At all stages of your treatment pathway, you will receive my direct access telephone number. This will negate the need to go via any third party, such as a secretary or the hospital, in order to obtain any routine or urgent advice. I will be available 7 days a week for you in this regard. This is a very important aspect to the service I pride myself in providing, giving you the reassurance and confidence to make your journey through this difficult time as smooth and anxiety-free as possible.
This and all other aspects of the service I provide have resulted in very high satisfaction levels from my former patients, rating my service an average of 4.9/ 5 on Trustpilot.
It is safe to perform light exercise after surgery. I will individualise the advice relating to more vigorous exercise when I review you at your post-operative visits.
You can shower and wash your hair from the day after your procedure, however, it is advisable not to allow water to enter the eye for approximately 2 weeks following surgery. This can be avoided with simple measures including wearing swimming goggles during showering or washing your hair backwards in a sink similar to hairdressers.
Drops are prescribed to be used for several weeks following the procedure. Additional drops will be prescribed if the pressure in your eye is found to be excessively high at any point.
There may be some discomfort initially which generally becomes less on a day-by-day basis. Simple oral analgesia such as paracetamol for a few days is usually sufficient, if required. It is common to experience mild itching for 1-2 weeks following surgery.
You will be able to go home 1-2 hours after a local anaesthetic, and slightly longer after a general anaesthetic. The eye pad is removed the next day and you can start instilling your eye drops. There may be a small amount of discharge at this stage. Initially, your vision is likely to be worse than before the operation, and this is more likely if gas is used to flatten your retina. This is perfectly normal and you must not feel alarmed about this. You will be reviewed 1-2 days following your operation for extra reassurance, to detect any immediate post-operative issues, and to answer any further questions you may have in detail. If any further drops are required at this stage, these will be prescribed. I will then check with you that you fully understand all the instructions. If you have received a gas bubble then your vision will fluctuate for the weeks the gas remains in your eye (see below). If oil is inserted, the vision tends to stabilise after a few weeks. You may experience floaters again following surgery, particularly if gas is used, however, these tend to settle after a few weeks. There is usually some redness of the eye which disappears after just a few weeks, which is a benefit of the modern microincision equipment I use exclusively.
There may be some discomfort initially which generally becomes less on a day-by-day basis. Scleral buckling surgery tends to produce slightly more discomfort than vitrectomy surgery. Simple oral analgesia such as paracetamol for a few days is usually sufficient. It is common to experience mild itching for 1-2 weeks following surgery.
Drops are prescribed to be used for several weeks following the procedure. Additional drops will be prescribed if the pressure in your eye is found to be excessively high at any point. If oil is used, I generally require you to use a few drops a day until the oil bubble is removed.
I will arrange to see you 1-2 days following the procedure, then again at 1-2 weeks and 2-3 months. If additional visits are advisable, for example, to check or control your eye pressure, then I will arrange as many visits as required in order to maximise the safety of your eye and to achieve the best final result.
After the anaesthetic is administered, your eye and face will be covered with a sterile drape. The whole vitrectomy operation will then be performed through 3 tiny incisions. You will hear vibrating noises throughout much of the procedure from the vitrectomy machine. You will not be able to see details of what is happening but may see only shapes or bright lights, or nothing at all. The operation will last from between 20 minutes for less complex vitreous haemorrhages to up to 2 hours or more for very complicated diabetic retinal detachments. At the end of the procedure I routinely administer some antibiotics and antiseptic to minimise the chance of infection in your eye. I will then place a protective eye pad to shield your eye overnight. I will fully inform you of the posturing instructions and you will then be able to return to the eye clinic or ward.
I generally employ modern sutureless microincision techniques for performing vitrectomy surgery, which does not usually require the use of stitches. |Sometimes stitches are required, however, and always so if a scleral buckle procedure is performed. These may take anywhere between 2-5 weeks to completely dissolve.
After vitrectomy for diabetic retinal detachment, posturing may not be necessary or you may be advised to posture for a few hours looking down towards the floor (prone positioning). After that, the instructions for posturing will depend on the location and number of any retinal breaks found during your operation. Posturing, if required, will typically be for 7 days. Instructions will be given in full by myself at the end of your procedure.
