Retinal Diseases

Treatment

Mayo Clinic offers the latest treatments for retinal diseases. The goal of many treatments is to stop further progression of the disease. In most cases, damage that has already occurred cannot be reversed, making early detection very important for vision preservation. Your eye care provider will work with you to determine the best treatment approach.

Laser photocoagulation

Laser photocoagulation is most often used to repair a retinal tear or hole.

In laser photocoagulation, the surgeon directs a high-energy laser to burn small pinpoints on the retina. For a retinal tear or hole, the burns create scar tissue, which adheres the retina to the underlying tissue.

Photocoagulation is nearly always done on the peripheral surface of the retina. Burns on the retinal surface cause blind spots.

Photocoagulation is usually an outpatient procedure and doesn't require any incisions. It's less irritating to the eye than surgical procedures such as cryopexy.

Panretinal photocoagulation (PRP)

Panretinal photocoagulation, also called scatter photocoagulation, is a procedure used for proliferative (advanced) diabetic retinopathy to shrink abnormal new blood vessels that are bleeding into the vitreous, the gel-like substance that fills the eye cavity.

In this technique, the surgeon treats the retina with multiple laser burns. The macula, responsible for central vision, is excluded. This treatment usually requires two or more sessions.

Panretinal photocoagulation offers benefits and drawbacks. The burns cause the new blood vessels to shrink and disappear, but they also cause some peripheral vision loss. By sacrificing some side vision, surgeons can preserve as much central vision as possible.

For some patients, panretinal photocoagulation can stop vision loss from diabetic retinopathy. PRP can also be used to stop proliferating blood vessels in other diseases such as retinal vein occlusions.

Cryopexy

Cryopexy (KRI-o-pek-see) is used to treat retinal tears. It's often used when tears are along the retinal periphery and difficult to reach with a laser.

In cryopexy, the surgeon uses intense cold to freeze the area around a retinal tear or hole. The surgeon applies a freezing probe to the outer surfaces of the eye, over the defect in the retina. The freezing produces inflammation that causes scarring. The scarring seals the hole and holds the retina to the underlying tissue to prevent fluid from passing through the tear, (which can lead to retinal detachment).

Cryopexy is an outpatient procedure, done with local anesthetic.

Pneumatic retinopexy

Pneumatic retinopexy is a treatment for uncomplicated retinal detachment when the tear is in the upper half of the retina.

First, your surgeon performs cryopexy around the retinal tear to seal it off. Then, a bubble of gas is injected into the vitreous cavity. The bubble expands over the next few days, sealing the retinal tear, and causing the retina to reattach itself to the wall of the eye.

To ensure that the bubble continues to press against the tear, you may need to keep your head upright or in a sideways position for a few days following surgery. The gas will dissipate from the eye in two to eight weeks. During that time, you need to avoid lying or sleeping on your back to reduce the risk of cataract formation or a sudden increase in eye pressure.

Pneumatic retinopexy does not require an incision and it's done on an outpatient basis with local anesthesia.

Scleral buckling

Scleral buckling is one of the most common surgeries for repairing retinal detachment. It slightly reduces the circumference of the eyeball, which aids in reattachment of the retina.

Scleral buckle

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Doctors usually start this procedure by treating the retinal tear or detachment with cryopexy. Then the surgeon sews a tiny synthetic band (buckling material made of solid or spongy silicone) to the eye wall or sclera (white part of the eye). This buckle indents the sclera and pushes the wall against the retina. This indentation helps close the separation between the retina and underlying layers and reduces the circumference of the eyeball. Pressure from the buckle promotes healing and helps prevent further pulling and separation.

Scleral buckling successfully repairs retinal detachment in more than 90 percent of cases. Vision preservation depends on how much the macula was affected before surgery. In some cases, some vision may be lost due to wrinkling or puckering of the macula. See epiretinal membrane.

Your doctor may recommend local or general anesthesia for this procedure. Scleral buckling is done in an operating room, but often on an outpatient basis.

Vitrectomy

Mayo Clinic doctors perform a vitrectomy to correct several concerns with the retina, including diabetic retinopathy, retinal detachment, macular hole, epiretinal membrane and intraocular eye infection. The procedure also may be used to remove a foreign body from the eye or to repair eye trauma.

In this procedure, the surgeon makes tiny incisions in the sclera (white portion of the eye) and uses delicate instruments to suction out blood-filled vitreous. A salt solution is injected to maintain the shape of the eye.

This surgery is used when bleeding or inflammation clouds the vitreous and obstructs the surgeon's view of the retina. Sometimes, removing the cloudy vitreous is the only surgical goal. In other instances, other procedures may be performed, such as peeling of scar tissue, laser photocoagulation, scleral buckle placement or gas injection. 

For most patients, vision improves after several weeks of recovery. New bleeding can occur after the procedure in some diabetics, but this is rare. As the blood dissipates, vision improves. 

The surgeon may recommend local or general anesthesia. A vitrectomy is usually an outpatient procedure.