Below, you will learn what to expect before, during and after retina surgery. Most, if not all, of this information will be discussed by your doctor in the office. It is a lot to remember, though, so this page will help to remind you of what to expect.
After the doctor discusses with you the risks, benefits and alternatives to the recommended operation, we will schedule the procedure for the date and time most convenient for you. Some conditions, such as severe infections, eye injuries and certain retinal detachments, require urgent surgery -- typically on the same day that the diagnosis is made or on the following day. In those cases, we will make the appropriate arrangements for you.
The surgery center will usually contact you the day before surgery with instructions, including when you should arrive (typically about 90 minutes before the operation is to begin). It is important not to eat or drink anything after midnight, the night before the day of surgery. Having an empty stomach helps to reduce the chance of breathing in stomach contents while you are under anesthesia.
After you are checked in at the surgery center, you will be given a gown to wear during surgery, an IV catheter will be inserted in a vein in your arm for delivering intravenous medications during surgery, and three sets of dilating drops will be placed in the appropriate eye to enlarge the pupil so the surgeon can easily see into the eye. The surgeon will greet you, make sure all of your questions are answered and confirm the correct eye by marking on the eyelid with a special pen.
Most retina surgery is performed under local anesthesia with sedation. This means that sedatives are given by vein to temporarily put you to sleep. While you are dozing briefly, numbing medicine is injected below the eye to keep the eye comfortable throughout the procedure. You will be kept in a "twilight" state -- conscious, but very relaxed. If you feel any discomfort at all, or if you prefer to be sleepier, just tell the surgeon. More medicine can be administered around the eye and/or by vein to make you more comfortable and/or more sedated. We occasionally use general anesthesia, which involves putting the patient completely asleep with a breathing tube down the windpipe. Retina procedures performed in the operating room include vitrectomy and scleral buckling, which are described in detail elsewhere.
Most retina surgery takes less than an hour, and some procedures take less than 30 minutes. More lengthy operations -- usually for complex retinal detachments -- can last about two hours, but such long procedures are unusual. At the conclusion of the operation, the surgeon will place a patch and a shield on the eye, to be left in place until the following morning.
Immediately after the operation is completed, the surgeon will meet with you and your family in the recovery area. The procedure will be reviewed and any remaining questions will be answered. The surgeon will give you instructions on how to limit your activity.
Fortunately, with current technology and surgical techniques, many patients can resume normal activity very soon after surgery. You will be told when to return to the office the next day for a postoperative check-up, when your patch will be removed and the eye will be briefly examined. This is a very short visit, and you will be "fast-tracked" to see the doctor with minimal waiting time. The doctor will review how and when to take your eye drops and confirm that all questions are answered. The drops are usually tapered gradually over about two months.
The schedule for office visits after surgery is fairly standard. Below is an outline of a typical schedule of postoperative visits (some patients require less visits; others need more):
1st visit: 1 day after surgery
2nd visit: 1 week later
3rd visit: 2-3 weeks later
4th visit: 4-6 weeks later
5th visit: 3 months later
6th visit: 6 months later
The vision is usually quite blurry in the days and weeks following retina surgery, so expect gradual recovery of vision. If you have a gas bubble in the eye, we typically examine the eye every two to three weeks until the bubble is gone, to ensure that the retina stays attached as the bubble dissolves.
1. Why gas bubbles are used. When your surgeon performs a vitrectomy, the eye is sometimes filled with gas -- most commonly for retinal detachments or macular holes. The purpose of the gas is to cover a defect in the retina so it can heal. In the case of a macular hole, the gas enables the hole to close. In the case of a retinal detachment, the gas covers any tears in the retina to allow time for laser scars around the tear(s) to develop a firm adhesion -- a process that takes about two weeks for maximum adhesive strength. At the conclusion of every vitrectomy, your surgeon will carefully inspect the peripheral retina to check for any tears, which can develop in a small percentage of vitrectomies regardless of the disease that required surgery. If a tear is identified, it is typically treated with cryotherapy, which causes an adhesive scar much like a laser scar, and a gas or air bubble will be placed in the eye to cover the tear and prevent retinal detachment.
2. Positioning with a gas bubble. If a gas bubble is placed in the eye, your surgeon will usually ask you to position yourself in a manner that "puts the bubble on the trouble" (i.e., covers the problem area, be it a macular hole, a retinal tear, etc.). For a macular hole, the recommended position is usually face-down, for about a week. For retinal tear(s), you will need to position yourself to keep the tear(s) at the highest point, as the bubble will "float" to the highest point in the eye. If the tear(s) is in the upper part of the retina, an upright position will be fine. Otherwise, you may need to position on one side or the the other, or possibly face-down in some cases. Most patients will do fine sleeping on one side or the other. Occasionally, patients are asked to position themselves face-down even while sleeping. Special equipment can be rented for this purpose. See "McFee Technologies" on our "Helpful Links" page.
3. How long each type of bubble lasts. The duration of the bubble depends on which gas is injected into the eye. The most commonly used gases are known as "SF6" and "C3F8". SF6 gas stays in the eye for about one month; C3F8 gas for about two months. SF6 gas is used most often, while C3F8 gas is reserved for more complex retinal detachments and some macular holes. Air stays in the eye for about one week.
4. How a gas bubble affects the vision. The vision through a gas bubble is very poor. A gas-filled eye can often only see movement. As you would expect, a gas bubble dissolves from bottom to top. The eye sees the opposite of what happens inside it, so from the patient's perspective, the bubble appears to dissolve from top to bottom. Patients often describe a "black line" that slowly migrates downward from the top of the visual field to the bottom. Once the black line drops below the central vision, the patient is usually able to see more detail. It is common for a gas bubble to break up into a few tiny ones shortly before it dissolves completely.
How to Instill Eye Drops
Most patients find it easiest to tug downward slightly on the lower eyelid and place the drop in the lower lid. It is best to wait about five minutes between drops to allow each one to "soak in" and avoid rinsing them out. Typically, we will recommend two or three different kinds of drops after surgery. If the eye pressure is elevated, we may recommend one or two additional drops to control the pressure. Some drops need to be shaken before they are instilled. Instead of trying to remember which drops need to be shaken, you may briefly shake each one before instilling it.