Coming into Hospital

What to expect on admission to hospital
What happens during surgery?

 

What to expect on admission to hospital

You will be welcomed at the hospital and shown to the ward where you will be settled in. A nurse will carry out routine investigations including checking your pulse and blood pressure. The nurse will also check the details of any medications you are taking and ask questions about your general health.

Once this has all been completed the nurse will instil the drops which dilate your pupil in readiness for the operation.

The Ophthalmic Nurse will come to see you on the ward to explain what will happen during and after the operation, and to answer any further questions you may have.

You will be asked to sign a consent form to state that you have been provided with, and understand all the information given relating to the operation (including the risks and benefits of surgery) and that you agree to the proposed treatment.

You will be taken to the operating theatre in your own clothes, so it is important to wear something comfortable.

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What happens during surgery?

The surgical procedure recommended for you is vitrectomy and gas tamponade.

Vitrectomy means removal of the vitreous, the jelly-like substance that fills the eye behind the lens; this is a necessary part of the treatment for a number of conditions affecting either the retina or the vitreous itself. In your case vitrectomy allows the eye to be filled with a bubble of inert gas, pushing the retina back into position.

Surgery is usually carried out under local anaesthesia which involves gently injecting anaesthetic around the eye. The anaesthesia will numb the eye and allow it to remain still during the procedure. You may be offered sedation if you are particularly anxious, which will help you relax whilst the procedure is carried out. You will be awake during the operation and will be aware of some movement and touch, but the procedure will be painless.

You will be made comfortable on the operating couch, following which the skin around your eye will be thoroughly cleansed and a sterile cover (“drape”) will be placed over your eye and face. The cover will be lifted off your mouth so you can talk and breathe easily. Your eyelids will be gently held open, although your eye will feel closed.

You will see little of what is happening during surgery but we will explain what we are doing as the operation goes along. The theatre staff will make sure you are comfortable and help you relax. Someone will be there to hold your hand if you wish.

The operation usually takes about forty-five minutes, but in some cases may take longer.

Surgery is performed with the aid of an operating microscope and special lenses which give the surgeon a clear image of the vitreous and retina.

Three tiny incisions are made in the sclera (the white of the eye) to enable instruments to be passed into the vitreous. The first of these is a saline infusion (a “drip”) to replace fluid in the eye, maintaining the pressure and therefore the shape of the eye during surgery; the second is a fibre-optic light to illuminate inside the eye; and the third is for the operating instrument, starting with a vitrectomy cutter which enables safe removal of the vitreous gel from inside the eye.

Following removal of the gel, a series of steps is performed to re-attach the retina. The water inside the eye is first replaced with air to push the retina back into position.

Laser or cryotherapy (freezing) is used to treat the area of retina around the hole. This causes inflammation and as the eye heals permanent adherence – “welding” - of the retina to the eye wall occurs.

The air inside the eye is replaced by an inert gas to give a longer lasting gas-fill and a better chance of the retina re-attaching successfully to the eye wall.

For the gas bubble to be effective, “posturing” may be required. Posturing means positioning the eye so that the bubble, which will always float vertically upwards, presses against the site of the repair. The bubble in the eye behaves like the bubble in a spirit level, always finding the uppermost point.

It is important to remember it is the position of the eye, (which way the eye is looking) rather than the position of the head, which really matters.

 

The gas re-absorbs over a period of time (between one and eight weeks depending upon the type of gas used) and the eye refills with the natural aqueous fluid which is produced by your eye.

Before leaving hospital you will be given clear instructions on precisely how to posture.

Occasionally, if it is felt that a gas bubble will be inadequate to re-attach the retina, silicone oil is used instead. This can remain within the eye indefinitely, but whenever possible will be removed two or three months after surgery.

 

Traditionally the three scleral incisions are sutured at completion of the operation but with the finer instruments now available, most patients will benefit from a “sutureless” technique, with self-sealing incision sites.

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