Last week unfortunately I went for my right eye retinal detachment surgery. New retinal detachment was detected after initially thought that I can avoid surgery after laser treatment to weld the earlier retina tear.
The surgery was done by Dr Angela Loo (Consultant Ophthalmologist – Retina Eye Specialist) at University Malaya Specialist Centre (UMSC) in Petaling Jaya.
The surgery wasn’t painful but I felt very painful when the needle pokes to my eye. I was only given local anesthesia and eye drop to numb the eye which is normal but nevertheless the surgery lasted only one hour.
After the surgery I was told to rest at home for 2 weeks with my face down at all time. That’s mean I have to lie and sit in a special position to keep the bubble up against the affected area.
During the surgery the surgeon injected a bubble of expandable gas into the eye. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it to the back of the eyeball. Every 2 hours I have to apply antibacterial eyedrop called Spersadexoline to help the healing process.
No work, no computer and no party for the next 2 weeks and possibly less activities until it is fully heal.
So guys if you are nearsightedness for a long time it is advisable to check your eye regularly. The only symptom is often the sudden appearance of a large number of spots floating loosely in the eye. Early detection can avoid surgery.
For the benefit for those who do not understand what retinal detachment is I have done some research and attached some interesting article related to my case.
What Is Retinal Detachment
Retinal Detachment is a separation of the retina (the inner nervous tunic of the eye) from the choroid in the back of the eye. The retina is the light-sensitive tissue that lies smoothly against the inside back wall of your eye and sends messages to your brain through your optic nerve. Underneath the retina is the choroid — a thin layer of blood vessels that supplies oxygen and nutrients to the retina. Retinal detachment occurs when the retina separates from the choroid.
Usually this happen when there is a small tear or hole in the retina that allows the vitreous humor (fluid) to leak between the choroid and the retina.
Most retinal detachments are caused by the presence of one or more small tears or holes in the retina. Normal aging can sometimes cause the retina to thin and deteriorate, but more often shrinkage of the vitreous body, the clear gel-like substance which fills the center of the eye, is responsible for deterioration and retinal tears.
The vitreous is firmly attached to the retina in several places around the back wall of the eye. As the vitreous shrinks, it may pull a piece of the retina away with it, leaving a tear or hole in the retina.
Though some shrinkage of the vitreous body occurs naturally with aging and usually causes no damage to the retina, abnormal growth of the eye (sometimes a result of nearsightedness), inflammation or injury, may also cause the vitreous to shrink. In most cases, a significant change in the structure of the vitreous body occurs before the development of a retinal detachment.
Once a retinal tear is present, watery fluid from the vitreous space may pass through the hole and flow between the retina and the back wall of the eye. This separates the retina from the back of the eye and causes it to “detach.” The part of the retina that is detached will not work properly and there will be a blindspot in vision.
Causes and Risk Factors of Retinal Detachment
It is more likely to develop in people who are nearsighted, or whose relatives had retinal detachments. A hard, solid blow to the eye may also cause the retina to detach. Severe trauma to the eye, such as a contusion or a penetrating wound, may be the cause, but in the great majority of cases, retinal detachment is the result of internal changes in the vitreous chamber associated with aging, or less frequently, with inflammation of the interior of the eye.
It should be noted that there are some retinal detachments that are caused by other diseases, such as tumors, severe inflammations or complications of diabetes. These so-called secondary detachments do not have holes or tears in the retina, and treatment of the disease which caused the retinal detachment is the only treatment which may allow the retina to return to its normal position.
Screening and diagnosis
An ophthalmologist can look carefully at your eye with special instruments to determine what’s causing your visual symptoms. It’s possible to tell if you have a retinal hole, tear or detachment by looking at your retina with an ophthalmoscope — an instrument with a bright light and powerful lens that allows your doctor to view the inside of your eyes in great detail and in three dimensions.
If blood in your vitreous cavity prevents a clear view of the retina, your ophthalmologist might also use sound waves (ultrasonography) to assess your retina. Ultrasonography is a painless test that sends sound waves through your eye to bounce off the retina. The returning sound waves create an image on a monitor that allows your doctor to determine the condition of the retina and other structures inside your eye. This test usually provides the information your doctor needs to determine whether your retina is detached.
Symptoms of Retinal Detachment
In most cases, retinal detachment develops slowly. The first symptom is often the sudden appearance of a large number of spots floating loosely in the eye. These spots, specks, hairs and strings are actually small clumps of gel, fibers and cells floating in the vitreous. And what you’re seeing are the shadows that this material casts on the retina. The person may not seek help, because the number of spots tends to decrease during the days and weeks before detachment. The person may also notice a curious sensation of flashing of sparkling lights when you eye closed or when in you’re in a darkend room.
Because the retina does not contain sensory nerves that relay sensations of pain, the condition is painless.
Detachment usually begins at the thin peripheral edge of the retina and extends gradually beneath the thicker, more central areas. The person perceives a shadow that begins laterally and grows in size, slowly encroaching on central vision. As long as the center of the retina is unaffected, the vision when the person is looking straight ahead, is normal; but when the center becomes affected, the eyesight is distorted, wavy and indistinct. If the process of detachment is not halted, total blindness of the eye ultimately results. The condition does not spontaneously resolve itself.
Treatment of Retinal Detachment
All cases of retinal detachment should be referred to an ophthalmologist as soon as possible.
