This week’s blog on Paediatric Cataract has been contributed by Dr Syed M. Asad Ali, Consultant Paediatric Ophthalmologist, Strabismus and Cataract Surgery
What is Cataract?
Cloudiness or opacity in the natural crystalline lens of the eye is called cataract. It is also called ‘white water’ or ‘white pearl’ because of its white appearance. Cataract is very common in people over the age of 50 but – contrary to common belief – it can happen at any age. When a child is born with a Cataract it’s called Congenital Cataract and it affects the vision by preventing all the light reaching the retina at the back of the eye.
Causes of Cataract in the young
Cataract can occur in one eye (unilateral) or both eyes (bilateral). In Western countries, the incidence of Cataract affecting childhood vision is about 3-4 cases in 10,000 live births. The incidence is higher in Asia.
Bilateral Cataracts can be caused by genetic mutations; over 15 gene defects have now been discovered. There are also systemic associations with metabolic disorders such as galactosemia, Wilson disease and diabetes. It has been noticed in people with Trisomy 21 (down syndrome) as well. If a mother acquires an infection such as rubella, herpes, toxoplasmosis or syphilis, this can cause Cataracts at birth.
Unilateral Cataracts are sometimes associated with other eye diseases like small eye, abnormal front of the eye (anterior segment dysgenesis), inflammation, vitreous and retinal diseases.
Any significant trauma (impact with a sharp or blunt object) to the eye can cause Cataract.
Presentation
At a very early age, parents may notice a white area at the centre of the pupil or an abnormal reflection in the pupil. Some children develop squint due to lazy eye caused by Unilateral Cataract. Children are sometimes brought to the ophthalmologist after failing a school eye test. In the case of Unilateral Cataract, even older children may not realise that they are only seeing with one eye, as they are able to manage well.
Treatment
Treatment of Cataracts depends on a number of factors like age at diagnosis, presence of Unilateral or Bilateral, mild or dense cataract and the presence of lazy eye. Dense Bilateral Cataracts at birth are operated on at around 6-8 weeks of age because early surgery can pose a high risk of Glaucoma (blue water) and delaying surgery beyond 3 months of age can limit the vision improvement, due to the development of lazy eyes. Unilateral Dense Cataract at birth has a poor visual prognosis because of the early development of lazy eye.
Mild Cataracts do occur but significant Cataract treatment involves surgery and the removal of the Cataract. In children under 3-4 years of age, Cataract removal also removes the part of front jelly (vitreous) of the eye.
An intraocular lens (IOL) is usually implanted in children above 1 year of age but this can be done earlier in unilateral cases. The power of the IOL selected also allows for the growth of the eye.
After surgery care is very important and may involve regular eye drops for 4-6 weeks after surgery, regular wearing of glasses, contact lenses and patching (covering the one eye with better vision) for the prescribed number of hours. This requires a lot of support and involvement of the parents
In these cases, early diagnosis and prompt treatment can save children from lifelong sight impairment.
It is important for all children to have regular eye check-ups.
What is Glaucoma?
Glaucoma is an increase in pressure inside the eye and is a potentially blinding condition in childhood. Glaucoma has many potential causes.
Our eyes are filled with a fluid-like substance called aqueous humor, which moves around the eye and drains through tiny passages.
In children, the most common cause of Glaucoma is congenital malformation of these passages during the formation of the eye in the mother’s womb.
Testing your child for Glaucoma
Detecting Glaucoma at an early stage can prevent vision loss. All newborns, soon after birth, undergo a baby wellness check, which includes examining the eye for the presence of red reflex and to test the clarity of the cornea.
What is the cornea and red reflex?
The cornea is like the windshield of a car – if the windshield is clear, we are able to see very well. When the eye pressure increases, the cornea becomes cloudy and the red reflex is not seen. Red reflex can also be dull or absent in the presence of cataract or clouding of the lens. Both of these conditions require urgent intervention.
My child’s eyes are big! Should I be worried?
In many cultures, big eyes are a sign of beauty but unfortunately it is also one of the signs of developing Glaucoma. Since the fluid is trapped inside the eye and cannot drain properly, the eye gradually increases in size, just like filling a balloon with air makes it bigger. This increase in the size of the eye can damage the optic nerve at the back of the eye and which is the main nerve involved in vision.
What are the signs of Congenital Glaucoma?
