3 Vitreoretinal Surgery Fundamentals
3.3 Post-Operative Care
The position and duration of posture depends on the indication for the vitrectomy:
Retinal Detachment:
- Most patients with macula off RRD undergoing retinal detachment repair with gas endotamponade should posture face down for 1 day, followed by positioning to cover the primary break for a total of 3-5 days. Patients with macula on RRD should position for the gas to cover the offending break
Macular Hole:
- Posturing for patients undergoing macular hole repair is controversial. Some surgeons recommend to posture face down for 3-7 days. Other surgeons recommend non-supine positioning. Posturing face down is usually recommended for large macular holes
Submacular Haemorrhage:
- Posture following vitrectomy for a submacular haemorrhage should be face down at 40º to the horizontal (“prayer position”)
The level of pain will depend on the type of operation performed. Vitrectomy for an epiretinal membrane will obviously be less painful than a scleral buckle. It is recommended that a supplemental peribulbar or subtenons block be administered to patients who undergo general anaesthesia, unless there is a contraindication such as a ruptured globe. Pain greater than that manageable with oral analgesics requires prompt ophthalmic evaluation. In particular, the intraocular pressure (IOP) must be checked.
Typical post-operative drops include:
- g. Antibiotic QID (e.g. chloramphenicol, moxifloxacin or gatifloxacin)
- g. Steroid QID (e.g. PredForte®)
- g. Cycloplegic BD (e.g. atropine 1% or homatropine 2%) if required
Some surgeons prefer to use a combined antibiotic / steroid (e.g. tobramycin and dexamethasone) if available. The antibiotic and cycloplegic can usually be stopped after 1 week, but topical steroid should be continued for 1 month. An IOP-lowering agent can be prescribed if intravitreal gas has been injected and there is concern over elevated IOP, or if a steroid response is seen after 1 week.
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