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 liquifies 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:
1. Removal of vitreous haemorrhage
2. Peeling of epiretinal membranes
3. 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 when Dr Pratik decides it is necessary.
THE RISKS OF SURGERY
1.Reaction to anaesthetic agents
2.Infection
3.Bleeding
4.Cataract
5.Secondary Glaucoma
6.Failure to attain the intended outcome
7.Blindness
8.Need of repeat surgeries
SPECIFIC PRE-OPERATIVE PREPARATION
You will not need to compulsory be nil-by-mouth before the operation.Most of time Dr Pratik prefers under local anesthesia with mild sedation given by a senior anesthetist.A light breakfast can be taken in the morning if no specific instructions have been given. You should have a shower, shave and wash your hair before the operation. You will be prescribed frequent antibiotic eye drops before surgery.
LENGTH OF TIME IN HOSPITAL
From morning till evening.
AFTER THE OPERATION
• Pain relief: Tablets are usually sufficient to control your pain. 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.Please tell if you have a history of Sulpha allergy.Mostly Dr Pratik uses small guage vitrectomy instruments which makes recovery faster and painless.
• Resuming diet after the operation: You may have a light diet and fluids following your surgery. 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. Dr Pratik or the staff 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 10-12 hrs a day). Maintain posture for the required time. Use ten minutes each hour to eat, and move around or put drops 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 Dr Pratik immediately.
DISCHARGE INFORMATION
• Pain management: You can take Paracetamol+Ibuprofen combination every 8 hrs or as and when required.
• Return to usual activities / work: No heavy lifting or bending. Please check with Dr Pratik 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 Dr Pratik. 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. 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 call 0777 108 9999 If you develop excessive pain, swelling, bleeding, offensive odour or discharge from your eye , or decrease in your vision, contact 0777 108 9999 .