Not all retinal treatment procedures require an operating room. In fact, the majority of conditions are managed in the office as outpatient procedures. The more commonly performed procedures include:
Also called photocoagulation, this treatment applies thermal energy to targets through a dilated pupil. Special contact lenses are utilized to carefully focus the laser onto lesions such as leaking diabetic blood vessels (microaneurysms) and to areas not receiving adequate oxygen. Anesthesia includes both numbing drops (topical) and, on occasion, injections through the lower lid (retrobulbar block).
Retinal holes and tears often need to be contained to lessen the likelihood of retinal detachment. Demarcation, or "barricade", laser is often performed in cases where little or no fluid has yet to accumulate under the retina. Topical anesthesia is almost always sufficient.
Adjacent tissues can be stimulated to fuse by application of either thermal (heat) and cryo (freezing) energy. A cold probe applied to the outside surface of the eye can generate a localized adhesion between the retina and deeper eye wall layers. This "spot welding" is very strong and often completely eliminates the problematic retinal hole or tear. The treating physician carefully monitors the evolving cryo spot(s) by observing with a head-mounted device (binocular indirect ophthalmoscope). Anesthesia is often a combination of topical (drops) and subconjunctival injection. The treated eye is generally not patched.
A select group of eyes with retinal detachment may be eligible for this limited procedure. In short, a gas bubble is injected into the eye and the patient's head is positioned to support the area of detached retina while treatment to the causative hole/tear matures. Very important inclusion and exclusion criteria must be considered prior to selecting this approach to retinal detachment repair. Final vision may be better when this non-incisional technique suffices.
Many retinal conditions that were once managed in the operating room are now treated with drugs. Generating adequate drug concentrations in the eye is often difficult, if not impossible, by the oral route alone. Injecting a drug directly into the vitreous cavity has become the standard method to maximize treatment efficacy in many conditions. The published risk of infection after intravitreal injection varies but is often between 1:1,000 and 1:5,000. CPE's data shows a rate of no more than 1:10,000 to date.
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