- Large eyes
- Cloudy corneas
- Unequal size of eyes
- Constant watery or teary eyes
- Sensitivity to bright lights (‘Photophobic’)
Can Glaucoma be treated?
Yes, Congenital Glaucoma can be treated either medically or surgically. The success of any treatment depends on how early the treatment starts.
Who treats Glaucoma?
A trained Consultant Ophthalmologist with experience in dealing with Congenital Glaucoma should lead the treatment. It’s a condition that requires lifelong monitoring and treatment.
This week’s blog on Eye Tumours has been contributed by Dr. Mandeep S. Sagoo, Honorary Consultant Ophthalmologist in Ocular Oncology, oncologist in Dubai, Retino Blastoma and Medical Retina, Moorfields Eye Hospital & Barts Health NHS Trust, London.
Eye Tumours
Tumours inside and on the surface of the eye can be benign or malignant, and can also be primary or secondary tumours. Certain lesions in the eye such as naevi or moles are very common, and usually do not require treatment. Other lesions such as melanoma are rare, and require specialised treatment such as surgery or radiotherapy.
Naevus and Melanoma
Naevus is a benign mole on the eye. Some occur on the surface of the eye, in the conjunctiva, but others are found inside the eye, in the iris, ciliary body or choroid. An optometrist or ophthalmologist often finds these moles inside the eye, during an examination. Most moles should be monitored, although some may require treatment if they are causing vision problems. If moles show any sign of change, such as an increase in size or development of suspicious features, then treatment might be necessary. If they have become malignant – this is usually the diagnosis in adults – many malignant melanomas inside the eye can be treated by radiotherapy. Larger malignant melanomas may require radical surgery, such as removal of the eye.
A Naevus or mole on the surface of the eye. This needs to be monitored.
A melanoma (type of eye cancer) inside the left eye that required treatment with radiotherapy.
Retinoblastoma
This is a childhood cancer of the developing retina and is rare, occurring in approximately 1 in 18,000 live births. It presents with a white-eye pupil reflex or a squint, though there are many other more common causes of these clinical signs. Retinoblastoma can occur in one or both eyes depending on the timing of the genetic mutation that causes tumour formation. Treatment is complex, ranging from chemotherapy to localised treatments such as laser, cryotherapy, localised chemotherapy, radiation, or eye removal.
The white pupil reflex on a photograph from this child’s right eye can be caused by many conditions, but one of the most serious is retinoblastoma, a type of rare eye cancer. Any child with this white reflex should be examined by an ophthalmologist within a week of onset.
A child with multiple retinoblastoma tumours in one eye (arrows). This is a type of eye cancer that requires specialist treatment.
Vascular tumours of the eye
Haemangiomas and vasoproliferative tumours are benign vascular tumours and most are asymptomatic. Some types of vascular tumour can be part of generalised disorders, such as von Hippel Lindau syndrome or Sturge Weber syndrome, but other haemangiomas are not part of a syndrome. The type of treatment depends on the type of lesion and its features, such as the disturbance of surrounding tissues and its potential to cause future problems with sight or the eye. A range of treatments can be used, from laser to photodynamic therapy and radiotherapy.
Other tumours
Other tumours of the eye are very rare. Examples include osteomas, which can cause visual problems. Lymphoma of the eye (primary intraocular or vitreoretinal lymphoma) can affect the vitreous and retina, and usually requires extensive treatment by an oncologist in Dubai. Local treatments with intravitreal methotrexate injections are sometimes necessary to control ocular disease. Choroidal lymphomas may be primary and are often low grade, and usually respond well to radiotherapy treatment.
Secondary tumours
Cancers from other sites in the body can move into the eye. In many cases, the site of the primary cancer is already known but in about one third of cases, the first presentation of the cancer is in the eye itself and an extensive investigation is then required. Treatment would be directed towards the underlying cancer, as well as the eye condition, using radiotherapy, and in some cases local treatment to the eye may be necessary to preserve vision.
Conclusion
In summary, there are many different types of eye tumour occurring in tissues on, around or inside the eye. Many are only found on examination, as they may not cause any symptoms, highlighting the need for appropriate regular check-ups with a consultant (oncologist in Dubai).
This week’s blog on Multifocal Intraocular Lenses has been contributed by Dr Hamed Mofeez Anwar, Consultant Corneal and Refractive Surgeon.
