Post-Vitreous Surgery: Visual Distortion After Retinal Detachment

After undergoing vitrectomy surgery due to retinal detachment, visual distortions and deformations may occur?

Hello, Doctor.
My mother underwent a vitrectomy with gas tamponade on July 18 due to a retinal detachment in the upper part of her retina.
Postoperatively, she was advised to sleep on her stomach or side.
However, on July 24, she noticed a distortion in straight lines, with text appearing irregular in size—some parts clear and others blurry.
Objects also appear elongated, which was not the case before the surgery.
Preoperative examinations did not reveal any detachment in the macula.
I would like to ask if this could be due to incomplete reattachment of the retina after surgery, or if there might be fluid accumulation beneath the retina or macula.
I apologize for the many questions, but the hospital will not be able to perform an examination for another two to three weeks, and both my mother and I are quite anxious.
Thank you very much for your assistance!

gua, 20~29 year old female. Ask Date: 2016/07/29

Dr. He Jianxian reply Ophthalmology

Basically, if there is a change in the arrangement of the receptors in the macula, it could potentially lead to this condition.
It is advisable to consult your attending physician directly during your follow-up appointment for more appropriate guidance.

Reply Date: 2016/07/29

More Info

After undergoing vitreous surgery for retinal detachment, it is not uncommon for patients to experience visual distortions, such as straight lines appearing wavy or distorted, and variations in text clarity. These symptoms can be concerning, especially when they were not present prior to surgery. Here’s a comprehensive explanation of what might be happening and what to expect moving forward.

Understanding Visual Distortion Post-Surgery
1. Retinal Attachment and Healing: After a retinal detachment surgery, the primary goal is to ensure that the retina reattaches properly. If the retina does not adhere completely or if there are residual fluid pockets beneath the retina, this can lead to visual distortions. The healing process can take time, and during this period, it is possible for the retina to still be adjusting, which may cause temporary visual anomalies.

2. Macular Status: The macula, which is the central part of the retina responsible for sharp vision, can be affected during surgery. Even if there was no pre-existing macular detachment, the surgery itself can lead to changes in the macula, such as swelling or distortion. If there is fluid accumulation under the macula (macular edema), it can lead to blurred or distorted vision.
3. Post-Surgical Changes: The introduction of gas into the eye during surgery is meant to help flatten the retina against the underlying tissue. However, as the gas dissipates, the eye may undergo changes that can temporarily affect vision. The brain may also take time to adjust to the new visual input, especially if the eye's shape has changed due to the surgery.

4. Visual Distortion Mechanism: The phenomenon of straight lines appearing wavy or distorted is often referred to as metamorphopsia. This can occur due to irregularities in the retinal surface or changes in the way light is processed by the retina. If the retina is not perfectly flat or if there are any irregularities in the retinal layers, it can lead to these visual distortions.

What to Do Next
1. Monitoring Symptoms: It is essential to monitor the symptoms closely. If the distortions persist or worsen, or if new symptoms arise (such as flashes of light or an increase in floaters), it is crucial to seek immediate medical attention.

2. Follow-Up Appointments: Since you mentioned that the next check-up is a few weeks away, it is important to keep that appointment. The ophthalmologist will likely perform a thorough examination, including imaging tests, to assess the status of the retina and macula. This will help determine if there are any complications, such as fluid accumulation or incomplete retinal attachment.

3. Patience During Recovery: Recovery from retinal surgery can be a gradual process. It is not uncommon for vision to fluctuate during the healing phase. The brain may also need time to adapt to changes in vision, especially after significant surgical intervention.

4. Discussing Concerns with the Doctor: When you attend the follow-up appointment, be sure to discuss all concerns with the ophthalmologist. They can provide insights into whether the symptoms are typical post-operative effects or if further intervention is necessary.

Conclusion
In summary, the visual distortions your mother is experiencing after vitreous surgery for retinal detachment could be due to several factors, including incomplete retinal attachment, macular edema, or the brain's adjustment to new visual input. It is essential to remain vigilant and attend follow-up appointments for proper assessment and management. While it can be a stressful time, many patients experience gradual improvement as the eye heals. Always consult with the treating physician for personalized advice and treatment options.

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