Definition

The Surgical Retina Operating Unit deals with the diagnosis and treatment of patients affected by all retinal pathologies requiring surgical therapy, which may involve the macular region or the peripheral part of the retina.

Pathologies

The macular pathologies treatable surgically are mainly represented by alterations of the macular region caused by mechanical phenomena. In this area of the retina, membranes can form in the zone in contact with the vitreous body, which is bounded by an external layer called the vitreous cortex. In the macula, there is a region where, due to specific anatomical characteristics, thin abnormal membranes can form, sometimes originating from remnants of the vitreous cortex or occasionally from the retina itself. These membranes, called "epiretinal membranes," come into contact with the macular retina, adhering to the inner retina.

If the cells composing these membranes are not contractile, meaning they do not exert traction at the points of contact, the visual disturbances caused by epiretinal membranes are moderate. In such cases, the disturbances are generally limited to image distortion due to slight wrinkling of the macular region subject to traction by the membrane. However, if tractional phenomena are more pronounced, the retinal tissue suffers due to the severe deformation caused by the membrane, leading to a more significant decline in vision that may result in severe vision loss if not treated surgically.

The main macular pathologies related to the presence of epiretinal membranes are:

• Macular pucker (a term meaning "wrinkling"), characterized by the presence of a contracted epiretinal membrane attached to the macular region, associated with image distortion and, in severe cases, the formation of central blind spots (scotomas). Surgery can lead to a resolution, though not always complete, of visual disturbances and, above all, a reduction in image deformation.
• Vitreomacular traction, in which the vitreous cortex remains attached to the central portion of the macula, called the fovea. The resulting traction on such a small area can cause significant visual impairment.
• Macular hole, characterized by the formation of an opening in the central portion of the macular region, which, especially in eyes with high myopia, may be associated with a posterior retinal detachment.

Activities

The most frequently used surgical technique is vitrectomy with the removal of epiretinal membranes. Vitrectomy has also proven to be of great importance in treating severe cases of retinopathy in diabetic patients. By removing the vitreous infiltrated with blood and the traction it exerts on the retina, this procedure allows the resolution of cases that previously would have led to blindness.

Patients can attend the outpatient clinic for initial ophthalmic consultations (booked through the CUP) or follow-up ophthalmic visits (booked through the Bietti Foundation).

The ophthalmic consultation includes:

• Measurement of visual acuity for distance and near vision,
• Evaluation of image distortion (metamorphopsia),
• Tonometry (measurement of intraocular pressure) with Goldmann applanation tonometer,
• Fundus examination to evaluate the macula and retina.