“Fluorescein angiography is an important test to study the retina (or “film”) at the back of your eye. It is used to diagnose certain eye conditions and to guide treatment. It is commonly performed in diabetic retinopathy, age-related macular degeneration and diseases affecting the blood vessels in your eye.”
“Fluorescein angiography uses a dye to take special photos of the back of your eye (retina)”.
“This is a commonly performed and generally safe procedure, but as with any medical procedure, complications can occur”:
More Common
Less Common
Optical coherence tomography-Angiography (OCT-A), OCT, indocyanine green angiography (ICG) and fundus autofluorescence may offer complementary information.
NB: Renal failure is not a contraindication to fluorescein angiography.
“An intravitreal injection is an injection into the jelly inside the eye called the vitreous. This delivers medication to the retina at the back of the eye. It is a commonly performed procedure used to treat a number of conditions including age-related macular degeneration, diabetic retinopathy, inflammation in the eye and diseases affecting the blood vessels in the retina.”
“There are two forms of macular degeneration: wet and dry. You have the wet form where abnormal blood vessels grow underneath the retina causing bleeding that blurs your vision. We now have drugs that when injected in the vitreous can stop the growth of these vessels and reduce the bleeding. Most patients will notice an improvement in their vision. You are likely to require a number of treatments, initially monthly.”
“Medication will be given into your eye as an injection”
Most patients tolerate the injection very well.
Common
Less Common
Serious complications occur rarely (<0.1%):
Any of these complications can lead to severe permanent loss of vision.
Vision
Astigmatism is common
May need glasses/contact lenses/another operation
Takes time for good vision
A) Anti-VEGF Injections
B) Intravitreal Steroid Injections
“You have swelling at the back of your eye (“retina”) due to leaking blood vessels from diabetes / vein occlusion. This swelling is causing a reduction in your vision (“wet camera film” analogy)”.
Aims:
Although macular laser has a good success rate, complications may occur:
Stress close follow-up, need for urgent review if vision declines.
“You have advanced damage to the back of your eye (“retina”) from diabetes. This has resulted in the growth of abnormal blood vessels in the retina. If left untreated these blood vessels can bleed (reducing your vision) or cause scarring and retinal detachment.”
Aims:
This is the mainstay of treatment for proliferative “severe” diabetic retinopathy and has been demonstrated to reduce the risk of severe vision loss by 50% (Diabetic Retinopathy Study DRS).
“Laser targeting the peripheral part of the back of your eye (“retina”) is required to prevent bleeding and preserve your central vision.”
“Although PRP has a good success rate, complications may occur:”
Pain / Discomfort
Can have peribulbar anaesthetic if unable to tolerate
↓ Peripheral / Night vision
↓ Night Vision (Nyctalopia)
Loss of Near Vision
Reduced accommodation in pre-presbyopic patients
Vision Loss
Uncommon (worsening of macular oedema, inadvertent foveal burn, CNV)
Stress close follow-up, need for urgent review if develops reduced vision.
“You have an abnormal blood vessel or vessels in the back of your eye that could result in long term vision loss without treatment. This treatment helps to seal off those abnormal blood vessels.”
PDT can be used for central serous chorioretinopathy (CSC) as well as certain types of wet age-related macular degeneration (polypoidal choroidal vasculopathy).
Aim: Stop further leaking and stabilise vision, may improve vision in some cases.
Preparation:
“PDT will make your skin very sensitive to sunlight for 48 hours after the procedure. You should wear long sleeve shirts, pants, feet and hand covering, hat and sunglasses if you need to go outside during this period. This also includes halogen type lights at home.”
You must exclude the following:
PDT consists of 2 parts:
PDT is a less common form of treatment for retinal conditions. There are very low but significant risks in treatment, though this appears to be reduced when treating CSR given that the treatment is halved.
“Your retina, which is like the film of a camera, has detached. A retinal detachment typically occurs because of a tear in the retina, which allows fluid to migrate underneath the retina, causing the retina to separate from the eye wall. You require an operation to re-attach the retina in an attempt to restore your lost.”
Your visual outcome will depend on the severity of the retinal detachment and whether the centre of the retina (macula) is involved. In some cases, it can take weeks to months before the vision improves.”
A retinal detachment can be repaired in multiple ways. The severity of the detachment, location and number of tears, presence of scar tissue and the age of the patient all factor into the choice of surgery.
Most operations are performed under a local anaesthetic in the operating theatre and take between 30-60 minutes.
“A vitrectomy removes the gel that fills the eye and relieves traction that caused the retina to tear. After the gel is removed, it may be replaced with a gas bubble which floats inside the eye and helps flatten the retina. The gas bubble dissolves on its own over many weeks and is replaced by the eye’s natural fluid. Laser is often used during surgery to fix the retina into place. If there is a large amount of scar tissue is present, silicone oil may be used instead but will need to be removed months later with another operation”
Patients are not allowed to fly with a gas bubble inside the eye.
“A scleral buckle involves the placement of a band around the outside of the eye. It hugs the eye wall towards the retina and helps to seal the tears that caused the retinal detachment. The scleral buckle is left permanently in place.”
Scleral buckles are generally indicated for younger, myopic, phakic patients with inferior retinal breaks.
Pneumatic retinopexy is a procedure which can repair certain uncomplicated retinal detachments. It is usually done as an outpatient procedure with a local anaesthetic.
“A gas bubble is injected into the middle of the eye and your head is positioned so that the bubble floats to the detached area and presses against the detachment. The retinal tear is sealed using a freezing probe or laser beam. The bubble helps to flatten the retina until a seal forms between the retina and the wall of the eye over a few weeks.”
The success rate with a single procedure is between 80-90%. It is generally accepted that pneumatic retinopexy has a slightly lower success rate than the other two procedures.
Complications of Vitrectomy Surgery Include:
Complications of Scleral Buckle Surgery include:
Deciding between the three procedures is dependent on the severity of the detachment, location and number of tears associated with the detachment, the presence of cataract, scar tissue or bleeding, the age of the patient and the ability of the patient to posture.
If no surgery is performed, the patient will inevitably have permanent vision loss, with disfigurement and shrinkage of the eye possible.
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12.1 Anterior Segment Procedures
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12.3 Glaucoma Procedures
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Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.