909 East San Marnan Drive
Waterloo, Iowa 50702

Tel: 319-233-2020

Fax: 319-234-1939

Meet Dr. Girschek

Dr. Brendan Girschek is a fellowship-trained retina specialist. He is board-certified by the American Board of Ophthalmology and the Royal College of Surgeons of Canada. Dr. Girschek is a fellow of the American Society of Retina Specialists, American Academy of Ophthalmology, the Royal College of Surgeons of Canada, and the American College of Surgeons.


Retinal Tear and Detachment

Often associated with a posterior vitreous detachment (PVD), a retinal tear may lead to the development of a retinal detachment. As the vitreous gel detaches from the lining of the retina in a PVD, an area of the retina that is inherently weak or unusually adherent to the vitreous gel may break and cause a retinal tear. The retina is attached to the back wall of the eye much like the lining of a pool that is attached to its concrete basin. A negative pressure or suction exists that keeps the retina attached to the eye wall. A retinal tear allows for the opportunity for fluid to gain access to the potential space under the retina and detach it from the eye wall. Retinal detachments will inevitably detach the retina completely and are potentially blinding if not repaired. The most critical factor in visual prognosis in regards to a retinal detachment is whether the macula, or part of the retina responsible for central reading vision, is detached.

Once the macula is detached, vision is rarely the same even after successful repair. Some select retinal detachments may be able to be repaired in the clinic with the injection of a small but expansile gas bubble inside the eye. The causative retinal tear or tears may then be treated with laser surgery a few days later. This procedure is called a pneumatic retinopexy and is often performed on smaller superior (top half of the eye) retinal detachments.

Most retinal detachments, however, require surgical repair with vitrectomy surgery and injection of a large gas bubble. Because the bubble needs to press against the retinal tear or tears, your retina specialist may require one to maintain a strict head position for one to two weeks after surgery in order to put “the bubble on the trouble”.

In some instances, a heavy liquid called perfluorocarbon may be used if your retinal tear or tears are inferior (lower half of the eye) in location. Long-standing and complex retinal detachments may require the use of silicone oil which may remain in the eye for months to years.

Depending on the urgency with which the retinal detachment requires repair, surgery may be performed as soon as hours after initial diagnosis. With a gas bubble inside the eye, it is critical that one does not engage in air-travel until the bubble is absorbed completely.

Vitreous Hemorrhage

A vitreous hemorrhage may occur due to a number of reasons and represents bleeding within the vitreous gel inside the eye. Often times, a vitreous hemorrhage will leave a patient with significantly decreased vision. Some hemorrhages may be carefully followed in clinic but some require vitrectomy surgery to remove. Vitreous hemorrhages are dangerous because your retina specialist is often unable to properly assess the retina for the cause of the bleed. in cases of significant vitreous hemorrhage obscuring the view of the retina, a retina specialist will perform an ophthalmic ultrasound examination to determine if the retina is attached or not. In the event that a vitreous hemorrhage is caused by a retinal tear, your retina specialist might be unable to diagnose and treat the retinal tear in order to prevent a potentially blinding retinal detachment.

Similarly, should a vitreous hemorrhage occur in a patient with proliferative diabetic retinopathy, a dense amount of blood within your eye would not allow your retina specialist to perform laser surgery to prevent further damage from occurring to the retina. When a vitreous hemorrhage requires vitrectomy surgery, it is often difficult for your retina specialist to tell you preoperatively what your visual potential is likely to be and whether or not a gas bubble will be required to be placed within your eye at the end of surgery.

Retina Specialist

A retina specialist is an M.D. and board-certified fellowship-trained ophthalmologist (eye physician and surgeon). Two additional years of intense fellowship training specializing in the diagnosis and treatment of medical and surgical diseases of the retina is undertaken upon completion of an approved three year ophthalmology residency. Even though retina specialists completed an ophthalmology residency, retina specialists do not perform cataract surgery or prescribe glasses and focus their practice exclusively to the practice of medical and surgical diseases of the retina.

Retina specialists are often consulted in the setting of decreased vision that cannot be explained by any changes to the front part (cornea or lens) of the eye. Most permanently debilitating visual diseases involve the retina.


For more information on Retina Procedures, call us at 319-233-2020.

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