Retinal Surgery in İzmir, Turkey

Retinal surgery is a vital intervention applied in the treatment of retinal diseases that can significantly affect eye health. Conditions such as retinal detachment, macular holes, and diabetic retinopathy can be treated with the correct surgical techniques. Methods like vitrectomy, pneumatic retinopexy, and scleral buckling are selected based on the type of disease and the patient’s condition. Surgical procedures aim to preserve retinal health and prevent vision loss. Modern surgical techniques and advanced instruments have increased success rates in this field and facilitated the healing process. Postoperative care is critical for preventing potential complications and requires collaboration between the patient and the doctor.

Prof. Dr. Tansu Erakgün
Retina Diseases and Vitreoretinal Surgery Specialist

Born on March 20, 1968, in İzmir, Prof. Dr. Tansu Erakgün completed his middle education at Saint Joseph College and his high school education at Karşıyaka Gazi High School. After graduating from Ege University Faculty of Medicine in 1992, which he entered in 1986, he began his residency training in the Department of Ophthalmology at Ege University Faculty of Medicine Hospital in the same year. In 1997, he became a specialist...

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What is Retinal Surgery?

The history of retinal surgery is filled with innovations that have revolutionized the treatment of serious diseases causing vision loss. In the 19th century, retinal detachments were considered untreatable until Hermann von Helmholtz invented the ophthalmoscope (1851), which allowed for detailed examination of the eye’s internal structures and improved understanding of the disease. During this period, Albrecht von Graefe experimented with surgical techniques like trans-scleral drainage, but these methods achieved limited success.

In the 1920s, Jules Gonin laid the foundational stones of retinal surgery, creating a significant turning point. Gonin identified retinal tears as the primary cause of retinal detachments and developed the “ignipuncture” technique to seal these tears. This approach greatly increased surgical success rates, and Gonin is recognized as the pioneer of modern retinal surgery.

By the mid-20th century, advancements in retinal surgery further increased success rates. Charles Schepens developed the binocular indirect ophthalmoscope and introduced the scleral buckling technique, improving surgical procedures. This method reduced vitreous traction, marking an important step in the treatment of retinal detachments. During the same period, Paul A. Cibis pioneered the use of liquid silicone oil in retinal surgery, ushering in a new era.

In the 1970s, Robert Machemer introduced the pars plana vitrectomy procedure, further advancing retinal surgery. This method revolutionized the treatment of vitreoretinal diseases and made it possible to address previously untreatable cases. The integration of laser technology into surgery has been effective in treating conditions like diabetic retinopathy and retinal tears.

In recent years, innovations such as microincision vitrectomy surgery (MIVS) and optical coherence tomography (OCT) have made diagnostic and treatment processes more precise. These advancements demonstrate the power of modern surgery in treating retinal diseases.

Who is Retinal Surgery Suitable For?

Retinal surgery is applied in the treatment of diseases that threaten the integrity and function of the retina. The need for surgical intervention depends on the type and stage of the disease, as well as the individual’s overall health status. Retinal surgery may be necessary in the following situations:

• Retinal Detachment: Separation of the retina from the underlying pigment epithelium can lead to vision loss. Rhegmatogenous retinal detachment, if not surgically treated, can cause permanent vision loss. Methods like vitrectomy, pneumatic retinopexy, or scleral buckling are preferred based on the severity of the disease.
• Diabetic Retinopathy: In advanced stages of diabetes, proliferative diabetic retinopathy can develop. This condition is characterized by abnormal blood vessel growth and can lead to vitreous hemorrhage or tractional retinal detachment. Vitrectomy is performed to clear the bleeding and alleviate traction.
• Macular Holes and Epiretinal Membranes: Central vision-affecting macular holes or epiretinal membranes are treated with vitrectomy. These interventions aim to improve visual acuity and ensure anatomical integrity.
• Vitreous Hemorrhage: Bleeding can obscure the retina and cause vision loss. Vitrectomy is performed to clear the blood and treat the underlying pathology.
• Tractional Retinal Detachment: Tractions caused by diabetes or other systemic diseases require surgical intervention. Early treatment prevents retinal damage.
• Penetrating Injuries and Intraocular Foreign Bodies: Eye traumas carry risks of infection and mechanical damage. Vitrectomy is necessary to remove foreign bodies and repair associated damage.
• Age-Related Macular Degeneration (AMD) Complications: In specific cases like submacular hemorrhage or choroidal neovascularization, surgery may be considered.

