Retinal Detachment: Challenges and Treatment Options

Q: Retinal Detachment: Challenges and Treatment Options

Hello Yan：<br>1. <br>Is proliferative vitreoretinopathy (PVR) difficult to treat? What is the likelihood of it not being resolved? The chance of resolution depends on the severity of the folds; it is usually a complex surgery, and if the retina can be reattached, it is considered

Retinal detachment issues?

Last July, I went to the hospital for an examination and was diagnosed with retinal detachment.
The next day, I underwent surgery to inject gas.
After regular follow-ups, over a month later, I discovered another detachment.
I was transferred to another hospital, where the doctor examined me and noted two areas of epiretinal membrane formation, medically known as PVR (proliferative vitreoretinopathy), which is severe and difficult to treat.
Consequently, I underwent surgery to remove the lens, and silicone oil was injected along with laser treatment and antibiotic eye drops.
After that, I continued to have regular check-ups, and they said everything was healing well.
About six months later, they said I could have the oil removed, so I had surgery to extract the oil and clean the area.
However, two days after discharge, I returned for a follow-up and found that there was another detachment (I am now completely blind).
My intraocular pressure is only 7 or 8, and about half of my corneal cells are damaged.
The doctor mentioned that I need to wait for the swelling to subside before undergoing another surgery to inject oil.
I have several questions:
1.
Is PVR (proliferative vitreoretinopathy) difficult to heal? What is the likelihood of it not being treated successfully?
2.
Is the success of oil extraction significantly related to the hospital's equipment and the doctor's experience? If the procedure is not performed correctly, will it lead to another detachment?
3.
How long can silicone oil remain in the eye? Can we wait until there are changes, such as bubbles or increased intraocular pressure, before taking further action? What happens if we do not extract it?
4.
Given the severe damage to my cornea, will injecting oil again worsen the condition? Will I eventually need corneal treatment?
5.
Is an intraocular pressure of 7 or 8 considered low? Could this lead to ocular atrophy in the future?
6.
Is it true that a fundoscopic examination cannot provide a 100% clear view?
7.
What could be the reasons for my multiple detachments? Are there any methods to improve this situation?
8.
Given the repeated detachments, should I consider transferring to a larger hospital or seeking a more experienced doctor?

yan, 60~69 year old female. Ask Date: 2020/03/31

Dr. Gao Pilin reply Ophthalmology

Hello Yan:
1.
Is proliferative vitreoretinopathy (PVR) difficult to treat? What is the likelihood of it not being resolved? The chance of resolution depends on the severity of the folds; it is usually a complex surgery, and if the retina can be reattached, it is considered successful.
2.
Is the success of vitrectomy significantly related to hospital equipment and the experience of the physician? If the procedure is not performed correctly, will it lead to re-detachment? The outcome of the surgery, including whether re-detachment occurs, is related to the recovery of the retina itself.
3.
How long can silicone oil remain in the eye? Should we wait for changes such as bubbles or elevated intraocular pressure before taking further action? What happens if we do not remove it? The decision to remove the oil depends on the situation; typically, if it can be removed, it should be.
Physicians usually plan to remove the oil a few months later, but in a few severe cases, silicone oil may need to remain in the eye long-term.
4.
If the cornea is severely damaged, will injecting oil during surgery worsen the condition? Will corneal treatment be necessary later? If oil is not injected, will it lead to blindness? In such cases, injecting oil should be considered first.
If the retinal damage is severe, corneal treatment is usually not performed.
5.
Is an intraocular pressure of 7 or 8 considered low? Will this lead to atrophy of the eyeball in the future? If the retina is not properly attached, it can lead to eyeball atrophy, so reattaching the retina is crucial.
6.
Is it true that a fundoscopic examination cannot provide a 100% clear view? If the cornea is clear, the lens has been removed, the vitreous is clear, and the pupil is sufficiently dilated, most of the retina should be visible.
However, nothing is ever guaranteed to be 100%.
7.
What could be the reason for my multiple detachments? Are there ways to improve this situation? If the degree of retinal detachment is too severe, it can lead to repeated detachments.
Sometimes multiple surgeries are required to achieve improvement.
8.
Should I consider transferring to a larger hospital or a more experienced physician due to multiple detachments? Retinal surgery requires an experienced physician, especially in complex and recurrent detachment cases.
If you have concerns, you may want to seek evaluation at a larger hospital's retina department.
Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday, Tuesday, Thursday, Friday from 8:00 AM to 12:00 PM; Wednesday from 2:00 PM to 4:30 PM.
Online responses are for reference only; it is essential to seek medical care at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Gao Pi-Lin

