Can amblyopia be cured surgically

If holes or tears appear in the retina, retinal detachment can occur. If left untreated, it can lead to blindness within a few days. The treatment of retinal detachment is a focus of our Sulzbach Eye Clinic. Every year we successfully treat 700 retinal detachments. In most cases it is important not to delay the necessary therapy.

Did you know?
We are the only center in the southwest, in addition to the normal emergency service, to offer 24-hour retinal standby with 7 experienced retinal surgeons. This enables us to deal with even difficult emergencies immediately and competently.

Important: The signs of retinal detachment

  • Flashes of light - similar to how they are perceived during a thunderstorm
  • Soot rain or that Appearance of black points
  • Narrowing the field of vision - similar to a dark wall that grows upwards from below or a curtain that lowers downwards, or a shadow that extends from the side towards the center of vision

How do retinal holes arise?
Degenerative changes in the retina or a vitreous detachment pulling on the retina can cause holes or tears in the retina. Sometimes small blood vessels are damaged, causing the vitreous humor to bleed. The changes described do not cause any pain. Often, however, patients perceive clear flashes of light through the vitreous body. If bleeding occurs, it appears like a shower of soot. If the bleeding is profuse, vision can be significantly impaired.

What is retinal detachment?
If holes or tears appear in the retina, fluid gets behind the retina and lifts it off the underlying tissue. Typical characteristics of a retinal detachment are sudden flashes of light, swarms of black dots, a restricted or shaded field of vision and a general deterioration in vision.
Figure: Retinal detachment (right half) with wavy, raised retina

What are the dangers without treatment?
If the retina begins to detach, it unfortunately does not attach itself again. Without surgery, the retina continues to detach until it is completely removed from its base. If we do not surgically re-attach the retina, the photoreceptors of the retina die. There is a risk of permanent blindness in the affected eye. If the detachment process has affected the center of the retina, you must assume that, despite the successful operation, you will not regain your previous vision. For this reason, a quick check by an ophthalmologist or a presentation to our emergency service is required in the event of the above-mentioned complaints.

Did you know?
As one of the largest centers for retinal / vitreous surgeries (> 2,200 vitrectomies), we offer you the entire spectrum of retinal surgery - including 24-hour operational readiness with 6 experienced retinal surgeons.

The treatment

What are the dangers without treatment?
If the retinal holes described are not treated, then liquid from the vitreous body reaches behind the retina and detaches it from its base. One then speaks of a retinal detachment. This is an emergency and usually has to be operated on immediately, otherwise there is a risk of blindness. Pay attention to the symptoms described above, such as lightning or soot rain.

Treatment with laser
We can usually close retinal holes without detachment with an outpatient laser treatment. A targeted laser beam is focused on the retina. This causes stable scarring of the retina in the area of ​​the defect edges and seals the retina permanently. Thus we can prevent a detachment. The process can be compared to welding.

Advantages:

  • Outpatient treatment
  • Treatment in the most modern drop anesthesia
  • Mostly painless

Limits:

  • Only possible in minor cases without a relevant replacement

Retinal hole (horseshoe foramen) surrounded and sealed with laser. Fresh laser foci on the left, stable scarring on the right after 3 months

At the first symptoms: act quickly!
Patients with a detached retina usually have to be operated on quickly in order to reattach the retina and ensure the oxygen supply to the center of the retina. The earlier we detect retinal detachment, the smaller the surgical procedure and the damage to vision.

Treatment with surgery
If a retinal detachment has already occurred, it usually has to be treated surgically. The type of operation depends on the individual retinal findings. It can be done either from the inside of the vitreous body (vitrectomy) or from the outside (seal stitching).
The aim of the operation is to permanently close the retinal hole that caused it. This is done in 2 steps: First, the retina is reattached (approximation with tamponade or seals). The retina is then permanently fused to the base in the area of ​​the defect (fixation with laser or cold treatment). There are three different methods for doing this:

The seal surgery
By sewing on a plastic seal from the outside, a permanent indentation of the eye wall is achieved: To do this, we open the conjunctiva and sew a plastic seal onto the dermis, which indented the eye wall. Sometimes we put a seal around the entire eye like a ring (cerclage). The body tolerates the material used well and does not need to be removed. This method is the oldest. We only use them in a few special cases.

Advantages:

  • Lens-sparing

Limits:

  • Older method
  • Reduced view of the surgeon
  • No direct lighting of the operating field
  • Invasive cold treatment instead of gentle laser treatment
  • Certain areas not easily accessible (holes under the muscle insertion)
  • Possible double vision after the operation

The vitrectomy (removal of the vitreous humor)
The retina is created from within. Access is made with micro-trocars through which we insert fine instruments (0.6 mm) into the eye. First, the vitreous is removed and then the retinal defect is sealed with a laser. At the end, the retina is sealed with a temporary tamponade. A gas bubble is usually used for this. Silicone oil is only used in severe cases. The process is more modern and has been technically improved significantly in recent years. It is therefore our standard procedure.

Advantages:

  • Modern, gentle process
  • Good wide-angle view to identify additional retinal holes
  • Gentle laser instead of invasive cold treatment

Limits:

  • Accelerated development of cataracts
  • Requires a tamponade at the end of the operation
  • Certain places problematic (holes at the bottom)

Hydrogel seal
This is a new method developed in our Sulzbach Eye Clinic that is particularly gentle. We close the retinal defect using a particularly small incision using only a special gel. In this way, the choroid is brought closer to the retina again and we can achieve scarring of the retinal defect with a laser treatment. This very elegant technique is minimally invasive and combines the advantages of seal surgery and vitrectomy. This technology was developed by our research team in 2014 and presented and scientifically published in numerous congresses.
P. Szurman, K. Boden, K. Januschowski. Suprachoroidal hydrogel buckle as surgical treatment of retinal detachments - biocompatibility and first experiences. Retina 2016 Jul 14; [Epub ahead of print] [IF 3.243]

The best from both worlds:

  • Particularly gentle process
  • Treat a retinal detachment in minutes
  • Lens-sparing
  • Good wide-angle view to identify additional retinal holes
  • Gentle laser instead of invasive cold treatment
  • Holes under muscle attachments can also be treated
  • Resorbable hump

How do I behave after the operation?
After the operation, you have to maintain a certain body or head posture for a few days so that the rising gas bubble lies exactly on the retinal defect and closes its edges. It can take a few weeks for the body to reabsorb the gas. In individual cases, a filling with silicone oil is necessary. The oil is not absorbed by the body and has to be removed again in a follow-up operation.

What are the chances of success?
In around 90% of patients, the retina can be permanently reattached with an operation. Occasionally, there may be scarring on the retina, which can lead to retinal detachment again. In such cases, multiple interventions are often required. Even if we have successfully created the retina, there is a permanently increased risk of a new retinal detachment - either in the same eye or in the partner eye. That is why regular checks by your ophthalmologist are necessary. If the symptoms recur (see above), please contact us or your ophthalmologist as soon as possible.