Vitrectomy

Vitrectomy is an operation to remove the vitreous gel, a transparent jelly, from the middle of your eye. This may be done when there is a retinal detachment or if blood in the vitreous gel does not clear on its own. Removing the vitreous gel gives your ophthalmologist better access to the back of the eye, allowing them to treat your eye.

The vitreous is located behind your iris (the coloured part of your eye) and the lens, and in front of the retina. Its function is to provide a transparent medium for the passage of light to the retina.

Symptoms

The general indications for vitrectomy are:

  • Residual lens fragments that need removing following surgery – redness, sensitivity to light, vision reduction and/or pain
  • Retinal detachment – dots or lines (floaters) suddenly appear in your vision or suddenly increase in number, you get flashes of light in your vision or you have a dark “curtain” or shadow moving across your vision
  • Macular hole –  blurred or distorted vision, or there’s a black spot in the centre of your vision
  • Diabetic vitreous haemorrhage – floaters, cobwebs, haze, shadows or a red hue in vision
  • Endophthalmitis (eye infection) – following surgery redness, sensitivity to light, vision reduction and/or pain
treatment-eye

Treatment

During surgery, your ophthalmologist will use small tools to remove the vitreous gel. Then the doctor will treat other eye problems, such as a retinal detachment, vitreous haemorrhage, scar tissue on the retina, or tears or holes in the macula.

At the end of the surgery, the doctor may inject an oil or gas bubble into the eye. This lightly presses the retina against the wall of the eye. If an oil bubble is used, the doctor will need to remove the oil after the eye has healed.

We’ve put together a journey map for our patients to show the stages of your vitrectomy treatment and what you can expect at each stage. You may be right at the beginning of your journey and not been diagnosed yet or somewhere in the middle and wondering what comes next. We hope you find this useful and that is answers some of your questions – please call us if you would like any more information about any of the stages or what to expect on your patient journey.

1. Getting a diagnosis

1. Getting a diagnosis

If you are an existing SpaMedica patient and there is an indication that you may require vitrectomy surgery, this will be picked up at your post-surgery assessment check or if you are experiencing difficulty with your eyesight in the first three months following surgery.

If you are not a SpaMedica patient please visit your local optician, who will examine your eyes and conduct a sight test to check the quality of your vision and they will refer you to your local hospital for an eye check and treatment.

2. Booking an appointment

One of our SpaMedica Referrals team will call you to talk through the next steps with you, answer any questions you may have and you choose an appointment date to suit you.

3. Confirmation of your appointment

You will receive written confirmation of your appointment date, along with a map and hospital location details. SpaMedica provides a comprehensive patient information booklet on Vitrectomy surgery, which includes what you can expect at each stage of your patient journey. You can download a copy of this booklet by clicking here.

4. Your pre-operative assessment appointment

The purpose of your first appointment at the hospital is to run a thorough check on your eyes to confirm what the best treatment for you is. Several eye tests will be conducted, with your appointment lasting about 1 to 1.5 hours (which includes about 40 minutes to allow your pupils to dilate – see ‘part 4’ below).

Dilating the eyes causes blurred vision and sensitivity to light, so you won’t be able to drive; so it’s important to make sure you organise a lift or arrange transport to/from the hospital. SpaMedica provides free transport for some patients, based on your location and other criteria – if you’re struggling to find transport please speak to a member of our Referrals team to see if you qualify for free transport.

Please feel free to ask any questions you may have with the nurse and/or optometrist – see ‘steps 5 and 6 below.

You’ll need to bring a list of your current medications, record book (if you’re diabetic or taking Warfarin) and a contact number of a relative/friend. If you wear contact lenses these should not be worn at least 24 hours before your appointment.

So what will happen at this appointment?

  1. Welcome – You will be welcomed and signed in by one of our friendly reception team members and directed to the assessment clinic. You will be seated in our clinic reception and offered complimentary tea, coffee and biscuits.
  2. Eye pressure – It is important to test the pressure in each eye to check eye health and test for glaucoma. Anaesthetic drops will be placed in each eye before the eye pressure test, which is conducted using a handheld meter, which gently touches the surface of the eye and provides a digital readout of the pressure in the eye.
  3. Pupils dilated – Drops are placed in each eye to dilate the pupils (this makes your pupils larger, so we can examine the eye). It usually takes about 30 to 40 minutes for your pupils to dilate and then we can examine your eyes. Dilating your pupils affects your vision and sensitivity to light for up to four hours, so you will not be able to drive yourself home after the appointment. And, of course, you will be offered more complimentary tea, coffee and biscuits while we wait for your pupils to dilate.
  4. Eye diagnostics – These are the different diagnostic tests conducted at pre-operative assessments – you may need some or all of these depending on your individual needs:
  • Optos eye scan takes a magnified colour photo of your eye
  • Imaging test to take a cross-section image of your retina
  • Imaging test to measure and check the shape of your cornea
  • B-scan – this provides data on the length of your eye and provides a two dimensional, cross section of your eye
  1. General healthcare – One of our friendly SpaMedica nurses will conduct a routine blood pressure test and temperature check. They will discuss your current health and what regular medication you are taking (both prescription and non-prescription). They will also talk through your vitrectomy surgery and what will happen on the day of your operation, explaining everything thoroughly and answering any questions you may have.
  2. Optometrist check – All your test results are checked and analysed by a SpaMedica optometrist (eye healthcare specialist). They check to make sure that vitrectomy surgery is suitable for you and will discuss the benefits and risks of surgery.
  3. Consent – We take time to discuss with each of our patients the details of your vitrectomy surgery, the benefits that you should get from the surgery and also the risks of surgery. We’ll check that you understand everything and ask you to sign a consent form, which lets us know you give your permission for your surgery to go ahead.  Please let us know if you have a lasting power of attorney (LPA) or require support for giving consent.
  4. Booking your surgery – The final stage of your appointment is to book a date for your surgery.  Our receptionist will give you available dates and you can choose a time and date to suit you.

