Patients Treatment-Retina Centre of Ottawa

A Macular Pucker usually requires no treatment. In many cases, the symptoms of vision distortion and bluriness are mild and no treatment is necessary. Neither eye drops, medications, nor nutritional supplement will improve vision distorted from Macular Pucker.

What is an Epiretinal Membrane?

An Epiretinal Membrane is a thin sheet of fibrous tissue that develops on the surface of the macula and can cause problems with central vision.

What is a Membrane Peeling?

Occasionally, vision deteriorates to the point where it affects daily routine activities. When this happens, surgery may be recommended. This procedure is called a Vitrectomy, with membrane peeling in which the vitreous gel is removed to prevent it from pulling on the retina and replaced with a saline solution. Also, the scar tissue which causes the wrinkling is removed. An Epiretinal Membrane peeling is performed under local anethesia. After the operation, you may need to wear an eye patch for the day to protect the eye. You will also need to use medicated eye drops to protect against infection. Surgery to repair a Macular Pucker is very delicate, and while vision improves in most cases, it does not always return to normal. Some people have significantly more vision restored, some less. In most cases, vision distortion is significantly reduced. Recovery of vision can take up to three to six months.

What to expect?

Epiretinal Membrane Peeling is an outpatient procedure and is done at the Ottawa Hospital, Riverside Campus, 3^rd floor. You will be notified by the Hospital for a time and date of your pre-assessment. You will be contacted the day before your scheduled surgery with a time to arrive at the hospital.

There is a greater than 50% chance that your surgery could be rescheduled up to the day of your surgery.

What is a Macular Hole?

Macular Hole is a problem that affects the very central portion of the retina. The most common cause is related to the normal aging process.
The vitreous gel inside the eye is firmly attached to the macula. With age, the vitreous becomes thinner and seperates from the retina. Sometimes this creates traction on the macula, causing a hole to form.
Macular Holes often begin gradually and affect central vision depending on the severity and extent of the problem. Partial holes only affect part of the macular layers, causing wavy, distorted, blurred vision. Patients with full-thickness Macular Holes experience a complete loss of central vision.

What will it do?

In many cases, surgery is necessary to close the hole and restore useful vision. Macular Holes are repaired with surgery. During the operation, the surgeon first gently removes the vitreous gel with a procedure called vitrectomy. This eliminates any traction on the macula. A gas bubble is injected in the eye to place gentle pressure on the macula and help the hole to seal. Following surgery, patients must remain in a face-down position for one week. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole. As the bubble is reabsorbed, the vitreous cavity refills with natural eye fluids. Maintaining a face-down position is crucial to the success of the surgery.

What to Expect?

Macular Hole surgery is an outpatient procedure and is done at the Ottawa Hospital, Riverside Campus, 3^rd floor. You will be notified by the Hospital for a time and date of your pre-assessment. You will be contacted the day before your scheduled surgery with a time to arrive at the hospital.

There is a greater than 50% chance that your surgery could be rescheduled up to the day of your surgery.

YOU CANNOT FLY FOR 8-10 WEEKS AFTER THIS SURGERY

Why would I need a vitrectomy?

Frequent reasons for requiring a Pars Plana Vitrectomy:

Proliferative Diabetic Retinopathy (including Vitreous Hemorrhage)
Macular Hole
Epiretinal Membrane (Macular Pucker)
Complicated, tractional or recurrent retinal detachment
Giant retinal tear

What is a Vitrectomy?

Vitrectomy is a procedure in which specialized instruments and techniques are used to repair disorders. The initial step in this procedure is usually the removal of the vitreous gel through very small incisions in the eye wall. The vitreous is removed with a miniature handheld cutting device and replaced with a special saline solution similar to the liquid being removed from the eye. A high intensity fiberoptic light source is used to illuminate the inside of the eye while the surgeon works. The surgeon uses a specialized operating microscope and contact lenses, which allow a clear view of the vitreous cavity and retina at various magnifications. The procedure is performed in an operating room under local anesthesia.

What to expect?

Although the eye is often red after surgery, there is usually not much discomfort. Typically, patients leave the operating room with an eye patch and return the next day for post-operative evaluation and removal of the patch. Eyedrops are started the first day after the procedure.

There is a greater than 50% chance that your surgery could be rescheduled up to the day of your surgery.

What is a Retinal Detachment?

A retinal detachment is a seperation of the retina from its attachments to the underlying tissue within the eye. Most retinal detachments are a result of a retinal break or tear. These retinal breaks may occur when the vitreous gel seperates from the retina. Once the retina has torn, liquid from the vitreous gel can then pass through the tear and collect behind the retina. The buildup of fluid behind the retina is what seperates (detaches) the retina from the back of the eye. As more of the liquid vitreous collects behind the retina, the extent of the retinal detachment can progress and involve the retina, leading to total retinal detachment.

What will a Scleral Buckle do?

Scleral Buckle surgery is the most common way to treat a retinal detachment. It is a method of closing and flattening the retina.

A Scleral Buckle is a piece of silicone sponge, rubber, or semi-hard plastic that your ophthalmologist places on the outside of the eye (the sclera, or the white of the eye). The material is sewn to the eye to keep it in place. The buckling element is usually left in place permanently.

The Scleral Buckle pushes in, or "buckles", the sclera toward the middle of the eye. This buckling effect on the sclera relieves the pull (traction) on the retina, allowing the retinal tear to settle against the wall of the eye. The buckling effect may cover only the area behind the detachment, or it may encircle the eyeball like a ring.

Laser is used to tack the retina down and hold it in place until a seal forms between the retina and the layer beneath it. The seal holds the layers of the eye together and keeps fluid from getting between them. Sometimes your ophthalmologist may inject a gas bubble into your eye to flatten the retina. He or she may also drain the fluid under the detached retina through a tiny hole in the sclera. If there is only a small amount of fluid, draining it may not be needed. The retina will pump it out.

Detachments are repaired on an outpatient basis with local anesthesia.

Right before surgery, you will have eye drops to dilate your pupils.

Surgery usually lasts 1 to 2 hours.

You may have some pain for a few days after the surgery. Your eye may be swollen, red, or tender for several weeks. Your ophthalmologist will put drops in your eye to prevent infection and keep the pupil dilated. You will have to wear a patch over the eye for a day.

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