117. Vitrectomy – everything you didn’t know you didn’t want to know!!!

By the time many of you read this, assuming it is the 12th of August by now, I will be under the knife and the expert hands of Mr Khan. I’m pleased he has been so busy lately. I’d hate to think he hadn’t been practicing!

So what can I tell you about what’s going on? Well first things first. I had a COVID-19 test on Monday and …………….

……….. they were passing the results straight to the eye hospital and were only going to ring me if I tested +ve.  No call so far. So far so good. Next step – hospital at the rather ungodly hour of 0730. I should be in for only a few hours and, thanks to current pandemic regulations, I will be unaccompanied. Most eye surgery is now done as a daycare so I expect to be home in the afternoon post-op and, I hope, post the post-op tea and biscuits 😀 – every cloud etc etc. Here we go then …… everything you didn’t know you didn’t want to know about vitrectomies.

The vitreous is a clear jelly that fills the space in the eye between the lens and the retina lining the back of the eye. It’s function is to provide a transparent medium for the

passage of light to the retina. The vitreous jelly can sometimes shrink and pull on the retina, causing a small hole or tear. This allows fluid to collect under the retina, causing it to peel off. Without treatment, in some cases urgent, the entire retina may detach leading to loss of vision and blindness. A vitrectomy is an operation to remove the jelly. Simples.

Reading my guidance notes tells me …

… that the surgeon … (good start, says I), … using delicate instruments … (the more

delicate the better, I hope!) … and after administering local anaesthetic … (hmmm ok, go on) … this means that you are awake during the operation … (🤪No shit, Sherlock, which bit of “go on” didn’t you get?) … removes some or all of the vitreous jelly via a series of tiny holes through the white of the eye (the sclera) … (really!!! And I get to WATCH????) … the eye lid is held open with a device called an eyelid speculum and your face will be covered with a pad/shield … (Phew! things are looking up) … and a nurse will be holding your hand … (ok, you talked me into it).

Actually the notes go on about local anaesthetic at some length.… The eye and the area around it will be frozen using drops on the surface of the eye and injections … (don’t worry, the s on the injection hasn’t gone in-noticed!) … of local anaesthetic around the eye … this will make your eye numb … (I bloody hope so!!!) … and you may not be able to move your eye … the injections may be a little uncomfortable … (given that I once described rescuing shipwrecked mariners in storm force winds as “pretty uncomfortable” I am not overly reassured by British understatement!) … but this will quickly wear off … there will be no need to take your dentures or hearing aid out …😳😳 … if you wear them … (phew, good job I turned the page!) … risks of local anaesthetic are rare but … (bracing myself) … but include severe bleeding around the eye which may mean the op will have to be postponed … (no tea and biscuits then I take it?) … or an allergic reaction to the anaesthetic drugs … which may also effect your heart rate making you feel lightheaded … (rather like these guidance notes then!) … very rarely the injection may accidentally enter the eyeball causing severe pain … 😳😳😳 … this would mean that the operation would need to be postponed … (yup, missing the initial target will do that to operations!) … and any damage assessed and treated … you may experience numbness, or tingling around the eye, and may notice double vision for a few days until the nerves and muscles around the eye are back to normal.

Once the vitreous jelly is removed the retina is repaired if necessary, foreign bodies and debris is removed and any leaking blood vessels are sealed and retinal laser treatment is performed if required. The removal of the vitreous jelly leaves a space in the eye into which a gas or silicone oil is inserted. This helps the retina to heal in the right place, acting as a bandage to press it flat onto the back of the eye to ensure there is no further damage or risk of retinal detachment.

I can expect my vision to be blurred for several weeks after surgery. If I have a gas bubble in the eye, vision will be very blurry for a while but this is only temporary. The gas bubble will gradually be absorbed and replaced by the natural fluid produced by the eye. I may also be able to see the bubble, which may appear as a wobbly black ring in my line of vision. The bubble will move as I move and gradually get smaller and break into smaller bubbles. The time this takes varies from 1 to 6 weeks. It will be back to wearing an eye patch or similar, at least to protect my eye at night as my vision improves and I will be putting drops in my eye, around 4-6 times a day at first, as my sight returns.

The procedure normally takes 1-2 hours and has a good success rate. At this point my guidance notes says that “complications are unusual.” It goes on to list ten!!! but let’s cross that particular bridge if and when we have to. Let’s cut to the tea, biscuits and sympathy bit ….

For Diabetes UK and the National Autistic Society see

https://justgiving.com/teams/keithsclipperadventure

for UNICEF UK see

https://justgiving.com/KeithWinstanley-TeamUNICEF

Please take a look. Thank you