Welcome to the Vitreo- retinal emergency (VRE) clinic.
The vitreo-retinal emergency clinic provides urgent care for eye conditions affecting the vitreous humour and retina.
Retinal detachment - when the retina pulls away from the eye wall.
Vitreous haemorrhage - bleeding into the vitreous.
Traumatic injuries to the eye that may require surgery.
Complications arising from cataract surgery where parts of the lens has fallen into the back of the eye.
Retinal tears.
Please note the VRE Unit is NOT a walk in service and you will require a referral before being accepted for any assessment.
Our telephone number is 0207 566 2593.
The VRE clinic is a highly specialised service, which accepts referrals from all over the country. The length of time you wait for treatment will depend on how many patients need to be treated and the seriousness of your condition.
Because some patients need surgery on the same day that they are referred to the clinic, we cannot operate a first- come, first-served policy. If your condition can be treated by laser, you will need to wait until all patients have been seen and diagnosed. Most patients who require laser treatment will have their treatment in the afternoon.
Please speak to a nurse to see if you can return after 1:00pm.
The order of the operating list is decided by the priority of need for surgery, which can change throughout the day.
Everyone is referred as an ‘emergency’ – your surgeon will decide whether the operation needs to be done immediately, or whether it can wait. Moorfields is a day surgery hospital, so you should be discharged on the same day.
Patients can eat and drink as normal and take regular medications as usual. You will generally be able to travel home alone.
Patients can eat a light breakfast before 7am if their surgery is scheduled for a week day, but must fast from midnight if surgery is scheduled for a weekend or bank holiday. You will need to be escorted home and ensure that there is someone with you at home overnight after your operation.
More information on these will be given by the nurse in clinic.
Please take any medications as usual and bring your regular medications to the hospital with you.
We have created this video in the hope of improving your experience and aftercare following your retinal detachment surgery.
The aim of surgery is to reattach the retina and to save further vision loss. The main ways in which we repair the detached retina are as follows.
This is the most common way that we repair detached retinas. The vitreous gel is removed using tiny instruments, and a bubble of gas or air is inserted into your eye to hold the retina in place. Cryopexi, is freezing the area of retina to help it to reattach.
In this procedure, your surgeon fits and secures a piece of silicone or sponge onto your sclera. This is the tissue that you know as the whites of your eye. The buckle pushes into your eye and indents it. This pushes your retina back into the tissues that normally support it so it can reattach.
Factors in deciding which type of surgery you have include:
What condition your vitreous is in,
Whether or not you have your natural lens or an artificial lens implant, and
Whether you are able to hold your head in a certain position following your surgery.
Your surgeon will explain to you which type of surgery they're proposing to repair your retina, along with the risks and benefits for each type of surgery.
You will have your vision tested and eyes dilated, along with examination by the clinician in Vitro Retinal Emergency. They will advise you about your diagnosis and treatment options.
You will then have a pre-operative assessment with the nursing team to ensure that you are fit for surgery, and to identify any health or anaesthetic issues that may need action before your surgery.
Please remember to bring all your current medications with you following this, you will need to wait until your surgery slot. This is usually in the afternoon.
Please be advised that our emergency unit runs a theatre operating list in the afternoon, and it is not always possible to perform surgery for all of our patients on the same day.
If there is not any theatre space, you'll be sent home and called in by a clinician when there is space available on the operating list to do your retinal detachment surgery. You'll be given an information leaflet and a contact telephone number should you have any issues.
First, you will be checked into the operating theatre. Then you will be seen by the anaesthetist who will explain all anaesthetic options.
Most of these surgeries are done under local anaesthetic with mild sedation, which means your eye will go numb and you will be awake but relaxed. You will feel touch and pressure during an operation, but nothing painful.
Should you have any particular concerns regarding your anaesthetic, you can discuss these with your anaesthetist before your surgery. We have a range of information leaflets regarding the anaesthetic types, which are available to read in the waiting room before your surgery.
After your surgery is complete, you will be taking to the wards for recovery. Relatives can stay in the waiting area until 7pm
In most cases, you will be asked to posture after your surgery. Your clinical team will instruct you how to hold your head and body, and for how long, after your surgery.
This is to ensure the gas or air bubble floats against the damaged retina in order to support and reattach the retina following your surgery.
There are several ways that you may be asked to posture depending on which area of the retina is detached. Again, you will be advised by your clinician which position you may need to be in, and for how long. It is usually five days with a break of ten minutes every hour.
You may be asked to posture in the face down position over a table using a simple travel cushion to support your head.
There are several online facedown cushion supports that can be purchased if you Google “face down posturing pillow after retinal detachments”.
You can also posture face down, lying down in your bed with the bed mattress pulled down to allow the posture pillow to fit or lie right over the edge of your bed, facing downwards.
You may be asked to posture in the upright position.
You may be asked to posture on your right or left cheek to pillow or alternating between sides. You can do this either sitting or lying on your bed.
It is really important to keep moving during your ten minute break from your posturing position. This is to ensure you reduce the risk of clots forming and neck and backache. This ten minute break is also for your food, showering and bathing.
You will have drops to put in after your surgery, usually to prevent infection and inflammation in your eye. Please ensure you follow the drop regime and wash your hands before and afterwards to avoid infection.
In time, the gas bubble will reduce in size each day.
Your vision will be very blurry when the gas bubble is initially very large. Then you may see a spirit level across your vision. Your gas bubble will eventually disappear.
Your ward discharge nurse will provide you with a special gas braces that tells you how long the gas bubble will last for.
Remember, no flying or high-altitude train or car journeys as sudden changes in air pressure can cause the gas bubble to expand and cause raised intraocular pressure with severe pain and potentially permanent vision loss.
Always inform any medical team that you have a gas bubble in your eye should they be considering general anaesthesia.
Continue to posture as instructed.
Use all of the eye drops that have been prescribed for you.
Bathe the eye in cool boiled water, if there is a little sticky discharge in the morning.
Keep you planned post operative appointment
Ensure you move around during your 10 minute posturing break
Come to accident and emergency if you have severe pain, flashing lights, shadows or curtains across your vision
Perform strenuous exercise.
Rub your eye.
Forget to put in your eye drops
Work for two (2) weeks after surgery
Forget to keep hydrated and eat healthily to promote recovery and well-being
Wait if you have a lot of pain or loss of vision – if in doubt check it out!
We hope this video has been informative and has reassured you about your upcoming procedure. Thank you for watching.