Retina and Vitreous

Retina and vitreous surgeries are among the most delicate and common eye operations. Professor Dr. Amin Faisal Ellakwa is a specialist in retinal treatment and a consultant in retina and vitreous surgeries. Dr. Ellakwa has clarified that these surgical procedures cannot be performed just anywhere; rather, the patient must choose the best retinal eye doctor in Egypt and the Arab world (Professor Dr. Amin Faisal Ellakwa). In light of this, today we will inform you about the types of these operations, their steps, and all their details, while highlighting an Egyptian eye doctor who is a specialist and a humanitarian before being an outstanding doctor: Professor Dr. Amin Faisal Ellakwa, who has successfully performed thousands of retina and vitreous surgeries with his own hands.

Types of Eye Retinal and Vitreous Diseases

It is impossible to comprehensively list retinal and vitreous diseases in a few lines, as they require extensive and detailed explanation. However, since we are focusing on retina and vitreous surgeries, it is essential to highlight the most common medical conditions affecting them, including:

• Diabetic Retinopathy: One of the most common retinal diseases that appears in diabetic patients. It is a complication of this disease, where a retinal vascular disorder and deformation of blood vessels occur, resulting in a lack of blood supply to the retina and its subsequent damage.
• Macular Degeneration: In this disease, progressive damage occurs in the center of the retina, specifically in the macula, leading to partial vision loss. It is divided into two types:
  • Wet Macular Degeneration: Characterized by abnormal blood vessel growth under the macula, resulting in bleeding and inflammation in the retina and vision loss.
  • Dry Macular Degeneration: Involves the death of the deep layers under the macula, and it may later transform into the wet type.
• Retinitis Pigmentosa: A hereditary disease in which there is progressive degeneration of retinal cells, ultimately leading to loss of peripheral and night vision.
• Macular Hole: A hole occurs in the macular region due to vitreous detachment, and it may sometimes be accompanied by retinal detachment.
• Retinal Tear: Occurs due to vitreous contraction, where it pulls the inner retinal layers because of its attachment to them, leading to a retinal tear.
• Central Retinal Vein Occlusion: A medical condition in which the vein that carries blood from the retina to the heart becomes blocked, due to narrowed veins or a blood clot, leading to increased venous pressure and swelling.
• Retinal Ischemia: A disease resulting from insufficient blood and oxygen supply to the retina. It occurs due to high cholesterol, blood clots, or any cause leading to narrowing of blood vessels.
• Vitreous Hemorrhage: Infiltration and leakage of blood into the transparent vitreous humor, making it opaque and obstructing the passage of light rays to the retina.
• Retinal Detachment: Considered one of the most dangerous retinal diseases, where vitreous fluid leaks due to the tearing of the supporting layers of the retina.

What are Retina and Vitreous Surgeries?

After learning about retinal and vitreous fluid diseases, we can fully understand that retina and vitreous surgeries are not limited to one, two, or three procedures; rather, there are dozens of operations and procedures used to treat diseases in these areas. However, we will review some of the most important of these operations below:

Argon Laser Retinal Surgery

Argon laser is considered one of the latest medical technologies, and it is the optimal treatment for cases of diabetic retinopathy, macular degeneration, retinal detachment, and others. This therapeutic procedure treats a wide range of symptoms of retinal and vitreous diseases, including: flashes, headaches, eye pain, night vision problems, elevated eye pressure, difficulty with distant vision, glare, and color discrimination problems.

As for the method of treatment with argon laser for the eye, it is as follows:

• Initially, the patient is given pupil-dilating drops, and topical anesthetic drops are also applied.
• After that, the argon laser is directed at the eye, which emits light rays of specific wavelengths targeting the retinal tissues without any surgery or additional procedures.
• The rays are initially absorbed by tissues rich in melanin, hemoglobin pigments, and xanthophyll, and then they transfer to the rest of the membranes.
• The retina absorbs the light rays and converts them into thermal energy.
• Using modern equipment, the temperature of the vital tissues in the eye is determined, and when it reaches 65 degrees Celsius, the therapeutic efficacy occurs, as the nature of the retinal proteins changes and photocoagulative necrosis occurs, indicating the treatment of retinal problems in less than 30 minutes.

Eye Injections with Cortisone and Other Treatments

One of the most widespread retina and vitreous surgeries, it is based on the principle of injecting a group of medications, especially steroidal treatments, directly into the vitreous body for absorption by the retina, which is rich in blood vessels and difficult to reach by injection. Eye injections with cortisone are indicated for the treatment of: retinopathy, retinal and vitreous hemorrhage, retinal vein occlusion, and both types of macular degeneration. The medications used in injections vary to include: cortisone (e.g., Triamcinolone Acetonide, Ozurdex), anti-vascular endothelial growth factor (Anti-VEGF) agents (e.g., Lucentis, Eylea), and antibiotics or antifungals.