If Retinal Detachment Has Not Occurred
If the retina is torn and retinal detachment has not yet occurred, a detachment may be prevented by prompt treatment. Treatment is aimed at closing retinal tears (so as to facilitate reattachment of the retina). Once the retina becomes detached, it must be repaired surgically.
If it can be caught when there is only a hole and no fluid has separated the retina from the back of the eye then laser treatment (photocoagulation) or cryotherapy may be used to seal around the hole to stop the fluid going through. Healing typically takes about two weeks. Your vision may be blurred briefly following either of these procedures:
Laser surgery (photocoagulation). During photocoagulation your surgeon directs a laser beam through a special contact lens or through a special ophthalmoscope to make burns around the retinal tear. The burns cause scarring, which usually “welds” the retina to the underlying tissue. This procedure requires no surgical incision, and it causes less irritation to your eye than does cryopexy.
Freezing (cryopexy). With cryopexy your surgeon uses intense cold to freeze the retina around the retinal tear. After a local anesthetic numbs your eye, a freezing probe is applied to the outer surface of the eye directly over the retinal defect. This freezes the area around the hole, and the resulting delicate scar helps secure the retina to the eye wall. Cryopexy is used in instances where the tears are more difficult to reach with a laser, generally along the retinal periphery. Your eye may be red and swollen for some time after cryopexy.
If Retinal Detachment Has Occurred – The Surgery
Doctors commonly use one of these surgical procedures to repair a retinal detachment. Some of these procedures are done in conjunction with photocoagulation or cryopexy. The purpose of these treatments is to close any retinal holes or tears and to reduce the tug on the retina from a shrinking vitreous. The type, size and location of any retinal detachment will determine which procedure your eye surgeon recommends. In general, these surgeries can successfully treat more than 90 percent of cases of retinal detachment, although a second treatment is sometimes necessary.
Pneumatic Retinopexy. This surgical technique is generally used for a relatively uncomplicated detachment when the tear is located in the upper half of the retina. It’s usually done on an outpatient basis under local anesthesia.
The retina is reattached by injection of a bubble of expandable gas into the vitreous cavity. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear. With no new fluid passing through the retinal tear, fluid that had previously collected under the retina is absorbed, and the retina is able to reattach itself to the back wall of your eye.
Once the retina is reattached, the retinal tear can be sealed by laser photocoagulation or cryotherapy.
You may have to hold your head in a cocked position for a few days after surgery, to make sure the gas bubble seals the retinal tear. And it may take several weeks for the bubble to disappear completely. Until the gas is gone from your eye, avoid lying or sleeping on your back. This keeps the bubble away from your lens and reduces the risk of cataract formation or a sudden pressure increase in your eye.
During this time, you can’t travel by airplane or be at a high altitude because a sudden drop in atmospheric or cabin pressure would cause the gas bubble to expand rapidly, resulting in a dangerously high pressure in your eye.
Scleral buckling. This is the most common surgery for repairing retinal detachment. It’s usually done in an operating room under local or general anesthesia. If you have an uncomplicated retinal detachment, this surgery may be done on an outpatient basis.
First your surgeon treats the retinal tears or holes with cryopexy. Then he or she attaches a tiny silicone band (buckle) to the white of your eye (sclera) over the affected area. The silicone material is in the form of either a soft sponge or a solid piece. The buckle closes the tear and helps reduce the traction on the retina, which prevents further vitreous pulling and separation. When you have several tears or holes or an extensive detachment, your surgeon may create an encircling scleral buckle around the entire circumference of your eye.
The scleral buckling material is stitched to the outer surface of the sclera. Before tying the sutures that hold the buckle in place, the surgeon may make a small cut in the sclera and drain any fluid that has collected under the detached retina. The buckle usually remains in place for the rest of your life. Some surgeons may choose a temporary buckle for simple retinal detachments, using a small rubber balloon that’s inflated and later removed.
A reattached retina doesn’t guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery, and if it was, for how long a period. Your sight isn’t likely to return to normal if the macula was detached.
Vitrectomy Operation. This the surgery type that I went through. A vitrectomy operation involves making 3 very tiny holes in the eye through which instruments can be put to help remove the jelly inside the eye.
Your surgeon accomplishes this with a variety of delicate instruments passed into the eyeball through small openings in the sclera. These instruments include a light probe that illuminates the inside of your eye, a cutter to remove vitreous or scar tissue, and an infusion tube that replaces the volume of removed tissue with a balanced salt solution to maintain the normal pressure and shape of the eye.
After completing the vitrectomy, your surgeon may perform a scleral buckling procedure or pneumatic retinopexy procedure by filling the inside of your eye with air, expandable gas or silicone oil to help seal the retina against the wall of your eye.
Vitrectomy surgery typically lasts more than an hour but may take several hours in more complex cases. The complex cases are often done under general anesthesia, but shorter procedures are usually performed under local anesthesia.
After surgery, you may experience some discomfort and a scratchy sensation in your eye. Severe pain is unlikely. You can expect your eye to be red, swollen, watery and slightly sore for up to a month following any surgery for retinal detachment. Wearing an eye patch may provide some relief. Your doctor may also prescribe antibacterial or dilating eyedrops to help the healing process. You’ll have to avoid strenuous activities during this time. It takes about 10 weeks for your eye to heal fully. Then your doctor will examine your eyes to assess your vision and, if you wear eyeglasses, determine whether you need a new prescription.
Your vision may take many months to improve after surgery to repair a complicated retinal detachment. Some people don’t recover any lost vision.
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To Your Millionaires Success
Michael Liew
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