(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
A patient who just underwent VR surgery may require very little attention afterward or may have to be monitored very closely for extended periods. If it is not the surgeon who follows the patient, the surgeon must at least make sure that the ophthalmologist who does the follow-up is competent and will refer the patient back to him if a serious issue arises.
If no serious complication occurred intraoperatively and none is expected postoperatively, the treatment is mostly anti-inflammatory; in this case a visit shortly after the surgery is needed, followed by another visit scheduled for a few weeks later and a final follow-up at 3–6 months.
The patient must always be advised about the possibility and symptoms of the most important complications and the need to seek help outside the normal follow-up routine if any symptom occurs.
If complications are present or expected, frequent follow-up visits should be scheduled.
Q&A
Q
Can PPV safely be performed on an outpatient basis?
A
In principle, yes. However, it requires a patient who has been properly informed about positioning, medications, and the consequences he will face if the instructions are not followed. It also requires at least one visit to the surgeon the day after surgery and a knowledgeable ophthalmologist who will follow the patient in his office.
In this chapter a brief summary is provided of the most common possible complications and their therapy (see Table 64.1).
Table 64.1
Postvitrectomy complications
Complication (sign or symptom) | Early (E) vs late (L)a presentation | Comment | Treatment |
|---|---|---|---|
Pain | E/L | E: corneal erosionb A lid speculum that was spread too wide. Extensive pulling on the extraocular musclesc Elevated IOPd Patients who underwent repeated surgeries, especially if these closely follow each other, experience more pain and irritation L: elevated IOP (see below) | Erosion: topical steroid is needed in the first 10 days; in addition: artificial tears, corneal gels, therapeutic contact lens, amniotic membrane. Especially if the erosion recurs, surgical intervention may be indicatede Elevated IOP: according to the etiology (see below) plus antiglaucoma drops, acetazolamide tablets, surgery |
Loss of visionf | E
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