Questions and Answers About Vitrectomy Surgery For Proliferative Diabetic Retinopathy (PDR)

1. How long will I be in the hospital for my vitrectomy surgery?

You will be admitted to the hospital or ambulatory surgery center the day before or the morning of surgery. Most patients are able to leave the hospital the same day or one day after surgery.

2. How is the surgery performed?

The surgery is performed under general or local anesthesia. Small openings are made in the white part of the eye called the sclera. Small, thin instruments are placed into the eye through these openings. These vitrectomy instruments include a fiber optic light used to light the inside of the eye and a variety of cutters, scissors, and forceps. The surgery is done using a microscope that focuses through the pupil.

3. What are the possible complications of vitrectomy surgery?

There are risks and complications that can occur with any surgery. The risk sand complications that can occur with vitrectomy include: infection, retinal detachment, retinal tear, cataract formation, glaucoma, more vitreous hemorrhage after surgery, and the development of scar tissue. Although these complications can often be managed by further treatment, any one of them may cause the vision to get worse or cause a total loss of vision and perhaps eventual loss of the eye.

4. Are there risks to anesthesia?

General anesthesia always carries a degree of risk. Minor risks include postoperative nausea, vomiting, and hiccupping. Some patients experience an upset stomach following surgery. If nausea does develop, it can be controlled with medication. Occasionally, patients will experience some confusion and prolonged sleepiness. Older men may have trouble urinating. Very rarely, serious reactions occur that may result in liver failure, cardiac arrest, and even death.
Local anesthesia involves placement of a needle through the lower eyelid, beneath the eye. There is the rare possibility that the needle could penetrate the eye or cause damage to the optic nerve.

5. Will my eye hurt after surgery?

Most patients will note some discomfort around the eye that can be relieved with medication if necessary. Severe pain is very unusual. The eye will remain swollen, red, and somewhat tender and uncomfortable for several weeks. Itchiness or a scratchy, foreign-body sensation when opening or closing the eyes is common. This is cause by small stitches. These stitches will gradually become soft and fall out or be absorbed.

6. What is I do experience a great deal of pain?

If you experience a great deal of pain, please let your surgeon know promptly. Pain can be an important symptom indicating infection, excessive pressure in the eye, or injury to the front surface of the cornea. You should notify your surgeon promptly if you are experiencing more that mild pain.

7. What instructions must I follow when I go home after surgery?

We ask that patients not engage in strenuous activity or exercise for about a week after surgery. They may return to work or to driving when they feel able to do so; this is usually within a week or two. They are encouraged to take walks and engage in normal activity as soon as possible.

If a patient has had the front surface of the cornea removed during surgery, a snug “pressure” patch or a bandage contact lens may be applied to the eye until the front surface heals. It is alright to remove the patch temporarily when eye medications are given.

If a gas bubble has been placed in the eye to hold the retina in position, the patient may be asked to lie face down or on one side. Usually, the patient is required to remain in this position most of the time for several days. This positioning will place the gas bubble in the correct position within the eye so that the retina stays in place. If a gas bubble is in your eye, you should not sleep on your back. Otherwise, the gas bubble rises and rests again the lens of your eye and may cause a cataract. Also, the gas bubble may rise and close off the normal flow of fluid out of the eye, which will increase the pressure in the eye. If a gas bubble has been used as part of your surgery, you may not travel by airplane until the gas bubble has absorbed, and travel to high altitudes should be done in a gradual fashion. It usually takes several weeks for the gas bubble to disappear. We will advise you as to when you may lie flat on your back and when you may travel by air.

8. What medicines do I use after surgery?

Most surgeons will use a type of dilating drop that eases the discomfort of the inflamed eye. An antibiotic drop may be used to help prevent infection. A steroid drop is often used to reduce inflammation and make the eye more comfortable.

If your surgeon is concerned about increased pressure in the eye, pressure-lowering eye drops or oral medications may be prescribed. Your surgeon will decide when to stop these medications, but most drops are used for a few weeks. If you run out of medications, call your physician and ask if more are required.

9. How long will I need to wear a patch or metal shield?

The patch may be worn for up to one week for the patient’s comfort. In most instances, it plays no role in the healing of the eye.

The use of a metal shield may be encouraged for protection. If a patient normally wears glasses, they may be work over the patch during the day and the metal shield worn at nighttime. We will advise you whether a patch or shield is necessary.

10. Will I see better right after surgery?

The eye and the retina may take several weeks to fully heal. When vitrectomy is done for a vitreous hemorrhage, there will always be some blood left. This causes some cloudiness of vision that may take several weeks to clear.

There may be oozing of blood from the retina after surgery, which may result in even more vitreous hemorrhage. This hemorrhage usually clears after several days to weeks. If it does not clear, it can sometimes be removed on an outpatient basis by removing the fluid in the eye and replacing it with a gas bubble. The gas bubble will slowly disappear over several weeks and be replaced by clear fluid made by the eye. Infrequently, it may be necessary to reoperate in order to remove this repeat hemorrhage.

If surgery has been performed for a retinal detachment, it will take time for the retina to resume its normal position again the back wall of the eye.

When retinal tears are present, gas may be used to fill the eye at the end of surgery. The gas is used to press the retina flat again the back wall of the eye. The vision will be very poor until the gas bubble disappears.

Often the retina is treated with laser during the surgery. This is done to keep it attached, to seal retinal tears, and to prevent the growth of neovascularization. A special laser instrument is placed inside the vitreous cavity of the eye to do this. This laser surgery can result in inflammation and cloudiness that may take a few weeks to clear.

Improved vision after retinal surgery is not immediate. It may take several months before the vision improves to its best possible level. In most cases, when the diabetes has caused such damage to the retina that vitreous or retinal surgery is necessary, the eye will never again see normally. Sometimes, small amount of visual impairment occur, and occasionally, a great deal of improvement occurs. Each eye is different. Before your surgery, we will discuss with your chances for better eyesight.

11. Is it possible that I might not see after surgery?

Despite our increasing knowledge of diabetic retinopathy, and despite the sophisticated surgical equipment and techniques that we bring into the operating room, we may find ourselves unable to improve a patient’s vision. The chance for blindness in PDR is very real. When considering surgery, the patient and the doctor together must weigh the risks, including the possibility of total blindness, against the possible benefits of either stabilizing or improving vision. It is important for the patient to know that surgery may fail because of complications or simply due to the progressive nature of diabetes.