Traditionally, the aim of cataract surgery has been to give patients the quality of vision to ensure a normal lifestyle including distance vision activities such as driving and watching movies. For clear near vision after cataract surgery, patients would often still require glasses for reading.
These days, candidates for cataract surgery have a wide range of options including multifocal IOLs (Intraocular Lenses) that offer patients total vision correction.
If you need cataract surgery and would like to have more freedom from spectacles after surgery then multifocal intraocular lenses are an excellent option to increase your range of clear vision. In fact, many people who choose multifocal intraocular lenses are generally glasses-free or may only need reading glasses occasionally for reading small print, after cataract surgery.
Who are the best candidates for multifocal IOLs?
If you’re considering having a multifocal IOL implant, it’s important to understand that they also have their limitations.
If you are in a job that needs you to have the best possible distance vision at all times, or excellent night vision – for example if you are a pilot or someone who does a lot of night driving – then you probably are not a good candidate for multifocal IOL implants and regular monofocal (single-focus) lenses would be a better choice and provide very good distance vision. This would mean that you would need reading glasses to see well, up close.
Another thing to keep in mind is that if you have an associated visual condition other than a cataract (such as diabetic retinopathy, glaucoma or age related macular degeneration), you would be more satisfied with the results using regular monofocal IOLs. This is because multifocal IOLs need good visual capability in both eyes for optimal results.
Other considerations
To get the best visual results with multifocal IOLs, the exact placement of the lens in the eye is very important.
So, a cataract surgeon may also recommend a laser cataract surgery procedure using a femtosecond laser to help ensure accurate positioning of the multifocal IOL and get the best possible results from the lens.
This week’s blog on Diabetic Retinopathy has been contributed by Dr Paola Salvetti, Consultant Ophthalmologist and Specialist in Medical Retina.
Diabetes
Diabetes is a disease related to the body’s inability to properly absorb, store and use sugar from food. This results in higher levels of sugar in the blood (hyperglycaemia).
Differences between type 1 and type 2 diabetes
Type 1 diabetes is often referred to as ‘insulin dependent’ and is mostly diagnosed in children or young adults. Type 2 diabetes is the most common type; it usually appears in adults over the age of 40 and is often related to overweight, obesity and lack of physical activity in people who are genetically predisposed.
Genetic predisposition affects people differently, depending on the type:
- In type 2 diabetes, if one parent is affected the risk of transmission to children is about 40%, which increases to 70% if both parents have the disease.
- In type 1 diabetes, the risk is much lower, being only 5%.
Diabetes is a significant public health issue in the region, with the UAE, Saudi Arabia, Bahrain, Kuwait all featuring in the top 15 countries in terms of the prevalence of diabetes worldwide. According to data from The Institute for Health Metrics and Evaluation from 2015, 19.3% of the UAE population between the ages of 20 and 79 have type 2 diabetes, which is almost 1 in 5 people, meaning that there are over 1 million people living with diabetes in the UAE. In the UAE, diabetes is also among the top seven causes of premature death and is 4th among the top causes of disability; diabetes increased by a staggering 174% between 2005 -2015.
Type 2 diabetes can sometimes be difficult to diagnose, as it is often painless and without symptoms, at least at the beginning. In fact, it is estimated that the interval between the first appearance of hyperglycaemia and the diagnosis of diabetes is around 5 to 10 years.
Prolonged and repeated hyperglycaemia leads ultimately to the damage of blood vessels and nerves throughout the body, and this includes complications in the eyes, kidneys, heart, brain and limbs.
Diabetic Retinopathy
Diabetic Retinopathy is one of the most common and serious complications of diabetes and its prevalence increases with the amount of time diabetes is present, with age, poor control of blood sugar, blood pressure, cholesterol and lipids.
Although some visual problems can indicate the presence of Diabetic Retinopathy (such as blurred letters when reading, vision difficulties when moving from light to dark) more commonly the disease starts in a completely silent way with no obvious symptoms.
Diabetic Retinopathy can be present even in patients with excellent visual acuity and no symptoms, and can only be diagnosed by the ophthalmologist with a Fundus examination. Sometimes, additional tests are required, such as OCT and Fluorescein Angiography to evaluate the risk of the progression of retinopathy. Some early cases can be just observed, whilst more advanced cases require active management.
Diabetic Retinopathy Treatment
Different treatment options are available, and sometimes a combination of the possible treatments is used. These include intravitreal injection of medications (anti VEGF and or steroids), conventional peripheral laser, subthreshold micropulse laser. In more advanced cases, with prolipherative retinopathy or with intravitreal haemorrhages, surgery may be the only possible option.
