Post-Vitrectomy Care: Common Concerns and Questions Answered - Ophthalmology

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Post-vitrectomy


Hello, Doctor.
A few days ago, I suddenly experienced a foggy vision in one eye along with some black spots and floaters.
The doctor at the major hospital said that the only option was a vitrectomy and that the procedure needed to be done immediately, as the scleral buckle method was not suitable.
They also performed laser treatment on the other eye the same day, but missed a small area that will need to be treated later.
I have several questions I would like to ask you:
1.
After the surgery, the attending physician said that I do not need to sleep on my stomach and can sleep on my side instead.
However, I have heard that sleeping on the stomach is better for the positioning.
Is that true?
2.
Can I wash my hair at a barbershop after the surgery, sitting with my head tilted back? Will this affect the positioning?
3.
On the third day post-surgery, I noticed a strange phenomenon in the operated eye, where it appeared as if I was looking through a small circular fishbowl filled about 70% with water, with a visible waterline.
When I tilt my head, lie on my side, or sleep on my stomach, the water level and horizontal line appear different, resembling a real small circular fishbowl.
However, during both follow-up visits, the doctors said that seeing the water is normal and that the positioning looks good.
The second follow-up visit revealed that what I was seeing was a water ripple effect caused by different interfaces, and that the vitreous was filled with gas, not silicone oil.
Despite the doctors' reassurances, I am concerned about whether there is fluid leaking in, as the visual appearance is quite distinct.

4.
Why was vitrectomy the only option for my situation, and why was the scleral buckle method not considered?
5.
Currently, for the operated eye, I am required to use "eye pressure-lowering drops" and "post-cataract surgery drops" three times a day, along with "dilating drops" in the morning and evening, which means I am using three types of drops in the morning and evening.
Additionally, I apply a steroid anti-inflammatory ointment before bed.
Will this regimen place a burden on my eyes post-surgery?
6.
During the second follow-up, I was supposed to have laser reinforcement on the other eye, but the nurse administered the dilating drops twice in a row, causing significant pain for over 20 minutes.
The doctor then advised to postpone the laser treatment for two weeks.
It has been two days since then, and the eye that was supposed to receive the laser treatment has become slightly blurrier at close distances.
Shouldn't the effects of the dilating drops have worn off by now? Could it be that the nurse administered too much, or that the medication was too strong? Or could the medications used in the operated eye affect the normal eye that was supposed to receive the laser treatment?
7.
The doctor mentioned that the gas would be absorbed in about 4 to 6 weeks and that I might see a dark mass.
They also said that it would be better if the gas remained for four weeks.
However, I am seeing a small circular fishbowl filled about 70% with water, with a visible waterline.
The bottom 70% of the water level appears somewhat blurry, while the area above the waterline shows a slightly clearer but still somewhat blurry image.
I am concerned that this is not just the black gas.
8.
The normal eye had laser treatment before the vitrectomy on the other eye.
However, the next day, I discovered that there were still some holes that needed to be treated.
What impact does intensive laser treatment have on the normal eye, and what should I be aware of moving forward?
Could you please help provide guidance on these questions? Thank you.

Wang Fangfang, 40~49 year old female. Ask Date: 2022/01/16

Dr. Gao Pilin reply Ophthalmology


Hello Ms.
Wang:
1.
To observe the location of the retinal detachment, it is sufficient for the position to remain at the top.
Your position should ideally be maintained while lying on your side.

2.
I cannot provide recommendations regarding your postoperative condition, so it is best to consult your attending physician for their opinion.

3.
The degree and location of the retinal detachment vary, which affects the choice of treatment.

4.
There should be no issues.

5.
The effect of the dilating agent should not last this long; please have your attending physician check the reason.

6.
What you are seeing is likely the appearance of the gas.

7.
If necessary, intensive treatment should be possible.
You can return to normal activities afterward, following your physician's instructions and attending follow-up examinations.

Reply Date: 2022/01/16

More Info


Post-vitrectomy care is a critical aspect of recovery, and it’s understandable that you have numerous questions following your surgery. Let’s address your concerns one by one, providing clarity and guidance based on medical knowledge and practices.

1. Sleeping Position: Your surgeon advised that you can sleep on your side rather than face down. While some surgeons recommend face-down positioning to facilitate the gas bubble's effectiveness in reattaching the retina, not all cases require this. Your surgeon's guidance likely reflects your specific condition and the type of surgery performed. Always follow your surgeon's instructions, as they are tailored to your individual needs.

2. Washing Hair Post-Surgery: It is generally safe to wash your hair after vitrectomy, but you should avoid any position that puts pressure on your eye or could cause discomfort. If you can comfortably wash your hair while sitting up, that’s preferable. If you need to lie back, ensure that your head is supported and that you’re not straining your eye.

3. Visual Phenomena: The visual effects you’re experiencing, such as seeing a "fishbowl" effect, can be normal post-surgery. This phenomenon is often due to the presence of a gas bubble or the interface between the gas and the fluid in your eye. As your eye heals and the gas is absorbed, these visual disturbances should diminish. It’s reassuring that your doctor has confirmed that your retina is well attached, but if you have persistent concerns, don’t hesitate to reach out for further evaluation.

4. Medication Regimen: The combination of eye drops you’re using post-surgery is common, but it’s essential to follow your doctor’s instructions closely. Each medication serves a purpose—reducing intraocular pressure, preventing inflammation, and aiding in healing. If you feel that the regimen is overwhelming or causing discomfort, discuss this with your doctor. They may adjust the medications or provide guidance on how to manage them effectively.

5. Effects of Pupil Dilation: If you experienced discomfort after receiving multiple doses of a dilating agent, it could be due to the cumulative effect of the medication. Dilation can cause temporary blurriness and discomfort, especially if the drops were administered in quick succession. If your vision remains blurry or you experience pain, consult your doctor to rule out any complications.

6. Gas Bubble Absorption: The timeline for gas absorption can vary, but it typically takes 4-6 weeks. During this period, it’s normal to see changes in your vision as the gas bubble diminishes. If you notice any sudden changes or worsening of your vision, contact your healthcare provider immediately.

7. Impact of Laser Treatment on the Other Eye: Laser treatments can be effective for addressing retinal tears or holes, but they can also cause temporary changes in vision. If your other eye has undergone laser treatment, monitor for any changes in vision and report them to your doctor. It’s crucial to ensure that both eyes are healing appropriately and that any new symptoms are evaluated.

In summary, your recovery process will involve careful monitoring and adherence to your surgeon's instructions. If you have any concerns about your vision, medication side effects, or the healing process, don’t hesitate to reach out to your healthcare provider. They are your best resource for personalized advice and support during your recovery.

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