Vitrectomy - facedown?

Diabetes Complications and other Conditions Eyes
1

Hello.

I’m blind in one eye, so facing a vitrectomy is a bit more daunting than it might be.

Does the fact that I had a cataract operation a couple of years back mean I won’t have to do the post-operative ‘posturing’, i.e. lying face down? I believe that the posturing is usually ‘prescribed’ to avoid the formation of cataracts, which in my case has already been done.

Also, any clues as to how long between operation and reasonable vision? Again, I’m only asking as given the other eye being blind, I’m going to be totally out of action for that period.

Thanks for your help.

Allen.

2

I have had vitrectomies in both eyes. I never had to lay face down with either procedure. After one of them, I saw clear as a bell immediately. With the other, it took a while–maybe a month before I was all cleared out. Each time is different, I guess.

3

I believe the “posturing” has nothing to do with preventing cataracts, but rather is intended to keep in place a bubble of gas or air (or combo of the two) introduced during surgery to prevent a retinal detachment, a common consequence of vitreous surgery. So, no, you can’t skip that step.

In my third vitrectomy, because I had to fly soon afterwards, they used a denser oil, which doesn’t require the face-down torture, but does require a subsequent surgery to remove it and replace it with saline or a lighter oil that is reabsorbed naturally. I’ve heard this option is becoming more common because it’s easier on the patient, but you’d want to weigh the downside of too many surgeries on the same eye. Can you discuss it with your surgeon?

As for recovery time, it’s very variable. Your surgeon can probably give you a rough guideline, but it’s anyone’s guess whether you will recover your vision later or sooner than the average person.

4

I have had three vitrectomy’s myself. The only time I had to worry about my posture was the one time they used a gas bubble because they saw a weakness at the edge of my retina. I did not have to lay facedown, but I did have to lean to one side for a week or so as the weak spot was at the outer eedge. Beacheris is absolutely right, this has nothing to do with preventing cataracts.

The recovery time is not entirely predictable, but my experience was that it was a matter of less than a week each time before it seemed totally cleared. That being said, my vision was still usable during that time. It was just a bit foggy or obscured. But you should know that the vitrectomy is often not the point of the procedure. Mine entailed other work being done within my eye. I believe that your recovery time will depend a lot on what they were trying to accomplish with the vitrectomy…

5

How did you get your a1c into the 5 range

6

Well, if you are talking about the first one, I would say I did it the hardest and worst possible way. I knew that when I got the results of 5.7 for a three month average it was not a good average. It encompassed the time I was learning to use insulin and experimenting with different foods to figure out how and what to eat. A good portion of that time my readings were well over 200. That means I had way too many really bad low blood sugar episodes. And I did.

(Another indicator that this was happening occurred one day when the paramedics showed up next door with their lights flashing. My dog jumped up in the window, got all excited and wagging his tail. He had come to really like the EMTs that showed up for my lows.LOL)

I was happy about the number, but I knew I needed to do a better job at stabilizing things. I did this by primarily eating very low carbon. In fact, in the beginning I narrowed my diet down to maybe a dozen items so that I could get to a baseline that I could work from.

As my blood sugar began to stabilize in the 120s I began to expand my menu and continued experimenting. My strategy was to consume less than 100 carbs per day and use the least amount of insulin that I could. At one point in time I was able to go two weeks without using any fast acting insulin. I just ate to my meter and used my basil insulin and very moderate exercise.

I began to gradually bring my number down and over time was able to settle in at a normal blood sugar level. I have been able to do that for the last several years eating between 100 and 150 carbs per day. My F SB is usually around 100 and no more than 130. Throughout the day it is usually less than 110 and more than 75. But I must be very careful in watching my intake and activity to avoid going low.

I also have celiac disease so I do not consume any type of wheat or ride. Zero bread, but I do use some gluten-free crackers and chips. I eat pretty much anything I want to (outside of food containing gluten).

I treat things like potatoes as a treat and a condiment never as a portion in my meal. I consume very little fruit other than berries and some apple. I eat most of my carbs this way with meals. I save the treats for snacktime’s.

In the last year or so I have gotten more comfortable being a little more aggressive with my insulin. So I am willing to venture out a bit more in my diet, but this also has helped me to bring my A1c down a bit more. My last one was 4.8. I’m quite happy to stay in that 5.0 to 5.5 range. This one was kind of a surprise.

I still try to use the minimum amount of insulin every time I take it. The majority of the time I use one or two units at a meal. Less frequently I will go to three and rarely four units. The most I have ever taken at one time is six units. I found that when I needed to use more insulin it was much more difficult to calculate, stay safe and have my numbers be anything close to stable.

7

Thanks for the replies, which I find much more useful than the explanations given out by our medics. I’d rather hear from people who’ve actually HAD the procedure, than people who DO the procedure!

Anyway, all knowledge is power, so thanks, even though some knowledge makes you depressed.

And yes, of course they’re not contemplating a vitrectomy just for the sake of it. My proliferative retinopathy, held at bay for many years, finally got the upper hand and I had a bleed a few months ago which is taking too long to drain. The docs have lasered my retina’s periphery, but there is still a persistent micro-bleed which seems to be coming from a more central position, so the plan is to do the vitrectomy, then find the recurrent bleed, and laser just that spot.

As I implied above, it’s not the operation that worries me, but the recovery. I really don’t fancy being totally blind for a month (or more).

Maybe I’ll just pray to the God of Drainage to work her miracles and clear out my vitreous.

Allen, in London.

8

One additional thought - talking to my ophthalmologist the other day, she reminded me that having a vitrectomy (whether ‘free’ on our NHS, or paid for if I wanted to choose my own surgeon), was no guarantee against future bleeds!

Thus, two or three weeks post-op I might have a retinal bleed. Now that WOULD upset me, I am sure…

A.

9

I have had retinal bleeds right after vitrectomy in one eye. It continued to run like a faucet. Very upsetting. It was only after I had sufficient lasering that that eye settled down. I haven’t had a bleed in that eye now for over a year. You might need more lasering if you continue to have bleeds. Just sayin’…

10

Cinderfella- quite agree. Trouble is, current bleeds seem to be central, and the periphery’s already been well covered.

So until centre is blood free, they can’t do central laser!

There’s a hole in my bucket, dear Liza, etc.

A

11

This is true. A vitrectomy is a repair procedure – in the case of retinopathy, to clear out coagulated blood that has not been reabsorbed and is therefore interfering with vision. Adjunct laser surgery is often done while the surgeon has easy access to the retina, and that is preventative, but the vitrectomy itself is not primarily a preventative procedure. In fact, given the complications, such as retinal detachment and cataract development, in cases where vision is not significantly compromised, vitrectomy may be inadvisable.