WHAT YOU SHOULD EXPECT BEFORE SURGERY
Prior to surgery, your doctor will carefully examine your eye and assess your general health. This typically involves a careful slit-lamp, dilated eye exam, and in-office testing such as OCT (ocular coherence tomography), fluorescein angiography, retinal photography, and/or ultrasound.
Other tests may be performed if the surgery is likely to involve the anterior (front) segment, cornea, or lens. If the eye has been damaged by traumatic injury, CT scanning, MRI, and other procedures may be needed to fully understand the extent of the injury. The goal is to stabilize any medical conditions, if possible, before surgery.
Once the retinal or vitreous condition has been identified, you and your retina specialist will make a plan for how to proceed. The risks, benefits, and alternatives (including observation) will be discussed as part of the informed consent. By signing, you give permission to schedule and proceed with the surgery.
It is very important to coordinate other medical activities such as dialysis, home care, and transportation both before and after your surgery date. You should anticipate a return visit on the day after surgery to evaluate your condition.
Typically, patients are asked to be “NPO” (nothing by mouth) 8 hours before surgery. Sometimes you will be told “nothing by mouth after midnight,” but this depends on the start time of surgery. Although your surgery may be later in the day, one reason to adhere to the “nothing by mouth after midnight” guideline is so your surgeon can move your case up in the schedule if there is an unexpected cancellation. Patients are also asked to be NPO so if vomiting occurs, stomach contents are less likely to get into the windpipe and lodge in the lungs.
Your physician and anesthesiology team will advise you whether to continue with medications on the day of surgery. In general, patients taking eye drops may continue even on the day of surgery. However, pills and other oral medications will need specific direction. If medication is critical for the heart, breathing, blood pressure, seizures, or anxiety, these likely will be continued with a teaspoon of water.
In the case of insulin, blood thinners, pacemakers, or other critical devices, each physician and anesthesiology team will inform you of their recommendations. Other pills, such as vitamins, cholesterol-lowering, or birth control pills, can probably wait until after surgery to resume.
It is always advisable to come earlier rather than to be late to surgery. You may have to wait if other surgery cases take longer than expected, but it is better to arrive and rest than to rush and feel anxious. After checking in, you will be assigned an identification (ID) band. It is the first step in making sure you are the right patient, having the right surgery, on the correct eye.
In the pre-operative area, nursing, anesthesia, and surgical staff will again confirm your procedure; they will also ask about your allergies, and confirm that you are in stable health to proceed. Before a marking pen is used to identify the eye to undergo surgery, you will be asked again to verbally confirm that the consent, chart, and scheduled surgery all match your expectation.
You will be asked to change your clothes and to lie on a stretcher specially designed for eye surgery. Usually IV and EKG patches and an oxygen monitor will be placed to allow the team to give you medication for comfort and to keep track of your vital signs during surgery. Most adults have only minimal sedation to avoid side effects of general anesthesia, and because most patients are more comfortable with light relaxation.
General anesthesia is usually reserved for children and severely injured, potentially unstable, or anxious individuals. Topical (eye drops) and periocular (around the eye) anesthesia are also typically given to make the eye comfortable and the surgery painless.
Before proceeding, your surgeon will lead a final “time-out” to make sure that all personnel agree and that all systems are “go!”
WHAT YOU SHOULD EXPECT AFTER SURGERY
As noted, most surgery is performed on an outpatient basis. The eye is generally comfortable, patched, and shielded to protect from injury. If a gas bubble or silicone oil has been used to treat the eye, your surgeon will give you instructions on how to do any required positioning (such as face-down), and how long you should continue it.
The gas bubble serves to press the retina back into its normal position and hold it there until the eye heals. Because only light sedation is usually used, patients generally feel well and are ready to leave for home in an hour or less. You will need a driver because hospitals/surgical centers do not feel it is safe for you to drive immediately after surgery.
When you return to the doctor’s office one day after surgery, it is advisable to have a driver to assist until your sight has returned enough to drive yourself. If a gas bubble has been used, air travel, use of nitrous gas anesthesia, and ascending to higher altitudes should be strictly avoided to reduce the risk of elevated eye pressure. Your doctor will give specific instructions on when you may resume these activities.
Maintaining head and eye positioning after a vitrectomy involving a gas bubble or silicon oil is a very important way to contribute to the success of your eye surgery. When traveling as a passenger, you should have your eye or head turned as directed. You should always wear your seat belt when traveling.
On your first post-operative visit, your doctor and her or his staff will review instructions for medications, drops, positioning, use of the eye patch, and general activities. You will also schedule your next follow-up appointment. You should NOT drive until you feel fully safe and capable of operating your vehicle; this can vary from a few days to several weeks following surgery.
RECOVERY
Surprisingly, a vitrectomy and removal of the vitreous has little effect on the health of the eye. The saline solution or gas bubble is gradually replaced by the eye’s own fluids (the aqueous humor).
If silicone oil is used as a vitreous substitute to help more serious conditions heal, a second procedure may be performed several months after surgery to remove the silicone oil. There may be some temporary swelling of the eyelids, bruising around the eye, and redness following the surgery, but these improve relatively quickly.
A mild sensation as if there is something in your eye is common following surgery, but severe pain is uncommon unless there is unusual inflammation or high eye pressure. Medicated eye drops are very important to help the eye heal.
As with most medical conditions, the healthier the eye is before surgery, the more likely the eye will heal quickly and the vision will improve. Some patients will note a decrease in vision for a few days following the procedure. Others, particularly if a gas bubble or silicone oil is used, may need weeks or even months for the vision to improve.
