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Surgeon dispels misconceptions about retina surgery
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NEW YORK — Three common misconceptions about retina surgery are that it takes a long time, patients do not see well after surgery and patients have to be face down after surgery, according to a speaker here.
“Most of you may have trained back in an era of 20-gauge surgery. You may have trained at a time where people did not see improvement or when retinal surgery was painful,” John W. Kitchens, MD, said at OSN New York 2014. “Some of these things are historical. We do things a lot different now.”
John W. Kitchens
Instrumentation has advanced, and 27-gauge surgery is now available. In a case of a 64-year-old man with crooked vision in his left eye, Kitchens performed epiretinal membrane removal with 27-gauge vitrectomy and membrane peeling.
“The cutters now use very high cut rates. These cutters can go up to 7,500 cuts per minute,” Kitchens said.
In a case like this, surgeons can expect anatomical improvement, a 70% to 80% chance of a three-line improvement in vision in 8 to 10 weeks and worsened vision after vitrectomy if the patient has a cataract, Kitchens said.
In a case of a 67-year-old man with a “shade” drawn over the vision in his right eye, Kitchens performed macular hole surgery with vitrectomy, membrane peeling and gas placement.
“We have four ways to fix a retinal detachment: pneumatic retinopexy in the office where we inject a gas bubble followed by laser or cryotherapy, we have scleral buckling, we have primary vitrectomy, and we have buckle vitrectomy combined,” Kitchens said.
Surgeons can expect successful reattachment 85% to 95% of the time and visual acuity improvement in 3 to 12 weeks if the surgery was macula-off. Peripheral vitreoretinopathy is the No. 1 reason why patients fail, and that happens 5% of the time, he said.
“Retina surgery is oftentimes quick. Most of our epiretinal membranes and macular holes are about a 30-minute procedure. Patients can see well after retinal surgery. You may need to position after retinal surgery, but it is not as rigorous as what we used to do,” Kitchens said.
Disclosure: Kitchens is a consultant to Allergan, Genentech, Regeneron and Synergetics.