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Retinal Laser Surgery

Retinal Laser Surgery (Laser Photocoagulation)

Overview

Our eyeball consists of: cornea, the foremost transparent layer of the eyeballs; the anterior chamber located behind the cornea, in which the aqueous humor is found; the iris and the pupil forming the rear border of the anterior chamber; the lens located in a capsule in the posterior chamber; the fluid, called vitreous humor, filling the eye globe in the posterior chamber; and the optic disc, the optic nerve and the retina at the rearmost part of the eyeballs. The white part seen from the outside of the eye is called sclera.

Vitrues body is the clear gel that fills the cavity at the posterior part of the eyeballs.  The retina is the first layer that confines the vitreous humor in the eyeball.

The retina hosts photoreceptor cells of the eye and the layer is located adjacent to the arterial and venous network (choroid plexus) of the eyeball; the macula – the layer that transmits light signals to the brain in order to sense the light and create the image-, the foveola, the optic disc and the optic nerve are located in the retina.

A visual disorder will be indispensable, if damage occurs in this layer of the eye (the innermost layer at the posterior part of the eye) that is so important for healthy vision due to various reasons, including but not limited to aging, trauma, diabetes mellitus, and hypertension as well as brain tumor.

Laser surgery aims treatment of retinal diseases using the thermal effect of high-energy beams. Retinal laser surgery is useful and preferred for retinal tear, bleeding and edema that are not severe enough to require surgical management.

Following conditions of the retina can be treated with laser surgery:

Retinal bleeding or leak: If bleeding or leakage develops in retinal blood vessels secondary to trauma or other diseases, such as diabetes mellitus and hypertension, the bleeding or leaking area is coagulated by the thermal effect of the laser.

Retinal edema: Edema is a result of bleeding or leakage in blood vessels and it can be regressed by laser beams.

Macular edema: It implies swelling of the macula and the treatment principle is identical to that of the retinal edema.

Macular degeneration: The macula is a part of the retina and it is responsible for the central vision; age-dependent degenerative changes may occur in the macula. There are two types of macular degeneration, namely wet and dry. The thermal effect of the laser is used to destruct the degenerative areas and to eliminate the vision problem.

Retinal hole or tear: The retina that lines the innermost wall at the posterior part of the eyeball may be torn or a hole may develop on this layer secondary to genetic factors, aging, ocular surgery such as cataract or an eye trauma. The vitreous humor may advance through this hole or the tear, resulting in complete detachment of the retina. In retinal laser surgery, thermal energy is used to coagulate the tear or the hole and a scar tissue is formed in order to stop the progression of the clinical picture.

Retinal detachment: The detachment of the retina is manifested by various symptoms, such as loss of visual accuracy, blurred vision, flashes in front of the eye, loss of peripheral visual field, total loss of the visual field and floaters in one or both eyes. If you recognize such symptoms, you should see an ophthalmologist to recover visual functions.

The known risk factors of the retinal detachment include age above 50 years, diabetes mellitus, hypertension and family history of retinal detachment.

When you see an ophthalmologist due to above mentioned symptoms, a detailed eye examination will be made. The anterior chamber that consists of the cornea, the iris, the pupil and the lens is examined.

This stage of the eye examination is followed by retinal examination by an ophthalmologist who is specialized in retinal diseases. At this phase, advanced imaging methods, such as fundus fluorescein angiography, optic coherence tomography and eye ultrasound, can be ordered to evaluate retinal vessels and retinal topography in detail and to image the eye. Here, the aim is to determine the location and the severity of the retinal detachment, if the retinal detachment is diagnosed.

Laser surgery for retinal detachment requires a reasonable size of the retinal detachment area. The thermal effect of the laser stitches or somewhat welds the detached layers of the retina to the posterior wall.

Malformation of retinal blood vessels: Abnormal swelling, tortuous contours and resultant blood leakage in retinal blood vessels are treated using laser beams.

Why is this procedure done?

Retinal laser surgery is a treatment option for retinal diseases, for which surgery is not absolutely indicated. While the complication rate is usually low for ocular surgery, retinal laser surgery (photocoagulation) is a far safer method.

Risks

The most common complications are cataract, loss of vision, increased intraocular pressure, recurrence, blurred vision and infection. 

Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.

Our specialists will employ all practices to minimize the risk of complications and our ophthalmologists will preoperatively inform you about the risks listed above and all other potential complications.

Preparation

After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.

You may need to use antibiotic eye drops or tablets before and after the surgery in order to eliminate the risk of postoperative infection.

It may not be necessary to stop eating and drinking before the retinal laser surgery. Your doctor will inform you about this issue depending on your condition.


Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.


Surgery and early postoperative period

Retinal laser surgery is usually a day surgery that is carried out at outpatient basis. After the skin around your eye is numbed, eye drops are used to dilate your pupils. The procedure is carried out in an examination chair that is similar to chairs used for routine eye exams. You will be alert throughout the procedure, but you will not feel pain.

A special lens will be placed on the cornea in order to focus the laser beams on the diseased portion of the retina. Meanwhile, your doctor will be able to see the retina under microscope. The area around the retinal bleeding, edema, hole, tear and degeneration will be burnt by laser beams in order to isolate the diseased zone. Next, the retinal lesion will be coagulated in a controlled manner.

You may see flashes in front of your eye throughout the procedure.

Treatment of retinal diseases takes about 15 to 30 minutes depending on the condition.

You may feel very mild discomfort after the retinal laser surgery is completed. Moreover, you will probably see floaters. Your doctor will take measures for such symptoms, if required, but they will mostly disappear without a need to treatment.

You should be very careful about physical activity for one week after the surgery. You should avoid lifting heavy objects and moving suddenly. Moreover, you will be asked to keep your head elevated to maximum extent. You can engage in work or school life, provided that you avoid strenuous activities.

Your doctor may ask you to use antibiotics, anti-inflammatory tablets and eye drops as a precaution. You should closely follow all advices of your doctor in order to prevent or minimize postoperative complications.

However, you should contact your doctor, if you feel severe pain or discomfort in your eye.

Results

Retinal damages are, unfortunately, irreversible, as retinal cells cannot regenerate.

The major factor that influences postoperative visual results is the location and the severity of the retinal damage.

It may take some time for preoperative visual disorders to disappear. Moreover, such problems may not completely disappear.

Since there is risk of recurrence in retinal diseases and restoration of visual functions takes some time, you should necessarily see your doctor at pre-scheduled visits. Extra treatments or interventions can be recommended depending on recovery of your disease and status of your visual functions.