Treatment of retinal detachment
An apparatus and minimally invasive method for removing fluid from a subretinal space to allow a detached retina to flatten. An apparatus, comprising a fluid withdrawal device and a guide for advancing and placing the device, is positioned on the exterior eye surface at the detachment site. Various embodiments of the apparatus are disclosed. Using the guide, the surgeon advances the device into the fluid-filled space and drains fluid, allowing the retina to flatten. Additional injection of saline or gas into the vitreous cavity normalizes intraocular pressure, and the patient is ambulatory immediately afterward. Unlike other retinal attachment techniques, in the inventive procedure the patient receives only a local anesthetic, and has no restraint on head movement.
1. A method for removing fluid from a subretinal space in the eye of a patient having a detached retina, the method comprising
visualizing the detachment site,
positioning on an external surface of the eye at the detachment site an apparatus comprising a guide tube and a fluid withdrawal device, the guide tube having proximal and distal ends and defining an internal bore at least partially containing the device, a terminus of the tube at the distal end contacting the external surface of the eye and being stabilized on the exterior eye surface, the device capable of movement relative to the guide tube,
advancing the device into the subretinal space guided by the guide tube,
withdrawing fluid from the subretinal space, and
introducing a fluid into a vitreous space after withdrawing the subretinal fluid.
2. The method of claim 1 wherein advancement of the device is guided by a control structure at the proximal end of the device and/or guide tube.
3. The method of claim 1 wherein the patient has diabetic retinopathy.
4. The method of claim 1 further comprising verifying the placement of the device within the subretinal space.
5. The method of claim 1 wherein the fluid introduced into the vitreous space is selected from the group consisting of saline, air, perfluorocarbons, low viscosity silicone oil, and combinations thereof.
6. The method of claim 1 wherein the apparatus stabilizes the eye during the method.
7. A method of repairing a retinal tear resulting in retinal detachment and through which fluid enters forming a fluid-filled subretinal space in an eye of a patient, the method comprising
visualizing the detachment site,
positioning an apparatus on an external surface of the eye over the detachment site, the apparatus comprising a guide tube having proximal and distal ends and defining an internal bore at least partially containing a fluid withdrawal device, a terminus of the tube at the distal end for positioning on an external surface of the eye at the detachment site and being stablized on the exterior eye surface, and the device at least partially contained therein, the device capable of movement relative to the guide tube,
advancing the device into the subretinal space,
removing the guide tube from the eye and maintaining the device in the subretinal space,
withdrawing fluid from the space sufficient to flatten the retina, and
coagulating the area surrounding the tear to close the tear.
8. The method of claim 7 wherein the device is selected from the group consisting of a needle, a wick, a flexible tube, a pin, and combinations thereof.
9. The method of claim 7 wherein the patient has diabetic retinopathy.
10. The method of claim 7 wherein the device remains in the subretinal space for up to about twenty-four hours.
11. The method of claim 7 further comprising retracting the device and thereafter removing the apparatus from the eye.
12. The method of claim 7 wherein the patient is ambulatory immediately following the procedure.
13. The method of claim 7 further comprising verifying placement of the device within the sub-retinal space.
14. The method of 13 wherein verification is by a method selected from the group consisting of ultrasound, x-ray, ophthalmoscope, optical coherence tomography, and combinations thereof.
15. The method of claim 7 wherein the device defines an internal bore further containing a wick or a flexible hollow tube that remains within the subretinal space after removing the guide tube and the device from the eye.
16. The method of claim 7 further comprising reattaching the detached retina by a method selected from the group consisting of laser coagulation, cryocoagulation, and combinations thereof.
17. A method of repairing a retinal tear resulting in retinal detachment and through which fluid enters forming a fluid-filled subretinal space in an eye of a patient, the method comprising
visualizing the detachment site,
positioning an apparatus on an external surface of the eye over the detachment site, the apparatus comprising a guide tube having proximal and distal ends and defining an internal bore at least partially containing a fluid withdrawal device, a terminus of the tube at the distal end for positioning on an external surface of the eye at the detachment site and being stabilized on the exterior eye surface, and the device at least partially contained therein, the device capable of movement relative to the guide tube,
advancing the device into the subretinal space,
withdrawing fluid from the space sufficient to flatten the retina, and
coagulating the area surrounding the tear to close the tear,
wherein the device defines an internal bore further containing a wick or a flexible hollow tube that remains within the subretinal space after removing the guide tube and the device from the eye.