retinal tear: solution laser 360 degrees circumference

[Pouatchee]

Dear @Sheryl

I have a retinal tear in my right eye. many floaters coming in and flashes. I went to see my optometrist 2 weeks ago and at first she could not find the tear. following a panoply of tests she found it and tried to laser it. she said it was difficult to access and after the surgery i still had the flashes but they were lesser. 

 

On thursday, my doctor booked me for next friday to do a follow up. her plan is to laser my retina in a 360 degree circumference. the laser smarts like heck just when she did the small spot and I know i am going to cringe when she plans to do the whole eye.

 

my questions:

1. is this normal practice?

2. are there risks other than she lasering somewhere by accident? 

3. what is the long term prognostic?

4. if for some reason i get hit by say, a tennis ball, can it cause retinal detachment more easily than if i dont have the procedure?

 

Maybe its just me, but I had my left eye done first (same issue a while ago) and last time my right eye hurt like heck and to this day i still need to put eyedrops every 20 minutes.

 

any help or advice will be greatly appreciated.

 

[connda]

I'm sorry to hear that.  I've have laser surgery in my eye and it is not pleasant.  Hope all works out for you.  Best wishes!

[Sheryl]

360 degree laser has advantage of getting even tears that cannot be seen. Prognosis is very good, and in skilled hands risk is quite low.

 

You will not be at increased risk of retinal detachment due to having the procedure. You are at increased risk of detachment if the tear is not corrected.

 

That said, quite small retinal tears do sometimes heal themselves. It needs a highly experienced specialist to determine, on a case by case basis,  which tears can safely be just monitored rather than immediately  treated.

 

Basically your choices are: 

 

1. Follow your doctor's advice.

 

2. Get another opinion. If you opt for that, do it at Rutnin in Bangkok, preferrably with Dr. Roy. Rutnin had very advanced equipment which might enable them to identify exactly  where  the tear is.  Possibly then you could avoid the 360 laser (but no guarantee). 

 

Regarding your concern about pain, you should share this with the doctor ask about an injected local anesthetic rather than just the numbing drops. (The injection is not into the eye but below it)  Can also request an oral sedative beforehand.  

[Pouatchee]

thank you for this detailed explanation. i will walk in to the operating room a lot more reassured. my left eye is starting to act up again, so if this is bearable i will likely ask to do it too. i dont get it... i had cataract surgery in both eyes and i read that following surgey retinal tears are relatively rare. yet, i am lucky enough to have it in both eyes and i am not even 60 yet.

 

sucks to be me...

 

thanks sheryl

[FarangRimPing]

I had laser surgery to repair a tear about a month ago. The doctor wasn't sure that the procedure would be successful because there was a lot of blood in the vitreous.

 

For me, it was not painful at all but it was very uncomfortable during the procedure because of the bright lights hitting my good eye. No pain afterward either. (I only had a local prior to the procedure but used no medication afterward.)

 

It seems to have gone well. The blood is dissipating but I still have quite a ways to go.

[Pouatchee]

On 6/29/2024 at 11:31 AM, connda said:

I'm sorry to hear that.  I've have laser surgery in my eye and it is not pleasant.  Hope all works out for you.  Best wishes!

 

thanks for that

 

On 6/29/2024 at 12:57 PM, FarangRimPing said:

I had laser surgery to repair a tear about a month ago. The doctor wasn't sure that the procedure would be successful because there was a lot of blood in the vitreous.

 

For me, it was not painful at all but it was very uncomfortable during the procedure because of the bright lights hitting my good eye. No pain afterward either. (I only had a local prior to the procedure but used no medication afterward.)

 

It seems to have gone well. The blood is dissipating but I still have quite a ways to go.

 

you are very fortunate. for me... it burns and my eyes dry up, hence the need for constant eye drops. my doctor had warned me of this.

 

Quote

No pain afterward either. (I only had a local prior to the procedure but used no medication afterward

 

as sheryl said, there are 2 options. numbing eye drops or injected local anesthetic. my doc gave me the numbing... as you said, you had a local. i guess that helps. because of the amount of 'laser zaps' (over a 100 according to the doc) i will likely ask for the local anesthesia

[FarangRimPing]

3 hours ago, Pouatchee said:

 

thanks for that

 

 

you are very fortunate. for me... it burns and my eyes dry up, hence the need for constant eye drops. my doctor had warned me of this.

 

 

as sheryl said, there are 2 options. numbing eye drops or injected local anesthetic. my doc gave me the numbing... as you said, you had a local. i guess that helps. because of the amount of 'laser zaps' (over a 100 according to the doc) i will likely ask for the local anesthesia

Sorry, I wasn't clear and should have been more careful. When I said local, I meant the external numbing drops. (Google generated: 'Medicine applied externally to a particular part of the body; local: a topical anesthetic.')

