Start your journey to retinal health in Kingston upon Thames

Mr Mostafa Elgohary, a consultant ophthalmologist at Kingston Hospital, discusses how retinal detachment and macular hole can be resolved by surgical procedures with a very high success rate


round four years ago, a vitreoretinal surgery unit was set up at Kingston Hospital’s ophthalmology department

that off ered treatments to patients with po- tentially sight-threatening conditions aff ect- ing the vitreous and retina. The vitreous is the gel-like structure that

fi lls the eye and is normally attached to the retina — the light-sensitive tissue at the back of the eye. The retina is similar to the fi lm in an old-fashioned camera. Formed of 10 layers of nerve cells and blood vessels, the integrity of the retina is key to maintaining good eyesight.

Occasionally, however, the detaching vitre-

ous pulls too hard on either the periphery of the retina — causing a retinal tear or even reti- nal detachment (RD) — or on the central, most sensitive but also thinnest part of the retina, the macula, causing a macular hole (MH). In RD, the retina falls off the back of the

eye like a strip of wallpaper falling off a wall. When the retina detaches, it gets deprived of the blood and oxygen that normally come from the underlying layer of blood vessels. If that lasts long enough, some of the retinal cells start to die off . Patients with RD often see fl oaters and

fl ashes of lights at the beginning, and with time develop a shadow that blocks part of their fi eld of vision. The shadow gets bigger with time and, unless treated urgent- ly, it may extend to aff ect the whole retina and cause blindness.

OCT laser scan before (left) and after (right) surgery for a macular hole

The eye as a camera Some serious and potentially blinding con-

ditions aff ect both the vitreous and retina and can only be treated by surgery. Two of the conditions I want to discuss here are ret- inal detachment and macular hole. As we get older, the vitreous gel tends to

peel away from the retina, a condition called posterior vitreous detachment (PVD). This is normally inconsequential.

Surgery for all the above conditions in-

Retinal detachment (left) and reattached (right) with a band of laser marks along the torn edge (shown by arrow)

With MH, the fi rst problem patients

notice is a diffi culty with reading, as they fi nd it diffi cult to make out letters, particu- larly similar-looking ones like c, e and o. One of my patients, who played tennis reg- ularly, described how it became diffi cult for him to see the ball. Other symptoms of MH are distortion of vision — with ob- jects appearing squashed, smaller or larg- er — and sometimes double vision. Clearly, experiencing this while driving could be highly dangerous. Early diagnosis and treatment of both

Detaching vitreous pulling on the retina in the periphery and at the macula

RD and MH increases the likelihood of success of surgery and can also help to preserve or improve of vision in the majority of patients

volves the removal of the vitreous gel from the back of the eye — an operation called vitrectomy. Occasionally, laser or freezing (cryotherapy) treatment is applied to the retina to treat any tears or bleeding vessels and an injection of a gas bubble is often re- quired. The gas initially blurs the vision but eventually gets absorbed and the vision re- covers nicely. The recovery of vision depends on how much of the retina had detached and for how long the patient had the detachment or the macular hole. Surgery for retinal conditions has a very

high success rate and the majority of patients have excellent vision after surgery and are satisfi ed with their vision.

NHS clinic: The Royal Eye Unit, Kingston Hospital Private clinic: The BMI Coombe Wing at Kingston Hospital & The London Clinic at 119 Harley Street, London Enquiries: T: 07787 290295

Surgery for retinal detachment and macular hole has a very high success rate and the majority of patients have excellent vision after surgery and are satisfied with their vision

Other conditions that may need surgical

treatment include bleeding inside the vit- reous — for example, due to diabetes and age-related macular degeneration, and com- plications from cataract surgery.

Normal OCT laser scan of macular Meet the expert

Mr Mostafa Elgohary MB ChB MSc MD FRCSEd FRCSI FRCOphth

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