DISEASE

Message of common value




SHOW YOUR EYES ...
WITH LENSES !!!





DAILIES: SAY IT WITH
YOUR EYES!


LENSES....
SO EASY !





METAMORPHOSIS
(=curved lines)




THIS MAY INDICATE AGE
RELATED MACULA
DEGENERATION
ARE THERE...
DISCREET MAGNIFIERS?



YES,  SUCH AS EASYPOCKET


HOLIDAYS = LENSES




YOU ONLY HAVE  2 EYES:

CHECK YEARLY !

SEE CLEARLY  !

WHAT IS CATARACT?



CLOUDING OF THE LENS
WHY DO YOU REGULAR NEED
EYE EXAMINATION WHEN YOU
HAVE GLAUCOMA? 



YOU DON'T FEEL ANYTHING
BUT YOUR EYE CAN GET BLIND
SLOWLY
WHEN THE EYE PRESSURE
IS TO HIGH!


Macular fibrous membrane, because of abnormal vitreous detachment 
  • PUCKER = MEMBRANE ON THE CENTER OF THE RETINA

  • MORE DETAIL

  • A PUCKER GIVES SWELLING AND FORMATION OF WRINCKLES

  • MORE DETAIL : WRINCKLE FORMATION

  • THE PUCKER CAN BE OPERATED WITH A VITRECTOMIE

  • THE PEELING OF THE EPIRETINAL MEMBRANE

PUCKER

CAUSE: VITREOUS DETACHEMENT

This is a trivial age-related phenomenon, which consists of the progressive shrinking of the vitreous, so that the structure suddenly (from one day to another) separates from the retina (the membrane that lined the inside of the eyeball). In nearsightedness, where the eye is longer than normal, this happens faster than the others. Sometimes a punch in the eye can be the provoking cause. Usually this is symptom-free.
Almost always, the bond expand of the retina. Exceptionally, the vitreous can detach from the bond. If this happens, it happens usually in the center of the retina (the macula). That bond remains at the level of the retina and is called AN EPIRETINAL MEMBRANE OR PUCKER.


SIGNS

SYMPTOMS OF THE PUCKER

The membrane usually shows some blurred vision. After some time, that  membrane can schrink a little bit, witch causes some distortion in the vision. In some patients the deformation may also be caused by swelling of the retina, because the surrounding blood vessels  can leak due to the distortion of the retina. When looking into the eye, you can see sparkles on the retina and blood vessels starting from the retina. A cross-section examination of the retina with OCT (Optical Coherence Tomography) shows the disappearance of a central well in the retina (the foveal depression ") possibly associated with swelling and deformation.

SYMPTOMS OF VITREOUS DETACHEMENT

Many people are worried when they suddenly notice a few spots in their visual perception, apparently flying in the air, floating and who moves with the movements of the eye ("flying flies" / "soap bubbles" / "wires"). They are best visible on bright backgrounds (white pages, ceiling, snow), but they disappear in the darkness. These spots are caused by disturbing vitreous bodies (= former bonds at the level of the retina), which are quite central.
- Some former bonds may hang onto the retina so they practice traction on the retina (fortunately usually temporary), which leads to typical FLASH SYMPTOMS.

 
CONSEQUENCES

THE IMPACT OF THE PUCKER

The distortion is best followed on an Amsler grid and with OCT.

THE EFFECTS OF VITREOUS DETACHEMENT

Exceptionally vitreous detachment can lead to other phenomena (eventually late): SMALL BLEEDINGS (these are bigger with anticoagulation!) or RETINA CRACKS
, witch can result to a retinal detachment. A check after one month is sometimes planned, to exclude with certainty eventually developed retinal tears. Who may possibly be treated with laser (almost painless, no hospitalization required) to prevent a retinal detachment would occur. The latter should possibly be surgically repaired.  If the black spots and flashes should significant increase, a consultation must be requested as soon as possible. This certainly must be done if you would expierence a curtain for the eyes.

Anti-inflammatory eye drops may be prescribed in the hope that faster  resorption of the bonds can be obtained (although this is not a panacea). You have to hope that the old bonds sag by gravity sedimentation or digestion, so they get more transparent. This usually takes several months. The sagging can not happen if those ties are still hanging. Thus it is stated that after many years some people still see those spots. If you see flashing lights, try to avoid sudden movements TIP: The less you notice the spots, the less load!
 
THE TREATMENT

A vitrectomy can remove the epiretinal membrane. However, it's concerning a radical operation, we wait until the vision is reduced below the threshold of 4 / 10 or until a sudden leak phenomena arise. The patient is therefore recommended to have a regular follow-up (every three to four months). With increasing deformation, the patient should consult quickly. The waiting  with vitrectomy is also inspired by three other reasons:

There is a SMALL CHANCE that the MEMBRANE that ADHERES with the retina, separates spontaneously with improvement of symptoms.

There is a chance that a RETINAL DETACHEMENT ARISE AFTER SURGERY. This means that there is an extra operation is required for retinal detachment repair.

The VISION AFTER SURGERY remains SUBOPTIMAL. The retinal cells are never going to reposition themselves spontaneously back perfectly, so the distortion partly remains. "We can not iron the retina."  It is therefore clear that we hardly can predict vision after surgery, but it's certainly at least as good as before the operation and probably a lot better, with a progressive improvement in six months.

We intend faster to operate as the other eye shows also signs of a pucker: disappearance of the central well at the level of the retina ("the FOVEAL DEPRESSION ") on OCT or seeing red in the central part of the retina, which points to a novice pucker.
For possible vitrectomy is usually chosen for general anestesie (given the meticulous manipulations), although a good co-operative patient-anesthesia injection also can be helped. Anti-coagulants such as aspirin, or asaflow Marcoumar must always be stopped. Best is also first the cataract surgery because the lens is fast becoming cloudy after a vitrectomy. Moreover, a cataract surgery after vitrectomy is very difficult: there is no back pressure through the vitreous, which makes the lens drops very deep in the eye, so the manipulations are much deeper than would normally be done.


 
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