In most cases, it will be sufficient to use a gas bubble to reattach your retina. There are 2 types of gas bubble commonly used in retinal detachment vitrectomy surgery:
SF6 gas which can stay in your eye between 2-3 weeks before completely absorbing
C3F8 gas which can remain between 8-10 weeks before completely absorbing.
For up to half of this time, you will have very limited vision in the eye, being generally only able to see hand movements in the middle of your vision. As the gas bubble absorbs, your vision will become clearer, particularly in the top part of your vision. You will become aware of a line in your vision resembling a spirit level, and it may feel as though you are seeing “underwater”. The gas will progressively absorb until just a small bubble is noticeable in the bottom of your vision before it also completely disappears.
If an oil bubble is used, then you will generally have better albeit limited vision in the post-operative period compared with receiving a gas bubble. Oil is used for more complex retinal detachments and is usually left for 2-3 months before removed. The timing of oil removal will be individualised to the needs of your eye specifically. Cataract formation is very common with oil use, and I usually combine the removal of silicone oil with cataract surgery in one sitting. There is a small risk of retinal re-detachment following the removal of silicone oil. In many centres, it is customary to simply remove the oil (+/- cataract) at this stage, without any specific immediate search for any new retinal breaks which would result in retinal re-detachment. Furthermore, it is not uncommon to be aware of oil bubble floaters in the vision following oil removal with this approach. I, however, prefer to remove oil in a more methodical, time-consuming and detailed fashion in which I combine the removal with a very careful inspection for any additional unexpected retinal breaks or other pathology that requires treatment. I also routinely perform additional measures to ensure that as much as possible of any remaining tiny oil bubbles are removed at this sitting, in order to minimise the risk of annoying oil floaters in your eye after oil removal surgery.
Generally, it is inadvisable to drive whilst there is gas in the eye due to the sudden loss of vision in one eye, and the often distracting nature of a partially absorbed moving gas bubble within the eye (see gas section above). It will be safe to drive once the gas bubble has completely absorbed, and if there is sufficiently good vision overall using both eyes to satisfy current DVLA visual criteria. If oil is used, you will be able to drive if the vision in your other eye meets DVLA criteria. In all instances, you must feel safe to drive. You will be advised whether you need to contact DVLA at your follow up appointments.
You must not fly at any point if there is any residual gas in your eye. Once the gas has fully absorbed, then may fly. It is safe to fly if you receive an oil bubble to reattach your retina. It is not advisable, however, to schedule any foreign travel for immediately after eye surgery, in particular retinal detachment surgery.
This will depend on multiple factors including your occupation, the level of vision in your other eye, whether you must drive for a living, the type of operation performed, and which type of gas or oil was used. I will tailor this advice to your circumstances, but it is generally prudent to allow at least 2 weeks off from work. In some instances, it may be possible to continue to work from home.
The clear benefit of surgery for vitreous haemorrhage is the rapid clearance of vitreous blood and accelerated restoration of vision. Surgery for retinal detachment is important to prevent loss of central and/or total vision in the eye, or to restore vision when it has been lost. The degree of improvement in vision from surgery will be dependent on multiple factors including the degree of irreversible damage to the retina or other structures from diabetes or other co-existing conditions. Approximately 65% of patients gain 2 lines of visionor more on reading charts.
What does laser treatment for diabetic retinopathy or macular oedema involve and what are the risks?
This procedure is performed in the eye clinic and does not involve surgery as such. Eye drops will be instilled in your eyes to anaesthetise the eyes, dilate the pupils and allowvisualisation of your retina. A special focussing lens is then placed on the eye and laser delivered gently using a specially designed retinal laser machine. You will experience brightflashing lights during the procedure and are unlikely to feel any significant discomfort. Occasionally, usually when a lot of previous laser has been performed for PDR, some discomfort may be felt, but thankfully, there are ways in which this treatment can be madepain–free in such circumstances. Risks associated with laser treatment are rare, particularly in experienced hands, but can include some reduction in central vision or colour perception,and some reduction in night and peripheral vision (likely only if lots of laser is required, andis less common with more modern lasers).
