Surgical Retina

Floaters are little spots or streaks that can look like flies or cobwebs in your vision. They move when you move your eye and most often continue to drift. Some floaters are completely normal at any age, especially in short sighted (myopic) people and can occur even in children. A sudden increase in the amount or size of floaters particularly if accompanied by flashes is important to get checked.

Floaters look like they are in front of your eye but they are actually floating inside it. The eye is like a round camera with lenses at the front and the film of the camera at the back. The main chamber of the eye is filled with a gel called the vitreous. Floaters are debris in the vitreous.

They may look to you like black or grey specks, strings, or cobwebs that drift about when you move your eyes and appear to dart away when you try to look at them directly.

• Posterior Vitreous Detachment – As we age the vitreous jelly starts to break apart and eventually, commonly after age 50, it peels away from the retina. This is NOT a retinal detachment. Separation of the vitreous gel is almost always associated with more floaters and sometimes flashes. When this happens you should get your eyes examined. This is a common cause of floaters.
• Posterior Uveitis – is an inflammation in the layers of the uvea in the back of the eye. This condition can cause the release of inflammatory debris into the vitreous that are seen as floaters. Posterior Uveitis may be caused by infection, inflammatory diseases or other causes.
• Vitreous Haemorrhage – Bleeding into the vitreous can have many causes, including diabetes, blocked blood vessels and injury. Blood cells are seen as floaters.
• Retinal Tears – Can happen when the vitreous detaches and is the reason that one needs have an eye examination when new floaters occur.
• Retinal Detachment – retinal tears can lead to retinal detachment. This is NOT a common cause of floaters.

Sudden onset of a large number of floaters particularly if associated with flashes (streaks down the side of the vision when moving the eyes
in dim light) should always be checked by an ophthalmologist or optometrist.

Floaters can be associated with retinal tears, bleeding or inflammation. Sudden new floaters, flashes or a curtain or shadow in your vision should be assessed urgently by an eye specialist.

An epiretinal membrane (also called macular pucker) is a thin layer of scar tissue on the surface of the macula, causing distortion or blurred vision. Mild cases may be monitored, while significant distortion or visual loss may be treated with surgery.

An Epiretinal Membrane is a thin film of fibrous tissue that forms a delicate scar or membrane at the back of your eye. The scar tissue looks like crinkled cellophane lying on top of the retina. This membrane pulls up on the central part of the retina (Macula).

Epiretinal Membrane also called a

• Macular Pucker
• Premacular Fibrosis,
• Cellophane Maculopathy

Predominantly people over the age of 60 but it can affected younger people.

We are not sure exactly how epiretinal membranes form and they are commonly referred to as idiopathic, meaning no known cause. Sometimes an epiretinal membrane will form after a retinal detachment, a retinal tear or in diabetics.

• Blurred vision
• Distorted vision (straight lines may appear wavy)
• Worsening central Vision

An Epiretinal Membrane does not cause complete blindness as it affects only central vision with peripheral vision remaining unaffected

Proper diagnosis of an epiretinal membrane requires imaging with an OCT. A full ocular examination with dilation is very important.

Treatment is not required for a mild Epiretinal Membrane that has very little or no effect on vision. However, when vision declines, surgery is the only treatment option available.

Vitrectomy is the surgical procedure performed to remove the Epiretinal Membrane.

If you are not aware of any visual problems, you might not need to have surgery. However, if the distortion affects your ability to work, drive, read, or perform other important activities, you should consider having an operation.
Some patients decide not to have an operation and accept the distorted central vision in the affected eye. This is reasonable, especially if the vision in the other eye is not affected.

Epiretinal Membrane may not get worse if left untreated, but if you find the visual distortion troublesome you should consider surgery.

A macular hole is a small, full-thickness defect in the centre of the retina (the macula), where detailed vision is processed. It typically causes blurred or distorted central vision.

A Macular Hole can have a significant impact on your vision as the condition can effect detailed vision, allowing us to read, recognise faces, drive and see colour.

It is not clearly understood why Macular Holes develop, but it is more common in women around the age of seventy.

When a Macular Hole has formed in one eye the fellow eye may also be at risk, so it is important to monitor both eyes in the postoperative period and beyond.

Macular hole formation is related to the vitreous and macular interface.

Trauma is very rarely the cause and a traumatic macular hole is a distinct condition.

A patient may experience blurring and distortion of central vision. In more advanced macular holes a central blind spot will develop. Macular holes do not lead to complete blindness.

Occasionally, a Macula Hole is detected as a chance finding, for example when covering the good eye or during a routine Eye Examination by an optometrist.

Definitive diagnosis requires an OCT scan which provides a cross sectional view of the macular.

Macular hole is treated by vitrectomy surgery. The surgery is performed under local anaesthesia with minimal discomfort. With modern techniques, sutures are usually not required. A bubble of gas is injected to keep the hole dry and allow it to heal. Your surgeon will explain any positioning instructions and how long to follow them. Do not fly while a gas bubble remains. Tell all healthcare professionals about the gas: nitrous oxide, including Entonox, must not be used while it remains.

A retinal detachment occurs when the retina separates from the back of the eye. It can cause sudden vision loss and needs urgent assessment. Our surgeons perform vitreoretinal surgery to repair retinal tears and detachments. Early treatment is important for recovery.

– flashes and floaters
– Dark shadows increasing in size from the edge of vision
– Blurred hazy vision
– Distorted images

Retinal detachments are a result of a retinal break or tear. This is not commonly as a result of trauma and most often happens spontaneously, not as a result of any specific action.

Very short sighted (myopic) people are most prone to retinal detachments.

Vitrectomy
This technique is more commonly used and involves removing the vitreous using very fine instruments through wounds in the sclera (white of the eye). The retinal tears are identified and the fluid under the retina is sucked out. A gas bubble is injected in the eye cavity to prevent fluid getting under the retina again. The time for the gas to be absorbed depends on the gas used. Your surgeon will explain any positioning instructions and how long to follow them. Air travel is absolutely prohibited until gas is completely gone.

Scleral buckle
This is an older technique but still is the most effective option for many types of retinal detachment. A piece of silicone rubber is sewn onto the sclera to push the wall of the eye inwards, bring it closer to the detached retina. The buckle is permanently left in place. Buckle surgery is less comfortable than vitrectomy, and may lead to double vision. In some circumstances it will be combined with a vitrectomy.