Early diagnosis of the complications of diabetes generally leads to better management and better outcomes, and that is why it is vitally important to make regular visits to the ophthalmologist.
This blog on Keratoconus has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery
What is Keratoconus?
The word Keratoconus comes from two Greek words: kerato (cornea) and konos (cone). Keratoconus is a degenerative disorder of the eye in which the shape of the cornea, which is usually round, is distorted and develops a cone-shaped bulge, resulting in reduced vision. Keratoconus is a relatively common condition. It affects one person in two thousand, occurs around the world and is quite common in the Middle East.
Progression of Keratoconus depends on the patient’s age at the time of onset and the severity of eye rubbing. The earlier the onset, the faster Keratoconus may progress. The condition always affects both eyes and is asymmetric, so one eye may be more affected than the other.
Causes
Keratoconus has many causes, and it results in a cornea that is more elastic than normal and that starts to thin and bulge forward, causing reduced vision and increased astigmatism. It can be inherited, and a chromosomal link has been identified. Keratoconus can be associated with other allergic diseases such as hay fever, eczema and asthma but we are not born with it, and its onset usually happens around puberty. It is strongly associated with eye rubbing, making it progress rapidly. It is also seen in contact lens wearers.
For the best outcome, Keratconus should be detected and treated early. Early detection is possible by generating computerized corneal shape and thickness measurements through corneal topography using advanced technology such as a pentacam machine. If left untreated, Keratoconus could lead to significant visual impairment and blindness.
Treatment
Spectacles
These can provide good vision in the early stages of the condition and usually help to correct myopic astigmatism.
Hard or Scleral Contact Lenses
When spectacles don’t work, rigid contact lenses and Scleral lenses usually provide very good vision if the patient can tolerate them; they should be fitted by a contact lens specialist.
CXL – Corneal Collagen Cross linking with Riboflavin (Vitamin B2)
This technique increases the strength of the cornea and prevents the progress of Keratoconus.
Intracorneal Rings (Intacs & Ferrara)
These rings inserted into the cornea change the shape of the corneal cone, flattening it and making it a more regular and central shape. This will help improve the vision for the majority of patients.
We use it when patients cannot tolerate contact lenses and while the cornea is still clear and the condition is not very advanced. A Femto-second laser is used to create the tunnel and the entry point for the rings, making it a very safe and reliable procedure.
Toric Implantable Contact Lenses
For those with stable Keratoconus and good vision with glasses, Toric Implantable Contact Lenses are generally used (sometimes after stabilizing the Keratoconus with corneal cross linkage) to improve corneal shape with an intracorneal ring or with very limited therapeutic Excimer laser correction. The Toric ICL can eliminate the need for optical aids altogether and, in some patients, results in improved vision and balance between the two eyes.
Phototherapeutic Keratectomy (PTK)
Keratoconus patients are not candidates for Lasik or normal laser correction. However, some patients benefit from limited excimer laser correction to improve the surface irregularity of the cornea when
contact lenses cannot be tolerated. PTK is always combined with corneal cross-linkage, undertaken during the same procedure or afterwards.
Corneal Transplants
Corneal Transplants are used in the advanced stages of Keratoconus, when there is corneal scarring. The procedure is either a partial thickness (Deep Anterior Lamellar Keratoplasty = DALK) or full thickness graft (Penetrating Keratoplasty = PK). The need for corneal grafts is declining because of the increasing success in the early diagnosis of Keratoconus and the effectiveness of corneal cross linkage to stabilize the condition, so Keratoconus generally does not reach the advanced stage.
This week’s blog on refractive surgery has been contributed by Dr Hamed Mofeez Anwar, Consultant Corneal and Refractive Surgeon.
If you’re nearsighted, farsighted, have astigmatism or are presbyopic (loss of reading ability due to age), refractive surgery is a term referring to procedures which can be used to improve your vision.
What are the benefits of refractive surgery?
For most patients, the vision after refractive surgery is similar to that with contact lenses prior to surgery, without the potential discomfort and limitations of performing activities.
Over 95% of patients are satisfied with the outcome of the surgery, with many describing it as a “life-changing”. Although refractive surgery is often considered to be a cosmetic surgery procedure, the benefits are primarily functional. It’s designed to make you less dependent on glasses and contact lenses, letting you lead an active lifestyle more easily.