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These are generally performed in a sterile “clean” room. You will have a combination of anaesthetic and antiseptic drops instilled in the eye in order to make the procedure as comfortable as possible and to minimise the risk of infection. The eye will be covered and a small sterile speculum used to keep your eyelids apart. A small volume of an antiVEGFsolution such as Lucentis, Eylea or Avastin, all of which are effective in DMO, is then administered into the eye using a tiny needle. This part of the procedure lasts only a few seconds, with the entire procedure lasting just over 5 minutes. Most patients report minimal discomfort from the injection. The eye is then cleaned and you go home. It is normal to experience some watering and redness for 24-48 hours after the procedure. It is common also to experience some floaters in the eye which also improve over a few days. Risks arerare, but do include less than 1 in 1000 risk of a blinding infection in that eye, a small risk of bleeding in the eye, and a slightly higher change of developing a complication during cataract surgery whenever that is required.
- Residual or rebleeding within the eye. This occurs commonly but usually self-clears from the eye, and much more rapidly than before surgery. I perform additional steps in the operation to maximise the chances of self-clearing of any recurrent bleeds.
- Retinal detachment. The risk of this is less than 1% but would require further vitrectomy surgery, and may result in worse vision.
- Cataract development. This is where the natural lens in the eye becomes cloudy, secondary to the vitrectomy with gas or oil insertion. Cataract surgery is required inmajority of patients within 2 years of initial vitrectomy surgery. When cataract surgery is performed, this also provides an opportunity for correcting any pre-existing refractive error such as short-sightedness.
- Blindness in the affected eye due to post-operative infection or bleeding during the operation. The risk of this is extremely low (< 1 in 1000 cases) and is far outweighed by the benefits of this sight-saving surgery .
- Significantly worse vision after the vitrectomy (losing 2 or more lines on Snellenreading chart). This is unlikely, occurring in between 8-15% of patients.
- Risks of laser treatment (see laser FAQs)
- High or low eye pressure after the operation
- Inflammation in the eye which is usually tread with drops
- Temporary bruising and swelling around the eyelids
- Lid drooping which may very rarely persist
- Possible allergy to drops
- Double vision which is usually temporary
- Epiretinal membrane formation which may require surgery
- Pupil size and focussing – rarely, the pupil can remain larger on the treated side, even after stopping eye drops given after surgery. This can affect focussing and you could be sensitive to bright light. This usually almost completely recovers within several months following surgery
I perform most vitrectomy procedures under local anaesthesia, whereby a small amount of anaesthetic is administered around the eye to numb it and permit surgery to performed painlessly. Whilst you will need to be comfortable and lie still for the duration of the procedure, you can feel reassured that if you do need to move, you can simply inform me and I will then allow you to make yourself comfortable again. The advantages of this approach are that there will be no requirement to starve before the procedure, you can go home very soon after the procedure, and there will be no risk to your general health unlike with general anaesthesia. If you feel that you may be quite anxious during the operation, then mild sedation can be provided by an anaesthetist in addition to the local anaesthetic, which is an effective option in such cases, whilst still retaining the benefits of local anaesthesia. Some patients may still prefer general anaesthesia where you are put completely to sleep for the operation. You will be required to be nil by mouth prior to surgery and may require some pre-operative tests to ensure safe anaesthesia. I also provide supplemental local anaesthetic when general anaesthetic is given, as this significantly alleviates any immediate post-operative discomfort.
- Attend all your eye checks with your optician and diabetic retinopathy service on time as recommended. This is the most effective way to detect sight-threatening conditions. Your sight can usually be saved with early detection and treatment.
- Good diabetic control will significantly reduce your risk of severe diabetic retinopathy and blindness. However, even with good control some patients still develop sight-threatening retinopathy.
- Good blood pressure control
- Controlling your cholesterol and blood lipids.
- Keeping fit, adopting a healthy lifestyle and maintaining a normal weight.
- Giving up smoking. As well as reducing the risks from diabetes, this will also reduce the risk of several other conditions which are linked to smoking.
Your best chances of long-term reattachment and visual recovery are also related to the appropriateness, quality and success of the initial surgery, performed as soon as possible. For these reasons you can optimise your chances by choosing an experienced vitreoretinal surgeon, which is typically therefore a Consultant, who personally performs and not just supervises many retinal detachment procedures per year, including highly complex cases.