Surgery usually involves cutting the skin and doing something inside the body to change the functioning of that body part. All surgery carries risks that the patient must accept and consent to prior to the procedure. Not doing the surgery also carries risk and usually is worse than the risks of surgery, but not always. If the surgery is more risky than leaving it alone, the surgeon will tell you that and probably should not do the surgery. There are always exceptions to every rule. Write down your questions and when you see the surgeon, ask all the questions before giving consent. As a Surgeon, I would much prefer a patient that is fully informed of the risks, benefits and alternatives to the procedure and is willing to accept the risks, working with the medical team to get the best possible outcome. With Covid-19 in our communities, now the hospital requires Covid testing before any surgery is done and will be done prior to surgery with the other pre-op labs.
Usual routine for scheduling: The patient is seen in clinic and the eye problem is evaluated. If surgery is needed then a history and physical is done to determine if a pre-operative consult with your Primary Medical Physician is needed (family, internist, cardiologist etc.). This is then scheduled before surgery. The report needs to be back at our office in order to schedule the surgery as the Anesthesia Physician will need that information to give you the safest anesthesia during surgery. If no medical issues are blocking the scheduling, then a date for surgery is picked. Also a date for the pre-operative labs with also be scheduled at the out patient center at the hospital. These labs usually include CBC, SMA7, Chest X-ray, EKG, Covid test, MRSA test. If these test results are satisfactory to the anesthesia physician, then we do surgery. Sometimes the MRSA test may be positive and you will get an ointment to place in your nose for a few days to clear the bad bacteria that can hide there. If the Covid test is positive then most likely surgery will be postponed for 2 weeks and you must call your primary physician for advice. These other tests may show unknown medical conditions that make it dangerous to have surgery and you will need to have these issues resolved or controlled prior to surgery. All of this is to try to get you safely through surgery and anesthesia.
At East Carolina Retina Consultants, the more common surgeries include:
Vitrectomy (usually for vitreous hemorrhages, retinal detachments, dislocated lenses, infections and trauma).
Scleral Buckle (Retina detachments).
Shunt implantation (Glaucoma).
Implant (IOL) retrieval and new IOL implantation (dislocated lens).
Enucleation with implant (removal of the eye for blind painful eye).
Post-op information (how to take care of the operated eye).
Cleaning the eye:
Usually the day after surgery you will visit the clinic first thing in the morning and bring all the instructions and drops that you received at the hospital. There the patch will be removed and the eye examined. The post op instructions will be reviewed so that you understand the instructions.
At home, please take care of the operated eye by removing any patch and washing your face with soap and warm water. Then use a clean washcloth with hot water, wring the cloth out so it is only damp and put a damp warm cloth on the closed eye for 5 minutes. It will get cold in a few minutes so, reheat it again to get 5 minutes. Then put the drops in as follows.
The first drop is a STEROID drop like Pred Forte, Durzol or Lotemax taken as one drop in the operated eye four times a day. This is usually the #1 drop on the information sheet. It is used for four times a day for at least two weeks before slowing it down (tapering the drop). We do not stop this drop “cold turkey” as the irritation will return. After the first two weeks of four times a day, we use it three times a day for a week, followed by two times a day for another week and finally one time a day for the last week then stop. If the irritation returns, restart the drop for another two weeks at twice a day and then taper again. You should have a prescription for three refills in the information package from the hospital to be used after you finish the first bottle from the hospital. You probably will not need all the refills.
The #2 drop is an ANTIBIOTICS like Gentamicin or Ciloxan and is used four times a day for one week post operatively then stop the drop. You will not need refills for this.
The ointment you take home from surgery is usually called Maxitrol (Dexamethasone, Polymixin, Neomycin) and is used after you put in the other two eye drops, up to four times a day but is not necessary. It is used by putting about a 1/2′ of ointment in the pocket made by gently pulling the lower eye lid out and place the ointment in the pocket formed there. The ointment will blur the vision but it should relieve any foreign body pains or irritation. If the eye is not irritated, then you do not need to use it. You will not need a refill after the first tube.
Pain medications are usually not needed because a long acting local anesthetic was administered at the end of surgery. This keeps the eye asleep for at least 24 hours. You can use over the counter medications like Extra Strength Tylenol, Advil, Motrin or Aleve (follow the bottle directions). For more intense surgery like scleral buckles or ruptured globes, Tylenol #3 or Norco can be prescribed (follow the prescription directions, usually one tablet every 6 to 8 hours by mouth).
If you have increasing pain, puss like discharge or further declining vision, please call the office or go to the local emergency room (252-847-4100 Vidant ER). Usually after any surgery, the eye is sore and can be mildly to moderately painful. It may be blood shot and red but it should be slowly declining and getting better as time goes on. It will tear significantly as the irritation can be uncomfortable (use the ointment). Call if it is getting worse rather than slowly better.
Post operative positioning and activity:
Most patients should be relatively quiet activity without physical straining (doing too much physical activity). If constipation is a problem then take a laxative. The head of the bed can be up on one or two pillows. We like patients to be home for the first week. Watching television or playing cards quietly are good activities. Reading and physical straining are not good activities.
If you have either a Gas/Air/Silicone oil bubble implanted in your eye then positioning becomes much more important to get the “bubble” to press on the retina problem to get it to heal in the right position. For example: Macular holes are a hole in the back of the eye and a bubble is used to close the hole and keep it closed until it heals. Usually that position is straight face down (Gas bubble) for as long as you can stand it. We must have two weeks to get the best results. The gas bubble needs to be face down for 2 hours followed by 15 minutes of a break in which you can go to the bathroom or eat a meal. Keep the face down as much as possible while doing these breaks and then go back to bed or the sofa and resume another 2 hours of face down, etc… This is very hard to do but the patients that do it are the ones that may not have to have repeat surgery and will get the best vision out of the surgery the first time! You can rent positioning equipment for a month making this much easier on you. For patients that get silicone oil bubble in the eye, positioning is important for the first two days and nights to allow the oil to settle in the right position and not drive the eye pressure high. After that the positioning is much easier but must not position flat on back for more than 15 minutes to get the drops in. Flat on back can raise the eye pressure very high and can take the vision needing emergency surgery to remove it and get a gas bubble instead. Your discharge summary sheet from the hospital will have specific instructions tailored to your surgery and situation. Follow those instructions specifically.
Post op clinic visits:
You usually have post operative clinic visits on the day after surgery, usually at 7:30 AM so that you can be seen and go home quickly as possible with a minimal wait time as you have had a challenging day before this. The second post op day is usually one week later. The third visit is scheduled more related to the needs of the eye, usually somewhere between 1 and 3 months later. Bring all you eye medications and instructions to each visit as they will be reviewed by the nurse and changed as needed. After each visit, you should have the next appointment made for the next visit.
It is the most sincerest hope and desire from all of us at East Carolina Retina Consultant that you get better as quickly and as much as possible. Dr. “V”