Out-Patient Procedures
Scleral Buckle
Scleral buckling or scleral buckle surgery is a type of out-patient ocular procedure to close a retinal break or tear, both for acute and chronic retinal detachments. Retinal detachment happens when part of your retina detaches from the rest of your retina and eye, causing that portion of your eye to not function properly and results in partial or full vision loss.
You most likely experienced a retinal detachment either spontaneously or due to trauma to the eye. RD’s may be associated with aging, another underlying eye condition, such as uveitis, diabetes, nearsightedness, or a prior cataract surgery. Once you reattach the retina in surgery, it should restore much if not all your temporarily lost sight. If the detachment is left untreated it could result in permanent vision loss.
With any operative procedure there is always an uncommon underlying risk of complication. Risks may depend on your age, overall health, and specifics of your detachment. Here are the potential risks:
- The RD returns and you need another surgical repair
- Proliferative vitreoretinopathy
- Detachment of the eye layer beneath your retina
- Hemorrhage in your eye
- Retinal incarceration
- Infection
- Increased nearsightedness
- Cataracts
- Increased eye pressure
- Double vision
- New retinal tears
- Before surgery your surgical coordinator may send a clearance request to your primary care or urgent care physician to ensure you are physically healthy enough to undergo anesthesia and the procedure.
- Your surgeon will provide you with specific instructions. Always let your care team know of medications you are on, so they can instruct whether to continue use immediately before your procedure.
- Do not eat anything after midnight the day before surgery.
- There are two ways to perform this surgeon, one is under anesthesia, the other is through drops and injections to make sure you do not feel anything while you are still awake. Either approach your surgeon takes, you will not feel any pain during surgery.
- During the procedure your surgeon cut a small incision into your eye and will carefully attach a piece of silicone or a sponge onto the sclera (white of your eye), at the spot of the retinal tear or break. The “buckle” is designed to repair that detachment by pushing the sclera toward the retinal tear or break.
- Retinal detachment surgery usually also involves the use of cryotherapy or laser photocoagulation. The laser or cryotherapy forms a permanent adhesion around the retinal break and prevents further accumulation of fluid and re-detachment.
- Once complete, your doctor will seal your retina back together likely using a freezing device that scures the retina to the inner wall of the eye. Then place a very small band, known as a buckle around the outside of your eyeball so your retina stays in place.
- Once secured, fluid in your eye may need to be drained. An antibiotic ointment may be applied to your eye to help prevent infection and you will leave with an eye patch.
- You will need a driver, as you will return home the same day.
- Your surgeon may prescribe eye drops with antibiotics to help prevent infection.
- Your eye may be sore after, take over-the-counter pain medicines to relive mild pain.
- Your eye patch should remain in place until your post-op appointment the following day. If the patch is too irritating or uncomfortable, it can be removed 8 hours after surgery. Because a numbing solution was used it should be very hard to blink. Ideally, the patch should remain intact until you are able to blink normally. Once the patch is removed, you may notice some redness, bruising, tearing, discharge, or foreign body sensation, this is common.
- Do NOT miss your post-operative appointment with your surgeon the following day!
- Call our triage line right away at (303) 261-1600 if you experience decreasing vision, an increase in pain, or swelling around your eye.
Vitrectomy
Vitrectomy is a type of eye surgery that treats disorders of the retina and vitreous. The retina is the light-sensing tissue found lining the inside back part of the eye. The vitreous is the clear, jelly-like substance that fills the inside of the eye. The vitreous is removed during vitrectomy surgery and usually replaced by a saline-type solution.
Your doctor may suggest a vitrectomy for the following medical conditions to avoid vision loss or potential blindness.
- Diabetic retinopathy
- Retinal detachment
- Vitreous hemorrhage
- Infection inside your eye
- Severe eye injury
- A hole in the central part of your retina (macula)
- A wrinkle in the central part of your retina
- Certain problems after cataract surgery
Vitrectomy surgery is meant to improve or stabilize your vision. The operation removes any blood or debris (from infection or inflammation) that may be blocking or blurring light as it focuses on the retina. Removing the vitreous gives better access to your retina and decreases the tension on your retina. Improvement to vision is gradual, usually over the following 1-4 weeks after surgery.
