How serious is a detached retina surgery

Posturing involves keeping your eye in a position that allows the gas bubble to float against the tear (or tears if there is more than one). You won’t know which posturing position you’ll require until after the conclusion of your detached retina surgery, as the position depends on where the tears are located. Below, I’ve detailed several common posturing positions.

UPRIGHT

If the tear is situated at the top of your eye, posturing will be simple, as you will simply need to remain in an upright position. For night, you will be told what the best option is for your particular tear. You will also be told whether or not you can lie on your back.

ON YOUR SIDE

For this posturing position, you will need to lie on one side for 50 minutes out of every hour of the day and night for ten days. While doing this, it is vital to not let your head tilt up. This position is usually used for tears that are situated at one side of the retina.

FACE DOWN

If the tear is located at the bottom of the retina, the only way to get the bubble to press against the tear is to look vertically down towards the floor. This can be easily achieved if you tilt your head forwards and point your face downwards, with the position known as face-down posturing. You will most likely be asked to posture in this position for 50 minutes out of every hour of the day and for ten days. You will be given specific instructions for the position to be adopted whilst asleep.

While this period of face-down posturing is essential, I do recognise that it can be a daunting proposition. Fortunately, it can be made easier with specially designed posturing equipment such as the Retina Rest and through the use of mirrors. These allow you to look down but still see ahead; enabling you to maintain eye contact.

Often, it’s not possible to know what post-operative posturing will be needed until the operation is over, so it’s worth making some arrangements for face-down posturing just in case it’s needed.

HOW SHOULD I PREPARE FOR POSTURING FACE DOWN?

Here are some steps you can take before commencing face-down posturing to make the posturing period easier.

• As soon as you are informed of your retinal detachment surgery date, discuss booking equipment to help you with face-down posturing (such as RetinaRest). Explain that you will not be sure of the posture required until the day of surgery; after, the equipment can be supplied to be picked up the day after your surgery.
• Plan in advance how you will prepare meals, knowing that you will only have ten minutes per hour to both prepare and consume your meal.
• Before your surgery, go shopping for food, toiletries and other essentials. You may also like to purchase audio books and CDs to listen to, as well as large-print books and magazines.
• DVDs can help you keep your eyes in the correct position if you use Retina Rest equipment that includes the purpose-designed mirror. This will allow you to watch TV as well as talk to friends and relatives.
• Position your toiletries and medicines so they’re in easy reach without you having to raise your head.
• Put your kettle, coffee maker and other kitchen appliances somewhere low so you can make food and drinks without help. You should also buy straws to help you drink cold drinks while looking down.
• Ensure you have enough clean and comfortable clothes for the entire posturing period (up to ten days)

FOR FURTHER INFORMATION REGARDING POSTURING FACE DOWN AND PHYSIOTHERAPY, PLEASE CLICK BELOW TO DOWNLOAD A PRINTABLE INFORMATION SHEET:

The biggest reason for failure of retinal detachment surgery is the formation of scar tissue that redetaches the retina (proliferative vitreoretinopathy). The highest risk of redetachment is within the first 3 months following surgery. We will monitor carefully for this during your postoperative visits.

You need to keep in mind that our goal is to maximize the vision in your affected eye. A retinal detachment is a very serious and potentially blinding condition. Even after successful surgery, your vision will likely never be as good as it was prior to your retinal detachment.

Risks of Retinal Detachment Surgery

There are several risks associated with retinal detachment surgery that you need to be fully aware prior to proceeding with surgery. The most common are as follows:

• 1 in 1000 risk of infection (endophthalmitis). Anytime surgery is performed on the eye infection is a possible complication. Sterile technique is used during the procedure to minimize risk of infection. Despite this, there is a very small chance that an infection can occur. If such an infection does occur it can be treated, although it may leave you with worse vision or in severe cases lead to blindness.
• 1 in 1000 risk of bleeding. Anytime surgery is performed on the eye bleeding is a possible complication. This can occur in or around the eye and lead to permanent vision loss. We will review any medications you are taking prior to surgery to ensure you are not taking any blood thinners that can increase your risk of bleeding.
• Progression of cataract. If you have not yet had cataract surgery, having vitrectomy surgery will accelerate progression of cataract in that eye. Although not always the case, you can expect to need cataract surgery within a year of vitrectomy surgery in the operated eye.

Surgical Procedure

Your retinal detachment surgery will likely involve a scleral buckling and/or vitrectomy procedure. We use the most advanced surgical equipment and techniques available for retinal detachment surgery. A scleral buckling surgery involves positioning a silicone band around your eye beneath your eye muscles to bring in the walls of your eye. This elongates your eye and makes you more nearsighted. A vitrectomy surgery involves making 3 holes in the eye and using instruments to remove the jelly-like substance (the vitreous humor) that normally fills the center of the eye. The removal of the vitreous inside the eye does not cause any permanent harm. The vitreous is replaced by natural fluid produced inside the eye. The retina is then reattached and all retinal tears surrounded by laser. The eye is then filled with an inert gas to keep the retina in position as it heals. The gas bubble will dissipate from your eye within 4-6 weeks. You cannot change elevation (fly on an airplane) or undergo general anesthesia with nitrous oxide gas while a gas bubble is in your eye. We will place a green bracelet around your wrist indicating this after surgery, do not take off the bracelet until the gas dissipates from your eye. In certain cases we may use silicone oil instead of gas; your surgeon will review with you if this is appropriate for your surgery.

Retinal reattachment surgery usually takes one-two hours to perform. It is typically performed the under local anesthesia so that you are awake and comfortable during the procedure and have minimal complications from anesthesia postoperatively. If you are awake, it is very important for you stay still during surgery.

What should I expect following surgery?

After the surgery you will have an eye shield placed on your eye. Do not remove this shield until we see you in the clinic the following day when we will remove it for you. You will be given instructions on which eye drops to use and all your restrictions at this time. You do not need to use any eye drops the night after your surgery. Please bring all your eye drops to your first postoperative visit.

Most patients have some discomfort after surgery. If you have some pain we recommend you take Acetaminophen (Tylenol). Avoid Aspirin or Ibuprofen as this can increase your risk of bleeding.

You may need to position your head in a certain position after surgery. Your surgeon will review appropriate head positioning with you and your family members after surgery. The positioning will depend on where your retinal tear(s) are. It is very important that you position as instructed or your retina will be at a higher risk of redetaching.

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