An operation called Vitrectomy is sometimes required to remove the gel or vitreous humour that is located inside the eyeball. This operation is carried out though three very small or millimetric holes bored on the wall of the eye. A ceiling-hung microscope is used.
Professor Stanga may perform a vitrectomy to treat Retinal Detachment, Macular Hole, Proliferative Diabetic Retinopathy, Vitreous Haemorrhage and Floaters amongst others.
A bubble of gas or silicone oil may need to be injected into the eye during the surgery.
This operation can be performed under local anaesthesia (with or without sedation) or general anaesthesia.
Professor Stanga carries out small gauge sutureless (no stitches) vitrectomies, though sutures may be required and this may only become apparent during the surgery. Please ask Professor Stanga about this should you require more information.
Following the operation you may be required to adopt a ‘face down’ or other specified position, like resting on your side, which we call Posturing. Posturing helps the intraocular gas or silicon bubble to float towards a specific area of the retina to flatten and support it from the inside of the eye. Posturing is an extremely important part of the treatment and if requested it is usually carried out for 10 days. Special equipment is sometimes available to help you in achieving the best posturing position.
Different posturing positions are available but, most likely, only one will apply to you. Professor Stanga or a member of his team will discuss this with you and it will be demonstrated to you prior to leaving hospital. Posturing equipment is sometimes available to help you maintain your position. Please feel free to request it.
A ten-minute break from posturing is allowed every hour. It is important that you take your allocated breaks from posturing in order to relieve pressure on your skin. Short walks and leg exercises are important and will promote good circulation. Try altering your body position from lying to sitting whilst maintaining your posturing position.
Whilst posturing you may move about but you need to maintain your head in the correct position.
Never lie on your back or have your head tilted backwards for longer than the time it takes to put your eye drops in. Feed-back from patients who have postured suggest that you may feel isolated, down or depressed. Please do not hesitate to contact Professor Stanga or his team if necessary.
Whilst you are posturing we advise you to follow a light diet with plenty of drinks, fruit and vegetables. Use breaks from posturing to eat and drink. You may experience stiffness or an ache of your neck muscles. This is generally due to the unusual position you have to adopt. A warm bath or gentle massage can be useful in relieving muscle discomfort. A mild painkiller such as Paracetamol may help to relieve muscle stiffness and eye discomfort, but do not ignore your symptoms. Please contact Professor Stanga or his team whenever in doubt.
Your eye will most likely be red for between 2-4 weeks and feel uncomfortable and gritty for 3-5 days, especially when sutures have been used.
Because of your inactivity you may suffer with constipation and dehydration. If this is the case please contact your GP doctor for treatment and advice.
It is very likely that your vision will be blurred for 2-3 weeks following the vitrectomy.
If Professor Stanga has injected gas into your eye you may be able to see the edge of the bubble which will appear as a shaky black line in your vision and which will always remain horizontal or parallel to the floor as you move. Please note that if the line in your vision “moves with your head” you must urgently contact Professor Stanga or a member of his team as this may be a symptom of Retinal Detachment. The gas bubble will gradually get reabsorbed, get smaller or break into smaller bubbles. It can take somewhere between 4 to 8 weeks for the gas bubble to completely reabsorb depending on which gas Professor Stanga has utilised, though in a small number of patients it can take longer. The natural fluids produced in the eye will eventually replace the bubble.
If Professor Stanga has injected gas into your eye, please refrain from travelling by airplane until the bubble has been completely absorbed. There can be risk of expansion of the bubble inside the eye owing to the reduction in atmospheric pressure at high altitude; this can be extremely painful and lead to irreversible blindness. You must take this into account if you have booked or are planning a holiday. Please do not forget to discuss this with Professor Stanga.
Professor Stanga sometimes utilises special silicone oil that “sinks” in the eye instead of floating (Heavy Silicone Oil); this sometimes reduces the need for posturing. Professor Stanga will discuss with you the best option for your eye condition. Please note that standard or heavy silicone oil usually requires a short removal operation, as it does not get reabsorbed.
Possible complications and side effects of vitrectomies include, but are not limited to, cataract formation, retinal detachment, glaucoma (increased pressure in the eye), hypotony (reduced pressure in the eye), damage to the retina, optic nerve or cornea (structures of the eye), bleeding and even subsequent loss of the eyeball.