Most patients do very well with their vitrectomy, but complications do sometimes arise, as there are risks with any surgery. Your risks may depend on your age, your medical conditions, and the specifics of your eye problem. Note, there is also a risk that the surgery will not successfully repair your original problem. If this is the case, you might need a repeat surgery. Risks include:
- Infection
- Excess bleeding
- High pressure in the eye
- New retinal detachment caused by the surgery
- Lens damage
- Increased rate of cataract formation
- Problems with eye movement after surgery
- Change in refractive error
Most patients do very well with their vitrectomy, but complications do sometimes arise, as there are risks with any surgery. Your risks may depend on your age, your medical conditions, and the specifics of your eye problem. Note, there is also a risk that the surgery will not successfully repair your original problem. If this is the case, you might need a repeat surgery. Risks include:
- Infection
- Excess bleeding
- High pressure in the eye
- New retinal detachment caused by the surgery
- Lens damage
- Increased rate of cataract formation
- Problems with eye movement after surgery
- Change in refractive error
What to know before your procedure
- Before surgery your surgical coordinator may send a clearance request to your primary care or urgent care physician to ensure you are physically healthy enough to undergo anesthesia and the procedure.
- Ask your doctor whether you need to stop taking any medicines before the procedure.
- Avoid eating anything after the midnight before surgery.
- Pre-procedure, your surgeon may dilate your eye for a pre-exam or complete a quick ultrasound of your eye to clearly view your retina.
- Most vitrectomies are performed with local anesthesia on an outpatient basis, so you are sedated and won’t remember a thing when you awaken. If your surgeon concludes no anesthesia is necessary, you will be awake during the surgery but medicated to help you relax. In this case, your doctor may use anesthetic eye drops and injections, so you do not feel any pain.
- During the procedure, your surgeon will make a small incision in the sclera (white part of your eye) to remove the vitreous and any scar tissue or foreign material.
- If needed, your surgeon may make simultaneous repairs to your eye, such as a laser to seal up a tear in your retina.
- In some cases, your eye doctor may inject a gas bubble into your eye to help keep your retina in place.
- Your surgeon will replace the vitreous with another fluid, silicone oil or saline, then close that incision(s) with stitches, if necessary, which isn’t likely. A topical antibiotic ointment will used on your eye to help prevent infection and then covered with an eye patch.
- Your eye patch should remain in place until your post-op appointment the following day. If the patch is too irritating or uncomfortable, it can be removed 8 hours after surgery. With a numbing solution in place, it will be hard to blink. Ideally, the patch should remain intact until you are able to blink normally. Once the patch is removed, you may notice some redness, bruising, tearing, discharge, or foreign body sensation, this is common.
- If a gas bubble was placed in your eye, your surgeon may recommend you keep your head in a special position for a specific amount of time. With a gas bubble or other substance in the eye, your vision will be blurry. Vision gradually improves in the weeks following resolution of the bubble.
Do NOT fly in an airplane or travel at high altitudes until the gas bubble is gone if one was placed in your eye. A rapid increase in altitude can cause a dangerous rise in eye pressure.
Call our after-hours line ASAP at (303) 261-1600 and follow the prompts for “triage”.
A small amount of blood or discharge is completely normal and not a cause for concern. Simply use a sterile eye wash and rinse the blood/discharge out of the affected eye.
Most patients experience some bleeding and redness on the white of the eye and bruising around the eye after surgery. This usually clears up after 1-2 weeks.
Diminished vision or cloudy vision is very common after surgery as there is either silicone oil, gas bubble, or an air bubble where the vitreous used to be. With gas/ air bubble this will slowly improve as the bubble dissipates. With the silicone oil vision may remain cloudy or hazy until the oil is removed. You may also experience some double vision, distortions, and sunlight sensitivity for a few weeks after surgery.
You may shower the day after surgery but be overly cautious to not get water or soap into post-operative eye, and do not rub.
Generally, the return to light work time is about 1-2 weeks. This is usually determined at the 1-week post-operative appointment.
Immediately.
If you need to bend, stoop, or lift please do so slowly. Do not strain (red face). Do not lift more than 10-15 lbs. No strenuous activities including any full contact sports or recreational activities, try to limit yourself to light exercise only. Heavy reading during the first week after surgery is also advised against as it can put too much stress on the eye. At the 1-week post-operative appointment these restrictions will be reassessed.
The first week one (1) drop should be administered into the effected eye FOUR (4) times every day. After one week the need for drops will be assessed by a Physician.
