Retinal surgery is outpatient and does not require a hospital stay. It is performed in an operating room urgently or electively based on the condition being treated. Before the surgery, your operative eye will be dilated. Once in the operating room, your eye will be sterilized with a 5% povidone-iodine solution and your entire body, from head to feet, will be covered with sterile drapes. Next, anesthesia will be applied around your eye for the surgery. Additional anesthesia via an intravenous access can be given as well for breakthrough pain or comfort. Alternatively, general anesthesia can be performed if you are a good candidate and cannot lay still/flat for the duration of surgery or are claustrophobic. Surgery is typically done inside the eye (called a vitrectomy), or from the outside, such as placement of a scleral buckle over the white part of your eye, cryotherapy or laser treatment. Occasionally, Dr. Tieu will do both a vitrectomy and scleral buckle placement during surgery to achieve the best results.
A vitrectomy is the most common surgery performed for retinal problems. In a vitrectomy (also known as a pars plana vitrectomy, abbreviated PPV), very small incisions are made on the white part of the eye for placement of tiny ports to gain access inside the eye. Through these ports, instruments are placed to help directly visualize the retina, remove the gel inside the eye, peel scar tissue and do whatever is needed with the goal of restoring vision and treating the retinal disease. At the end of a vitrectomy, sometimes a large gas bubble or silicone oil is left temporarily in the eye to achieve the appropriate healing process. You will have blurry vision until the gas dissipates on its own or the silicone oil is surgically removed. Very rarely, the oil can be left indefinitely to continuously stabilize the eye. It is typical to have some eye discomfort and bleeding over the white part of the eye after surgery. An over-the-counter analgesic, such as Tylenol, is most helpful for post-surgical eye pain.
Placement of a scleral buckle is done for some retinal detachments, like in very young individuals, those that result from a type of retinal tear called a dialysis, or when there is excessive scar tissue in the eye causing shortening of the retina. In this type of surgery, the skin over the white part of the eye is temporarily dissected off the eye and a silicone band (like a silicone ring for a finger) or a silicone sponge is placed on the surface of the eye to squeeze it. This helps bring the wall of the eye closer to the retina to help it reattach. The skin is then sutured back into place over the buckle, which is meant to be left permanently. Usually you will not be able to see the scleral buckle or notice it after the surgery. It is typical to have some eye discomfort and bleeding over the white part of the eye after surgery. An over-the-counter analgesic, such as Tylenol, is most helpful for post-surgical eye pain. Sometimes a short course of steroid treatment by mouth is prescribed to help control post-surgical swelling and inflammation.
Another common surgery performed by Dr. Tieu is special placement of an intraocular, plastic lens after complicated cataract surgery, where some of the cataract could not be safely removed and or a plastic lens could not be placed in the eye. Dr. Tieu can remove the residual cataract and sew in a plastic lens with long-lasting stitches anchored to the white part of your eye. If a plastic lens has already been placed inside the eye, but not in a good position, he can reposition it with or without sutures.