KPJ Miri Specialist Hospital records first-ever Vitreoretina Surgery

MIRI: KPJ Miri Specialist Hospital, one of KPJ Healthcare’s leading specialist hospitals in Sarawak, recorded a major milestone by conducting the first-ever Vitreoretina Surgery (VR) among private hospitals in Miri. 

The surgery was performed by KPJ Miri Visiting Consultant Retina Specialist, Dr Alisa Victoria Koh, with the assistance from the Operation Theatre nursing team. 

The maiden VR surgery was conducted on Sept 23.

What is Vitreoretina surgery?

Retina is a very important light sensitive layer in our eyes that converts light into electric signals that eventually allows us to see. 

Hence, it is of pertinent importance that it stays attached, just like how the cables of a light bulb have to be well connected for the bulb to light up. 

Vitreoretina surgery is not the same as cataract surgery where in the latter, the original lens in the eye is removed and replaced with a new artificial lens. 

In Vitreoretina surgery, the surgery requires a special machine, microscope and viewing systems. In layman’s term, the sclera (white part of our eyes) is penetrated with a needle size instrument and the gel (vitreous) in the centre of our eyeball is cut and aspirated before the actual “repair” work of the retina could be done. 

Depending on the eye disease involved, it may require laser, peeling of membrane or endotamponade, meaning filling up of the eyeball with air, gas or silicone oil. 

Symptoms of retina damage 

Rhegmatogenous retinal detachment happens when a tear or hole in the retina allows fluid in the eye cavity to seep through it and goes underneath, pushing the retina off its attachment, hence a detachment. 

Once it is detached, you will need Vitreoretinal surgery to fix it. 

The retinal detachment may also happen following a posterior vitreous detachment where you may experience floaters with flashes of light. 

Floaters are seen in various shapes and sizes of blackish spots that follows as you move your eyes. You may experience flashes of light in your eyes with each eye movement. If the retinal detachment has developed, you may see curtain like visual field defect, in other terms, parts of your field of sight has disappear.

Treatment for retinal damage

There are many types of retinal diseases. 

1.  Mild diabetic eye changes would require monitoring but when there is proliferative changes, one will need laser treatment. 
2.  Some conditions such as diabetic macula oedema (swelling), retinal vein occlusion with macula swelling or age related macular degeneration with macula swelling or bleeding will require injection of anti-vascular endothelial growth factor into the eye. However, it is not a magic treatment for every type of bleeding in the eye. For example, if the vitreous bleeding has caused direct viewing of the retina to be obscured, there is no way that we will be able to know the anatomical condition of the retina, meaning whether the retina is flat or not, whether there is any tractional retinal detachment, whether the bleeding is due to macular degeneration etc.Hence prior to injection of the anti-VEGF in these cases without view of the retina, it is important to have a B-scan (ultrasound) done to ascertain that the injection would not further worsen the underlying eye condition. Injection of anti-VEGF into eyes with Advanced Diabetic Eye Disease without any plan for vitreoretinal surgery may lead to Crunch Syndrome characterise by development or progression of retinal detachment. 
3. If there is a retinal detachment, vitreous haemorrhage (bleeding), macula hole, epiretinal membrane, dislocated lens into the vitreous and so on, surgery will be required.
4.  Untreated retinal detachment will eventually lead to blindness. This condition does tend to happen more commonly in short sighted people, those with previous eye surgeries and those with history of eye trauma. 

Is Vitreoretina surgery risky?

Vitreoretina surgery is considered a major surgery of the eye. It is more complex than a cataract surgery and Vitreoretina Surgeon has undergone specialised training in this field to be able to perform vitreoretina surgeries. 

General risks include eye bleeding, infections, retinal tear or detachment, recurrence of the underlying condition and even loss of vision, more so due to the advanced disease condition rather than the surgery itself.  The success rate of the vitreoretina surgery depends on the nature of the retina disease, chronicity of the eye disease as well as the baseline vision. 

Recovery from the vitreoretina surgery generally takes one month. Full recovery of vision depends on the underlying eye disease. 

What age is prone to Vitreoretinal disease?

Vitreoretinal disease can affect any age group. However, it is more prone in the elderly such as for Epiretinal membrane, macula hole, diabetic retinopathy, retinal vein occlusions and age related macular degeneration. In the case of retinal detachment, it occurs quite commonly in the younger age group especially people who are short sighted and diabetic retinopathy in those who have been diagnosed with diabetes mellitus at a younger age and in which their diabetes is not well controlled. 

In diabetic patients, the vision may be perfect today but the next day, it may drop to just being able to see movements if the patient develop vitreous haemorrhage. Of course diabetic retinopathy doesn’t develop over 1 day. The changes in the eye could have been there for years without patients noticing it. 

What types of food are useful for eye health?

“I believe in a balanced diet, moderation is the key. Optimisation of the underlying medical conditions such as diabetes mellitus, hypertension and hypercholesterolemia is of utmost importance especially in delaying progression of diabetic retinopathy and reducing the risk of retinal vein occlusion,” said Dr Alisa.   

Are there many retina cases in Sarawak? 

“I wouldn’t say there are many retina cases that require surgery in Sarawak. Although it may be an underestimation as there are some patients who opted not to have the surgery done mainly due to logistics circumstances. Many a time, patients presented late to us and the eye was deemed inoperable as any surgical intervention would have been futile at these late stages. 

“In my opinion, the awareness is not across the board. Our community may be aware of these eye conditions but they may not be aware of how severe it may turn out to be,” added Dr Alisa. 

Dr Alisa’s advice to the public:

1.  To seek treatment early if experiencing any abnormal eye symptoms
2.  To have baseline eye fundus examination done at the diagnosis of diabetes mellitus and then yearly or as advised by eye doctor
3.  There is no single wonder drug or supplement that can treat all eye problems