performed before childbirth, then in the process of contractions, a caesarean section is performed. The natural birth of a child can lead to an increase in intraocular pressure and the development of angle-closure glaucoma.

Retinal surgery is performed to restore the integrity of the neurosensory layer of the eye. There are several techniques for the procedure. The type of surgical intervention is determined by the ophthalmologist who performed the diagnostics of 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.

In case of rupture or detachment of the retina, surgical treatment is prescribed to restore the integrity of the eye tissues. Operations are performed under the control of a microscope, they are considered highly accurate and quite complex. Despite this, in almost all patients it is possible to achieve positive results with early intervention. 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 cold is applied to it. Most often, operations for or rupture of the shell 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 (diagnosis of visual acuity, perimetry, electroretinography) and general clinical diagnostics (blood, urine, biochemistry, coagulogram, and fluorography). Many interventions require general anesthesia. The anesthesiologist measures the main parameters of hemodynamics, injects anesthetics, sedatives and hemostatic drugs.

The first stage of operations in most cases is the destruction and removal of the vitreous body - vitrectomy. With a slight clouding of the eye media, vitreolysis is prescribed - the evaporation of abnormal inclusions by laser radiation. After that, proceed directly to the treatment. For this, apply:

"soldering" of the retina to the epithelial layer by laser coagulation;
freezing to connect the retina and choroid (cryopexy);
installation of a silicone seal (extrascleral sealing);
pressing the retina with a balloon (extrascleral ballooning);

To improve the nutrition of tissues, implantation of the fibers of the muscles of the eye, episclera, stimulating the formation of new vessels to nourish the membranes and nerve structures, is used. In the presence of membranes that reduce vision, they are excised.

Extrascleral filling operation for retinal detachment

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

Antibiotics or anti-inflammatory drugs are injected under the conjunctival membrane, the eye is closed with a bandage, the patient is transferred to the 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 first perceives the image of the object and sends signals to the visual centers of the brain. Normally, it is tightly soldered 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 cell destruction occurs. If help is provided late, then complete loss of vision develops. The countdown in such situations goes to the clock.

Watch the video about retinal detachment and rupture:

For treatment, operations are required: ballooning or filling with an extrascleral (external) method, vitrectomy.

filling

The purpose of the operation is to reduce the distance between the membranes of the eye using a silicone sponge. Such a filling compresses the sclera, prevents tissue rupture, and provides gradual resorption of the accumulated fluid under the retina. Sealing is carried out according to the radial, sectoral or circular method, depending on the zone and area of exfoliation. Stages of surgical intervention:

selection of the detachment area and the manufacture of silicone fillings;
conjunctival incision;
sponge implantation, suture fixation;
fluid removal, drainage;
the 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 can be infection, weakening of the oculomotor muscle fibers, increased pressure inside the eye. In the late period, the development of cataracts, myopia is possible.

Ballooning

It is used only with uncomplicated detachment of the retina, the absence of rupture or hemorrhage into the internal environment of the eye. With the help of a catheter, a balloon is passed behind the eyeball, into which liquid enters after it has reached the right place. Pressure on the sclera causes the retina to be fixed in its normal position.

Extrascleral retinal ballooning

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

Vitrectomy

Such an operation involves the removal of the vitreous body and its replacement with the help of artificial polymer compounds, oils, gases. The method is contraindicated in case of reduced transparency of the cornea, severe retinopathy or pathology of the optic nerve. Through several thin punctures, a gel-like substance is removed, which fills the space between the lens and the retina.

The remaining tissues of the retina are cauterized with laser beams, the areas of detachment are compacted, and the lost integrity is restored.

Microinvasive vitrectomy surgery

The duration of the surgical intervention is about 3 hours. With sufficient qualification of the ophthalmologist, postoperative complications (glaucoma, corneal edema, infection of the membranes of the eye, hemorrhage, relapse of the detachment of the membrane) are rare.

retinal replacement surgery

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

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

Implants allow for electrical stimulation of the remaining retinal cells; after the operation, it is possible to achieve an eye reaction to light and perception of the contours of objects. A new treatment is growing new tissue from stem cells. Japanese doctors performed a retinal transplant, for which the patient's cells served 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 photocoagulation are the main ways to strengthen the eye membrane in case of its detachment.

Exposure to liquid nitrogen

Cryopexy is indicated for damage to one eye against the background of 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 against 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 attached to the patient's eye to fix the eyeball and limit involuntary movements. After the beam is directed to the damaged area, point effects are applied, 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. Drawing points can be of the following types:

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

Pneumoretinopexy

A mixture of fluorine-containing gas and air is introduced into the syringe. Under the control of an ophthalmoscope, this mixture enters the retina, and the liquid is pumped out with the same syringe. Such actions are repeated, and 3 hours after the procedure, laser coagulation is performed. The points are applied as close as possible to the delamination zone. If the area of discontinuity is at the periphery, then liquid nitrogen can be used instead of laser light.

Recovery after eye surgery

As a rule, the patient's stay in the hospital 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 the control examination by an ophthalmologist. During the recovery period, a scheduled visit to the doctor is required to examine the fundus and determine visual acuity.

For several days, you need to wear an eye patch and goggles to protect from the sun's rays. Also, until the end of tissue repair, it is prohibited:

If the removal of the vitreous body was carried out, then for six months you need to abandon air travel and hiking in the mountains. Patients are shown taking drugs to accelerate healing, injections of metabolic activators, instillation into the eyes:

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, the prescribed remedy should be dripped prophylactically 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.

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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 loss of vision.

