Treatments

Many macular and retinal diseases are currently being treated with periocular (around the eye) and intravitreal (inside the eye) injections, intravitreal implants, laser photocoagulation, microsurgic al vitrectomy techniques and sclera buckling. A brief description of the most common treatment techniques includes:

Periocular (usually reserved for steroids) and intravitreal injections are the mainstay of treatment for macular degeneration, diabetic retinopathy and vascular occlusions. Steroids have long been used but since 2004, we have the advent of antivascular endothelial growth factor (anti-VEGF) medications that have revolutionized our treatment options. These medications are genetically engineered and are directly injected into the vitreous cavity. Sometimes combinations of intravitreal injections and laser treatments are employed.

Pneumatic Retinopexy is performed for certain retinal detachments and involves a gas bubble being injected into the vitreous space in the eye and requires certain positioning depending on the location of the tear that produced the detachment. Laser photocoagulation or cryoablation (freezing treatment) is applied to area of the tear so that it seals off. The gas disappears gradually. This procedure is usually performed in our office.

Intravitreal implants usually consist of steroids which are performed in the office or antiviral implants that required hospital surgery. They have the advantage that the drugs stay in the eye much longer. Laser therapy for diseases of the back of the eye is indicated for many retinal diseases and remains a very important tool for retina specialists. These conditions include the following:

  • Focal Laser for macular edema (swelling) due to diabetic retinopathy, branch retinal vein occlusions, abnormal blood vessels due to macular degeneration when the vessels are away from the center of the macula, focal leakage from central serous chorioretinopathy
  • Panretinal Scatter Laser for proliferative diabetic and non-diabetic retinopathies, abnormal vessels due to central vein occlusions, neovascular glaucoma, to surround retinal tears or repair localized retinal detachments

Vitreoretinal Surgery

Scleral Buckling procedure is used for selected retinal detachments depending on the characteristics of the detachment. The sclera buckle treatment involves placement of a flexible band, much like a belt, that supports the eye and counteracts the force that is pulling on the retina. Sometimes this procedure involves drainage of fluid under the detached retina. It can be performed without or with gas but it is done in the operating room, usually under general anesthesia.

Vitrectomy surgeryis a hospital or outpatient surgery center based surgery performed by a vitreoretinal surgeon with the aid of a microscope and instruments that are smaller than most needles used to draw blood from your veins. Special lenses are used in conjunction with the microscope. Vitreoretinal surgery is facilitated by various small instruments, visualization aids and vitreous substitutes. Vitrectomy surgery has a very important role in restoring and preserving vision in cases of complications due to proliferative diabetic retinopathy. It can be used in conjunction with scleral buckling procedures for certain retinal detachments. Indications for Vitrectomy Surgery:

  • Vitreous Hemorrhage (blood in the cavity of the eye)
  • Macular Pucker
  • Macular Hole
  • Complications of Diabetic Retinopathy
  • Certain Retinal Detachments
  • Complications of Cataract Surgery/ Dislocated Intraocular Lenses
  • Endophthalmitis (severe infections of all cavities of the eye)
  • Ocular Trauma