Fluorescein and Indocyanine Green Angiography
In order to find abnormal blood vessels under the retina and/or to identify conditions that can cause retinal swelling and reduced vision, it is often necessary to perform a test called angiography.
This test is performed by injecting a dye into the vein of the arm and photographing the dye as it passes through the circulation in the back of the eye.Depending on the pattern of dye transmission and leakage, certain disease processes can be identified and treated. Two different dyes are commonly used: fluorescein and indocyanine green. Special digital cameras joined to modern computers are used to maximize the effectiveness of this test.
When it is impossible to view a patient's retina because the vitreous is sufficiently cloudy so as to prevent light from passing through the eye effectively, the physician will employ ultrasonography to view the back of the eye.The machine in our office is quite similar to that used by obstetricians when viewing a fetus in the mother's womb. This painless test can often identify retinal detachments and tumors in the back of the eye when the actual disease process cannot be viewed directly.
A laser is a powerful beam of light which, combined with ophthalmic equipment and lenses, can be focused on the retina. Small bursts of the laser can be used to seal leaky blood vessels, destroy abnormal blood vessels, seal retinal tears, and destroy abnormal tissue in the back of the eye.
The retina specialist in the treatment of wet macular degeneration and diabetic retinopathy commonly uses laser photocoagulation.
Cryotherapy involves the application of a very cold probe to the outside of the eye, which because of the thin nature of the eye wall (sclera) transmits the freezing temperature to the retina. Like a laser, the intense cold stimulation to the retina can seal abnormal leaky retinal blood vessels or seal retinal tears. This technique is often preferable to laser in treatment of certain conditions in the far periphery (corners) of the retina.
This is an in-office method of repairing certain types of retinal detachment. It relies on an intravitreal injection of a small amount of medical grade gas to seal and repair the inciting retinal hole (the cause of the retinal detachment), by positioning the retinal hole against the wall of the eye.
After placement of the gas, the patient must maintain a certain head position for approximately one-week to allow maximum gas-retinal hole contact. The intravitreal gas spontaneously dissolves several weeks after its placement, at which time the retina is hopefully permanently reattached.
A scleral buckle is a flexible piece of sponge or hard rubber, which is sewn to the outside of the eye during an operative procedure, which is usually performed in the hospital. Combining placement of the scleral buckle with other techniques, such as drainage of fluid under the retina, cryotherapy, or laser, a retinal surgeon can reposition a detached retina.
Vitrectomy is a microsurgical procedure, performed in an operating room, during which time the vitreous gel is removed from the eye. This operation is usually associated with other intraoperative techniques, such as removal of intraocular scar tissue and laser.
Sometimes, air is injected into the vitreous cavity at the conclusion of such surgery, but this air will spontaneously dissolve on its own in days to weeks following the procedure.
A vitrectomy is useful in the repair of complicated retinal detachments, diabetic retinopathy, macular holes, and macular pucker.
In an attempt to control cytomegalovirus retinitis, a common manifestation of acquired autoimmune deficiency syndrome (AIDS), a long-acting pelletized capsule of antiviral ganciclovir is placed into the anterior vitreous cavity during short a operative procedure. By slowly releasing the medication into the vitreous cavity, the retinal infection can be held in check and preserve vision.After 6-7 months, this implant may need to be replaced by a fresh one. This type of localized treatment for this serious eye infection obviates the need for daily intravenous injections.
In-Office Temporary Balloon Scleral Buckle
This procedure reattaches the retina using similar repair mechanisms as the in-hospital scleral buckle procedure, except that it can be performed in the office and does not result in the placement of a permanent silicone sponge sewn to the eye wall.Instead, a small balloon (about the size of a pea) is positioned on the outside of the eye in an area corresponding to the retinal hole. Gentle pressure exerted on the hole by the balloon, combined with laser or cryotherapy, results in permanent retinal re-positioning against the inner curvature of the eye.
Usually, the balloon buckle is withdrawn 7-10 days after placement.
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