DR. FRANK VENZARA III: Retinal Detachment – Severe PVD Is An Ocular Emergency
By Dr. Frank Venzara III // August 30, 2017
BREVARD COUNTY, FLORIDA – If you think of your eye as a camera the retina would be the film. It is a thin layer of nerve tissue that lines the inside back wall of the eye and is composed of over 120 million photoreceptors, which are responsible for sending the signal of an image to the brain via the optic nerve.
The back chamber of the eye (behind the lens) is filled with a jelly like substance called vitreous. As we age, the gel becomes more liquefied and tends to separate from the retina, causing what is called Posterior Vitreous Detachment (PVD).
Severe PVD Is An Ocular Emergency
The majority of the time when a PVD occurs people notice a few new floaters. However, in more severe cases the vitreous gel can pull abruptly away from the retina resulting in a tear of the retina.
A retinal tear is an ocular emergency because it can lead to a retinal detachment. The incidence of retinal detachment is about 1/5,000 people per year, and without intervention it frequently leads to permanent blindness.
Retinal Tear Risk Factors
Risk factors for retinal tears include, people who are highly nearsighted, cataract surgery, trauma to the eye, genetic disorders, family history and weak areas in the retina.
Timing Is Key To Treatment
Timing is key when it comes to retinal tears and retinal detachments. Fortunately retinal tears and detachments always start in the peripheral vision. The goal is to fix the problem before a detachment of the retina involves the central vision. There is no pain with a retinal tear or detachment only the below mentioned visual symptoms.
Immediate dilated eye exam by an eye doctor is recommended if you experience any of the following:
• Flashes of light (quick bursts lasting only a second)
• Sudden dramatic increase of floaters (more than just occasional few) this can be an indication of bleeding inside the eye from a tear.
• Floaters with a clouding of vision
• Dark curtain or shadow in periphery of vision that doesn’t go away.
Treatment For Retinal Detachment
You go to your local doctor and you are informed you have a retinal detachment, what next, surgery? In many cases, if the retina detachment is small, it can be barricaded and sealed with a laser procedure in the office.
If the retinal detachment is large or involving the central vision there are two options. One is an in office procedure called a pneumatic retinopexy the other is going to the operating room for vitrectomy and/or scleral buckle surgery.
A pneumatic retinopexy involves injecting a gas bubble in the eye and a week of head down positioning. The gas bubble plugs the hole and within 24 to 48 hours the retina will flatten and then laser can be placed around the retinal tear.
The advantages of a pneumatic retinopexy include lower cost, less invasive and near immediate reattachment of the central retina. The disadvantages include very strict head positioning and a success rate that is slightly lower than vitrectomy surgery in the operating room.
For the right patient, pneumatic retinopexy is safe, effective, minimally invasive and a quick procedure.
Advantage of Vitrectomy
For complicated retinal detachments with multiple retina tears or scar tissue present, the operating room is the best choice.
A procedure called a vitrectomy is performed to remove the vitreous gel from the back of the eye, identify all tears, drain the fluid from behind the retina, laser the tears and fill the entire posterior eye with gas or oil.
The advantage of vitrectomy surgery is that all tears can be identified, treated and scar tissue can be removed from the surface of the retina. In rare cases a silicone band, known as a scleral buckle, may also be placed around the outside of the eye to further support the retina.
I specialize in retinal detachment repairs and have successfully treated hundreds of retinal detachments, frequently performing outpatient pneumatic retinopexy in the office. I manage more severe and complicated detachments in the operating room at Cape Canaveral Hospital, which has state of the art equipment.
To get more information on retinal tears and detachments please visit the website FloridaRetinaSpecialists.com
ABOUT THE AUTHOR
Dr. Frank Venzara III is a native of Merritt Island, Florida. He received a biomedical engineering degree and medical degree from the University of Miami, and spent a full year performing research at the prestigious Bascom Palmer Eye Institute where he published articles in peer reviewed journals and presented his work at multiple national meetings.
He went on to Texas A&M Scott & White Eye Institute where he completed a four year internship and ophthalmology residency training program and served as chief resident. Following residency, Dr. Venzara completed a two year surgical retina fellowship at one of the most surgically intensive retina programs in the country. While at the Retina Consultants of Alabama fellowship program at UAB Callahan Eye Hospital, he performed over 1,100 retina surgery cases, which is greater than 2.5 times the national average for retina fellows.
Dr. Venzara is Board Certified by the American Board of Ophthalmology and a member of the American Society of Retina Specialists, American Academy of Ophthalmology, Florida Society of Ophthalmology, and the Christian Ophthalmology Society. To reach Dr. Venzara call 321-735-8800 or log on to FloridaRetinaSpecialists@gmail.com