I routinely examine patients the first day after retinal surgery. It’s the shortest visit you’ll ever have at my office. Surprisingly, there are very, very few things for me to check the first day after surgery.
Whether you have had retinal surgery for removal of an ERM (macular pucker), repair of a macular hole, a vitrectomy for vitreous hemorrhage, floater only vitrectomy (FOV) or retinal detachment surgery; the post-operative exam is brief.
Removing the eye patch can be intimidating. The cotton patch, affixed with paper tape (my favorite due to its’ stickiness), comes off the next morning and stays off. It is usually a bit moist and bloody.
Though a little unsightly, the blood is expected, but insignificant. Also, the eye patch has little therapeutic value.
Especially in cases of a scleral buckle, I like to use a “pressure patch” as it eliminates any lid swelling the next day and facilitates a nice easy exam (sometimes it’s difficult to examine an eye with the lids swollen shut).
I expect your vision to be lousy immediately after removing the patch. There are so many reasons why you shouldn’t see, I don’t bother wasting time having you read the eye chart. Simply seeing a strong light is sufficient.
What causes the vision to be so bad?
The cornea is warped from the patch, there might be post-operative bleeding, you might have air or gas in your eye…etc. Therefore, careful measurement is meaningless as it has no bearing on the actual function of your retina (i.e. how well your retina can “read.”)
This is somewhat important to ensure that the eye is neither too low (not uncommon after 25 gauge sutureless vitrectomy) nor too high (especially with gas injected).
At the end of each operation, I prefer to use stronger dilating drops to keep your eye dilated for a few days following surgery. While it may add to the blurriness after surgery, you will already be dilated for the next morning’s exam…avoiding the need to dilate your eyes again! It may also keep your eye more comfortable for the first few days.
Once the patch is removed, therefore, I can examine your retina immediately, looking for complications of surgery including retinal detachment or infection.
What Does This Mean?
Checking your vision, pressure and looking at your retina is all that I need to examine you after your retinal surgery. Most of the time is spent going over your instructions on how to use your drops and…if needed (it is usually not!), any special head positioning.
Complications immediately following retinal surgery are uncommon, but include; retinal detachment, bleeding, infection and problems with eye pressure. All can be assessed quickly, and comfortably, after your retinal eye surgery!