Retinal detachment represents separation or the retinal layer from other parts of the eye, due to the brakes in one or more layers of the retinal tissue.
At a beginning, while the detachment is still small, patient can see dark spots in their visual field. When detachment comes in the macular area, which can happen within 1 or 2 days, the vision becomes poor and the patient cannot read, or see farther.
Prof. dr Nikica Gabrić, dr med.
Mr sc. Bojan Kozomara dr med.
Ernesta Potkonjak, dr med.
Nebojša Đogatović, dr med.
Sanja Savičić, dr med.
Ana Aničić, dr med.
Miloš Milićević, dr med.
Vladimir Račić, dr med.
Borjana Solomun, dr med.
Dajana Abdulaj, dr med.
Tamara Bojanić Barić, dr med
Every retinal detachment is treated by vitrectomy. Since the retinal sensory cell survives only if the retina is attached to the rest of the eye, it is crucial to undergo the surgery within 24-48 hours upon detachment development. The surgery itself is done under local anesthesia with sedation. The surgery is painless, it lasts around an hour, and the patient leaves the clinic immediately after the surgery.
During vitrectomy, four small ports are made on the eye’s sclera (white part of the eye). Vitreous is then removed, retina repositioned to its anatomical place in the eye and all retinal holes are closed. The eye is filled with gas or silicone oil, depending on the degree of damage. Silicone oil may be removed from the eye in 3-6 months with another surgery, while the gas evaporates by itself within a month postoperatively.
After vitrectomy, the eye is not panful, nor inflamed. During postoperative period, it is mandatory that the patient uses prescribed topical therapy. Postoperative exams are scheduled at first postoperative day, then 1 and 2 weeks after the surgery. It is advisable that the patient rests as much as possible, and to position the head so that the retina can heal better. During postoperative period, the patient can read, work on their computers, or watch TV.
With retinal detachment, the time is crucial in getting better postoperative results. Delaying surgery can only cause irreparable damage to the retinal cells, and consequently the vision of the eye. Eye Clinic “Svjetlost” Banja Luka can organize the surgery within 24 hours of retinal detachment occurrence, which to many patients can save their vision. The surgery itself is done under local anesthesia with sedation, meaning that the patient can go home the same day.
Rupture of the macula is a defect that can occur as full or partial thickness. The disease itself develops without any specific cause, but always due to the aging of the eye. Therefore, it is more often seen in patients over 60 years of age. In rare cases, eye trauma can be a cause of the macular hole.
The disease usually develops in one eye only and it is completely painless. Macular rupture can be divided into four stages, depending on the size of the hole. Considering the fact that the disease is only seen in one eye, it makes it hard to notice and almost always late to diagnose. Patients with macular hole complain on the poor central vision, even though the visual field is healthy and complete. While reading, patients can also notice that some letters are missing from the text and that the lines are not straight, but rather dashed.
Macular pucker is a disease of the macula which develops due to thick membrane formation over fovea. As the membrane progresses and turns into scan tissue, it becomes macular pucker.
Experienced ophthalmologist can diagnose macular pucker during regular examination, when the pupils are dilated and posterior pole of the retina can be well visualized. More detailed examination can be obtained by OCT (optical coherent tomography) of the macula, where a thick membranous formation can be seen. Regular assessment of the hole and the pucker are crucial for further proceeding when it comes to the therapy determination. Big holes and thicker membranes are usually an indications for surgical procedure.
In general, treatment for macular pucker and macular hole is strictly surgical. As in retinal detachment and diabetic ocular diseases, the method of choice is vitrectomy. During this procedure, vitreous is cleaned in both cases. When it comes to the macular hole, the whole itself is closed with gas that is instilled into the eye, while in the case of macular pucker, the thick membrane is peeled off the macula and the eye is also buffered with gas. The patient is advised to keep the head down as much as possible, in order to have the best therapeutic effect of the gas inside the eye. Visual improvement can be expected one month postoperatively. The procedure itself is done under local anesthesia, and it is painless.
Postoperative recovery is fast, while the eye is not painful or inflamed. During the first postoperative weeks, it is mandatory for the patient to use prescribed local therapy regularly. Considering the fact that the eye will be filled with gas, the vision will recover subsequently, as the gas evaporates from the eye. The surgeon will ask the patient to position their head more downward in order to get as much of the effect from the gas as possible
Foreign bodies in the eye can vary according to their nature-from dust, leafs, to glass and metal. When the foreign body is discovered in the anterior or posterior eye segments, it means that the eye is perforated and that possibly various structures may are damaged.
What are the symptoms of the foreign body in the eye?
There are many symptoms of the eye’s foreign body, but most often those are the pain, tearing, photophobia, blinking and redness. If the eye is perforated with the large object, there is usually a leakage from the eye.
What is the examination process?
First and foremost, the eye is anesthetized with topical anesthetic drops. The anterior segment is died with fluorescein in order to discover the entrance wound and possible leakage point. After that, detailed examination is conducted to the anterior and posterior segment, including B-scan ultrasound. If there is any suspicion that the foreign body ended up behind the eye, it is advisable to do CT scan of the eye and orbit.
How is the foreign body extracted from the eye?
Surgical management is the only option for the foreign body removal. First, it is mandatory to close the entrance wound and stabilize the eye, and after that posterior segment surgery is conducted in order to extract the foreign body from the eye. After the closure of all wounds, patient is given high dosage of wide specter antibiotics due to a high risk of postoperative eye inflammation.
What kind of prognosis can be given to the patient?
Perforating eye injuries are the most dangerous and most devastating conditions in ophthalmology. Prognosis mainly depends on the degree of perforation, type of the foreign body and the timing of the surgical procedure. If the perforating injury is small and the patient is operated on time, then the full recovery can be expected. On the other hand, if the foreign body is big in size, it damaged retina significantly, and inflammation occurs, then the prognosis is usually poor. It is crucial that the patient is referred to a proper institution as soon as the injury occurs. That way, good postoperative results can be expected.