[Mike Lister]

I had a retinal tear that wasn't spotted for three weeks, eventually it was and it was lasered by a very panicked Dr. Later, I consulted a second opthamologist who recommended 360 degree laser treatment, in both eyes! I became very confused about this so I went to see Dr Roy at the Rutnin. Dr Roy did all the tests and took all the pictures before shaking his head at the previous diagnosis and suggested I get a new Opthamologist. This was in Chiang Mai two years ago. 

[Pouatchee]

On 6/29/2024 at 5:03 PM, FarangRimPing said:

Sorry, I wasn't clear and should have been more careful. When I said local, I meant the external numbing drops. (Google generated: 'Medicine applied externally to a particular part of the body; local: a topical anesthetic.')

 

you are fortunate...had my left eye done around 3-4 years ago and still feels like i have sand in it. i have a high level tolerance for pain... generally, but my eyes? not at all... complete waste

[Pouatchee]

3 minutes ago, Mike Lister said:

I had a retinal tear that wasn't spotted for three weeks, eventually it was and it was lasered by a very panicked Dr. Later, I consulted a second opthamologist who recommended 360 degree laser treatment, in both eyes! I became very confused about this so I went to see Dr Roy at the Rutnin. Dr Roy did all the tests and took all the pictures before shaking his head at the previous diagnosis and suggested I get a new Opthamologist. This was in Chiang Mai two years ago. 

 

so what was the prognostic... what did you end up doing?

 

i think my doctor (considering my left eye also has problems) is going to do this to avoid future issues...

[Mike Lister]

1 minute ago, Pouatchee said:

 

so what was the prognostic... what did you end up doing?

 

i think my doctor (considering my left eye also has problems) is going to do this to avoid future issues...

I had the original tear lasered and nothing more, I ignored completely the recommendation for 360 degree laser, on the basis of Dr Roys advice. One year later I had a piece of retina detach in my other eye and cause a large floater but it didn't tear. 

 

The logic I was given for having 360 degree laser treatment was that if one retina tears, the other will tear also. Medically, that was not supported by the condition of the retina's as photographed in high res at the Rutnin. The scuff/floater in the second eye a year later was not at the edge and would have not been prevented by 360 degree laser treatment. DTW, flashing lights are feature and have been for over two years, they are considered normal given the state of the vitreous fluid and my age. Wearing dark glasses helps a lot

[Sheryl]

@PouatcheeJust to be clear, the above poster's issue was that his doctor wanted to do 360 on both eyes, including an asymoptomatic one.

 

That said, it would be very worthwhile for you to get a second opinion from Dr,. Roy at Rutnin (and might avoid the need for the 360  procedure, though no guarantee) if you can make the trip to Bangkok.

 

 

[Pouatchee]

thanks sheryl. in my case i am symptomatic in both eyes and i am getting these weird flashes in my left eye which was treated 3-4 years ago. this week... and no i am not on drugs... i had a light flash that had the shape of a circle with lines around it... just like a crude drawing of a child. i think that if i dont do the 360 degree on both eyes i might be in for a surprise down the line... specially considering i am not in my 60's yet.

 

thanks all... good posts

[jas007]

Seven years ago, I had surgery to repair a retinal tear.  I was in the USA at the time, I’m sure they used a laser, but I don’t know about the 360 degree part. The surgery was done the day after the tear was discovered at an outpatient surgery center.  I didn’t feel any pain at all, probably because they knocked me out with something.

 

More recently (just last week) I had surgery in Bangkok to replace a previously installed IOL, which had dropped and was just floating around inside my eye along with the capsular bag. That surgery was done under general anesthesia. Again, I didn’t feel a thing.  I’m currently putting drops in my eye at various intervals, and I should be back to normal in another week or so. 

[Pouatchee]

On 7/3/2024 at 6:59 PM, jas007 said:

More recently (just last week) I had surgery in Bangkok to replace a previously installed IOL,

 

i hope you fare well. when i asked my dr if i could switch my lens to the new kind for short distance and far away distance (dont remember... myopia or whatever the proper terminology is) improvement she told me that removing/swapping lenses was actually dangerous... good luck

[moe666]

I had my eye done years ago, the Dr. used a cold laser for the firsttreatment and froze the retins then after a few days he decides to use the hot laser to burn the retine. Both surgeries weresucessful nd used the direct injection of pain killer into the eye. My big problem was the air bubble he injected into the eye and until it had disappeared while awake and when I slept I had to keep that bubble over the area of the eye he had preformed surgery Now some 20 odd years later eye in good shape

[LosLobo]

22 hours ago, jas007 said:

More recently (just last week) I had surgery in Bangkok to replace a previously installed IOL, which had dropped and was just floating around inside my eye along with the capsular bag. That surgery was done under general anesthesia. Again, I didn’t feel a thing.  I’m currently putting drops in my eye at various intervals, and I should be back to normal in another week or so. 

