Risks and Solutions for Retinal Tear Laser Treatment

Follow-up questions regarding retinal tear laser treatment?

Hello, Doctor: I have high myopia (650 degrees in both eyes) and have undergone cataract surgery in both eyes.
During a recent follow-up visit, I was found to have a retinal tear, and the doctor advised me to undergo laser surgery promptly to prevent retinal detachment.
I would like to ask:
1.
I was informed that there is no guarantee I won't have further retinal tears in the future, and that this type of laser surgery may need to be repeated multiple times.
What are the risks associated with having this surgery done repeatedly? I have heard that it can lead to retinal folds or macular folds.
Does having multiple procedures increase the likelihood of retinal detachment?
2.
Some doctors online suggest that instead of laser treatment for retinal tears, it is better to first address the issue of vitreous traction to prevent further tears after the laser treatment.
What does it mean to address vitreous traction, and how can I bring this up with the hospital?
Thank you.

Mr. Chen, 50~59 year old female. Ask Date: 2021/09/12

Dr. He Jianxian reply Ophthalmology

1.
Laser treatment generally carries very low risks and is unlikely to produce side effects, and the claim that it is more likely to cause retinal detachment is unfounded.
2.
The notion of addressing vitreous traction issues is fundamentally misguided, as it requires surgical interventions such as vitrectomy.
It is incomprehensible to opt for surgical treatment for issues that can be easily managed with laser therapy.
Dr.
He Jianxian, Department of Ophthalmology, Nantou Hospital.

Reply Date: 2021/09/12

More Info

When it comes to retinal tears, particularly in the context of high myopia and previous cataract surgeries, the urgency and importance of treatment cannot be overstated. Your concerns about the risks associated with repeated laser treatments and the potential for further complications are valid and warrant a thorough discussion.

1. Risks of Repeated Laser Treatments: Laser treatment for retinal tears is generally considered safe and effective. However, like any medical procedure, it does carry risks, especially if performed multiple times. The primary risks associated with repeated laser treatments include:
- Retinal Wrinkling: Repeated laser applications can lead to the formation of retinal folds or wrinkles, which may affect vision.

- Macular Pucker: This condition occurs when scar tissue forms on the surface of the retina, particularly in the macula, leading to distorted vision.

- Increased Risk of Retinal Detachment: While laser treatment aims to prevent retinal detachment, multiple procedures can sometimes lead to changes in the retinal structure that may increase the risk of detachment.

- Visual Disturbances: Patients may experience new visual symptoms, such as flashes or floaters, after laser treatment, which can be distressing.

It is crucial to have a candid conversation with your ophthalmologist about the specific risks associated with your case, especially considering your history of high myopia and previous surgeries.

2. Addressing Vitreous Traction: The concept of addressing vitreous traction before laser treatment is an important one. Vitreous traction refers to the pulling of the vitreous gel (the clear gel that fills the eye) on the retina. In some cases, this traction can contribute to the formation of retinal tears.
- Vitreous Detachment: As we age, the vitreous gel can shrink and pull away from the retina, which is a natural process. However, in individuals with high myopia, this process can occur earlier and may be associated with retinal tears.

- Surgical Options: If vitreous traction is significant, your doctor may recommend a vitrectomy, a surgical procedure that removes the vitreous gel and alleviates the traction on the retina. This can reduce the risk of further retinal tears and may be a more effective long-term solution than repeated laser treatments.

To discuss this with your healthcare provider, you can express your concerns about the vitreous traction and ask if a thorough evaluation of the vitreous gel is warranted. You might say something like, "I understand that vitreous traction can contribute to retinal tears. Could we evaluate whether this is a factor in my case, and would a vitrectomy be a suitable option to consider before proceeding with more laser treatments?"
In conclusion, while laser treatment for retinal tears is a critical intervention, understanding the potential risks of repeated procedures and addressing underlying issues such as vitreous traction is essential for optimal eye health. Regular follow-ups with your ophthalmologist and open communication about your concerns will help ensure that you receive the most appropriate care tailored to your specific situation.

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