An operation called Vitrectomy is sometimes required to remove the gel or vitreous humour that is located inside the eyeball. This operation is carried out though three very small or millimetric holes bored on the wall of the eye. A ceiling-hanged microscope is used.

Mr Stanga may perform a vitrectomy to treat Retinal Detachment, Macular Hole, Proliferative Diabetic Retinopathy, Vitreous Haemorrhage and Floaters, between others.

A bubble of gas or silicone oil may need to be injected into the eye during the surgery.

This operation can be performed under local with or without sedation or general anaesthetic.

Ms Stanga carries out vitrectomies in the traditional way using sutures as well as sutureless vitrectomies (no stitches). Please ask Mr Stanga about this new modality.

Following the operation you may be required to adopt a 'face down' or other specified position, like resting on your side, which we call Posturing. Posturing helps the intraocular gas or silicon bubble to float towards a specific area of the retina to flatten and support it from the inside of the eye. Posturing is an extremely important part of the treatment and if requested it is usually carried out for 10 days. Special equipment is sometimes available to help you in achieving the best posturing position.

Different Posturing positions are available but, most likely, only one will apply to you. Mr Stanga or a member of his team will discuss this with you and it will be demonstrated to you prior to leaving hospital. Posturing equipment is sometimes available to help you maintain your position. Please feel free to request it.

A 10-minute break from posturing is allowed every hour. It is important that you take your allocated breaks from posturing in order to relieve pressure on your skin. Short walks and leg exercises are important and will promote good circulation. Try altering your body position from lying to sitting whilst maintaining your posturing position.

Whilst posturing you may move about but you need to maintain your head in the correct position.

Never lie on your back or have your head tilted backwards for longer than the time it takes to put your eye drops in.
Feedback from patients who have postured suggests that you may feel isolated, down or depressed. Please do not hesitate to contact Mr Stanga or his team if necessary.

Whilst you are posturing we advise you to follow a light diet with plenty of drinks, fruit and vegetables. Use breaks from posturing to eat and drink. You may experience stiffness or ache of your neck muscles. This is generally due to the unusual position you have to adopt. A warm bath or gentle massage can be useful in relieving muscle discomfort. A mild painkiller such as Paracetamol may help to relieve muscle stiffness and eye discomfort, but do not ignore your symptoms. Please contact Mr Stanga or his team whenever in doubt.

Your eye will most likely be red for between 2-4 weeks and feel uncomfortable and gritty for 3-5 days, especially when sutures have been used. Please ask Mr Stanga about sutureless vitrectomies (no stitches).

Because of your inactivity you may suffer with constipation and dehydration. If this is the case please contact your GP doctor for treatment and advice.

It is very likely that your vision will be blurred for 2-3 weeks following the vitrectomy.

If Mr Stanga has injected gas into your eye you may be able to see the edge of the bubble which will appear as a shaky black line in your vision and which will always remain horizontal or parallel to the floor as you move. Please note that if the line in you vision "moves with your head" you must urgently contact Mr Stanga or a member of his team as this may be symptoms of a Retinal Detachment. The gas bubble will gradually get reabsorbed getting smaller or break into smaller bubbles. It can take somewhere between 4 to 8 weeks for the gas bubble to completely reabsorb depending on which gas Mr Stanga has utilised, though in a small number of patients it can take longer. The natural fluids produced in the eye will eventually replace the bubble.

If Mr Stanga has injected gas into your eye, please refrain from travelling by airplane until the bubble has been completely absorbed. There can be risk of expansion of the bubble inside the eye owing to the reduction in atmospheric pressure at high altitude; this can be extremely painful and lead to irreversible blindness. You must take this into account if you have booked or are planning holidays. Please do not forget to discuss this with Mr Stanga.
Mr Stanga sometimes utilises special silicon oil that "sinks" in the eye instead of floating (Heavy Silicon Oil); this sometimes reduces the need for posturing. Mr Stanga will discuss with you the best option for your eye condition. Please note that standard or heavy silicon oil usually requires a short removal operation, as it does not get reabsorbed.

