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.
The clear benefit of retinal detachment surgery is that it prevents you from blindness in that eye. The degree of recovery of vision is dependent upon a multitude of factors. These include the initial cause of retinal detachment, extent of retinal detachment by the time of initial surgery, pre-existing eye conditions, the presence of retinal PVR scarring, whether your retina re–detaches, and the success of initial surgery which is significantly dependent upon the experience and competence of your surgeon.
- Retinal re-detachment. The risk of this is 5-10% if you have an uncomplicated primary retinal detachment without PVR scarring (see success rates). Re-detachment would require further surgery
- 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 in the majority of patients within 2 years of initial vitrectomy surgery. This is much less common if scleral buckling is performed. When cataract surgery is performed, this also provides an opportunity for correcting any pre-existing refractive error such as short-sightedness which is common in patients with retinal detachment.
- 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 very high risk of blindness if you do not proceed with sight-saving surgery.
- High or low eye pressure after the operation
- Inflammation in the eye which is usually treated 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
I perform most retinal detachment 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. This option is also required for scleral buckling surgery. You will be required to be nil by mouth prior to surgery and may require some pre-operative tests to ensure safe anaesthesia. I always also provide supplemental local anaesthetic when a general anaesthetic is given, as this significantly alleviates any immediate post-operative discomfort.
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 20-40 minutes for less complex retinal detachments to up to 2 hours or more for very complicated PVR 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.
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.
After vitrectomy for retinal detachment you will 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 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. Posturing is ordinarily not required after a scleral buckling procedure.
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.
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.
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.
This can be defined both in terms of anatomical success (a fully reattached retina) and visual success. We tend to measure anatomically success at approximately 2-3 months following surgery with gas, or after the oil has been removed. If your retina were to re-detach then multiple operations may be required for final reattachment. Approximately 99% of retinal detachments can be reattached after multiple operations if needed. Vision can be defined both in terms of central vision and peripheral vision. If your operation is performed soon enough, there is a good chance you will eventually recover central vision that is as good as it was before your detachment. If however, your central retina is detached and there is a delay in prompt treatment, or there is PVR scar tissue, then there is less chance of recovering the same quality of central vision. The longer your retina is detached, the worse the prognosis for central vision, hence underlying the need for prompt consultation and surgery. However, it is important to appreciate the contribution of your peripheral vision in such cases. Even if your central vision could be affected in these cases, surgery is generally very successful in restoring your peripheral vision which is vital in allowing you to navigate and see in the dark. Furthermore, many of these patients report that they are much less aware of any reduction in their central vision when using both eyes, which is generally how we use our eyes on a day-to-day basis.
See PVD /retinal tears FAQ