Am I a good candidate for refractive surgery?
Refractive surgery may be a good option for you if you:
- Want to decrease your dependence on glasses or contact lenses.
- Are free of eye disease.
- Accept the inherent risks and potential side effects of the procedure.
- Understand that you might still need glasses or contacts after the procedure to achieve your best vision.
- Have an appropriate refractive error
What types of refractive surgery are there?
It’s important to remember that there is no universally-accepted, best method for correcting refractive errors.
The best option for you should be decided after a thorough examination and discussion with your ophthalmologist, especially taking into account your lifestyle and vision needs.
The focusing ability of your eyes can be adjusted by procedures which include:
- Laser vision correction – these procedures adjust the focusing power of the eye by reshaping the cornea (the clear window at the front of the eye).
- Implanting a lens inside the eye.
Laser refractive surgery:
Laser vision correction procedures use an excimer laser to reshape the cornea (the clear window at the front of the eye), therefore correcting refractive errors. Generally speaking, the cornea is flattened to treat near-sightedness or steepened to correct far-sightedness.
Laser refractive surgery procedures include:
- LASIK
- Surface laser treatment (PRK/Trans-PRK/LASEK)
The risks and benefits are similar amongst the two procedures and they generally provide good results in the appropriate patients.
The main difference among the two procedures is the speed of recovery. LASIK patients are usually able to return to work within a day or so after surgery while patients who have PRK done may need up to a week to attain driving standard vision.
It’s important to keep in mind that the visual results at 3 months are equivalent for all types of surgery.
LASIK
In LASIK, a very thin flap is created on the surface of the cornea using a femtosecond laser. This flap is then lifted up and an excimer laser is then applied to the corneal surface. At the end of the procedure, the flap is then placed back into its original position. After surgery, a minimal amount of discomfort may be experienced. Visual recovery after surgery is rapid, with many patients seeing well enough to work and drive within a day or so. However, it’s important to remember that patients who engage in contact sports must wait a month before resuming activities.
This video http://fyi.rendia.com/XZN8k shows how LASIK eye surgery is performed.
Surface laser treatment (PRK/TransPRK/LASEK)
In PRK laser treatment, a laser is applied directly to the corneal surface. This removes a lens shaped piece of tissue immediately below the clear skin of the cornea. The skin regrows over the course of a week, and then smooths out over the next 3 months. While the skin is growing again, the eye surface is normally very sore. This is the main difference between surface laser treatments and LASIK, both of which aim to keep the corneal skin layer intact.
This procedure requires minimal surgical manipulation and is especially suited to patients that aren’t suitable for LASIK because of a thin cornea or a very active lifestyle that puts them at risk of dislodging a corneal flap. The downsides of this procedure are postoperative pain that lasts a day or so after surgery and a more prolonged visual recovery that would extend to a week to attain driving standard vision. Patients who engage in contact sports can resume activity much sooner than with LASIK.
Laser vision correction for decreased reading vision (presbyopia)
Age related loss of reading vision (presbyopia) can be treated with laser vision correction surgery. To do this, one eye is treated so it sees well for distance, while the other eye is treated to see well for closer objects. This type of treatment is called monovision. When both eyes are open, our brain combines the two images to partially restore near vision with little compromise optically. This is the default strategy for improving the near range in older patients undergoing laser vision correction.
Lens implantation surgery:
Laser vision correction is not suitable for all patients.
Some people have high degrees of refractive errors which can’t be safely corrected with laser-based refractive surgery. Other people (generally above the age of 50) may have early cataractous changes in the lens of their eyes.
Younger patients:
In younger patients, a lens is surgically implanted inside the eye in front of the natural lens. This lens is placed either in front of or behind the iris of the eye. Once the lens is properly positioned inside the eye, it provides the necessary correction to focus light rays onto the retina. It’s important to note that the natural lens of the eye is not removed during this procedure.
Older patients
Early stages of cataract are often seen in older patients, and lens replacement surgery may be more appropriate in this group. In this surgery, the natural lens is replaced with a lens implant. A variety of different implants are used, which include multifocal lenses designed to reduce reliance on spectacles for near, intermediate and distance vision.
Is refractive surgery permanent?
In most cases, yes. Short sight and astigmatism normally stabilise in the late teens or early 20s, however natural changes in your eye power can happen at any stage in life. As a result, laser vision correction sometimes needs to be repeated.
