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, the damage that has already occurred cannot be reversed, making early detection very important for vision preservation.

Experienced Mayo Clinic ophthalmologists have performed hundreds of treatment procedures on patients with various retinal diseases. Based on symptoms, diagnosis and location and extent of damage, the physician will recommend one of the following treatments:

Photocoagulation

In photocoagulation, the surgeon creates small burns in the retina using a high energy laser. For a retinal tear or hole, the goal is to create scar tissue around the tear, which usually holds the retina to the underlying tissue. For diabetic retinopathy, the burns help seal off the abnormal blood vessels, stopping leakage of blood and fluid into the eye.

Creating burns on the retinal surface will cause blind spots, but photocoagulation is nearly always done on the peripheral surface of the retina. Any blank spots or loss of vision will occur in the peripheral vision, leaving central vision intact.

Panretinal Photocoagulation

Panretinal photocoagulation is a procedure used for proliferative diabetic retinopathy where abnormal new blood vessel growth is diffuse and causes bleeding into the vitreous. With this technique, the retina (except the macula, responsible for central vision) is treated with laser burns. These burns cause the new blood vessels to shrink and disappear, but the burns cause some peripheral vision loss. By sacrificing some side vision, surgeons can preserve as much central vision as possible.

Cryopexy

In cryopexy, the surgeon uses intense cold to freeze the area around a retinal tear or hole. This causes scarring which seals the hole and holds the retina to the underlying tissue to prevent fluid from passing through the tear, leading to retinal detachment.

Pneumatic Retinopexy

Pneumatic retinopexy is a treatment for retinal detachment. This surgery can be performed on uncomplicated retinal detachments with tears located in the upper half of the retina. First, cryopexy is performed around the retinal tear to seal it off. 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. Since the bubble must push against the tear, it may be necessary for patients to keep their head in a cocked position following surgery, depending on where the tear(s) is. Until the gas is gone from the eye (two to eight weeks), the patient must avoid lying or sleeping on his or her back to guard against cataract formation or a sudden increase in eye pressure.

Scleral Buckling

Scleral buckling is one of the most common surgeries for repairing retinal detachment. The surgeon sews buckling material (solid or spongy silicone) to the eye wall causing localized indenting of the sclera (eyeball) under the retinal tears. This indent, or buckle, closes the tear and changes the circumference of the eyeball, thereby preventing further pulling and separation. This procedure successfully repairs retinal detachment in more than 90 percent of cases, but preservation of vision depends on how 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.

Vitrectomy

When the back part of the eye is entered to treat a problem, the surgery is referred to as vitrectomy. During this procedure the eye is entered through tiny incisions and the vitreous gel is removed, followed by additional surgical steps, as necessary. Sometimes cloudy vitreous is removed as the only surgical goal. In other instances, peeling of scar tissue, laser photo coagulation, scleral buckle placement, gas injection or other steps are undertaken.