The new vitrectomy techniques create the conditions for highly atraumatic surgical procedures, without the use of sutures and with thinner instruments (25 gauge), which are essentially the thickness of an insulin needle.
The duration of surgery is shorter, the traumatic surgical burden on the eye is less and the recovery time is shorter. Overall, these benefits create the conditions for much better results.
A few hours after the operation, the patient returns home, following the post-operative instructions of the ophthalmic surgeon. The healing process is completed after 15-20 days. The macular diseases that are treated surgically are macular hole, macular membrane and diabetic macular edema.
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Α. The hole of the macula
In an area of 1 - 2 mm located in the centre of the retina we find the largest concentration of optical cells. This is why the macular region is responsible for excellent quality visual abilities, such as reading, writing and driving. The surrounding areas of the retina are responsible for the rest of the visual field.
Macular hole is a disease that affects the macula. If it develops, there is reduced central visual acuity. Without intervention, the condition worsens and vision becomes very poor. The purpose of the operation is to close this hole in order to stop the loss of vision and even lead to an improvement.
Β. The epiretinal or epiretinal membrane
It is a membrane, which begins to form on the macula. It develops slowly and affects central vision, causing blurring and distortion of the image.
Over time it grows and hardens and creates an attraction which leads to swelling (fluid collection).
This membrane begins to appear in the 50s (3-5% of the population) and progressively increases over the decades (to 20% in the 70s).
The idiopathic form, which is the most common, is not caused by any condition but by age. There are, however, cases due to certain eye diseases, such as diabetic retinopathy, posterior vitreous detachment, retinal detachment, trauma, inflammation, etc.
Treatment of the condition is only surgical. The decision for surgery is taken when vision is poor or when it is found to be progressively deteriorating.
The post-operative objectives are twofold:
The anatomical result (removal of the membrane and elimination of the traction-edema) and the functional recovery (the resumption of the function of the cells that after a long time are back in place).
Increased vision.
Γ. Diabetic macular edema
It refers to the accumulation of fluid in the layers of the retina and can occur at any stage in the progression of diabetic retinopathy.
The main risk factor for diabetic macular edema is elevated levels of glycosylated haemoglobin HbAlc, as well as arterial hypertension, hyperlipidemia, diabetic nephropathy and smoking.
Diabetic macular edema is the most important cause of visual acuity loss in diabetic patients. In addition, image distortion, reduced contrast sensitivity, photophobia, colour perception disturbances and paracentral darkness may also be observed.
One of the treatments for the condition is surgical removal of the vitreous to increase oxygen access to the macula, which will help reduce swelling, and the simultaneous removal of the inner aphoretic membrane, which will relax the traction on the macula.
