AIR BUBBLES
I will frequently leave some air in the eye at the end of Vitrectomy surgery. I do this for two main reasons. The first is that I want to ensure the wounds in your eye are sealed at the end of the procedure. If you have a small puncture in an inner tube you pump it up and put it under water. I am doing the same thing! It is easy to see the wounds bubbling and that lets me know they are leaking. If they do not stop after some pressure I will put a suture in the wound. I do this very rarely (less than 1%). The second reason is less important but the bubble may aid sealing through surface tension and preventing fluid leaking.
In this situation you will have a grey/ dark area bobbling around at the bottom of your vision and it usually gets even smaller and rounder over a few days and then disappears. If you lay on your side it quickly moves. The bubble always goes to the top and as everything is upside down you see it always at the bottom.
Sometimes I will fill the eye with air. I will often do this when removing oil to try to get all the oil out, in patients with diabetes and when I have had to treat the retina with laser or freezing as a result of tear in the retina during surgery. In this situation you will have very little sight on day 1 and then the shadow gets smaller, rounder and lower over a week. Patients with diabetes have poor blood supply to the eye and as a result the bubble will often last longer than 1 week. Again it will always go to the top of the eye and so move quickly as you tilt your head and always appears to you at the bottom.
IMPORTANT:
1.YOU CANNOT SEE THROUGH AIR
2. YOU CANNOT FLY WITH AIR IN THE EYE
GAS BUBBLES
Sometimes I will use gas. This behaves the same as air but lasts longer. I use gas when there has been a retinal detachment andwhen there is a macular hole. Like air (which is a gas!) the same thing will happen with vision but it disappears more slowly. In general I use a 2 week gas, 5 week gas and an 8 week gas. The time represents how long it takes for the gas to completely disappear.
IMPORTANT:
1.YOU CANNOT SEE THROUGH GAS
2. YOU CANNOT FLY WITH GAS IN THE EYE
2. THE BUBBLE ALWAYS GETS SMALLER, ROUNDER AND LOWER WITH TIME AND NO NEW SHADOWS SHOULD APPEAR ABOVE THE BUBBLE
Sometimes the bubble develops 'friends!' and so do not worry if one bubble becomes several.
IMPORTANT:
AT NO POINT SHOULD A NEW SHADOW APPEAR ABOVE THE BUBBLE. IF THIS HAPPENS YOUR RETINA MAY BE DETACHING SO GET HELP AS SOON AS POSSIBLE.
OIL
If I use oil in the eye you will find that the vision is very blurred unless you are very shortsighted as the oil makes you very long sighted. There is no shadow or bubble in this case but vision is just blurred. I use oil when I am 'planning for failure'. This sounds odd but there are cases where the retina scars and I know this process will take some time to settle down. Oil provides support for the inside of the eye as it continues to scar, protecting the delicate central part of the retina, the fovea, which is the only part of the eye we can see detail with. Oil is also used in complex detachments and trauma. Another good reason for oil is it allows me to leave the patient alone! In complex redetachments the patient may have had several procedures and oil allows some breathing space for the patient to recover and settle both physically and psychologically. Oil allows the patient to live a fairly normal life and to fly. When all has settled the oil is removed but there are situations where it may be best to leave the oil in long term. Oil is removed in a similar operation to the vitrectomy operations discussed but is generally a much shorter procedure. It is very common to have small bubbles of oil that remain in the eye and float around. Although I do my best to get all the oil out by washing several times with air, some will remain as small floaters.