What are the post-operative care instructions for a patient after a left eye vitrectomy for epiretinal membrane?

Post-Operative Care After Left Eye Vitrectomy for Epiretinal Membrane

Patients must be examined on postoperative day 1 and again at 1-2 weeks following vitrectomy for epiretinal membrane, with earlier visits required if complications arise. 1

Immediate Post-Operative Follow-Up Schedule

• Day 1 examination is mandatory to assess for early complications 1
• 1-2 week follow-up is standard unless complications necessitate earlier evaluation 1
• Earlier or more frequent visits are required if any of the following develop: 1, 2
  • High or low intraocular pressure (IOP)
  • Wound leak
  • Pain
  • Worsening vision
  • Any concern for retinal complications

Essential Components of Each Post-Operative Examination

Every follow-up visit must include: 1

• Interval history focusing on new symptoms 1
• IOP measurement to detect secondary glaucoma or hypotony 1, 2
• Slit-lamp biomicroscopy of anterior segment, wound sites, and central retina 1
• Indirect binocular ophthalmoscopy of the peripheral retina to detect retinal breaks or detachment 1, 2

Critical Patient Education and Counseling

Patients must be counseled on the following before discharge: 1

Postoperative Medication Use

• Review proper administration and schedule of prescribed eye drops 1

Warning Signs Requiring Immediate Contact

Instruct patients to notify you immediately if they experience: 1, 2

• Increase in floaters
• Loss of visual field
• Flashes of light (photopsias)
• Decrease in visual acuity
• New onset of pain or redness

Retinal Detachment Education

• Counsel specifically on signs and symptoms of retinal detachment, as this occurs in approximately 1% of 23-gauge vitrectomies and 3.5% of 20-gauge procedures 1

Gas Precautions (If Applicable)

• If intraocular gas was used, provide specific positioning instructions and aviation/altitude restrictions 1

Expected Visual Recovery and Complications

Visual Outcomes

• Most patients improve by 2-3 lines of vision (mean improvement of 0.31 log units) 1, 3
• 83% experience reduced metamorphopsia postoperatively 1
• Visual recovery continues for up to 12 months, with improvement noted at 3 months and further gains by 12 months 1
• 16% may have unchanged visual acuity, and approximately 1% may experience worse vision 3

Common Complications to Monitor

Cataract Formation (Most Common):

• The majority of phakic patients develop progressive nuclear cataract following vitrectomy 1
• This occurs in approximately 52% of phakic eyes postoperatively 3

Retinal Complications (Less Common but Serious):

• Retinal breaks: approximately 1% incidence with 23-gauge systems 1
• Retinal detachment: 1% with 23-gauge, 3.5% with 20-gauge vitrectomy 1
• These complications have decreased with smaller-gauge instruments and improved peripheral vitreous management 1

Endophthalmitis (Rare):

• Reported in less than 0.05% of vitrectomies 1

IOP Management Considerations

• Monitor for both elevated and decreased IOP, particularly in patients with pre-existing glaucoma 1
• IOP abnormalities are a primary reason for earlier or more frequent follow-up 1, 2

Long-Term Monitoring

• Continue follow-up beyond the initial 1-2 weeks to monitor for delayed complications, particularly cataract progression and late retinal detachment 1
• Quality of life improvements correlate strongly with reduction in metamorphopsia rather than visual acuity alone 4