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5 The VR Surgeon’s Relation to His Patient: Counseling

Dogma

Comment

If you had VR surgery, do not lift objects

Would the scleral wound rupture or a VH occur?

heavier than 5 kg

And why would the limit be 5 kg? What

needs to be discussed with the patient is the

risk associated with Valsalva maneuvers

If you have high myopia, you must have

Would straining during vaginal delivery cause a

cesarean delivery

retinal tear and then RD?

If you have a corneal erosion, do not use

True after the first week, but during the first days

topical steroids

postoperatively, the beneficial effects of the

steroids far outweigh any potential risk

Your other eye is okay; therefore it is unwise

May be a valid argument if someone could

for you to suffer through a difficult

guaranty that the fellow eye’s condition will

operation with poor prognosis in the

never worsen. If something happens to that

affected eye

eye in the futurea, it may then be too late to

save any vision in the affected eye

Because of the risk of sympathetic

The risk of sympathetic ophthalmia mandates

ophthalmia, we should instantly remove

extensive counseling, not enucleationb

your injured eye

Your eye is getting smaller, the best option is

This is a cosmetic issue, and the decision is up

to remove it now

to the patient

We will wait with the operation until your

So that the prognosis is also likely to get worse

vision is (much) worse

Let’s go ahead and remove the IOFB now,

IOFB removal is not the goal of the surgery; it is

and we can decide later, based on what

part of a comprehensive procedure to deal

happens in the eye, whether we need to

with the mechanical injuries the IFB caused

do a second operation for the damage

caused by the IOFB

Unless your retina detaches, and we’ll see

Why risk an RD when removal of the VH is

this on ultrasonography, let’s wait

likely to prevent RD development, restore

3 months until we decide whether to

your vision instantly, and is a very low-risk

remove the blood from your vitreous

procedure? And if wait, why 3 months?

We will remove the blood from your vitreous

In other words, we will wait until PVR starts to

when we see on ultrasonography that the

develop

tissue starts to organize