5. Your vitrectomy surgery

Your surgery appointment will last about 4 to 6 hours, with the surgery lasting between 60 to 90 minutes. You will have a local anaesthetic to numb your eye so you will not feel any pain.

At home, following surgery, you may need to keep your head in a certain position for a while. This helps the gas or oil bubble push against the detachment. Your nurse will tell you what position you need to be in and how long for.

Advice and recommendations for treatment

  • The time given for your appointment is the time you should arrive at the hospital and NOT the time of your treatment – arriving earlier will mean a longer wait for you
  • Please arrange transport to and from the hospital – your eyes will be dilated during the appointment and this causes blurred vision and sensitivity to light, so you won’t be able to drive; so it’s important to make sure you organise a lift or arrange transport. SpaMedica provides free transport for some patients, based on your location and other criteria – if you’re struggling to find transport please speak to a member of our Referrals team to see if you qualify for free transport
  • We recommend eating a light meal before you arrive at the hospital
  • Please take all your medications as normal, unless we have specifically advised you not to
  • You should wear comfortable and loose fitting clothing
  • Remove all make-up before arriving at the hospital
  • We recommend that someone takes you home after your surgery, but it is not necessary for them to stay with you overnight

And here’s some detailed information about what to expect during your treatment appointment – all the SpaMedica team are here to support you, make you feel at ease and make your time with us as stress-free as possible.

  1. Welcome – You will receive a big smile and warm welcome from one of our friendly reception team. They will check you in and take you to the patient waiting area. You will be offered complimentary tea, coffee and biscuits.
  2. Arranging pick up – Our reception team will ask contact details of the person who will be picking you up after your treatment and we will give them a ring when you’re ready to go home.
  3. Nurse pre-surgery check – You’ll be called through to the surgical ward where you’ll be greeted by one of our skilled and friendly nurses, who will spend about 5 to 10 minutes with you. They’ll take your blood pressure and temperature and check all is OK for your surgery to go ahead. An arrow will be drawn above the eye you are having surgery on – don’t worry, this is standard procedure for all surgical operations. The nurse will make sure you understand what will happen next, you can ask any questions you may have to make sure you are happy with everything. A tiny pellet (click here for picture) is then placed in your eye – this is used to dilate your pupil. If required (most patients do not need this) the nurse will provide sedative medication at this time.
  4. Surgical ward – the nurse will show you through to the surgical ward. It is very important for your pupil to be fully dilated for surgery and so there will about 30 to 45 minutes waiting time on the surgical ward to allow the pupil to fully dilate.
  5. Pre-surgery – One of the surgery team will call you through to the surgery preparation room to get you ready for surgery. The nurse will remove the small pellet from your eye and administer anaesthetic drops to numb your eye. We give you a couple pieces of protective clothing to pop on before surgery – a cap and shoe covers. If you wear a hearing aid we ask that this is removed at this point and the nursing team will look after this and give it back to you straight after your surgery.
  6. Consultant pre-surgery check – Your consultant ophthalmologist will check through your details with you, discuss your surgery and what will happen next. Again you can ask the consultant any questions you may have and they will make sure you’re all OK with everything before taking you through to surgery.
  7. Your surgery
    1. The nursing team will take you through to the operating theatre and help get you comfortable on the operating bed.
    2. The area around your eye will be cleaned using an iodine based solution; this can stain light clothing, so we advise you to wear dark clothing on your surgery day.
    3. A sterile sheet is placed across your head and chest; this does not lie directly on your face or head, but is held above your face and body using a bar fixed to the operating bed. The sterile sheet sticks to the skin around the eye to create a sterile zone around your eye area.
    4. The surgeon uses a special microscope with a very bright light, which magnifies your eye. You will be looking at this very bright light throughout the surgery and this is all that you will be able to see.
    5. Obviously, we will ask you to keep still during the surgery and our patients don’t find this an issue and, if you need to move, to sneeze for example, that’s fine, just let the surgeon know – just think of it like the dentist where you have to keep your head still for a few minutes. And, as a matter of fact, many of our patients have said that they found cataract surgery a much better experience than going to their dentists!
    6. It’s important to keep the eye moist during surgery and so water is used to irrigate the eye and this sometimes runs down your face onto your ear or neck. This is why we ask that any hearing aids are removed before your surgery.
    7. The procedure lasts, on average, about 5 to 10 minutes, that’s all, and most of our patients are (pleasantly) surprised when our surgeon lets them know it’s finished!
    8. We have asked hundreds of patients to describe what they feel or experience during surgery and the feedback is that they just see a very bright light or bright colours and don’t feel anything. If you experience any strange or unpleasant sensation during surgery please let your surgeon know and they will give you some more anaesthetic drops.
    9. The sheet is removed very carefully from around your eye at the end of the surgery – this feels similar to a sticky plaster being taken off, so there is a small amount of discomfort, but this only lasts for a second or two.
    10. An eye pad and eye shield will be taped over your eye to help protect the eye and prevent infection.
    11. One of the nursing team will support you as you get off the operating table and take you through for your post-op check.
    12. Surgery all done – take a deep breath and smile!
  8. Post-surgery check – you’ll spend a little time with one of our nurses following surgery to check you are OK and talk you through your post-surgery care at home. You’ll be given a booklet with lots of useful information on dos and don’ts and advice about what to do when you’re back home. A very important part of post-surgery care is your eye drops – these help to prevent infection and reduce any swelling. The nurse will give you a bottle of eye drops to take with you, with instructions on how and when to use them.
  9. Posturing – If you have had gas inserted into your eye you may have to keep in a certain position for a short period of time, this is called posturing. If this is the case the nursing staff will give you an info leaflet on this, explain the position you need to be in, what you need to do and how long for.
  10. Recovery time – you’ll need about 10 to 30 minutes following your surgery to rest back in the hospital reception. We recommend having a hot drink and a biscuit and these will be offered to you while you wait.
  11. Time to go home – we’ll call the contact you gave us to organise a lift home. If you have organised a lift on our SpaMedica bus, you’ll be booked in with the driver, who will come and get you when the bus is ready to go.
  12. Next day check-up – We will book a suitable time with you for your appointment for the day following surgery

