Vitrectomy is a surgical treatment for various retinal and vitreous disorders. The retina is the light-sensitive nerve layer on the inner back wall of the eyeball. It receives object/image signals and transits the visual information to the brain through the optic nerve. The vitreous is the gel-like material that occupies the middle cavity of the eye, and light passes through it to reach the retina.
Retinal and vitreous abnormalities can block light reception and affect vision. Vitrectomy is useful in conditions, such as:
- Severe eye trauma
- Retinal detachment
- Diabetic retinopathy
- Vitreous hemorrhage
- Inner eye infection (endophthalmitis)
- Certain post-cataract surgery anomalies
- Tear or hole in the center of the retina (macula)
- Creases or wrinkles in the macula
These abnormalities can cause loss of vision, and without treatment, some of them can lead to blindness. Vitrectomy is a viable treatment option and can restore lost vision in some cases.
- Anterior vitrectomy
- Posterior/pars plana vitrectomy
Before the Procedure
During the consultations, the surgeon will establish the complete medical and surgical history of the patient. The patient must inform the doctor if they have a medical condition and all the prescription medicines, counter drugs and supplements they take. S/he may need to discontinue some of the medication because it can cause complications during or after the operation. S/he will perform a thorough eye examination, which may include physical check, visual acuity test, slit-lamp evaluation and imaging tests, such as ultrasound, OCT and MRI scans.
The patient can ask the doctor what they wish to know about the surgery, including preparations. Usually, the patient needs to fast for some hours before the operation. The patient should also arrange transportation or come with someone to drive them home after the surgery.
Vitrectomy is an outpatient procedure conducted in an eye surgeon's office or an outpatient surgery center under local or general anesthesia. The details of the process may vary somewhat, and so it can last from one to several hours. In general, after the medication takes effect, the surgeon makes a small cut on the edge of the white part of the eye and uses a treatment lens to see inside the eye. S/he uses tiny instruments to remove the cloudy vitreous, cataract, foreign material, or scar tissue.
The surgeon then makes the necessary repairs, such as repositioning the retina on the back wall or sealing a macular hole/tear. S/he may inject a gas bubble into the eye to keep the retina in place. S/he replaces the vitreous with fluid, such as saline or silicone oil, and may close the surgical cuts with stitches. Often, the stitches are unnecessary, s/he places an antibiotic ointment on the eye to help prevent infection and covers it with a patch.
After the surgery, the patient is monitored in the recovery room before they are allowed to go home.
Risks & Complications
Vitrectomy is a relatively safe procedure, and the occasional risks include:
- Vision loss
- Lens damage
- Double vision
- Cataract formation
- Night vision impairment
- Loss of depth perception
- Change in refractive error
The patient may experience increased sensitivity to light, soreness, mild headache and blurred vision for some hours after the treatment.
Complications associated with the treatment are rare and are more likely to arise in immune-compromised individuals and patients with a history of eye surgery or eye disease. The complications may include:
- Retinal detachment
- Eye movement disorders
- A repeat procedure due to an unsuccessful redress of the original problem
After Care & Recovery
The surgeon will prescribe medication to prevent infection and give aftercare guidelines. The patient should see the doctor for follow-up within 36 hours. S/he will assess the result of the surgery, recovery progress, and schedule follow-ups. To avoid complications, the patient must follow the specific instructions given by the doctor. For example, the patient must wear an eye patch to protect the eye for a day or two. If there is a gas bubble in the eye, the patient must remain in a facedown or other specified position for a given period. It helps to keep the bubble in place until it's absorbed. The patient must also avoid activities that can raise eye pressure, such as reading, driving, intense exercise, heavy lifting, mountain climbing, scuba diving, air travel, etc. Complete healing takes between four weeks and a few months.
The patient should urgently contact the doctor if they experience decreasing vision, eye discharge, redness, increasing pain, swelling around the eye, or floaters or flashes of light.
According to the American Society of Retina Specialists (ASRS), vitrectomy is successful in over 90 percent of the cases.