This week’s blog on Uveitis has been contributed by Dr Avinash Gurbaxani, Consultant Ophthalmic Surgeon in Uveitis and Medical Retinal Diseases and Cataract Surgery.
Uveitis is not a single disease but a clinical spectrum of symptoms and signs caused by a variety of medical conditions. Although it accounts for about 1% of all eye diseases, Uveitis is the cause of 10-15% of blindness, thus, it must be managed very carefully. Prompt and appropriate treatment is needed to ensure good visual recovery, which is very often achievable. In most cases, a Uveitis specialist – an eye doctor with specialist training in diagnosing and managing these diseases – should manage Uveitis.
Uveitis can affect children, especially those with childhood arthritis or infections. Uveitis affects young adults of a working age and more often women are affected. Symptoms include red eye (although in children the eyes do not become red, so if diagnosed with arthritis, they must have regular screening with the Uveitis specialist), pain, light sensitivity, and blurred vision. It may be associated with skin rashes, joint pains, and stomach symptoms.
Causes:
The cause of Uveitis can be infection (like TB, Toxoplasmosis or viruses like herpes and CMV) or autoimmune conditions (sarcoidosis, arthritis, inflammatory bowel disease). In about half of the cases, we may never find a specific cause but prompt treatment is always needed.
Initially, patients will often need to have a variety of blood tests to look for infection or auto immune conditions, chest x-rays and other imaging. In the eye clinic patients may need an OCT scan of the retina and a flurosein angiogram to look for leakage from the blood vessels in the retina. Patients may also be referred to othzer specialists like rheumatologists, gastroenterologists or neurologist to help diagnose a systemic cause of the Uveitis.
Types and treatment:
Uveitis can be in the anterior segment (front part of the eye), which usually can be treated with drops and sometimes injections to get a quick response. When Uveitis affects the back of the eye, more aggressive treatment may be needed. This usually consists of a high dose of oral steroid medications for several weeks. Antibiotics are given in case of infection. Long-term treatment or more serious cases may need steroid sparing immune suppressant medication. This scan be in the form of tablets like mycophenolate or methotrexate or newer biologic medications, which are given in the form of injections. Steroid injections into the eye may be needed as well. Although protracted, early, aggressive and appropriate treatment can achieve good control of this condition and patients can maintain good vision.
Complications:
Complications of Uveitis include cataract, high pressure in the eye and macular oedema. These may need additional treatment including surgery.
If you have been diagnosed with Uveitis or suspect that you may have Uveitis, it is essential to see a Uveitis specialist
This week’s blog on Retinal Detachment has been contributed by Dr Igor Kozak, Consultant Ophthalmologist, specialist in Vitreoretinal Surgery, Medical Retina and Uveitis.
What is Retinal Detachment?
Retinal detachment is a condition when the most light-sensitive layer of the human eye, the retina, is separated from its underlying structures. This is associated with decrease in vision.
Causes
Various causes lead to such separation, such as forceful traction of the vitreous causing a retinal break, contraction of the membranes that can grow on top of the retina or inflammation causing accumulation of fluid under the retina.
Treatment
The treatment should start immediately. When untreated, retinal detachment usually causes permanent vision loss due to death of light sensitive cells – photoreceptors. These cells cannot regenerate and, therefore, retinal detachment represents a serious, vision threatening condition.
Treatment should address underlying mechanism causing the detachment. If mechanical causes such as trauma or membrane contraction lead to retinal detachment, then reattachment surgery is the standard of care. The technique of scleral buckle uses silicone band to be placed externally on the eye. Another surgical approach is from inside the eye and is called pars plana vitrectomy. In this technique, a small opening is made in the eye for infusion, light and vitrectomy probe. The gel inside the eye, the vitreous, is removed and retinal break causing the detachment is identified and sealed, usually with laser. A tamponading agent is placed in the eye to keep retina attached until the causative break is completely sealed. This can be either intraocular gas or silicone oil. In general, post-operative recovery in retinal surgery is usually longer that in other ophthalmic surgeries given the complexity of retinal anatomy and surgical techniques we use. Topical therapy is used after retinal surgery for some time.
In cases of inflammation causing fluid exudation, the potent anti-inflammatory therapy is the treatment of choice. The amount of fluid under the retina can be monitored using imaging technology.