6. Post-surgery care

Your eye is likely to be sensitive, swollen and red following surgery.

Your vision will be extremely blurred in the operated eye after surgery if the eye is filled with a gas bubble.

While you have a gas bubble in your eye, you must not travel by airplane, drive or climb to high altitudes because gas expands at low atmospheric pressures.

This bubble disappears on its own over 6 to 8 weeks, as the gas absorbs and the bubble shrinks. Depending on how well the retina is functioning you will be able to see better each day over the 2 to 3 week period.

Do take your posturing seriously. Failure to stay in the correct position will result in failure of the operation.

Sometimes the eye may feel a little scratchy after the operation but it should not be painful.

If you have discomfort, we suggest that you take paracetamol or your regular choice of painkiller every 4 to 6 hours, in accordance with the correct dosage OR your prescribed painkillers, as directed.

Do not rub the eye which has been operated on.

  • Always wash your hands before touching your face and eye
  • Wash your hands before instilling your eye medication

Your eye is likely to be sensitive, swollen and red following surgery.

Your vision will be extremely blurred in the operated eye after surgery if the eye is filled with a gas bubble.

This bubble disappears on its own over 6 to 8 weeks, as the gas absorbs and the bubble shrinks. Depending on how well the retina is functioning you will be able to see better each day over this period.

While you have a gas bubble in your eye, you must not travel by airplane, drive or climb to high altitudes because gas expands at low atmospheric pressures.

Do take your posturing seriously. Failure to stay in the correct position will result in failure of the operation.

Sometimes the eye may feel a little scratchy after the operation but it should not be painful.

If you have discomfort, we suggest you take your choice of painkillers every 4 to 6 hours, in accordance with the correct dosage OR your prescribed painkillers, as directed.

Do not rub the eye which has been operated on.

  • Always wash your hands before touching your face and eye
  • Wash your hands before instilling your eye medication

 

7. Post-surgery DOs and DON’Ts

The main thing to consider following eye surgery is to reduce the risk of infection in the eye, so it’s important to avoid any environments or activities that would increase this risk.

Urgent post-care – If you experience any of the following symptoms following surgery then please call our emergency helpline on 0161 838 0883 – if you have a general enquiry please call 0161 838 0870, the helpline is for emergencies only.

  •  Excessive and increasing pain after the operation
  •  Increasing redness of the eye

If you run out of drops or think you may run out of drops please contact your GP for replenishment.

We will write to your GP immediately after surgery so that they know what discharge medication you were supplied with. If they are unable to find the letter sent to them, you may need to take the empty drops bottle into your practice to obtain a prescription.

Working

Normally patients are off work for one week following surgery but on occasions this may be longer.

Please download our Journey Map as a PDF.

DOWNLOAD JOURNEY MAP

If you would like this information sending to you in the post please send us your email and we will contact you within 2 days.

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