Who is Not Suitable for Retinal Surgery?

While retinal surgery is an effective method for preserving eye health and preventing vision loss, not every patient may be suitable for this surgery. Surgical eligibility depends on a range of factors, including systemic health status, ocular-related factors, anatomical features, and the individual’s capacity to adhere to postoperative care.

• Systemic Contraindications:

Uncontrolled diabetes and hypertension can increase surgical risks. For example, uncontrolled diabetes increases the risk of severe bleeding during surgery. Similarly, conditions like recent myocardial infarction or cerebrovascular accidents can lead to complications related to anesthesia and surgical stress. Patients with bleeding disorders or those on anticoagulants have an increased risk of intraoperative and postoperative bleeding, which can negatively affect the success of the surgery.

• Ocular-Related Contraindications:

Active eye infections (e.g., conjunctivitis or keratitis) increase the risk of spreading the infection during surgery and should be treated before the operation. Conditions like advanced proliferative vitreoretinopathy (PVR) can reduce the effectiveness of retinal surgery. Severe dry eye or corneal opacities can complicate the surgical procedure. Uncontrolled glaucoma adversely affects retinal perfusion, delaying the healing process.

• Patient-Related Factors:

Adherence to postoperative care is a critical factor in the success of retinal surgery. Patients who cannot comply with special instructions, such as maintaining a face-down position, may find it challenging to achieve optimal results. Additionally, individuals with multiple comorbidities or those in poor general health that cannot tolerate surgical stress may face surgical risks that outweigh the benefits.

• Anatomical and Other Factors:

Extensive retinal damage or advanced degeneration can limit surgical success. Additionally, the effects of certain medications on ocular physiology can negatively impact surgical outcomes and should be carefully evaluated before the operation.

How is Retinal Surgery Performed?

Retinal surgery encompasses specialized techniques and procedures applied to treat diseases that impair retinal function. Each method is carefully selected based on the patient’s condition, the type and extent of retinal damage, aiming to preserve vision and improve quality of life.

Vitrectomy involves the removal of the vitreous humor and is typically performed for conditions like retinal detachment, macular holes, and epiretinal membranes. The procedure is carried out by making small incisions in the eye and inserting specialized surgical instruments through these openings. Removing the vitreous humor relaxes the retina and allows for the repair of damaged areas. Retinal tears can be sealed using laser photocoagulation or cryotherapy. Intraocular gas bubbles or silicone oil are used to keep the retina in place. Modern vitrectomy methods are performed in a minimally invasive manner with smaller surgical instruments, thereby shortening the healing time and reducing the risk of complications.

Scleral buckling is a method primarily used to treat retinal detachments. In this procedure, after localizing the retinal tears and securing them with cryotherapy, a silicone band is placed on the sclera. The band supports the retina and reduces traction over the tear, preventing fluid from accumulating beneath the retina. Subretinal fluid drainage may be performed if necessary. While scleral buckling is an effective method, rare complications such as infection, myopia progression, or band slippage can occur.

Pneumatic retinopexy is a less invasive surgery typically suitable for simple retinal tears located in the upper part of the retina. During this procedure, a gas bubble is injected into the eye to help close the tear by applying pressure. The tear is stabilized with cryotherapy or laser photocoagulation. Patients must carefully maintain head positioning during the healing process. Although this method offers the advantage of rapid recovery, high patient compliance is critical for success.

In recent years, the use of robotic technologies in retinal surgery has increased, enhancing surgeons’ precision and accuracy. Gene therapies and retinal implants are expanding treatment options, offering hope for previously untreatable conditions. These advancements continue to improve the success and safety of retinal surgery.

What are the Side Effects of Retinal Surgery?

Retinal surgery is an important treatment method aimed at preventing vision loss and preserving eye health. However, like any surgical intervention, retinal surgery carries various side effects and risks of complications. Being aware of these situations helps patients act consciously during the preoperative and postoperative processes.

Complications that may occur during surgery include posterior capsule rupture, suprachoroidal hemorrhage, and intraoperative floppy iris syndrome (IFIS). Posterior capsule rupture occurs due to damage to the back part of the natural lens and can lead to issues such as infection, corneal edema, or retinal detachment. Rare suprachoroidal hemorrhage develops from blood accumulation in the space between the choroid and sclera, potentially causing vision loss. IFIS involves the loosening of iris tissue, narrowing the surgical field and posing risks to intraocular structures.

