Question by Charles C: Doctors and Whoever knows: on revitalizing and restoring normal visual acuity and health to hypotonic eye?
Our daughter had lost vision in left eye due to extended overdosing with cortesteroids for skin allergy more than 2 years ago, then detachment of retina, then left eye went hypotonic. Right eye also affected w/minor cataract. Subsequent 4 hr. surgery not satisfactory. Retina coiled, no art. lens implanted, silicon oil still left inside left eye since 2 years ago. Still hypotonic, left smaller, redder. On Maxitrol. Very worried. Resources strained, continue trying to find a better cure – what appears impossible today may be easily attained tomorrow. Most urgent now is revitalize her left eye. Any help or suggestion will be highly appreciated.
Best answer:
Answer by Paul MB
I can’t tell you the number of people I’ve seen with this problem. Basically the eye has gone into phthisis.
That said, which is so sad to say…
this is the basic physiology so you can understand what’s really happening…I know you have more knowledge of this than I’m going to assume, but please just bear with me for a little bit.
The retina forms from an out pocketing of neuroectoderm. It forms a sort of ball at the end of a stalk. When the outer part of the ball gets near the real ectoderm not the neuroectoderm, it causes the ectoderm to change character and it in-folds to become the lens. The ball sort of collapses into a cup with the lens bending into the opening. Later, as the cup gets more cup like, the center area that used to be the inside of the balloon so to speak, disappears (but it’s still there). The eye forms around the optic cup, the lens is inside the vascular layer forms outside the cup, then the sclera and cornea….
Now we have a whole eye. The outer white sclera goes all the way around to the surface of the nerve and in the front of the eye it changes character and becomes the cornea. People look through the cornea and see the iris which continues back around the eye as the ’second’ layer. It’s full of blood vessels. The third layer is the retina which is made up of the two layers, the outer layer forming the Retinal Pigment Epithelium, and the inner layer which forms the sensory retina. (space or virtual space still there between those layers).
Vitreous in the middle cavity helps the eye ‘blow up’ to normal size by year 8 or so.
For some reason, the vitreous causes a tear in the retina. Fluid can now get under the neruosensory retina into that space. The retina detaches. Got to close that hole. But as you’ve seen, not so simple, even in the best hands, with the best tools, with membrane peeling, with perfluorocarbons which is sort of heavy water, subretinal surgery, epiretinal peeling, special scissors and all of it. Once the retina is flat, they’ll do laser or cryo around the tear so it will seal and…possibly a buckle to support the whole thing and decrease traction distances, etc….all done.
But..
We tend to want to heal things that are broken. In proliferative Vitreoretinopathy, the retina, blood, fibrin, and it all heals up and folds that lovely retina into a bunch of folded scar tissue. No seeing anymore from that retina.
BUT, the way the retina says attached inside that eye in the first place is that the RPE pumps fluid OUT into the choroid. So that space is a virtual space unless something gets in it. Like the lung cavity, no space unless air gets there then the lung collapses.
This constant pumping of the RPE in that eye has led to the hypotony, the phthisis, and this is disfiguring.
No matter what fluid you put into that eye to keep it ‘hard’, that RPE will pump and keep it soft. Also, the retina, as it’s detached like that for a long period, goes into some degenerative changes, and there’s a loss of photoreceptors so that if it is attached tomorrow, it probably won’t work. Yes we do have new stem cell research that can make new photoreceptors and those are being used to try and regain lost receptors in macular degeneration patients. It is possible that in her lifetime we’ll be ‘fixing’ these retinas, possibly.
That’s what you are up against. As long as it doesn’t hurt her, e.g. having a blind painful eye, there are other things to do to make it more cosmetically comfortable…like a prosthesis which sits on top of the eye and looks like a ‘real’ eye and moves well because it’s sort of a contact lens to that hypotinous eye. And it’ll give her more social confidence as no one can really tell, unless she tells them or it doesn’t move quite right.
If you need more info, or just want to talk about this, contact me,
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sorry about how stupid this question sounds. heh.
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