Am considering a vitrectomy and want to hear about your experience


#1

My stats: Type 2 x 21 yrs. Insulin dep since year 2. Sugars always good. A1C’s under 7 for greater than 10 yrs and even better controlled now after gastric bypass surg in 8/08 and 120lb wreight loss. Pre-op: was taking 150 units of lantus daily and sliding scale regular, usually 80-100 units with EACH meal. Yes, you all read those numbers correctly! Now am taking 30 units of lantus daily. A1C now is about 6, with fastings at 80 and postprandials at 120. Dx with retinopathy in 2004 after 15 yrs of disease and have had numerous PRP laser surgeries. All has remained good despite the occassional bleed that produced floaters and cobwebs but generally cleared within about 2 weeks. Have had big bleed now for 10 days that doesn’t seem to be improving at all. Am considering vitrectomy and just want to hear about others experiences. Two docs say wait a month from first bleed day, but that means time off work while waiting AND time off after surgery AND going stir crazy at home on house arrest because I can’t drive!


What to expect during vitrectomy recovery
UPDATE...Vitrectomy
#2

hi, Vivian, welcome to TuDiabetes. I have not had a vitrectomy, only laser years ago, but there is a friend here that has had it - Kathy here - and I’m sure she would tell you her experience.


#3

Thanks Marie. Invited her as a friend so we’ll see.


#4

Hi Vivien - sorry I didn’t see this earlier but my mother is quite ill and my job moved and I’ve been preoccupied with stuff.
Now, please remember that every person is different. But, here’s what happened to me. My vitrectomy had to be done because of a detached retina. I’d had laser for proliferative retinopathy, and in rare situations, as the blood vessels die and contract, they pull the wrong way and loosen the retina from the back of the eye. So it was a big mess. If the retina did not need to be repaired, as in your case, I believe it can be done under local anesthesia. I had to be put out, totally. You would probab ly have to wear a patch for a day or two, and also rest, but as far as I know, that’s it. From my understanding, one reason they remove the vitreous is so that they can have a clear view of the retina, in case more laser is needeD. Also, if it doesn’t seem to be clearing, maybe it was not one big bleed but a slow continuous leaking each day that needs to be sealed off. Heck, I’m not a doctor and sometimes I get the smarty pants attitude that I am.
I guess if two doctors say wait, I’d wait. I really don’t know what the risks of the vitrectomy itself is, but I guess if any surgery can be avoided, that’s the best route to take.
Prior to my laser, I had small bleeds and yes, they took about a month to clear.
I know you have other considerations, like your job, and that is significant.
If I can do anything more, or answer any questions, please give a shout.
Good luck to you, Vivien.


#5

Thanks Kathy. Sorry to hear about your momma. I’m surprised to hear that you had a detached retina. That is the number 1 prob following a vitrectomy, but the laser you had should have significantly decreased your chances of that happening. The laser, in essence, tacks the retina down to the back of the eye. Tomorrow I see the surgeon and I believe I am going to schedule the surgery for Feb 16th, which will be 2 days shy of a month. If any great changes happen before then, I can cancel right? Thanks for the info.
Viv~


#6

Vivian, it would be so helpful for the TuDiabetes community if you could report on your surgery here at some point in time. Is this just happening to you in one eye? What do you already know about the procedure? Let us know if there’s anything we can do for you. I’m already saying prayers for you.


#7

I will keep the community updated on my status. I know quite a bit on the procedure actually. I did part of my thesis on diabetic retinopathy so I feel fairly well informed. I am a nurse practitioner but I do women’s health. I only know about diabetes and eye stuff because I live with it. What I learned from the thesis didn’t help me too much in OBGYN. lol Thanks for the good thoughts.
Viv~


#8

I am actually only having problems in my left eye. A vitrectomy can be the next step after PRP (panretinal photocoagulation) laser surgery. The PRP is done to somewhat help existing bleeds but more so to prevent new ones

Bleeds can occur even if ones blood sugars are controlled. Roughly 85% of those with diabetes will have some form or another of complications at about the 15 year mark even with good control. It may be a problem that just bears watching, or it maybe more serious. Bleeds can occur if the disease is PROgressing or if the disease is REgressing so a bleed isn’t always bad, but more so just always inconvenient.

The vitrectomy is a procedure done normally under local anesthesia in which the vitreous fluid, or the gelatinous matter in the eye, that gives the eye it’s shape, is sucked out. Along with the vitreous fluid comes all the gooky stuff that is impairing your vision, i.e. blood, crappy vessels, fibrous materials. The eye is filled with a saline solution which is absorbed by the body as the body reproduces new vitreous fluid. The new vitreous is free of all the gooky stuff that impaired your vision. 80% of the time, there is complete resolution of the problem and the vision returns without issue. 10% of people have no change and their vision remains impaired. The other 10% of the time, more severe problems can occur, such as post surgical bleeding, infection or a detached retina. I

n a person who has had PRP laser treatments, the risk for a detached retina is reduced significantly because the laser has produced scar tissue that has, in essence, tacked the retina down to the back of the eye. I was surprised to hear that Kathy had had a detached retina after having had laser.

