Retinal eye surgery, either vitrectomy or scleral buckle, is usually performed while the patient is awake and as an outpatient, allowing you to go home the “same day.” Usually, there is absolutely no pain with retina surgery and recovery takes place in the comfort of your own home.
In most cases, operations are performed under “local sedation.” This term varies, but at our surgical center local sedation involves giving a sedative through the intravenous (I.V.). This puts the patient in “la la land” for a few minutes during which the eye is then numbed using an injection. When the patient awakes, the eye is numb and can’t move.
Pain is transmitted via nerves. The anesthetic prevents the perception of pain by blocking nerve conduction. The nerves that control the eye muscles are also blocked, thus, the eye can not move. Both pain and movement are controlled.
The eye remains in the eye socket during the operation. The eye lids are held wide open with a wire clamp, or speculum, to allow maximum exposure of the eye for the surgery.
The time for surgery depends on the retinal procedure and the amount of work required, but the anesthesia will work for several hours.
Vitrectomy eye surgery involves minimal cutting on the eye. The use of 25-gauge instruments for vitrectomy eliminates cutting tissue on the outside of the eye, thus, there isn’t much discomfort any way. Scleral buckle surgery for retinal detachments creates the most discomfort due to increased cutting on the outside of the eye, but this method of anesthesia is still very effective.
Most of the time, my patients are completely awake…and comfortable. We can talk and listen to music. On occasion, patients will report they are able to see the instruments moving inside the eye!
On rare occasion general anesthesia is required. This may be due to the age of the patient (i.e. child), anxiety, claustrophobia, etc. We usually prefer the patient fully awake or slightly sedated. The recovery is much faster, easier and safer without general anesthesia.
What Does This Mean? In most cases, technology has improved retina surgery to be completed much faster, and safer, than even 10 years ago. The reduction in operating times, the time it requires to perform an operation, has allowed “local” anesthesia to become preferred by many doctors.
Along with shorter operating times, and less general anesthesia, most surgery is easily performed as an outpatient as the time it takes to recover from “anesthesia” is much shorter.
Many practices choose to operate in a surgical center, a freestanding outpatient surgical site, – usually maximizing efficiency…and time.