As for the method of treatment with eye injections, here are its steps:

• As is the case with most retina and vitreous surgeries, the eye is locally anesthetized.
• Then the doctor thoroughly cleans the area around the eye.
• After that, the patient is asked to look in a specific direction, and the specialized syringe is carefully inserted into the vitreous body.
• The eye injection procedure ends within a few minutes, and the patient feels only slight pain or mild stinging.

Retinal Hole Surgeries

Retina and vitreous surgeries that involve piercing the retina target all cases where there has been a tear in the retina, such as: retinal detachment, retinal tears, vitreous hemorrhage, and others. Thus, laser retinectomy treats the most important symptoms of these diseases, namely: intermittent peripheral lights, spots, and black threads (floaters). Retina and vitreous surgeries that focus on piercing the retina are divided into 4 procedures, categorized as follows:

• Laser for Retinal Treatment: Using a non-surgical laser, a contact lens is placed to protect the natural eye lens, and then the laser is directed to the site of the injury to cauterize the area surrounding the retinal hole, thereby repairing the perforated retina.
• Scleral Buckle (Retinal Band): After the patient is given general anesthesia, Professor Dr. Amin Faisal Ellakwa performs the scleral buckle procedure by implanting a precise external support around the retina to help it return to its natural position, along with cryopexy (freezing) of the area surrounding the retinal hole.
• Cryotherapy for Retinal Treatment: A non-surgical procedure where the patient is given general anesthesia and then a freezing technique is used by directing a cold probe to the tissues surrounding the retinal hole to repair it.
• Retinal Hole Surgery (Vitrectomy): The final option for severe retinal tears, where a surgical procedure is performed to treat holes at the edges of the retina, especially if there are multiple holes in it.

Gas Injection into the Eye

One of the widely spread retina and vitreous surgeries, also called "pneumatic retinopexy," it is the primary specialized treatment for cases of retinal detachment, choroidal detachment, retinal vessel occlusion, macular edema, and macular holes. In this operation, the eye is injected in approximately 30 minutes with special types of gas that remain in the eye for a period ranging from two weeks to 8 weeks. The best types of gases used include: SF6 gas and C3F8 gas.

As for the procedure of gas injection into the eye, it is performed through a set of explained stages:

• Initially, the eye is locally anesthetized, and the surrounding skin is disinfected.
• Then the doctor precisely injects a bubble of air or gas into the vitreous cavity.
• When the gas bubble takes its correct place, it pushes the damaged retina towards the eye wall to stop the flow of vitreous fluid behind the retina.
• Gas injection is often accompanied by cryopexy to treat retinal holes.
• The accumulated fluid beneath the retina is automatically absorbed.
• Upon complete absorption of this fluid, the retina reattaches to the eye wall as it was in its natural state, and the injected gas bubble in the eye disappears.

Scleral Buckle (Eye Surface Tightening)

One of the most precise retina and vitreous surgeries that requires deep and genuine expertise in ophthalmology and its surgery, therefore, Professor Dr. Amin Faisal is your first choice for performing it. The procedure of eye surface tightening or scleral buckling treats various types of retinal detachment, in addition to retinal holes and wrinkles.

As for the steps of performing a scleral buckle, they are as follows:

• Initially, the eye is locally or completely anesthetized, and the patient is given intravenous painkillers.
• Then a silicone band is placed around the outer layer of the eye wall, i.e., the white of the eye.
• The surgeon sutures the band to the outer eye wall to patch holes and tears and tighten retinal wrinkles.
• This pushes the sclera inward, which relieves the pressure applied to the retina.
• This procedure is often accompanied by cryopexy or photocoagulation by argon laser to fix the retina in place.
• It may also require draining the fluid accumulated under the retina to facilitate its repositioning on the posterior eye wall.

Vitrectomy (Vitreous Body Removal)

Vitrectomy in the eye is a microscopic surgical procedure used to treat cases of retinal detachment, diabetic retinopathy, macular holes, macular pucker, retinal ulceration, and vitreous hemorrhage. There are many options for performing this procedure, where the vitreous fluid is replaced with another completely transparent fluid that does not affect the passage of light rays to the retina, such as (saline solution, silicone oil, gas bubble...).

Regarding the steps of vitrectomy surgery, which lasts for one hour or more, they can be clarified as follows:

• First, the patient is given local or general anesthesia.
• Using surgical microscopes, an incision is made on the outer surface of the eye.
• After that, the vitreous body, which is a gelatinous mass, is removed.
• Dr. Amin works to fill the vitreous cavity with another substitute fluid.
• In some cases, a gas or air bubble is injected to stimulate the renewed secretion of vitreous fluid