For the first time such a diagnosis was made by de Saint-Yves in the early 1700s, but they began to speak about the disease with certainty since 1851, when Helmholtz first invented the ophthalmoscope. Unfortunately, until the 1920s. retinal detachment always resulted in blindness until Jules Gonin, MD, had the first retinal detachment operation. In subsequent years, there has been a rapid growth in the methods and technologies for the surgical treatment of retinal detachment, and the modern possibilities of ophthalmic microsurgery make it possible to successfully deal with 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, timing of the disease, the patient's condition and the presence of concomitant ophthalmic pathology.

Consider different clinical situations:

Rhegmatogenous retinal detachment is undoubtedly a medical emergency requiring emergency surgical intervention. The optimal time for surgery is 1-2 days after the onset of the disease. The sooner the integrity of the layers is restored, the more chances the patient has to regain good vision. If the macula is involved in the process, treatment should be started within a day. If the macula remains intact, the operation can wait a few days, provided that strict bed rest is observed. Regardless of the age of the patient, surgical treatment should consist of two main components - the closure of the defect (rupture) and the elimination of traction effects, which led to the formation of the gap.

Surgery for traction retinal detachment may not be as urgent - the patient can be observed dynamically, especially if there is no marked progression. But when the macular region is involved in the process, microsurgical intervention is often indicated. With a significant traction component, vitrectomy is indicated, sometimes there is a need for episcleral sealing.

Exudative retinal detachment rarely requires emergency interventions. The exception is submacular hemorrhage, the 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 the treatment is the selection of an insulin 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 performed on an emergency basis, 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.

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

Since there are several types of operations for the treatment of 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 choice of method of surgical intervention, the goal of its implementation is to identify and close the site of retinal break or breaks, while minimizing iatrogenic damage. It is retinal tears in the vast majority of cases that are the cause of detachment. Also, during the 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 methods and endovitreal methods. Extrascleral sealing of the retina is carried out outside the eyeball on the surface of the sclera, and the detached retina approaches the underlying pigment epithelium due to the depression of the outer wall of the eye. Endovitreal methods involve pressing the retina from inside the eye. Defects are sealed by forming strong chorioretinal adhesions due to temperature or energy effects on the eye tissues in the area of retinal rupture. The following methods are most widely used:

For episcleral retinal sealing, seals made of solid silicone or silicone sponges are used, which allows radial, sectoral or circular extrascleral sealing, 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. Indirect ophthalmoscopy is performed to localize all breaks. After the defects are identified, they are closed using transscleral cryopexy.

The filling element is prepared and sutured outside the eyeball, pressing the sclera into the projection of the retinal break so that the gap is completely located on the shaft of the seal. If there is a significant amount of fluid under the retina, the surgeon decides whether it is necessary to drain the subretinal space to ensure a snug fit of the detached retina on the filling without a significant increase in intraocular pressure. A circular continuous suture or interrupted sutures are applied to the incision of the conjunctiva, which are removed 10-14 days after the operation.

Initially, it was the operation of choice for complicated conditions, such as giant retinal tears or diabetic traction detachments. To date, microinvasive vitrectomy has been successfully used by many vitreoretinal surgeons for uncomplicated primary conditions.

The most popular is the 3-port technique using 23- and 25G instrumentation. In the presence of axial opacities (for example, hemorrhage into the vitreous body), they are removed. In phakic pars plana patients, vitrectomy has a higher risk of cataract formation compared to scleral buckling, so the vitreoretinal surgeon takes the necessary steps to avoid damage to 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. With the help of a vitreotome instrument, the vitreous body 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 existing retinal defects, and the edges of the retinal tear are then subjected to cryotherapy or laser photocoagulation to form a chorioretinal adhesion. For the purpose of reliable fixation of the retina, intraocular tamponade is used with a long-term absorbable gas-air mixture or silicone oil. The advantage of gas is a 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 ophthalmic care adopted in a particular medical institution.

Pneumatic retinopexy

Pneumoretinopexy consists of an intravitreal injection of an expanding gas bubble to press the retina from inside the eye in the region of the rupture 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, either cryopexy is performed in the area of ruptures at the same time.

Possible complications and consequences

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

infectious processes. Attachment 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 constantly taken drugs, pay special attention to anticoagulants and antiplatelet agents.

Lens damage and cataract development after vitrectomy.

Development after episcleral filling.

intraocular hypertension.

Recurrent retinal detachment requiring reoperation.

All the described complications are successfully corrected with timely diagnosis. After the operation, the specialist determines the schedule for visiting the clinic for follow-up examinations. In case of a sudden deterioration in the condition, the appearance of pain or a sharp deterioration in vision, it is necessary to visit your doctor on the same day.

Recovery period

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

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

It is forbidden to rub your eyes, put external pressure on them, use makeup cosmetics for 2 weeks.

For the first few days, it is optimal to observe a sparing regimen, subsequently avoid intense physical exertion and weight lifting.

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

There are restrictions on visiting baths, saunas.

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

CHI operation, price in private medical centers

There is a possibility of free operation for retinal detachment. Public health institutions have quotas for such treatment. That is, having waited in line, the patient can undergo a vitrectomy or extrascleral retinal filling free of charge. Laser coagulation is also carried out free of charge as prescribed by the attending physician. In the hospital, the patient after the examination is recorded for surgery. However, timely, as soon as possible, carrying out surgery for retinal detachment is the main factor that allows you to restore vision lost as a result of the disease.

There are practically no queues in private ophthalmological 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 the operation method. The price of laser coagulation of the retina varies within 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.