Download Retinal detachment surgery

C O N S E L L E R I A
D E
Retinal detachment surgery
S A N I T A T
1. Identification and description of the procedure
The retina is the most internal layer of the eye. It is a fine and transparent membrane made up of fibres
and cells sensitive to light.
The retinal detachment consists of its separation from the rest of the ocular layers of the eye, caused by
in most of the cases by one or various holes in the retina and in a higher percentage by a traction,
inflammation or intraocular tumour. Only in the first two cases of the initial detachment treatment will
it be surgical.
To reapply the retina there are diverse procedures that are performed in function of the type, location
and size of the detachment and of the patient’s general state.
The different techniques are:
Vitrectomy:
A surgical technique in which the vitreous humour is substituted by physiological saline, gases or silicone
oil to enable the intraocular manipulation and proceed to the application of the retina. It can be associated
to the rest of the different techniques.
Scleral indentation:
Consists in the application of an implant on the sclera which provokes a local bulging of the ocular wall
towards the exterior of the eye nearing it to the retina. As well as the previous one, it can be associated
to the rest of the different techniques.
Cryopexy:
Applying cold through a probe through the extrascleral track with the purpose of creating a chorioretinal
scar that plugs the hole causing the detachment.
Photocoagulation:
It consists, just as the cold, in creating a chorioretinal scar that plugs the hole or retinal detachment; but
in this case it is by a burn caused by a laser. It can be intraocularly applied associated to the vitrectomy
or extraocularly through lenses.
Intraocular gas injection:
A small quantity of gas is injected in the eye which provoked by pushing the application of the retina. It
requires an associated positioning treatment together with the Photocoagulation or the cryopexy.
The anesthesia election will depend on various factors such as:
The patient’s general state.
Surgical technique to be applied.
Duration of the intervention.
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The most used anaesthesia if the general and the local via retro or peribulbar injection.
2. Purpose of the procedure and benefits that are expected to be achieved
The purpose of the previously described techniques in the anatomophysiological recuperation of the retina.
The objective is to reach the maximum visual sharpness possible and avoid the reoccurrence of the
symptoms.
3. Reasonable alternatives to this procedure
For the moment, there are no alternatives to those described in section 1.
4. Foreseeable consequences of its performance
After the surgery the eye will present a level of inflammation, more or less depending on the procedure
performed. If the eye’s response is good, vision will be recuperated progressively during the following 6
to 12 months. In the cases with intraocular gas injection, the patient the patient must perform a postural
treatment on the days following the surgery.
With the current surgical techniques, approximately 90% of all the RDs can be reapplied. Sometimes,
more than one operation is needed. Approximately 40% of the RDs successfully treated reach a good
vision, the rest reach variable vision levels that can be useful both for reading as well as walking around.
The level of final vision will depend on various factors, with the worse prognosis being in the cases where
a macular affection exists, the retina has been detached for a long period of time, there is a vitriretinal
proliferation or second or posterior operations have been performed.
Retinal detachment surgery
5. Foreseeable consequences of its non performance
The retinal detachment usually progresses with a progressive deteriorization of the anatomical structure
of the retina and posteriorly of the eye sometimes even producing an ocular atrophy and consequently,
blindness.
6. Frequent risks
The most usual are postoperative pain from a moderate to intense level that can last various months,
increase in the intraocular tension, cataract formation, and retinal re-detachments, to these we must add
he associated risk adherent to ameasthesia.
7. Infrequent risks.
An intraocular haemorhase can occur that depending on its quantity will worsen the patient’s visual
prognosis less or more. In some cases, a serious infection can also occur. Just un the section before, both
the local and general anaesthesia can produce complications such as ocular perforation, retrobulbar
haematoma and severe allergic actions.
8. Risks depending on the patient's clinical situation
Systematic diseases such as diabetes, arterial hypertension, cardiac insufficiency and the degenerative
pathologies of the eye can condition the final result of the surgery.
9. Declaration of consent
Mr./Mrs./Miss.
aged
, with home address at
, National Identity No.
Mr./Mrs./Miss.
and SIP number
aged
, with home address at
acting in the capacity of (the patient's legal representative, relative or close
, with National Identity No.
friend)
HEREBY DECLARE:
That the Doctor
situation to perform
In
has explained to me that it is advisable/necessary in my
on
,2
With National Identity Card No
Signed: Dr.
With National Identity Card No
Associate number
10. Revocation of the consent
I hereby revoke the consent granted on the date of
to carry on with the treatment that I hereby terminate on this date.
In
Signed: The Doctor
Associate number:
on
,2
Signed: The patient
,2
and I do not wish
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Signed: Mr./Mrs./Miss.