Postoperative complications include infection (endophthalmitis), elevated intraocular pressure (IOP), retinal detachment, cataract formation, macular edema, and proliferative vitreoretinopathy (PVR). Infection is a serious condition after surgery and can be mitigated with proper preparation and hygienic procedures. Elevated IOP may result from intraocular gas or silicone oil and, if untreated, can increase the risk of glaucoma. Although retinal detachment can be surgically successful, it may recur, typically due to scarring. Cataract development is common after vitrectomy and sometimes requires additional surgical intervention. Macular edema results in swelling in the central retina and can be treated with corticosteroid injections. PVR causes scar formation on the retinal surface, leading to recurrent detachment.

How Successful is Retinal Surgery?

Retinal surgery is one of the most advanced fields in modern ophthalmology, achieving high success rates in treating retinal detachments, macular holes, and other retinal diseases. However, these success rates can vary depending on the type, severity, chronicity of the disease, the surgical method used, and the surgeon’s experience.

• Retinal Detachment Surgery:

85-90% of retinal detachments can be successfully treated with a single surgical intervention. Key factors affecting surgical success include the type, location of the detachment, and the presence of scar tissue. Rhegmatogenous (tear-related) detachments generally respond better to surgical interventions. Methods such as pars plana vitrectomy (PPV) and scleral buckling (SB) can achieve anatomical success rates of up to 93% with a single operation.

• Macular Hole Surgery:

Pars plana vitrectomy and internal limiting membrane (ILM) peeling techniques used in macular hole surgery have achieved primary closure rates exceeding 90%. However, the size of the hole is a significant determinant; smaller holes have higher surgical success rates, while larger and chronic holes may require additional techniques.

• Factors Affecting Success:

The duration and severity of the disease, as well as factors like scar tissue formation, can limit surgical success. Additionally, the surgeon’s experience and the patient’s adherence to postoperative instructions directly influence treatment outcomes.

How to Prepare for Retinal Surgery?

The preparation process for retinal surgery should be carefully planned to increase the success of the operation and minimize the risk of complications. This process includes detailed medical evaluation, medication management, anesthesia planning, and patient education.

• Medical Evaluation: Before surgery, the patient’s overall health status is thoroughly examined. Information such as past surgeries, chronic illnesses, and medications used is reviewed. Evaluating intraocular factors and systemic diseases is critical for accurate treatment planning. Additional tests like blood tests and electrocardiograms may be required.
• Medication Management: Medications that can increase surgical risks, such as blood thinners, may need to be discontinued for a certain period before surgery. For example, diabetic patients are often advised not to take their medications on the morning of the surgery. All medication changes should be made according to the surgeon’s instructions.
• Anesthesia Planning: The choice between local or general anesthesia depends on the patient’s health status and the complexity of the surgery. Local anesthesia is commonly used in retinal surgery, but general anesthesia may be preferred for more complex cases.
• Patient Education and Instructions: Patients are thoroughly informed about the surgical process, potential risks, and the recovery period. They are advised to fast on the morning of the surgery, avoid makeup and jewelry to maintain a sterile environment, and make transportation arrangements since there may be temporary vision loss postoperatively.

How Should Postoperative Care Be Managed After Retinal Surgery?

Proper care after retinal surgery is essential for a successful recovery, and patients must meticulously follow their surgeons’ instructions. Initially, positioning, especially for patients with gas bubbles inserted, plays a critical role. Maintaining a face-down position ensures the gas bubble adheres to the retinal repair area, supporting the healing process. This position is usually maintained for several weeks, including during sleep.

Physical activity restrictions are also part of the recovery process. Patients are advised to avoid heavy lifting, bending, and strenuous activities as these can increase intraocular pressure and the risk of complications. Additionally, patients should refrain from driving until their vision stabilizes to ensure safety.

Medication use is vital for preventing infections and controlling inflammation. Patients must use prescribed antibiotic and anti-inflammatory eye drops as directed and consult their doctors if they miss any doses.

Regular monitoring and follow-up visits are necessary for early detection of postoperative complications. Symptoms like increased pain, sudden vision changes, or flashes of light require immediate medical attention, and patients should remain vigilant for these signs.