I had that operation 18 months ago and watched some of the operation before dozing off.

A new IOL was stitched to the anterior of the eye as the posterior capsule was too far gone.

 

My vision was a bit grainy first week or so but soon came good.

Stitches were removed a month later. The whole process was painless.

 

[jas007]

Pouatchee,

 

I think they tell you it’s “dangerous “ because it’s more dangerous than doing nothing and because it’s probably not medically necessary.  
 

My surgery was a medical necessity.  The entire capsular bag with the IOL inside had become detached and was floating around in my eye.  Anyway, if I wanted to regain the sight in that eye, I needed the surgery.  I talked to the surgeon before hand and she said the operation was fairly common.  So I went ahead with it.

 

It has now been a week or so and my vision in that eye is improving every day.  I’m still using drops and will be for another few weeks.  I’m guessing I’ll be back to normal in a few weeks.  I’ve had surgery on the eye twice before.  Once to remove a cataract and insert an IOL, and another time for a retinal tear.  On both occasions, the recovery was fairly quick. I’m going this time will be no different. 

[jas007]

LosLobo,

 

My surgery was done under general anesthesia.  I don’t remember anything.  The brought me to a room where the operation was performed, I was transferred to another table, they started hooking me up to stuff, they gave me some oxygen to breath, and I think at the same time they must have started the drugs.  The next thing I knew, it was 3 1/2 hours later and I was in the recovery room. I had to spend the night in the hospital u see “bed rest.”  

[Pouatchee]

On 7/4/2024 at 8:18 PM, jas007 said:

I think they tell you it’s “dangerous “ because it’s more dangerous than doing nothing and because it’s probably not medically necessary.  

 

i believe my dr that reopening an eye, taking a lense out, putting another one in can be dangerous complication wise... its not as straightforward as just putting the lense in.

 

tomorrow i am getting the laser 360 degree surgery in the afternoon.  as some members here said it was painless for them... unfortunately not my experience. the 3 times i did it i was left with a burning sensation that lasted a few weeks. needless to say, i am worried i will accidentally flinch and get zapped in the wrong place.

 

the dr has to hold a magnifying glass in contact with my eye for the duration of the intervention... it really is uncomfortable

[jas007]

16 minutes ago, Pouatchee said:

 

i believe my dr that reopening an eye, taking a lense out, putting another one in can be dangerous complication wise... its not as straightforward as just putting the lense in.

 

tomorrow i am getting the laser 360 degree surgery in the afternoon.  as some members here said it was painless for them... unfortunately not my experience. the 3 times i did it i was left with a burning sensation that lasted a few weeks. needless to say, i am worried i will accidentally flinch and get zapped in the wrong place.

 

the dr has to hold a magnifying glass in contact with my eye for the duration of the intervention... it really is uncomfortable

 When I had laser surgery for the retinal detachment, they used some kind of sedation.  I don’t think it was general anesthesia, but I was most definitely out of it.  I went home after the surgery, but at this point I’m not sure how I got there.  I’m pretty sure I didn’t drive myself, but if someone else brought me home, I don’t remember at this point. Usually in the US, they want you to have someone to drive you home.

[Sheryl]

42 minutes ago, Pouatchee said:

 

i believe my dr that reopening an eye, taking a lense out, putting another one in can be dangerous complication wise... its not as straightforward as just putting the lense in.

 

tomorrow i am getting the laser 360 degree surgery in the afternoon.  as some members here said it was painless for them... unfortunately not my experience. the 3 times i did it i was left with a burning sensation that lasted a few weeks. needless to say, i am worried i will accidentally flinch and get zapped in the wrong place.

 

the dr has to hold a magnifying glass in contact with my eye for the duration of the intervention... it really is uncomfortable

As mentioned before:

 

You should tell the doctor your prior experience and concerns about pain.

 

Request a nerve block (injection under the eye that deadens nerve) and nto just eye drops

 

This will not help with burning days afterwards, but it will certainly help during and immediately after the procedure.

[Pouatchee]

2 hours ago, Sheryl said:

As mentioned before:

 

You should tell the doctor your prior experience and concerns about pain.

 

Request a nerve block (injection under the eye that deadens nerve) and nto just eye drops

 

This will not help with burning days afterwards, but it will certainly help during and immediately after the procedure.

