Boleslav Kotlyar
Vitreous Retina Macula Specialists of New Jersey, USA
Title: Surgical approach to Rhegmatogenous Retinal Detachments
Biography
Biography: Boleslav Kotlyar
Abstract
The retina is the essential structure on which light has to be focused to allow for vision. Movement of the retina out of position with buildup of sub retinal fluid between the retina and the retinal pigment epithelium (RPE) defines a retinal detachment. The annual incidence of retinal detachments in the US has historically been reported as approximately 1 in 10,000 or about 1 in 300 over a lifetime.
Retinal detachments come in three varieties, Rhegmatogenous, Tractional, and Serous. Successful treatment of a Rhegmatogenous Retinal Detachment relies on isolating the retinal defect and closing the space between the RPE and the retina. In this lecture through photos and video, I will show examples of pneumatic retinopexy, scleral buckling, and vitrectomy.
Pneumatic Retinopexy involves the intravitreal injection of an expansile gas to flatten a retinal detachment along with retinopexy with either Cryotherapy or laser retinopexy of the offending retinal tears or defects. This is typically done in the clinic as a single session or over a few days if laser is used.
Scleral buckling involves the placement of a silicone sponge or band to physically indent the outer wall of the eye, decreasing the space between the retina and the RPE. Relieving existing traction, and supporting the existing retinal breaks in combination with, typically, cryotherapy leads to re-attachment of the retina.
Pars Plana Vitrectomy involves surgery with micro-instruments inside the eye, now though 23-, 25- or 27- gauge trocar ports. The vitreous gel is removed during vitrectomy, sub retinal fluid is drained, retinal defects are treated with laser or Cryotherapy and a tamponade is used of either gas or oil is used to help maintain retinal adherence to the RPE during the initial stage of treatment scar formation.