Post-Vitrectomy Gas Retention: Common Concerns and Solutions

Q: Post-Vitrectomy Gas Retention: Common Concerns and Solutions

Hello： <br>1. <br>The time for gas to dissipate after surgery varies from person to person, and in some cases, it may take longer. <br>However, the presence of gas typically does not directly cause cataracts. <br>Gas does not increase the risk of cataracts, but if you have any co

Six weeks after right eye vitrectomy, the gas has not dissipated, making it difficult to wear glasses for vision correction?

I have approximately 1500 diopters in both eyes.
My right eye experienced macular traction on July 12 and underwent vitrectomy with intravitreal C3F8 gas injection.
At my follow-up on July 20, I was advised that I no longer need to sleep face down and can sit normally, but should use two pillows while sleeping.
At my follow-up on August 4, I was informed to wait for the gas to dissipate, which may take a little over a week, and I have another follow-up scheduled for mid-September.
It has been over six weeks since the surgery, and I still see a black-gray circular bubble caused by the gas in the lower left area of my vision.
I have some questions:
1.
Is it normal for the gas to not have dissipated after six weeks? Does a longer duration of gas presence increase the risk of cataracts?
2.
Is it normal for objects and light to appear whiter in my right eye? Will this be a permanent condition?
3.
In the mornings, I experience a flickering sensation near the left side of my nose in my right eye that lasts for about half an hour after waking up.
Is this normal?
4.
When using both eyes, the gas bubble in my right eye affects my ability to focus (the prescription in my right eye is also not suitable), so I have to cover my right eye with a patch and use only my left eye.
Will my ability to focus improve once the gas dissipates? If my vision remains unstable after the gas dissipates, how should I wear glasses? (Using plano lenses in my right eye causes too much disparity.)
5.
Sometimes, after prolonged use of my eyes at work, I see small moving black dots in my right eye.
Are these likely to be blood clots that will gradually disappear?
6.
Currently, I have a slight strabismus in my right eye.
Will this improve after the gas dissipates?
Thank you for your assistance! Wishing you good health and safety!

Huang Huang, 50~59 year old female. Ask Date: 2023/08/24

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
The time for gas to dissipate after surgery varies from person to person, and in some cases, it may take longer.
However, the presence of gas typically does not directly cause cataracts.
Gas does not increase the risk of cataracts, but if you have any concerns, it is still advisable to consult with your physician.
2.
After surgery, you may experience a whitish appearance or increased brightness in your vision, which may be due to the gas introduced during the procedure.
Over time, this condition may gradually improve, but it is best to confirm with your physician during your next follow-up appointment.
3.
You may experience eye twitching or flashes upon waking in the morning, which could be a physiological response of the eye.
If this phenomenon resolves on its own after a while, it is generally not a cause for concern.
However, if it persists or worsens, it is advisable to consult your physician.
4.
The presence of gas in your right eye may cause difficulty in focusing your vision, which is somewhat normal and may affect the adaptation to your old prescription glasses.
Once the gas dissipates, your vision may gradually stabilize.
If stability remains an issue, your glasses prescription may need adjustment.
Your eye doctor can evaluate your specific situation and provide appropriate recommendations.
5.
The small black dots you see may be floaters in your eye, which is a normal phenomenon.
These floaters typically do not have a long-term impact on vision, and over time, you may notice that they become less prominent.
6.
Strabismus may occur as a result of the surgery, and this condition often improves gradually after the gas dissipates.
However, a detailed evaluation by your physician may be necessary to determine if further intervention is needed.

Reply Date: 2023/08/24

More Info

Post-vitrectomy gas retention can be a concerning issue for patients, particularly after procedures involving the injection of gas into the eye, such as C3F8. This gas is used to help flatten the retina and promote healing after surgery. However, it can lead to a variety of symptoms and concerns, especially if it persists longer than expected. Let's address your questions one by one.

1. Duration of Gas Retention: It is not uncommon for gas to remain in the eye for several weeks after vitrectomy, especially with C3F8, which can take up to 8 weeks to fully dissipate. However, if you are noticing that the gas has not diminished significantly after six weeks, it is advisable to consult your ophthalmologist. Prolonged gas retention can potentially lead to complications, including increased intraocular pressure or cataract formation, although the latter is more commonly associated with longer-term gas retention.

2. Visual Changes: Seeing things as "whiter" or experiencing changes in light perception can be a normal phenomenon after vitrectomy, particularly when gas is present. The gas can create a different refractive environment in the eye, which may alter how light is perceived. This effect should improve as the gas dissipates, but it is essential to discuss any persistent changes with your eye doctor.

3. Flashing Lights and Visual Disturbances: The sensation of flashing lights or "floaters" can occur after surgery and may be related to the presence of gas or changes in the vitreous gel. If these symptoms are transient and resolve after a short period, they may not be a cause for concern. However, if they persist or worsen, it is crucial to seek medical advice, as they could indicate other issues, such as retinal detachment.

4. Focusing Issues: Difficulty focusing with the right eye due to the gas bubble is expected. The gas can obstruct the view and alter the optical pathway, making it challenging to achieve clear vision. Once the gas dissipates, you should experience improved focus. If vision remains unstable after the gas is gone, your ophthalmologist may need to reassess your prescription for glasses. It is common to have different prescriptions for each eye, especially after surgery, so your doctor can help you find a suitable solution.

5. Moving Black Spots: The appearance of small moving black spots can be related to floaters, which are common after vitrectomy. These are typically remnants of the vitreous gel or blood that may have been released during the procedure. While they can be annoying, they often become less noticeable over time. However, if you notice a sudden increase in floaters or flashes of light, you should contact your doctor immediately, as these can be signs of retinal detachment.

6. Strabismus (Squinting): A slight misalignment of the eyes (strabismus) can occur post-surgery, particularly if there has been any change in the eye's structure or muscle function. This may improve as the gas dissipates and your vision stabilizes. If it persists, your ophthalmologist may recommend further evaluation or treatment options.

In summary, while some of the symptoms you are experiencing can be typical after vitrectomy with gas injection, it is essential to maintain open communication with your healthcare provider. Regular follow-ups are crucial to monitor your recovery and address any concerns promptly. If you notice any significant changes in your vision or experience new symptoms, do not hesitate to reach out to your ophthalmologist for further evaluation. Your health and vision are paramount, and your doctor can provide the best guidance tailored to your specific situation.

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