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Elevation and Retina Surgery

Among the many characteristics that make our state of Arizona unique is its variety of land elevations. For example, Yuma in the southwest sits only 163 feet above sea level. Elevation in the Phoenix Valley averages 1,000 feet above sea level, and height above sea level in our mountain regions, which include Flagstaff and Show Low, soars to at least 6,500 feet. While this variety of land elevations gives us our beautiful landscapes and a choice between valley and mountain living, it also poses a potential risk that anyone undergoing retina surgery needs to be aware of. To understand why, let’s back up a few steps.

The retina plays a key role in our ability to see. Located inside the back of the eye, it consists of multiple layers of specialized nerve cells. The cells sense the light that enters the eye and convert it to impulses that travel to the brain, resulting in the images we see. Like any part of the body, the retina is susceptible to certain conditions and diseases that, in some cases, may require surgery. To perform surgery of the retina, eye surgeons often rely on a procedure called a vitrectomy. During a vitrectomy, the jelly-like substance that fills the eye, called the vitreous, is removed. This gives the surgeon access to the parts of the retina he or she needs to fix. Once the surgical procedure is complete, it is necessary to keep the retina flat and in place so it can heal properly. One of the most effective ways to do this is to inject into the back of the eye a bubble of a medical-grade gas specifically designed for this purpose.

In order to keep the gas bubble, and therefore the retina, where it needs to be, post-surgery patients are usually instructed to keep their head in a certain position for several days. The body eventually absorbs the gas and replaces it with natural fluids. However, while the bubble is still in the eye, patients should not travel in an airplane or to a land elevation that is higher than the area where they had surgery. Either of these increases in altitude could cause depressurization of the gas bubble, which in turn would make it expand. Such an expansion can put excess pressure on the structures of the eye, leading to pain, damage and loss of vision. The vision loss can be permanent.

Because of this potential danger, it is best for patients whose retina surgery requires placement of a gas bubble to have the procedure done in a location at or very near the elevation at which he or she will reside postoperatively. This is easily accomplished if the surgeon has access to the necessary facilities in more than one location. If he or she only uses a surgery center in the Valley, for example, patients who live at higher elevations would have to travel to the Valley for surgery and make arrangements to remain there for their entire postoperative period. Instead, undergoing surgery close to home not only eliminates the risk of an expanding gas bubble upon returning home, but also is more convenient and less expensive.

Medical silicone oil is sometimes used as an alternative to a gas bubble for keeping the retina in place following surgery. This approach does not require travel restrictions. However, the oil does not dissolve on its own, which means a second surgical procedure is required to remove it once the retina is stable. Because a second surgery would introduce its own risks, inconvenience and expense, it is best avoided whenever possible.

Whether a gas bubble will be used as part of retina surgery and where the surgery will be performed are two very important issues that Northern Arizona patients and their eye doctors should discuss. FBN

 

Written by By Jordan Graff, M.D., Barnet Dulaney Perkins Eye Center.  New location at 350 N. Switzer Canyon Drive.  928-779-0500

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