PATIENT INFORMATION ON RETINAL AND VITREOUS SURGERY

This information is intended as a general guide only. Please ask the nurse or doctor if you have any questions relating to this information.

DISEASE PROCESS / INTRODUCTION

The retina lines the inside of the eye and is a thin tissue composed of layers of light-sensitive cells which send visual information to the brain. The retina is held in place by the vitreous humour which is a transparent gel composed of water and collagen and lies in the centre of the globe of the eye between the retina and lens. A retinal detachment occurs when the retina pulls away from inside wall of the eye causing loss of vision. This is often due to a hole or tear in the retina produced when the vitreous contracts with the aging process. Trauma may also lead to retinal detachment. The vitreous may also become filled with blood, particularly in association with severe diabetic eye disease where traction may detach localised areas of retina.

THE OPERATION

The indications for retinal surgery include: removal of vitreous haemorrhage, peeling of epiretinal membranes, treatment of macula holes and most frequently retinal detachment. Small holes or tears in the retina may be treated with laser photocoagulation or cryopexy (freezing).

Laser photocoagulation consists of pinpoints of laser which creates minute burns around a small hole in order to help the retina adhere to the wall of the eye. It can also be used to treat areas of the retina which have a poor blood supply.

Cryopexy is a procedure which freezes the area around a hole to the wall of the eye.

Scleral buckling is a surgical procedure used in large retinal detachments in which a synthetic band is placed around the outside of the eye in order to push the wall of the eye against the detached retina.

Vitrectomy is the surgical removal of diseased vitreous and the insertion of an artificial substance to push the retina back against the wall of the eye. The substance may consist of an expandable gas or silicone oil. The gas is slowly absorbed by the body after a couple of weeks. The silicone oil may be removed surgically whin the doctor decides it is necessary.

Retinal Detachment

THE RISKS OF SURGERY

• Reaction to anaesthetic agents
• Infection
• Blindness
• Bleeding
• Cataract
• Sympathelic ophthalmia.

SPECIFIC PRE-OPERATIVE PREPARATION

• You will need to FAST (not eat or drink) for six hours before your operation.
• You should have a shower, shave and wash your hair before the operation.
• You will be given eye drops to dilate (open) the pupil one hour before surgery.

LENGTH OF TIME IN HOSPITAL

1 – 2 nights after your operation.

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AFTER THE OPERATION

Pain relief
Tablets are usually sufficient to control your pain. If the tablets are not relieving your pain please inform the nursing staff. Use the analgesia as necessary to enable and assist you to maintain ‘posture’, eg if you get a sore neck, use analgesia, rub the neck with cream. If the pain in your eye is not relieved by an analgesic then the pressure may have risen in your eye. You may be given a medication called Acetozolamide (Diamox) to help reduce the pressure.

Resuming diet after the operation
You may have a light diet and fluids following your surgery. If you feel nauseated the nurses will be able to administer some medications to help ease this.

Intravenous therapy
You may have an intravenous drip in your arm following surgery. This is removed once you are drinking enough fluids. Please ensure that the needle is removed from your arm before discharge.

Activity / walking
You will be required to ‘posture’, to keep your head in a position that allows the gas bubble or silicone oil that has been placed into your eye to keep the retina in the correct position. This position will vary from person to person and is dependent upon where the retinal damage in your eye is located. Your Ophthalmologist will tell you the exact ‘posture’ that is required before you leave the hospital. They will also tell you how long this ‘posture’ is to be maintained (usually fifty minutes out of each hour).

Maintain posture for the required time.
Use ten minutes each hour to shower, eat, and move around so that you don’t become stiff.

Eye care:
Clean the eye at least once a day. Wash hands using soap and water. Use clean cotton balls and water that has been boiled and allowed to cool. Moisten cotton wool with water. Close eye and wipe cotton wool ball over closed lids gently to dislodge any debris. Only use each cotton ball for one wipe. Continue until lid is free from mucous and crusting. Put in eye drops as ordered by your doctor. Gently pull down the lower lid and instil the drops in the sac. Do not contaminate the eye drop bottle opening.

If you have sticky discharge from the eye, pain in the eye that does not settle with analgesia, there is decreased vision in the eye, sensation of seeing flashing lights or a ‘curtain’ coming down, you need to contact a doctor immediately.

DISCHARGE INFORMATION

Pain management
You can take two Paracetamol 4 hourly to assist with analgesia as well as the non-steroidal anti-inflammatory drug which is usually Indomethacin.

Return to usual activities / work
No heavy lifting or bending. Please check with your Ophthalmologist when you can resume bending and lifting and go back to work.

Driving
Please discuss this with your doctor. You will need to wait at least until any gas has resorbed.

Specific care management related to the surgery
Continue with eye drops and eye care until otherwise directed by your doctor.
Take your antibiotics and/or steroid eye drops and medications as directed by your Ophthalmologist.

The usual discharge time is 10.00am, however you may be discharged at a later time for a specific reason.

ADDITIONAL INFORMATION

Do not fly in an aeroplane after retinal surgery if you have a gas bubble in your eye, because the changing air pressures in the plane will affect the gas bubble in your eye.Check with your doctor. The air pressures can also change if you drive up into the hills.

FOLLOW UP

It is important that you keep your outpatient’s appointment. If you need to change the time or date please telephone 8222 5313 during business hours.

If you develop excessive pain, swelling, bleeding, offensive odour or discharge from your eye dressings, or decrease in your vision contact the Eye Registrar at Royal Adelaide Hospital.

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Last revised: 25-February-03
URL:http://www.rah.sa.gov.au/retinal/patient.htm