Possible complications and side effects of vitrectomies include, but are not limited to, cataract formation, retinal detachment, glaucoma (increased pressure in the eye), hypotony (reduced pressure in the eye), damage to the retina, optic nerve or cornea (structures of the eye), bleeding and even subsequent loss of the eyeball.
Seventy percent (70%) of patients who undergo a vitrectomy develop a cataract therefore requiring further surgery at a later date. Cataract is the clouding of the normally clear lens in the front of the eye, which may be traumatised during surgery or affected by the silicone oil or gas, inserted at the time of the operation. It can be successfully removed in most cases.

There is also the possibility of an infection inside the eye (endophthalmitis).  You will receive eye drops with instructions on when to use them to reduce the possibility of this occurring.  Any of these rare complications may lead to severe, permanent loss of vision or blindness and in extreme cases, even loss of the eyeball. You may require to be admitted into hospital for treatment that could include, between others, further injections into the eye or surgery. The prognosis in such event is usually guarded.

You must immediately contact Mr Stanga or his team if any of the following signs of infection or other complications develop: pain, blurry or decreased vision, sensitivity to light, redness of the eye (compared to immediately after the operation), or discharge from the eye. You should not rub your eyes or swim until authorised by Mr Stanga or his team. Please keep all postoperative appointments or scheduled telephone calls so that Mr Stanga or his team can check for complications.

Mr Stanga or a member of his team will tell you about your eye medication including how often it needs to be used and for how long. A nurse will be available to show you how to put your eye drops in safely prior to you leaving the hospital. Always wash your hands before and after you put eye drops in to reduce the risk of infection. Avoid touching any part of your eye with the drops bottle to avoid its contamination or injury to the eye. Make sure the bottle lid is placed on a clean surface. For instilling drops, hold your head back and with the bottle in one hand and with the fingers of the other hand gently pull the lower eyelid to form a gap. Squeeze the bottle so that one or more drops go into the gap between the eyeball and the lower eyelid. Most patients find that the drops sting. Close your eye gently and keep it closed for approximately one minute and wipe away any drops that did not go into the eye with a clean tissue. If you are having more than one type of drop they will be appropriately labelled including the order they should be used in. Try to leave approximately three minutes between different drop types. Replace bottle lid immediately after use and store the drops as instructed. Always keep the eye clean. If the lids are sticky, clean them using cotton wool balls and cooled boiled water. If you lose or run out of your drops before the end of your treatment get more from your GP doctor. It is important that you continue to use your eye drops as prescribed. Once opened the drops can be kept for four weeks and then must be thrown away. Please get more drops from your GP doctor if you have been asked to continue applying them.
If you are posturing face down you should put drops in by turning your head to the side and then promptly resume your face down position again. You may find it useful to purchase a drop aid from your local chemist - which can assist you when putting your eye drops in.

Please do not use eye make-up for four weeks or until all redness has gone from your eye.

Please remember that you may bath, shower, shave and wash your hair but avoid getting soap into your eyes and keep your head in the correct position. Never put your head right back.

You may resume normal household and sexual activity once you are no longer required to posture and feel able to. Light housework is possible as long as you keep your head in the correct position. Avoid vacuuming, gardening, dusty environments and accept any offers of help from family and friends, if necessary. You may go out with friends and family, read, listen to music, play board games or watch television (using an angled mirror) once you feel well enough but again you must keep your head in the correct position and maintain the posturing regime.

It is usually normal for eyelids to appear swollen during the posturing period and this should subside in time. If you develop nausea, vomiting, sudden loss of vision or a reaction to your eye drops please contact Mr Stanga or a member of his team.

It is very important that all loaned posturing equipment/pillows are returned on time for other patients to use.

Please do not leave the hospital without an appointment to see Mr Stanga postoperatively.

When you can return to work or driving varies from one patient to another and will depend upon your vision. Please ask Mr Stanga or a member of his team to provide you with a sick note if needed.

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Please remember that each patient is different and the information here provided is only a general guide. If you require further advice or information please contact Mr Stanga or a member of his team.