Reply Date: 2020/03/31

More Info

Retinal detachment is a serious condition that can lead to permanent vision loss if not treated promptly and effectively. Your experience with multiple surgeries and complications highlights the complexity of managing this condition, particularly with the presence of proliferative vitreoretinopathy (PVR), which can complicate treatment. Let’s address your questions one by one.

1. Is PVR difficult to treat? What are the chances of it not healing?
PVR is indeed a challenging condition to manage. It occurs when scar tissue forms on the surface of the retina, which can cause the retina to pull away from the underlying tissue. The success of treatment can vary significantly based on the severity of the PVR and the overall health of the retina. In some cases, PVR can lead to recurrent detachments, and the chances of achieving a successful outcome decrease with each subsequent surgery. However, many patients do benefit from surgical intervention, and ongoing monitoring is crucial.

2. Does the success of oil removal depend on hospital equipment and physician experience?
Yes, the success of the oil removal procedure and the overall management of retinal detachment can depend significantly on the quality of the medical facility and the experience of the surgeon. Advanced surgical techniques and equipment can improve outcomes. If the procedure is not performed correctly, there is a risk of re-detachment. It’s essential to choose a surgeon with expertise in retinal surgery, particularly in complex cases like yours.

3. How long can silicone oil remain in the eye? Should it be left until there are changes?
Silicone oil can remain in the eye for an extended period, sometimes several months to years, depending on the individual case and the surgeon's recommendation. However, it is generally advisable to remove it once the retina is stable and the risk of re-detachment has decreased. Leaving the oil in place for too long can lead to complications, including increased intraocular pressure or cataract formation. If there are no significant changes, it may be prudent to schedule the removal sooner rather than later.

4. Will further surgery with silicone oil worsen corneal damage?
If your cornea is already significantly damaged, additional surgeries could potentially exacerbate the situation. It is essential to weigh the risks and benefits of further procedures carefully. Your ophthalmologist may consider corneal treatments or interventions to address the damage before or after the retinal surgery, depending on the severity of the corneal condition.

5. Is an intraocular pressure of 7 or 8 too low? Will it lead to atrophy?
An intraocular pressure (IOP) of 7 or 8 mmHg is considered low and could potentially lead to complications, including the risk of ocular atrophy over time. Normal IOP typically ranges from 10 to 21 mmHg. It is crucial to monitor your IOP closely and discuss with your ophthalmologist the best strategies to manage it, especially if you are experiencing symptoms related to low pressure.

6. Is it true that fundus examinations cannot provide a complete view?
Fundus examinations can sometimes miss subtle changes or complications, particularly in cases with significant scarring or PVR. While they are a valuable tool for assessing retinal health, they may not always provide a complete picture. Advanced imaging techniques, such as optical coherence tomography (OCT) or fluorescein angiography, may be necessary for a more comprehensive evaluation.

7. What could be the cause of multiple detachments? Are there ways to improve this?
Multiple detachments can result from various factors, including high myopia, previous eye surgeries, or underlying retinal conditions. Improving management may involve regular monitoring, timely surgical interventions, and possibly lifestyle modifications to reduce strain on the eyes. Discussing your specific risk factors with your ophthalmologist can help tailor a management plan.

8. Should I consider switching to a larger hospital or a better physician?
If you feel that your current treatment is not meeting your needs or if you have concerns about the management of your condition, seeking a second opinion from a more specialized center or a surgeon with extensive experience in retinal detachment may be beneficial. It’s essential to feel confident in your treatment plan and the expertise of your healthcare provider.

In conclusion, managing retinal detachment, especially with complications like PVR, requires a comprehensive approach and close collaboration with your ophthalmologist. Regular follow-ups, open communication about your symptoms, and proactive management of your eye health are crucial for the best possible outcomes.

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