Informations sur ce blog - Mes favoris

And one scleral buckle for retinal detachment, for my Daddy!

The surgery that awaits my father next week:



Ooopsie ... I'd be better off if I hadn't seen this ... The first time he suffered from retinal detachment, my father decided ... to wait and see ... for a few additional days (he was travelling abroad) ... Anyway, thanks to Dr. Frédéric Betis - Hôpital Princesse Grace, Monaco - he was able to recover a good visual acuity, even after retinal detachment involving the macula ... but he still had this macular fold causing him to see double, like he's had too much whisky ... One year passed, and he got used to it, for driving especially ... And then, two weeks ago, here we go again, retinal detachment beckons ... My father was travelling (again), but this time, lesson learned, he got to his surgeon in no time ... another emergency operation ... same procedure: Pneumatic retinopexy and vitrectomy ... meaning you're left with a gas bubble in you eye and must wait for several weeks, until no gas at all is left. Then (and only then) you can "see" if there is a visual loss or not, and if so, what kind of it (central, upper part, lower part) ... My father couldn't see straight lines, he saw them curved ... Pouring some water or wine in a glass was not easy ... But he was able to drive ... The first time he had the surgery, he had to keep looking upward, and sleep on a surelevated surface ... This time the retinal laceration occured on the exact opposite side of the eye, thus he had to do ... just the opposite ... Laying flat, looking on the right side only, and when sitting, keeping his face on his lap ... The week following the surgery has been challenging (no sleep at night, sleepy during the day, aching shoulder and back at all times) ... Last Monday, my father saw his surgeon again, for the first post-op visit ... It was supposed to be okay, keep up with the good job, said the surgeon to my dad ... but he wanted to follow up on him ... So, this morning, my parents are back in the surgeon's office. And this time, there is ... a retinal hole, nice and big ... Operation again. Scheduled next Monday ... This time, the procedure will be a scleral buckling, which I understand is the indication for retinal hole ... The surgeon said to my father he did hesitate during his last operation:  should he do the scleral buckling already?  He thought this was maybe inappropriate:  there was no retinal hole back then, and waking up after a scleral buckling is not very comfortable ... That's why Dr Betis wanted to spare him this, if possible ... Well, it won't be ... The thing is, this will be his second surgery with full anesthesia in less than four weeks ... The good thing is that this time, postop positioning will not be so challenging, in fact it won't even be an issue, because there will be no gas in the eye ... Mind you, he still has got some from the last procedure ... Well I do hope my mon won't get to watch this video - no chance, she's not reading my Blog, too busy for that ...

I understand that with Pneumatic retinopexy and vitrectomy, you try to have the eyeball stick to the retina, according to Mother Nature's plan ... When it is not working any more (because of multiple lacerations and/or retinal hole), then you have to force the retina to stick to the eyeball, with the scleral buckling procedure ... The former procedure is less invasive than the latter (this is why the surgeon hesitated to perform it in the first place) ... I'm grateful that my dad's surgeon was honest and he told my dad about his hesitation and, now, his regret:  my father, 73 years old in just two days, will have to undergo two procedures with full anesthesia instead of one, in less than four weeks ...

7 commentaires:

  1. pour le trou rétinien (dans le cas d'un décollement de la rétine), il faut faire la technique du cerclage de l'oeil (voir lien Wikipedia) :

    "Le cerclage oculaire dirigé permet la réapplication de la rétine par compression externe du globe oculaire. Cette technique ne nécessite pas l'ouverture de l'œil. C'est une technique efficace dans plus des
    trois-quarts des cas."

    http://fr.wikipedia.org/wiki/D%C3%A9collement_de_r%C3%A9tine

    http://www.em-consulte.com/article/138285

    http://edouard.benois.pagesperso-orange.fr/cerclage.htm

    CONTRAINTES
    DE LA CHIRURGIE OPHTALMOLOGIQUE

    "Le décollement de rétine est une chirurgie complexe, de longue durée.
    Elle peut associer différents gestes : ponction de liquide
    sous-rétinien, cryo-application externe ou une photo-coagulation
    interne, indentation ou un cerclage, et échange gazeux avec injection d'un tampon interne gazeux. L'utilisation du protoxyde est contre-indiquée dans ce dernier cas. Une vitrectomie peut être réalisée indépendamment d'un décollement de rétine."

    Nausées et vomissements postopératoires

    "Classiquement élevée en ophtalmologie, l'incidence de ces
    vomissements est évaluée entre 16 et 76 % selon le type de chirurgie
    et la prévention mise en œuvre [6]. Ils sont particulièrement
    fréquents pour la chirurgie du strabisme et du décollement de rétine.
    Ils sont potentialisés par la douleur et l'hypertonie oculaire que l'on retrouve fréquemment après un décollement de rétine."

    Particularités liées au patient

    Une large part de la chirurgie ophtalmique, tout particulièrement la chirurgie de la cataracte s'adresse à des sujets âgés. Ces patients sont fréquemment atteints d'altérations multiples des grandes
    fonctions. La polymédication est fréquente, source d'interférences
    avec les agents anesthésiques. La demande d'anesthésie ambulatoire est en augmentation. La chirurgie ophtalmologique a cependant une
    mortalité et une morbidité cardiovasculaire périopératoires plus faibles que toutes les autres formes de chirurgie confondues."
    (Source : http://www.sfar.org/acta/dossier/archives/ca02/html/ca02_21/ca02_21.htm)

    RépondreSupprimer
  2. http://en.wikipedia.org/wiki/Scleral_buckle

    http://en.wikipedia.org/wiki/Adie_syndrome

    RépondreSupprimer
  3. http://www.webmd.com/eye-health/scleral-buckling-surgery-for-retinal-detachment

    RépondreSupprimer