Retinal Detachment and Trabeculectomy: A Patient's Journey

Q: Retinal Detachment and Trabeculectomy: A Patient's Journey

Hello Mr. He： 1. Intraocular pressure may gradually decrease; it is not uncommon to experience elevated eye pressure postoperatively. 2. An evaluation is necessary to determine the appropriate management. 3. Initially, you can engage in light activities su

Retinal detachment surgery and trabeculectomy?

Hello Doctor, I have high myopia with -9.50 in my left eye and -14.50 in my right eye.
I have a history of iritis in my right eye.
In February 2019, due to persistent elevated intraocular pressure in both eyes, the doctor decided to perform bilateral trabeculectomy.
After the surgery, I experienced complications with choroidal detachment, but my eyes have since healed, and my intraocular pressure is stable.
My vision in both eyes is 0.9, and I have been following up with medication and massage.

However, at the end of December 2021, while playing basketball, I was hit in the right eye, which led to a retinal detachment.
For the first two months, the doctor attempted to manage it with laser treatment, but in the last two months, it has been uncontrollable and has not affected the macula.
I see a small black spot on the right side.
On February 26, I underwent surgery involving vitrectomy and gas injection.
Two months post-surgery, the doctor said my recovery is good, and I can resume sports once the gas bubble disappears.
However, the intraocular pressure in my surgical eye has increased from an average of 16 to around 23.

I would like to ask:
1.
Could the elevated intraocular pressure in my surgical eye be due to the four months without massaging the filtering bleb, or could it be caused by the gas? Can it return to normal?
2.
If the intraocular pressure remains high long-term, can I undergo needling treatment for the bleb?
3.
The doctor mentioned I can resume all types of exercise once the gas bubble disappears, but I would like to know your recommendations.

4.
How long does it typically take for the retina to stabilize and adhere properly? The doctor seems optimistic, but I am a bit concerned and want to be cautious.

5.
Are there any specific things I need to pay attention to moving forward? I apologize for asking so many questions; I am still quite young and very worried.

Mr. He, 20~29 year old female. Ask Date: 2022/04/22

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
He: 1.
Intraocular pressure may gradually decrease; it is not uncommon to experience elevated eye pressure postoperatively.
2.
An evaluation is necessary to determine the appropriate management.
3.
Initially, you can engage in light activities such as walking, and gradually progress to jogging or playing sports, while being careful to avoid any impact to the eyes; wearing protective eyewear is advisable.
4.
The extent of the injury and the healing process will be assessed by the physician, and the timeline is uncertain.
5.
Be cautious to avoid any impact to the eyes, and seek medical attention promptly if you notice any abnormalities.

Reply Date: 2022/04/22

More Info

Hello! Thank you for sharing your journey regarding retinal detachment and trabeculectomy. It’s understandable to have many questions after such significant eye surgeries, especially given your history of high myopia and previous ocular conditions. Let’s address your concerns one by one.

1. Increased Eye Pressure: The rise in intraocular pressure (IOP) from an average of 16 mmHg to around 23 mmHg can be attributed to several factors. After a vitrectomy and gas injection, it is common for IOP to fluctuate. The gas bubble can cause temporary changes in the eye's internal dynamics, potentially leading to increased pressure. Additionally, not massaging the filtering bleb (if you had trabeculectomy) could contribute to higher IOP, as the bleb may not be functioning optimally without regular massage. It is essential to monitor this pressure closely with your ophthalmologist, as they can provide tailored advice and treatment options.

2. Long-term High Eye Pressure: If your eye pressure remains elevated over time, your doctor might consider performing a needling procedure on the filtering bleb. This procedure can help to reopen the bleb and improve fluid drainage, potentially lowering the IOP. However, this decision should be made in consultation with your ophthalmologist, who can assess the specific circumstances of your case.

3. Resuming Physical Activity: Your doctor’s advice to wait until the gas bubble dissipates before resuming sports is standard practice. Generally, once the gas bubble is gone, you can gradually return to your normal activities, including sports. However, it’s wise to start with low-impact exercises and avoid any activities that could risk trauma to the eye, such as contact sports, until you have a follow-up appointment to assess your eye's stability.

4. Stability of the Retina: The time it takes for the retina to stabilize after surgery can vary widely among patients. While some may see improvement within weeks, others may take several months. Your doctor’s optimistic outlook is encouraging, but it’s also reasonable to remain cautious. Regular follow-ups are crucial to monitor the retina's attachment and overall health.

5. Post-operative Care: After retinal surgery, it’s essential to follow your ophthalmologist's instructions closely. This includes using prescribed eye drops, attending all follow-up appointments, and being vigilant about any changes in vision. If you notice any new symptoms, such as increased floaters, flashes of light, or a sudden decrease in vision, contact your doctor immediately.

In summary, your concerns are valid, and it’s crucial to maintain open communication with your healthcare provider. They can provide the most accurate information tailored to your specific situation. Remember, recovery from eye surgery can be a gradual process, and it’s essential to be patient with yourself as you heal. If you have any further questions or concerns, don’t hesitate to reach out to your ophthalmologist. Wishing you a smooth recovery and improved vision ahead!

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