Retinal detachment is a sudden and unexpected condition that can happen to anyone. The retina , which is the thin nerve layer at the back of your eye, separates from the rest of the eye due to a hole in the retinal layer. People who are short-sighted (myopic) are at higher risk of retinal detachment.
There are several eye diseases that can be treated by injection of special drugs into your eyeball. These diseases are diabetic retinopathy, AMD, infections in the eye, and, retinal vein occlusion. The drugs that can be used are Avastin, Lucentis, Eyelea, steroids, antibiotics, antivirals, and antifungals. As the drugs are injected into the vitreous cavity of the eye, these injections are called “intravitreal injections”. It is now one of the most commonly done eye procedure worldwide.
Intravitreal injection is safe and painless
Many patients are often frightened at the thought of having a injection into their eye. It is actually not that bad and is less painful than having an injection in your arm. The needle that I use to inject the drugs is the smallest sized needle available(30 gauge) and the injection only takes less than 10 seconds. I also give anesthetic eye drops before hand. Many patients all over the world are having monthly injections of anti-VEGF drugs like Avastin, Lucentis, and Eyelea. It is very well tolerated and is very safe. Rare complications include infection in the eye, retinal detachment, bleeding in the eye, and glaucoma.
Prevention of infection is most important
To prevent infection after intravitreal injections, I use iodine to clean the eye throughly. Then, I use a special eye speculum to open the eyelid to prevent the eyelashes from contaminating the part of the eye that will be treated. I then prepare the drug that will be given. Before the giving the drug, I use a sterile cotton bud to move the skin of the eye (conjunctiva) away from the eyeball (sclera) and then give the injection. This means that after the drug has been given, the skin of the eye will move back over the site of the injection. This prevents the drug from coming back out and any bacteria from entering the eyeball. The patient has to use antibiotic eyedrops for 1 week. They are told to report back to me should they experience any pain or redness in their eyes as this could mean they have an infection. The overall risk of an infection is about 1 in 1000 cases. This is considered to be very small.
The most important factor is to have your treatment done by a trained retinal surgeon who can manage any complication arising from the intravitreal injection. Retinal specialists can also determine whether or not you need an injection and when the treatment has to be stopped or changed.
Have a great day!
While surgery for retinal detachment is very successful, there may be a few rare complications that can occur. Among the complications that can occur are recurrence of retinal detachment, scar tissue forming on the macula (epiretinal membrane), high eye pressure, and infection.
Macular Hole is Uncommon Complication
One of my patients recently developed a macular hole soon after a successful retinal detachment operation. This is the second time that I have come across this complication. The macular hole was not observed during the procedure and was only noticed 2 weeks after surgery. It turns out that this rare complication occurs in less than 0.5% of eyes after vitrectomy surgery (as reported by my Korean colleagues in a recent scientific article).
Many Diseases Affect the Macula
The macula is the most sensitive part of our retina. It has the highest concentration of nerve cells and is responsible for our ability to see sharp details and colour. It is very easily damaged by various diseases like AMD and diabetic retinopathy. As it is the thinnest part of the retina, holes can also occur there. Macular holes are caused by the vitreous gel pulling on the macula. Scar tissue around the macula can also cause holes to occur.
Surgical Repair for Macular Holes
Macular holes can only be treated with surgery. An essential surgical step is to peel off the innermost layer of the retina called the ILM. This is a very difficult surgical procedure but is essential to ensure the complete closure of the hole. By peeling away the ILM, the retina tissue at the macula is less stretched and can come together to close the hole. I also put a gas bubble in the eye at the end of surgery and instruct my patients to sleep with their face facing down for one night after surgery.
The gas bubble will help close the macular hole. Many surgeons have different posturing regimes after macular hole surgery and I don’t think that you need to sleep face down for more than 1 night and I tell my patients to just avoid sleeping on their back for 1 week after surgery. This ensures that the gas bubble is always in contact with the macula.
My patient had a second operation to fix the macular hole and to mine and her relief, the hole has closed up and she can see well again!