 

i will... thanks

[Pouatchee]

surgery is over. now i am in serious pain. those of you who are only inconvenienced by this procedure are VERY LUCKY. now i see a half moon black line on the right side of my eye i guess that might be the scarring from the laser.. the doctor did not really want to give me the anesthesia as @Sheryl recommended saying it did not really help. not a pleasant procedure at all. also. i just noticed, when i look atr a blank google page on my tv screen there seems to be a wobbling circle in the centre of my vision... maybe due to where i was being zapped by the laser

 

 

[Sheryl]

1 hour ago, Pouatchee said:

surgery is over. now i am in serious pain. those of you who are only inconvenienced by this procedure are VERY LUCKY. now i see a half moon black line on the right side of my eye i guess that might be the scarring from the laser.. the doctor did not really want to give me the anesthesia as @Sheryl recommended saying it did not really help. not a pleasant procedure at all. also. i just noticed, when i look atr a blank google page on my tv screen there seems to be a wobbling circle in the centre of my vision... maybe due to where i was being zapped by the laser

 

 

 

You should ask your doctor whether these symptoms are normal post-laser.

 

Were you given any hand out on what to expect?

[Pouatchee]

nothing whatsoever. i had to ask: can i shower? can i lift heavy objects?

this dr is a lieutenant commander and her english is so so at best. my previous dr had yo go to bkk... i miss her...

this hospital has no hand outs whether in tha or english... and it is actually one of the best in thailand. queen sirikit chonburi... most dr's moonlight at bkk pattaya and bkk rayong...

 

i actually got many answers on google and here

[BKKBike09]

On 6/29/2024 at 11:44 AM, Pouatchee said:

i am getting these weird flashes in my left eye which was treated 3-4 years ago. this week... and no i am not on drugs... i had a light flash that had the shape of a circle with lines around it... just like a crude drawing of a child

 

Sorry to hear of all your problems.

 

What you describe here sounds like an optical migraine. Starts with flashing in one part of your field of vision and then over 30 mins or turns into a flashing uneven circle that goes round the field of vision and then stops. No pain at all.

 

If that is what you had, that (at least) is nothing to do with the retina, it is caused by temporary changes in brain chemistry.

 

Good luck.

[jas007]

On 7/6/2024 at 11:09 AM, Pouatchee said:

surgery is over. now i am in serious pain. those of you who are only inconvenienced by this procedure are VERY LUCKY. now i see a half moon black line on the right side of my eye i guess that might be the scarring from the laser.. the doctor did not really want to give me the anesthesia as @Sheryl recommended saying it did not really help. not a pleasant procedure at all. also. i just noticed, when i look atr a blank google page on my tv screen there seems to be a wobbling circle in the centre of my vision... maybe due to where i was being zapped by the laser

 

 

Sorry to hear about all the pain.  
 

My surgery was about 10 days ago, and I had to spend one night in the hospital under “bed rest.”  I couldn’t even get out of bed without setting off a bed alarm.  Anyway, they gave me a bunch of pills when I finally checked out, including some Tylenol for pain and some sleeping pills in case I was having trouble sleeping.  So far, I haven’t taken any of the pills.  I never take Tylenol, and when I’m sleepy, I sleep. Otherwise, I’ve been on a regimen of eye drops.  Steroid eye drops and antibiotic eye drops. Plus, some antibiotic ointment before bed.  I also have to wear a protective shield over the eye at night.  
 

My vision has been slowly improving.  The first day or so after surgery, I couldn’t see much at all.  Since then, it has gotten a little better every day.  At the rate I’m going, I should be back to 20/20 in another week, maybe sooner.

 

When I had my first follow up appointment four days after surgery, the doctor told me about all the symptoms I might experience following surgery.  The gist of it was that a lot of what might happen is normal and is to be expected.  On the other hand, she told me to call if I experienced severe pain that wouldn’t improve with Tylenol, or if I had a lot of severe discharge or bleeding.

[Pouatchee]

On 7/7/2024 at 6:03 PM, jas007 said:

My surgery was about 10 days ago

 

can you remind me what surgery? i read back and you had retinal problems and cataract surgey. if i am not mistaken this was a lense replacement, right?

[jas007]

14 hours ago, Pouatchee said:

 

can you remind me what surgery? i read back and you had retinal problems and cataract surgey. if i am not mistaken this was a lense replacement, right?

About seven years ago, I had cataract surgery in both eyes.  Six months later, I had a retinal tear in one eye and had surgery to repair that.  They used a laser, and I also had a gas bubble for a while.  After that I was fine for a number of years, but a few months ago the “capsular bag” that normally holds the eye’s natural lens but at that point  contained an IOL became totally detached from its usual position and was floating around inside my eye.  Sometimes I could see it, depending on how I held my head. So, I needed surgery to repair that problem.

 

From what I understand, they took out the old IOL and the capsular bag and replaced the IOL with an IOL that could be held into place with stitches.  The IOL had eyelets and it was attached to either side of the iris.  They called it a “scleral attachment.” I think the surgery itself lasted about 1 1/2 hours. I don’t remember any of that, though.  One minute they were hooking me up to stuff in the operating room and the next thing I knew, it was several hours later and I was in the recovery room.  
 

So, it was all a bit more complex than the typical cataract surgery. So far, the recovery seems uneventful.