Vitrectomy

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Vitrectomy

A vitrectomy is a surgical procedure commonly performed for various retinal conditions. With this operation, a surgeon removes the vitreous gel (also known as vitreous humor) from the back of the eye.

This clear, jelly-like gel is the eye’s largest structure, making up about 80 percent of the total volume. Responsible for maintaining the eye’s shape, vitreous gel fills everything, except for the lens at the front and the retinal lining at the back. It also provides a clear space for light to pass through to reach the retina. This is important, as the retina converts light and images into nerve signals sent to the brain.

• Performing Vitrectomies for Retinal Interference

  Certain problems can interfere with the vitreous gel’s ability to allow light to connect with the retina. You may then develop opacities or cloudiness that interferes with your normally clear vitreous, impacting your vision. Examples may include:

  • Bleeding into the vitreous, due to trauma or conditions like diabetic retinopathy and high blood pressure
  • Cataract surgery complications
  • Dislodged or displaced intraocular lens (IOL), tiny, artificial lenses implanted to replace those removed during cataract surgery
  • Eye infections
  • Inflammatory or autoimmune diseases affecting the eye
  • Severe floaters

• Performing Vitrectomies for Conditions with Scar Tissue

  A vitrectomy may be required when scar tissue displaces or tears your retina, which can impair vision. By removing the vitreous, your doctor gains better access to your retina, decreasing the tension placed on it. Vitrectomies are performed for such conditions as:

  • Macular holes
  • Epiretinal membranes (ERMs, or macular puckers ), avascular (few or no blood vessels), semi-translucent membranes on the retina’s inner surface
  • Lamellar holes of the macula (LMH), small partial-thickness defects affecting the macula, the retina’s central part, which controls sharp, straight-ahead vision
  • Vitreomacular traction (VMT), in which the vitreous is unusually attached to the retina, causing macular edema (swelling)
  • Retinal tears or detachments

What Does the Vitrectomy Procedure Entail?

Vitrectomy surgery can have multiple parts. The procedure may take anywhere from 45 minutes to 2 hours, depending on the need for complicated retinal detachments. Before the procedure, your eye is carefully cleaned with antiseptics. Next, sterile coverings are placed around the eye, and a smooth wire speculum is placed to gently hold the eye open.

For the procedure, your surgeon uses very small (25-gauge) instruments to enter through the sclera (the white part in the back of the eye). Tiny incisions (less than 1.8 mm) are made, reducing surgical invasiveness and improving outcomes. Your surgeon will remove the majority of the vitreous, replacing it with sterile saline. Three microscopic incisions (about 0.5 mm each) are made through the sclera, providing access for:

1. Light to help visualize the inside of the eye
2. Fluid to be slowly added to the eye as needed
3. A vitrectomy probe, which carefully removes the vitreous gel

Surgery is performed under a microscope. The vitrectomy probe then cuts small vitreous pieces, which are removed with suction. These incisions are checked for any leaking; while you may need stitches, they’re usually unnecessary.

Once the vitreous gel’s been removed, the surgeon may then perform any other necessary procedures, such as removing scar tissue and repairing retinal detachments or macular holes. The surgical team may then inject a substance — balanced saline solution, gas, air, or silicone oil — into the vitreous gel to help keep the retina in its proper position. After a few days, it’s replaced with aqueous humor, which is produced by your eye.

Following the procedure, antibiotic ointment will be applied and a patch and shield are placed over the eye. After being observed in the post-operative area, you can go home.

• Am I awake for a vitrectomy?

  Patients are typically awake during the vitrectomy procedure. Rest assured, you should expect no discomfort or unpleasant visual sensations during the procedure. Your eyes will remain open, and while you can speak, you should only do so if necessary. While your forehead will be secured with tape to minimize head movement, try not to move your head, eyes, or body. Once finished, the surgeon will remove the drapes and patch your eye closed.

• Is anesthesia used for the procedure?

  In most cases, vitrectomies don’t require local anesthesia, but your surgeon will use an anesthetic around your eye, while an anesthesiologist administers intravenous medication. This ensures total comfort during the procedure, as you won’t feel any pain.

What is the Recovery Process Like?

Typically, we find that most vitrectomy patients do well, with little discomfort after the procedure. You may need a week or more for a full recovery, or even longer, depending on your procedure, and if a gas or silicone oil bubble was used. As your eye will be red and irritated, you’ll have to administer antibiotic eye drops for a few days. You’ll probably also have to use a mild steroid eye drop for three weeks.

Special post-surgical positioning, such as keeping your head down, may be necessary, particularly for retinal detachments and macular holes. If so, we’ll provide specific instructions. You’ll also want to avoid any strenuous or high-impact physical activity for the first week after surgery.

We recommend that you stay close to home for two weeks after surgery, so you’re nearby for follow-up exams. If your eye has a gas bubble, avoid air travel, until it goes away. Air travel can cause irreversible blindness if a gas bubble’s in place. The good news is that a gas bubble always goes away, although it could take a few days or even months, depending on the type of gas.

Risks and Complications of Vitrectomies

Vitrectomies are an effective and safe way to restore vision, but it’s still surgery, and there are (rare) risks. Your surgeon will discuss the procedure with you and your family. Among the potential risks are:

• Retinal Tears
• Retinal Detachment
• Infection
• Scar tissue formation
• Cataract formation (in patients without prior cataract surgery)

If you experience significant pain, loss of vision, or any concerning symptoms, you should contact your retinal surgeon immediately.