Most doctors will tell you to wait 6 months after you get a bleed before you have a vitrectomy, but some have altered views of that suggestion in light of the patients history. As I mentioned above, laser is generally used as preventative, not treatment and in my case, I’ve already had so much laser that not only is there no room in my eye for more.

The laser is actually put in the periphery of the retina and makes the retina smaller. You can go only so small or you risk permanent blindness from the laser because the macula, located at the back of the retina, the function of which lets in the light you need to see, can become affected because there is so much laser to the retina surrounding it. If you can’t get light into the eye, you can’t see.

I’ve rambled on a bit here, but I just really believe in education and if I can provide that to others who need it, I am more than willing. If anyone has any questions, please let me know.
Viv~


Vision before vitrectomy
#9

Yes, my retinal detachment as a result of the laser happens in about 1 out of 500 cases. And because my vitreous was murky, I did not know it was happening until it had pulled off the macula. Detachments at the edge are much easier to repair.
But, in addition to the d. being rare in my situation, the level of healing I attained afterwards was also rare. The opth says I remain to this day one of his best “success stories”. I have 20/30 vision in that eye, with corrective lenses. Lost some peripheral vision, but I’ve adapted. I feel pretty thankful.


#10

Hello Vivien
I have had bilateral PRP’s - and 1 vitrectomy. The procedure is performed under conscious sedation and a local anesthetic to the optic nerve. The mechanics of the procedure are similar to a chole-lap. The recovery period is around 6 months. You will have vision loss for a month or so and when you do regain your vision it will be reduced and viewed through a red filter - the blood that has accumulated in the cavity and has not been re-absorbed yet. You will use steroid gtts every 4 hours and antibiotic drops. Follow-up is 24 hours then you will use an eye patch. Suggest you find a pharmacy that sells the pirate patch and purchase 2 of them now. You wouldn’t think that they are so difficult to find, but they are :slight_smile: I had my OS done which complicated driving a bit because I could not see the side view mirror. I think I started driving at 6 weeks. Forget about night driving. You will be relying on your unaffected eye for your entire field of vision. Plus, while you are a “cyclops” your depth of field will be miserable - I cannot tell you how many curbs I walked into or stepped off of. You really need to have a good sense of humor.
Post operatively there was not really any “pain” (the Tylox was very effective - but I only took it periodically after the first 48/72 hours). There was a deep ache and I found that sleeping on that side with my face in the pillow (pressing the pillow slightly into the bandaged orbit) was effective in relieving the discomfort. Of course you will be restricted in lifting or doing anything that would increase the ICP &/or ITP(Valsalva). Once you are able to have the bandage removed your sclera will be mostly red. That takes a while to resolve so I found wearing the patch was practical otherwise it is really grotesque looking for the public at large. Plus, you will find that your good eye will become fatigues with visual stimulation overload.
In addition to the vitrectomy I had my first PRP (1 of 3).
Finally on the positive side - if even temporarily you will be able to see in the dark out of the op eye. The procedure “paralyzes” the bilateral synchronization of the pupils so the affected eye’s pupil will not constrict in unison with the unaffected eye. It is amazing how much you can see in a dark room when your pupil is dilated. Eventually it will resume its normal function but it is fun while it lasts :wink:
I would be more than happy to discuss this further with you. SHoot me a message.
Peace+
Tim


#11

When did you have your surgery Kathy? If longer than a year, any problems with cataracts? Nearly 100% of people will need cataract surgery with a few years of having the vitrectomy. The younger one is when the procedure is performed, the longer it usually is before the cataract creeps up. Older patients will typically get a cataract sooner.


#12

I had the surgery about 6 years ago. No one told me that there was a good chance of getting a cataract, so, when my vision began to slowly fade (about 4 months post surgery) I was terrified, thinking the laser hadn’t worked. Because I was so frazzled emotionally about the entire retinopathy incident, I had no reserves left. I crawled into bed for two days and sobbed. Then I went back to the opth, wailing and he said “oh sweetie, it’s just a little cataract - we’ll pop it out and things will be good as new”. I was so mad at his flip attitude. He continues to be the only retinal specialist in my insurance providers network, so I have to keep going to him. The c surgery was uneventful - I went shopping in the evening. But then, I got a secondary cataract, which is a little film of skin over the lens. Fortunately I had read about this and was prepared. They use a special laser called a “yag” laser to melt it away. When I went for the procedure, they had lost the yag machine and didn’t know where somebody had put it. I had to wait on a bench for 3 hours until they found it in a file room. But, that was one zap, and, bingo, I could see clearly again. I had forgotten about all of this. But now, in looking back, I feel strong and proud that I endured such a mess, and came to the other sie with my wholeness intact. You will too.