Retinal Surgery:

Things to Know
Before, During, and After Retinal Surgery

Before Surgery

Level of Urgency

Different types of retinal surgery have different levels of urgency. The most urgent cases involve infections inside the eye and traumatic ruptures or lacerations. These are true emergencies and need to be treated immediately. Retinal detachments are not usually true emergencies but they are urgent, and require treatment usually within a few days. Longstanding detachments can be treated on an elective basis. Some retinal problems, such as macular holes and macular puckers are non emergent and can be treated at any time on an elective basis. We will discuss the degree of urgency of your problem with you individually.

Medical Clearance

Whether the case is urgent or not, we do need to make sure that your surgery is as safe as possible. At a minimum, this entails a careful review of your medical history and discussion with the anesthesia team. We also obtain appropriate medical clearance from your medical doctors. Depending on the type of anesthesia used, we may need to obtain an EKG and certain blood tests. Sometimes a chest x-ray is necessary, especially if you are over 50 or have lung ailments.

About Your Medicines

If you are taking blood thinners, we may ask you not to take such medicines for a few days prior to surgery. If the surgery cannot wait, or if your doctors do not want you to withhold your blood thinners, we can take measures to accommodate your situation. You can take your normal medicines as usual up to the day of surgery. On the day of surgery, you should skip nonessential medicines, but go ahead and take any medicines for your heart or blood pressure on schedule with a small sip of water. You are not to eat or drink ANYTHING else after midnight of the night before surgery, and if you are diabetic you should skip any oral diabetes medicines and take no more than half of your normal insulin. We may ask you to skip it altogether. If you take glucophage, you should stop it two (2) days before surgery if possible.

The Day Before Surgery

You may eat normally and follow yor normal routine on the day before surgery, but DO NOT drink any alcoholic beverages. Also, if at all possible, do not smoke or use any tobacco products or recreational drugs. Relax and get a good night's sleep. You should not eat or drink ANYTHING after midnight. (Not even coffee, tea, or water, and especially not juice.) See the section above regarding your medicines. Before bed, wash your face with an antibacterial soap.

The Day of Surgery

Devote the day to surgery. This is not a day that you should plan anything else. You need to arrive at the surgery center at least an hour, and preferably an hour and a half before your surgery. Do not wear ANY eye makeup on the day of surgery. You may shower and brush your teeth normally, but do not drink anything. After you return home from surgery, do not plan on doing anything or going anywhere. You should, at the very least, take it easy, and we may ask you to maintain a special head position. Some types of retinal surgery cause significant discomfort for the first day and others only mild scratchy discomfort. You will feel better if you keep still and do nothing that might raise your blood pressure. In most cases, simple over the counter Tylenol or Advil are all that is necessary for comfort. If we anticipate more than the usual discomfort, we will prescribe an analgesic.

After Surgery

The First Postop Day

We need to see you the day after surgery. You will have a patch on after surgery, which in most cases, we leave on until the first postop day check. In most cases, we leave the patch off after that. We will check your eye and start you on one or more eyedrops. We will also give you wrap-around sunglasses that will fit over most regular glasses to help you keep out the sun and wind and will protect your eye. In most cases, the vision in your operated eye will still be blurry, possibly even worse then preoperatively. This is because the eye will be red and teary, because we sometimes use medicines that blur the vision, and of course because your retina needs to heal.

Driving and Other Activities

Because the vision is blurry, your depth vision is also affected, so you should not drive or operate hazardous machinery until well after surgery. How long depends on your vision and what you want to do. We will discuss your limitations with you individually. In some cases we may inject air or special gas mixtures into the back chamber of the eye. This is usually to hold the retina still and help it to stabilize or heal better. While you have a bubble in your eye, it is EXTREMELY IMPORTANT that you not get into an airplane or have certain types of anesthetic gases. Either could cause the pressure in the eye to rise drastically, which is very painful and can be very dangerous to the eye. If you have a bubble in your eye, we will have you wear a medical alert bracelet until it is gone. The bubble will dissolve on its own in a few days to a few weeks.

Your Eye Comfort

In most cases, the eye is fairly comfortable after taking the patch off, but after some surgeries it may be uncomfortable for several days. Sometimes, the eye pressure is high or low following surgery, either of which can cause pain. We will watch this and other factors very closely.

Positioning

In some cases, we may ask you to keep your head tilted or face down for a few days or even longer. This is VERY importatnt to the success of your operation, so please do your best to follow these instructions very carefully.

What the Future Holds

What the future holds depends entirely on the nature of your eye problem. We will discuss your individual circumstances with you directly. Retinal surgery has undergone major advances in recent years, and new techniques and refinements continue to appear. There are still many serious problems for which we have no good solution, but in most cases, there is good cause for optimism. We will work with you to give you the best possible outcome, and if you ever have any questions or problems, you should discuss them with us right away.