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Summarized below are different laser
treatments and surgical procedures applied for a variety of retinal
problems.
Diabetic Retinopathy Treatments
Three laser treatments have been developed for the treatment of
diabetic retinopathy at different stages of the disease. The goal
for each of these procedures is to stabilize the vision; they cannot
correct the damage already done.
Focal Laser Treatment is
an in-office procedure used to treat macular edema, or swelling
in the anterior part of the eye. Patients undergo a dilated eye
examination and a flouroscein angiograph
prior to the treatment in order to identify the location of leaky
blood vessels that cause the swelling. During the procedure, a laser
is used to seal off the leaky blood vessels and prevent further
leakage. As the existing blood dissipates, the swelling is reduced.
The sooner the problem is diagnosed and the earlier treatment is
applied, the higher the likelihood of a successful outcome.
Grid Laser Treatment also
an outpatient procedure that is used to seal off a wider array of
leaky blood vessels over a diffuse area. Because there are more
leaks, there is also more swelling in the eye. The laser treatment
is similar to focal laser treatment except that more leaks are sealed
in the eye. Again, the object of this treatment is to reduce swelling
in the eye.
Pan Retinal Photocoagulation (PRP)
As the severity of diabetic retinopathy progresses, swelling causes
ischemic tissue (oxygen-deprived tissue) that sends signals to the
body to produce new blood vessels. These new vessels tend to be
abnormal and often break open and bleed, making the situation worse.
With PRP, tissue is selectively destroyed using a laser in order
to force the new blood vessels to shut down. When successful, this
technique reduces the eyes demand for oxygen and stops the
signal for more new blood vessels.
PRP is a same day, outpatient procedure. Patients must have a clinical
examination as well as a flouroscein angiograph prior to the treatment.
There are no sutures and no patching or eye drops are required afterwards.
Recovery time is roughly 90 days.
Vitrectomy is a surgical
alternative for the treatment of severe diabetic retinopathy. In
this procedure, the damaged tissue, blood vessels and any accumulated
blood are removed from the middle of the eye with the help of a
laser and replaced with saline solution to keep the globe formed.
Vitrectomy is a same day, outpatient procedure.
Retinal Detachment
A retinal detachment occurs when the retinal tissue detaches from
the eye wall in the back of the eye. There are many possible causes
for retinal detachment, such as blunt trauma, weakness in the tissue
or holes. Retinal detachment is often marked by the sudden loss
of half or all of the vision in one eye. It may also be accompanied
by light flashes. Retinal detachments are easily diagnosed in a
dilated eye examination.
The specific treatment used to re-attach the retina to the eye
wall depends on where the detachment occurred. The options include
injecting a gas bubble (pneumatic
retinopexy) to support the retina while new tissue builds
to connect it to the wall of the eye; cryosurgery
that creates scar tissue that allows the retina to reattach to the
eye wall; or sclera buckle,
in which a device is inserted permanently into the eye to reduce
tension on the retinal surface. Patients generally go home the same
day as the procedure. Depending on the treatment used, patients
may have to maintain a head down position for a few days. The full
recovery period can take several months. Retinal re-attachment surgery
is usually very successful, although in some cases a second surgery
is required.
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