How can I prepare for surgery?
One week prior to surgery: Unless your internist feels that stopping blood thinners unacceptably increases the risk of blood clots (stroke/heart attack), do not take aspirin-containing products, Effient, or Brilinta for one week prior to surgery. Coumadin may be stopped four days prior to surgery. Pradaxa, Xarelto, and Eliquis may be stopped two days prior to surgery. Your EyeMD will schedule an appointment with your primary care doctor if evaluation is needed prior to surgery. Please inform your doctor of any chest pain/pressure, fever, productive cough, shortness of breath, or bleeding tendencies.
The morning of surgery: Take no medications for diabetes unless instructed differently by your doctor. Please do take all of your other medications with a sip of water and you may use any prescribed eye drops as usual. Otherwise, do not eat or drink anything on the morning of the scheduled surgery. Report promptly to the hospital as scheduled, but expect to wait while the nurses prepare you for the operating room. Bring a complete list of your medicines with dosages. Do not wear make-up. Arrange for someone to drive you to and from the hospital.
What type of anesthesia is available?
With local anesthesia the patient is sedated with IV medication so there is no memory of the anesthetic injection around the eye. Surgical drapes are placed over the face leaving plenty of breathing room. During surgery the patient is awake, but there is usually no pain. It is important to lie still on the operating room table so that there is no movement of the head during surgery. The main advantage of local anesthesia is that the patient can leave the hospital more quickly than after general anesthesia.
With general anesthesia the patient is asleep throughout the surgery and remembers nothing of the surgery. The anesthesiologist places a tube down the throat into the trachea to breathe for the patient. After surgery the throat may be sore. Which type of anesthesia is best for a patient may be determined by the health of the patient. Otherwise, if a person cannot lie still for the surgery or if claustrophobia is a problem, general anesthesia is preferred.
What are the risks of surgery?
Although uncommon, problems such as bleeding and infection may arise from any surgery. Retinal detachment or abnormal scar tissue formation may require additional surgery. Rarely, there may be loss of vision, double vision, glaucoma, or loss of the eye. The most common problem following vitrectomy surgery is progression of cataract requiring cataract surgery at a later date.
Although serious problems are not encountered often, the risks and benefits must be weighed for each individual to arrive at a decision for surgery. For many eye problems, surgery is the only hope for improvement in vision or prevention of blindness.
What can I expect after surgery?
A soft eye patch and a hard eye shield are placed on the eye at the end of surgery. Leave these in place until your exam on the day after surgery. Tylenol (no more than 4,000 mg per day; caution with liver disease) or Ibuprofen (no more than 2,400 mg per day; caution with kidney disease) may be used if there is pain. Call the doctor for a prescription if your pain is not relieved. It is not common to have severe pain after vitrectomy surgery. A scratchy feeling is due to sutures on the white of the eye. These sutures dissolve in about three weeks and you may use a lubricating ointment (Lacrilube is available without a prescription from the drugstore) as needed for comfort. At your exam after surgery, you will be given eye drops and/or an ointment to keep the eye comfortable, to prevent infection, and to promote healing. Wearing the eye patch is optional after you are seen in the office, but wear the hard protective shield at night for at least two weeks.
The vision usually returns slowly over days to weeks after surgery, but may take many months for final recovery. Use caution while walking as your depth perception may be altered until your vision returns after surgery. You may experience light flashes, floaters, and temporary double vision for days to weeks after the surgery. Do not be alarmed, but feel free to notify the doctor of any concerns that you may have. The swelling and redness slowly disappear over two or three months. There are no restrictions to using the eyes to read, watch TV, or bathe. Ask the doctor when you may resume driving. You may shower after the patch has been removed in the office. Avoid heavy lifting and straining for one week after surgery. You may resume taking all your medications after the surgery; however, blood thinners should be withheld until after the first visit in the office one day after the surgery.
Depending upon the reason for your surgery, it may be very important to lie face down or on either side after your surgery. Be sure you understand any positioning requirements given by your surgeon. Additionally, if a gas bubble is placed in your eye at the time of surgery, you may not fly on a plane until it has dissolved or you could risk severe pain and blindness. Similarly, nitrous oxide should not be used if any other surgery is required while you are healing from your eye surgery. Be sure to wear a wristband for six weeks after eye surgery to notify health care providers that you have a gas bubble in the eye. Remove the wristband only when your doctor has notified you that the gas bubble is gone.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
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