Following your Detatchment Surgery

Immediately following surgery
The day after your surgery
How quickly will your vision improve?
When can you resume normal activities?
Driving and travel
What can you do to help make the operation a success?
What are the risks and complications?

 

Immediately following surgery

After the operation you will return to the ward with a pad and plastic shield covering the operated eye. This remains in place overnight. You will be given a combination antibiotic and anti-inflammatory eye drop and a pressure lowering drop to take home, with written instructions on how to instil these and the frequency with which they should be used. We will make sure you know how to care for your eye when you get home.

You will be given information on caring for your eye and any particular instructions regarding posturing. This is an important part of the treatment and your co-operation is vital to give your retina the best chance of re-attachment.

Whilst resting after the operation you will be offered refreshments. You may leave the hospital when you feel ready.

During the first few hours after your operation the eye may feel sore. This is nothing to worry about and your normal headache tablets should settle any discomfort.

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The day after your surgery

The pad and shield covering your eye can be removed on the morning after your surgery. You do not need to use it thereafter, although some patients prefer to wear the clear plastic shield for the first few nights for peace of mind.

You may find the eye is a bit sticky and there might have been a slight discharge overnight. This is quite normal and you should cleanse the eye only if necessary, by wiping gently across your closed eyelids with cotton wool dampened with clean water.

You will then need to start your eye drops, following the detailed written instructions given to you before you left hospital.

If you are running out of drops before your appointment at the clinic, you can request a repeat prescription from your GP.

The operated eye may be sore for the first few days and feel gritty for a couple of weeks. Occasionally the area surrounding the eye can become slightly bruised and you may notice puffiness of the eyelids if you have been asked to posture in certain positions. This is nothing to worry about and will settle over the first couple of weeks.

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How quickly will your vision improve?

The success of the operation depends on how much of the retina had detached and for how long prior to surgery. If you had noticed a shadow or curtain blocking out part of your vision, this will usually improve when the retina has been put back in place.

If your ability to see fine detail had been damaged before the operation (implying detachment of the central macular retina) this will not fully recover following the procedure. Your final visual result will not be known for several months following surgery.

The gas bubble will obscure your vision whilst it re-absorbs over the next few weeks. As the bubble re-absorbs your view of the world re-appears from above, the upper “edge” of the bubble gradually lowering in your visual field. The world viewed through the bubble will be fuzzy or blurred. The bubble will become smaller and may break up before disappearing completely, at which time you should have a full field of vision.

If silicone oil has been used this will result in poor vision whilst the oil is present. Oil produces a long-sighted change, for which a temporary spectacle prescription may help. We will advise whether new spectacles are appropriate. In most cases, once the retina has re-attached to the back of eye, surgery will be performed to remove the oil. Laser is sometimes applied prior to oil removal, to minimise the risk of re-detachment.

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When can you resume normal activities?

You may return to your normal daily activities as soon as you feel ready to do so, although the need for posturing may initially be limiting. As a guide however, for the first two weeks you should refrain from swimming, strenuous activities, high impact sports, heavy lifting and wearing eye make-up.

If for any reason you are admitted to hospital whilst the gas bubble is present, you must mention this to your surgeon and anaesthetist as certain anaesthetic agents can be absorbed into the eye, causing a dangerous pressure rise. Alternative anaesthetics are available.

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Driving and travel

It is vitally important that you do not fly until the gas bubble has re-absorbed, as altitude can cause a pressure rise within the eye and irreparable damage.

You will be unable to drive for the first two or three weeks. The field of vision will be impaired and the movement of the gas bubble very distracting. Following this, your ability to drive will depend upon a number of factors including the vision in your other eye and the level of your vision when using both eyes together.

If you are in any doubt regarding your visual status you should refrain from driving until you have been seen for review in the clinic.

Please also remember that you will need to continue putting drops in the eye for approximately three to four weeks after surgery.

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What can you do to help make the operation a success?

Following your retinal detachment repair it is very important that you instil the eye drops as instructed as this will help prevent any complications such as infection or inflammation in the eye.

If you have been asked to posture during the day or sleep in a particular position at night, this is an important part of your treatment and will give your retina the best chance of remaining attached.

You should avoid knocking or rubbing your eye, but you may touch the surrounding area. Although it is safe to have a shower or bath, take care when washing your hair to avoid getting soapy water in your eye.

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What are the risks and complications?

The aim and potential outcome following vitrectomy surgery for retinal detachment will be discussed with you in clinic and again prior to your operation.

Our team operates from modern private hospitals where the equipment and products used in the operating theatre are of the highest standard. Every effort is made to minimise risk and ensure your operation is safe. Serious problems during or after surgery are rare, however every surgical procedure has risks and potential complications.

Complications early in your recovery:

  • Initial poor vision. It is not possible to see clearly through a gas bubble and vision will be compromised until spontaneous re-absorption occurs.

  • Bruising of the eye or eyelids. The local anaesthetic may cause some bruising around the eye, particularly on the lower lid. The sclera may be red where the tiny incisions are made into the eye. This usually resolves completely within the first month.

  • Double vision. The local anaesthetic injection used to numb your eye takes some time to wear off and this may leave one or more of the muscles around the eye weak for the first few hours. This causes double vision, which resolves spontaneously.

  • A temporary increase in the intra-ocular pressure in the eye. This necessitates an additional course of eye drops or tablets.

  • Allergy to eye drops. Ocular allergy typically causes lid swelling, itching or redness. If this happens please let us know and we can prescribe an alternative. Some patients are allergic to the preservative used in eye drops. If you have previously had a reaction, please inform us prior to surgery so that we can prescribe a preservative-free option.

  • Endophthalmitis. Infection in the eye is a very rare, but potentially devastating complication affecting less than one in a thousand cases. Increasing discomfort, increasing redness of the eye or worsening discharge should be reported immediately.

  • Cystoid macular oedema. Swelling of the central macular area of the retina causes blurred vision. This usually resolves within a few weeks of using additional eye drops.

Complications late in your recovery:

  • Re-detachment of the retina. Vitrectomy surgery involves the insertion of instruments into the vitreous cavity of the eye which carries a small risk of additional tears in the peripheral retina. Although normally identified and treated at the time of surgery, retinal detachment can occur months or even years later. Any increase in floaters and flashing lights, or the appearance of a shadow spreading inwards from the edge of vision, should be reported urgently.

  • Post-vitrectomy cataract. This is an inevitability following vitreous surgery. It can develop as quickly as a few weeks after surgery, or may take several years to become significant. In some cases patients may be offered phaco-emulsification (cataract surgery) combined with the vitrectomy procedure to avoid the need for further surgery at a later date.

  • Glaucoma. Any ocular surgery can increase the risk of glaucoma in later years. Glaucoma is damage to the main optic nerve of the eye, caused by an unsuitably high pressure. It is more common in short-sighted eyes and in individuals who have a family history of glaucoma. It can nearly always be controlled with eye drops, although prolonged or even indefinite use may be required.

  • Dry eyes. This is a common symptom with increasing age, for which many sufferers use simple lubricating drops. Interfering with the conjunctiva on the surface of the eye can upset the production of mucus, which is an important constituent of the tear film. In most cases this is temporary, responding to simple measures such as ocular lubricants and warm compress bathing. We will advise you on a treatment regime if required.

Information explaining how to care for your eye together with contact telephone numbers will be given to you on discharge from hospital.

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