Retinal surgeries

Minimally invasive trocar-guided (27-gauge) vitrectomy

A "vitrectomy" refers to the removal of the vitreous body. Such an operation is necessary, for example, when there are diseases of the macula or retina . The outer diameter of the 27-gauge instruments measures a thickness of 0.4 mm. In comparison, it is 0.8 mm in the conventional 20-gauge technique, making it twice as large. The 27-gauge technique enables a seamless and painless eye operation with a significantly lower complication rate.

The operation

Through the smallest openings behind the corneal margin, the surgeon inserts 3 fine surgical and illumination instruments into the eye. The transparent vitreous is stained with a cortisone preparation, then cut and aspirated with an instrument. During the slow removal of the vitreous, the surgeon simultaneously fills the lost volume with a special fluid to keep the intraocular pressure constant. The diseased area of the retina is treated with a third instrument. At the end of the operation, the small entries into the interior of the eye are independently sealed seamlessly by the minimally invasive technique.

Risks of vitrectomy

Common complications include lens opacity within a year in 77% and additional retinal tears caused by the procedure in up to 17%. Rare complications include bleeding into the vitreous body in about 1% or inflammation of the interior of the eye up to endophthalmitis, which is very rare (< 0.01 %).

After vitrectomy

In the first days after a vitrectomy, the patient may experience mild pain and discomfort in the form of a foreign body sensation and still blurred vision. Complete visual recovery can take up to six months after surgery. With the minimally invasive 27-gauge technique, our patient can slowly return to everyday visual activities without disturbing air or gas tamponade postoperatively. Sauna, weightlifting and swimming should be avoided by our patients for the first 3 weeks.

Laser vitreolysis for vitreous floaters

Almost everyone will develop vitreous floaters - also called floaters - at some point in their lives, whether temporarily or permanently as in most cases. Floaters are perceived by some patients as very annoying due to the shadow cast on the retina. Patients have previously been advised to accept these shadows and the associated impairment of vision. Vitrectomy was only considered in particularly severe cases because such procedures carry a relatively high risk of complications (such as retinal detachment). For a few years now, laser vitreolysis (Ellex, Ultra Q Reflex) has been available as another option and is increasingly being recognized as a low-risk and effective method.

What is laser vitreolysis?

Laser vitreolysis is a non-invasive, painless procedure for the treatment of vitreous floaters using a new low-energy Nd:YAG laser. During laser vitreolysis, extremely short laser pulses are precisely directed at the floaters in the vitreous cavity, and the opacities are vaporized by the high-energy plasma.

How is the laser vitreolysis treatment performed?

After the patient has been fully informed, the pupil is dilated, the eye is anesthetized, and a suitable contact lens is placed on the cornea. Depending on the position of the floater, contact lenses with different focal depths are used or the applied laser energies are varied: 2–3 mJ for anterior opacities, 4–5 mJ in the mid-vitreous, and
10 mJ for the posterior floaters. The session usually lasts between 5 and 20 minutes. There are no restrictions for patients after the laser treatment and no further therapy is necessary.

Which vitreous floaters are generally suitable for therapy?

Fibrous strandsThese frequently occur in younger people and are perceived as a collection of dots or string-like tissue. Laser vitreolysis is the least suitable for these floaters, and waiting is the best option. The success rate is only 10%.

Cloud-like FloatersThese cloud-like floaters are the result of natural aging. Laser vitreolysis can achieve success rates of over 75% here.

Weiss-Ring Floaters (Martegiani Ring)These ring-shaped floaters are relatively large, well-defined floaters with the highest success rate (95%).

The Nanolaser Therapy: gentle treatment of the retina - without heat development

How does the regenerative therapy of the retina with the nanolaser work?

Laser therapy can stimulate the natural regeneration process of the retinal pigment epithelium (RPE) at the macula by focusing on the interior of individual RPE cells. This is done using the new nanosecond laser from the company Ellex, whose laser shots, positioned around the macula, generate very tiny gas bubbles. They only affect the interior of individual cells and leave their cell membranes intact. Because this RPE cell subsequently no longer performs its tasks, natural regeneration is stimulated, and a new cell is formed. Treatment with the cold light laser is very gentle, allowing it to be used in the macula area. Unlike laser coagulation, no heat develops that could fuse the retinal tissue layers. The sensitive photoreceptors also remain intact.

Nanolaser therapy in Chorioretinopathia Centralis Serosa (CCS)

A macular disease typical for younger people is Chorioretinopathia Centralis Serosa (CCS), also known as Retinopathia Centralis Serosa (RCS). The accumulation of fluid under the macula causes a detachment of the retina. Men are four times more likely to be affected by CCS than women. The main symptoms are unilateral blurred vision, image distortions, perception of a gray spot in the visual field, and color desaturation.

A possible cause could be a dysfunction of the outer retinal layer, i.e., the retinal pigment epithelium (RPE), and/or a strong blood circulation of the choroid (Choroidea). A thickened choroid leads to mechanical pressure on the vascular structures. This results in a disturbance of the pump function of the retinal pigment epithelium and leads to fluid accumulation. Currently, two forms of CCS are distinguished: an acute and a chronic, recurrent form. Up to 50 percent of cases of acute CCS result in a chronic, recurrent course. In particular, the development of defects in the pigment epithelium is responsible for permanent functional impairments.

Compared to the currently recommended therapeutic approach of waiting during the first four weeks, the use of the nanolaser improves 50 percent of findings within the first 40 days. By contrast, patients would have to wait about twice as long (about 90 days) for a comparable result without treatment. This form of laser therapy is quick, painless, and can be performed on an outpatient basis. Compared to photodynamic therapy (PDT), it is significantly less complex and invasive.

In particular, a faster remission compared to the spontaneous course is to be aimed for, as the vast majority of those affected are not only fully professionally committed but also suffer significantly from the typical symptoms such as micropsia, metamorphopsia, and visual impairment. Simply waiting for spontaneous improvement over a period of up to six months is not an acceptable alternative for these patients.