A Personal Experience with Vitrectomy Surgery and the Recovery Process

Macular hole surgery, also known as Vitrectomy is serious, and it's recovery process can be long and somewhat difficult. The level of vision regained after surgery depends in large part on following doctor's orders during the recovery process. This is a personal story of my mother's recent macular hole and cataract surgery from the date of surgery on Aug. 1 through her latest doctor's appointment on Aug. 24.

Monday, Aug 1. 2011 - The Vitrectomy or (macular hole) surgery

Following a night of fasting, my mother was weak and the eye surgery wasn't scheduled until 1PM. The Vitrectomy was to repair a macular hole that had started developing at least five years ago, and to remove a cataract, both in the left eye. My mother is 78, and we realize now that it would have been a little easier on her had she had the procedure several years ago before the hole became so large and while she was younger. The doctor expects 60% or less vision recovery, depending on how well she follows the orders to maintain a face-down position during the recovery. The surgery lasted only 1 Ã'½ hours and was performed under local anesthesia, so she was awake but could not feel the procedure. A retinal doctor performed the macular surgery and the ophthalmologist removed the cataract and both were announced as successful!

After Mom was out of surgery, she stayed in the recovery room about an hour until her blood pressure had stabilized and all post operative and recovery instructions were explained and presented to us in written form. An appointment was scheduled for Aug. 2 for a 24 hour follow-up exam.

Arriving home with post-op instructions such as 1) maintain face -down position for 45 minutes out of each hour, 2) apply 2 different drops 4 times per day in the operative eye, 3) no air travel (she's never even been on an airplane, a piece of cake), 4) no sex (okay, no problem here), 5) take Advil for pain, 6) wear an eye shield every night for the first week, 7) no driving until doctor says so, 8) sleep on either side with operative eye facing down, 9) no bending, stooping or lifting, and 10) call the doctor's office if she still had eye pain that Advil wouldn't relieve. The recovery process had begun and it was up to the patient to follow orders!

Mom experienced nausea and vomiting on the way home from the surgery and up until bedtime. This was normal for her after receiving any amount of anesthesia. This first night she slept through the night after taking Advil for pain.

I want to offer some further information on instruction 1) maintaining a face-down position as listed above. Mom's doctors allowed her options to be up walking, sitting, or lying in bed on her stomach, as long as her face was facing the floor for 45 minutes out of every hour. Depending on the doctor, some patients may be instructed to only stay in the bed on their stomach and face-down for the same time period. Either way, maintaining the face-down position is crucial in the recovery process to keep the gas bubble placed in the eye during surgery in the correct position until the hole has completely healed. Maintaining the face-down position is also the most uncomfortable and inconvenient part of the recovery period, as it causes a lot of neck pain and headaches for most patients.

Tuesday Aug. 2-8, 2011 - First week following macular hole surgery

Tuesday, I drove Mom to the follow-up appointment. During this post-op visit, her vision was tested and she had not regained any of her central vision, which was to be expected. The vision slowly returns after the gas bubble has dissolved 50% or below, which will take a few weeks depending on the patient. Mom's eye and blood pressures was taken and both were good! Next, her eye was dilated and the retinal doctor examined it to make sure the gas bubble he placed in the eye during surgery was still holding in the right position. It must stay over the retina and macula area in the back of the eye for proper healing, which is why the face-down position is so crucial.

She was reminded to maintain the face- down position for 45 minutes out of every hour, until the next week when she was to return to the retinal doctor. At that point, he will re-check the eye and the bubble and decide whether she can decrease the time she is in the face-down position for week #2.

So, the first week after surgery, she continued to follow all of the post-op instructions listed earlier.

Tuesday Aug. 9, 2011- One week follow-up appointment

During this visit, the eye and blood pressures were checked and were good. Prior to surgery, Mom's central vision was just a blank black spot, now one week after the Vitrectomy, the black was gone and she could see white light, but still couldn't read any letters shown to her on the eye charts. The gas bubble had dissolved from 100% to approx. 70%. After examining the dilated eye, the doctor told us the gas bubble was still correctly in place over the retina and macula area keeping the area dry to facilitate healing. The Doctor decided to decrease the amount of face-down time to just two hours per day until the next scheduled appointment on Aug. 24! One of the eye drops was discontinued, and the frequency of the other drop was reduced from four times per day to three. Needless to say, we were very happy to receive this good news.

Mom was also given permission to start driving again, but chose not to do so yet. At this appointment she told the doctor she had had some pain and soreness in the eye, as well as heaviness in the eye, but that she had continued to take Advil every 4 hours and it had kept the discomfort to a minimum.

Aug. 24^th - Most recent appointment and a little over a month since surgery

Mom reported some soreness and heaviness in the eye, but was told that this is normal. The operative eye was dilated again and examined. The doctor reported the gas bubble had reduced to 30% and everything looked good. He decided she did not have to do any additional face-down time, but to still sleep on either side or stomach and not on the back. Mom was able to read some of the letters on the eye chart, so the vision is slowly returning. The doctor said that the majority of the expected vision will return over the next 6 to 8 weeks, and may possibly improve slightly as far out as 4 years following surgery. She is driving again and happy so far with her progress.

The recovery from macular hole surgery is long, but doable. It takes patience and a determination to maintain the face-down position as directed, realizing that how well this is done determines the degree of success in vision regained. The instructions for recovery will vary between doctors and patients should not assume their recovery process will mimic someone else's. Each person's experience will be unique.

I hope this personal account will help someone who is in the process of deciding whether or not to have macular hole surgery! Mom of course recommends it!

Note: The information in this article is for informational purposes only. It should not be used in any other way. Always seek the advice of your physician.