Retinal detachment occurs when the retina is pulled away from the surrounding tissue. Warning signs that may precede a retinal detachment are caused when the vitreous gel pulls away from the retina causing a retinal tear. This is called a posterior vitreous detachment (PVD), and warning signs may include any of the following: a sudden rush of eye floaters (black rain), light flashes or a back shadow in the periphery of your vision that does not go away. There is no pain associated with a retinal tear or retinal detachment; however, a detached retina is very serious and can cause permanent loss of vision if left untreated; therefore retina surgery is required. The condition is generally diagnosed during an eye examination and can be treated either with thermal lasering or a freezing procedure, called cryopexy if it is diagnosed early enough. In some cases, Dr Enslin Uys will opt to repair the condition with retinal detachment surgery known as a vitrectomy. Tiny instruments are placed through the side of the eye, and the retina is repaired from the inside. This has to be performed in theatre, and in most cases, a gas bubble or silicone oil bubble is inserted into the eye. The gas bubble or silicone oil helps close the tear by pushing the retina and surrounding tissue together. In some cases the retina can be repaired from the outside – this is called an external retinal detachment repair. This is done by placing a buckle, also called a tyre or silicone band, around the outside of the eye. Dr Enslin Uys will be able to discuss the best surgery for your eye or your family member's eye.
Removal of epiretinal membranes
The epiretinal membrane is a thin layer of tissue that sometimes develops on the retina over the area of best vision – called the macula. The membrane can affect vision and can occur for a number of reasons. This includes previous retinal detachment, inflammatory eye disease, or as a result of an injury, and can be removed surgically. During the epiretinal membrane surgery, Dr Enslin Uys will make tiny incisions in the eye, and with the use of small surgical tools, the membrane is gently peeled away.
A macular hole refers to a small tear or defect in the centre of the macula area of the eye. Because the centre of the macula is essential for clear vision, a hole in this area causes distorted vision or a dark patch in the centre of your vision. Rarely, very early macular holes repair themselves. In most cases, macular hole surgery is required to repair the tissue and improve vision. During the procedure, Dr Enslin Uys will remove the vitreous gel in the eye followed by peeling the internal limiting membrane, which is the most inner layer of the retina and thinner than a newspaper. The vitreous cavity will be filled with a bubble made from a particular gas, which keeps the macular hole in a stable position as it heals.
Bleeding in the eye (vitreous haemorrhage)
Vitreous haemorrhage refers to bleeding in the vitreous humour (a jelly-like substance) at the back of the eye. Because the substance is usually transparent, bleeding in the eye can cause blurriness or, in some cases, complete loss of vision. Common reasons for a bleed are retinal tears, diabetic eye disease, trauma to the eye or a previous retinal vein occlusion also known as a stroke in the eye. Treatment of this condition depends on its cause, but in most cases, laser treatment is performed on the bleeding vessels, and around any tears in the retina. If the bleeding is too dense to have any view of the back of your eye, surgery might be required.
Diabetic eye disease
Diabetic eye disease refers to a group of conditions, which affect patients with diabetes. Some common diabetic eye problems in this group include glaucoma, cataract formation, diabetic retinopathy and diabetic macular oedema. Treatment options depend on the condition, although early detection helps to reduce the risk of blindness considerably in all of the diabetic eye diseases. Good glucose control, treating high blood pressure and treating high cholesterol as well as regular follow-up is key to preventing blindness.
Argon laser and Selective laser trabeculoplasty (SLT) are used to treat a wide range of eye conditions, including diabetic eye disease, glaucoma, retinopathy of prematurity and tears in the retina. Both laser treatments work with heat energy and can be focused to perform a number of functions very precisely. However in Glaucoma, selective laser trabeculoplasty (SLT) in comparison to Argon laser trabeculoplasty (ALT), has a better safety profile where complications following the laser treatment are less frequent, and if so are more mild and temporary. Argon laser is usually preferred to repair tears, reduce swelling and help regress blood vessels, depending on the condition. This can either be performed in the rooms or in theatre.