Vitreoretinal service

Ophthalmology

Retinal surgery was established in the Queen Elizabeth Hospital, King’s Lynn, in September 2010.

Mr M Saeed, Consultant Ophthalmic and Vitreoretinal Surgeon, with his team of highly skilled and dedicated staff, would be more than happy to answer any queries relating to vitreo-retinal surgery.
Common retinal conditions treatable with vitreoretinal surgery include:

Retinal detachment

Retinal detachment usually presents when a patient notices flashing lights and floaters in the vision. If left untreated, visual loss then often begins with a curtain effect obscuring part of the vision. Urgent diagnosis is crucial in order to attempt to save the vision.

The risk of retinal detachment increases with age. Previous eye surgery may increase the chances of retinal detachment, and ‘Short sighted’ (myopic) individuals have a higher risk of developing retinal detachment.
Patients with a possible retinal detachment are advised to see their GP or Optometrist for an urgent referral to eye casualty. Alternatively, patients may attend the QEH Emergency Department, from where they will be referred to the Eye Department on an urgent basis.

After the initial examination by Mr Saeed and his team, surgery is planned to be carried out within a few days, depending on the deterioration and extent of the retinal detachment. Surgery is carried out in the Arthur Levin Day Surgery Centre under either local or general anesthetic.

Using microsurgical techniques, the vitreous gel inside the eye – a jelly-like ‘packaging in the eye - is removed, and retinal tears are identified and treated with laser. Surgical ‘gas’ or silicone oil may be placed inside the eye to help to keep the retina in place while it heals. Very often patients will then be advised to keep their head in a certain position for a week or so (this is called posturing) to help keep the gas or oil pressing against the area. Gas can take several months to completely absorb, while oil must be removed with a further operation. Air travel is not permitted during this time.

Sometimes more than one operation is required to achieve a successful outcome. Some patients will also require and undergo removal of a cataract at the time of surgery.

Macular hole

Macular hole is a condition of unknown cause. It usually affects middle aged individuals and is more common in females. The symptoms of a macular hole are usually develop slowly, and include distortion of the central vision. Peripheral vision (the edges of the vision) is not usually affected. The potential for visual improvement is greater if the condition is diagnosed and treated early.

Cataract extraction may take place during macular hole surgery, if required. The surface of the macular, which is the central part of the retina, is stained with a special blue dye to make it easier for the surgeon to see. The fine membrane which lines the retina is then peeled away using microscopic instruments. This releases the tension on the macular hole and allows it to close. The eye cavity is filled with gas and patients are advised to keep their face down for seven to ten days, with a ten to fifteen minute break every hour being quite acceptable. This is hard work on the part of the patient but it helps to achieve the best result.

Epiretinal membrane

In this condition, a thin fibrous membrane develops over the macular region of the retina. It causes generalized distortion and blurring of vision. Epiretinal membranes usually affect middle aged individuals. Sometimes, previous ophthalmic surgery or retinal laser treatment can cause this problem.

The surgery is very similar to a macular hole, involving removal of the vitreous gel and the fibrous membrane. Surgery takes about one hour and may be combined with cataract removal if required.

Vitreous haemorrhage

Vitreous haemorrhage - or bleeding in the vitreous gel inside the eye - can be due to diabetic retinopathy or retinal vein occlusion (blockage of one of the veins at the back of the eye). The treatment for vitreous haemorrhage is usually not urgent as most of the time the blood will clear over the course of a few weeks. A non-clearing haemorrhage however can be treated with vitrectomy and laser.

In the absence of diabetes or retinal vein occlusion, and particularly when an individual is short sighted, a retinal tear must be excluded as a cause for the haemorrhage. In such cases urgent intervention may be necessary. The surgery for vitreous haemorrhage for a person with diabetes often entails removal of fibrous tissue and membranes on the retina, and using a laser to prevent further haemorrhage. Sometimes gas or oil is used to hold the retina in place and prevent further bleeding.

Floaters

Floaters are a very common symptom that most of us have experienced at some stage. Most floaters are innocent in nature, but significant amounts of floaters, especially if accompanied by flashing lights, should be investigated to rule out a retinal tear or detachment. In the absence of a retinal problem, floaters are usually inconsequential. If they become troublesome, surgery may be considered to remove them.

Complicated cataract surgery

Cataract surgery is a commonly performed eye operation. Due to the large number of operations carried out, there are inevitably a small number of patients who develop complications. Our facilities and expertise enable us to treat any complications quickly and effectively without having to refer patients to remote units. In most cases, patients regain normal or near to normal vision after the surgery has been completed.

Our specialist team

The specialist team delivering this service is:

• Mr M Saeed - Lead Clinician
• Mr Manish Gunda - Associate Specialist

Useful documents links

The documents here may be of interest to you:

• Cataract information sheet
• Diabetic eye disease information sheet
• Understanding eye conditions related to diabetes

Go to the Ophthalmology overview page.