Vitrectomy

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Vitrectomy

A vitrectomy is a surgical procedure, in which some or all of the eye’s vitreous is removed from the back of the eye. Doing so provides surgeons with unobstructed access to the retina and nearby parts. Typically, a vitrectomy is performed in situations interfering with retinal function or those involving retinal scar tissue. Minimally invasive, safe, and effective, this procedure usually has little pain and discomfort. And depending on the condition, additional procedures may be performed in conjunction.

Why Would A Vitrectomy Be Necessary?

With a vitrectomy, a surgeon removes part, or all of your eye’s vitreous from the eye’s back region. Also known as the vitreous gel or humor, this clear, jelly-like gel fills about 80 percent of the eye’s total volume, everything but the front lens and the retinal lining at the back. The vitreous is responsible for maintaining the eye’s shape, and for providing clear access for light to reach the retina, enabling you to see. The vitreous is typically removed due to conditions involving retinal interference or scarring.

Retinal Interference

It is possible for interference, such as opacities or cloudiness, to obstruct the vitreous’ clear pathway for light to reach the retina, which can affect your normal vision. If so, a vitrectomy may be performed to remove the causes of the interference, such as:

• Displaced or dislodged intraocular lenses (IOLs), which are tiny, artificial lenses implanted to replace those removed during cataract surgery
• Autoimmune diseases affecting the eye
• Vitreous bleeding, resulting from such causes as trauma, high blood pressure, or diabetic retinopathy
• Cataract surgery complications
• Eye infections or inflammation
• Severe eye floaters

Retinal Scar Tissue

The normal aging process causes the vitreous to shrink, pulling on the retina in the process. Should scar tissue develop and accumulate, a vitrectomy may be necessary, as the retina can be displaced or torn. By removing part or all of the vitreous, surgeons can reduce the retinal tension, gaining better access to the retina and neighboring components. Among the conditions in which a vitrectomy may remove scar tissue are:

• Macular holes, breaks or tears in the macula, the retina’s central part that controls sharp, straight-ahead vision.
• Macular puckers, or epiretinal membranes, are semi-translucent, avascular (having few or no blood vessels) membranes on the retina’s inner surface.
• Lamellar holes of the macula (LMH), small partial-thickness macular defects.
• Vitreomacular traction (VMT), in which the vitreous is unusually attached to the retina, causing macular edema (swelling).
• Retinal tears, where the retina peels off the back wall, or retinal detachments, in which the entire retina moves out of its proper position.

The Vitrectomy Surgery, In Detail

Generally, a vitrectomy takes anywhere from 45 minutes to 2 hours to complete. It has multiple parts, and additional procedures may be completed. In most cases, a vitrectomy is performed under sterile conditions, in an operating room, either at a hospital or ambulatory surgery center.

Will I Be Asleep For The Procedure?

You will be given anesthesia of some kind, to ensure comfort and eliminate any pain and discomfort. This could be either local or general anesthesia, putting you to sleep. Your surgeon may also just use an anesthetic around your eye, with an anesthesiologist administering intravenous medication. In this case, your eyes will remain open, and you should only speak if necessary. Your forehead will be secured with tape to minimize head movement, so try to remain still.

A Vitrectomy, Step By Step

• Your eye is carefully cleaned using antiseptics.
• The eye is “draped,” as sterile coverings are placed around the eye. They’ll be removed at the procedure’s completion.
• A smooth wire speculum is placed to gently hold the eye open.
• The surgeon uses tiny (25-gauge) instruments to make three microscopic incisions (about 0.5 mm) through the sclera, the eye’s white part. These incisions reduce surgical invasiveness and improve outcomes. They also allow access for a light to illuminate the eye’s interior, and fluid to be slowly added to the eye, as needed. The surgeon uses a vitrectomy probe to carefully remove the vitreous, cutting it into small pieces, and then, removing it with suction.
• Once the vitrectomy is completed, a surgeon may perform other procedures, such as repairing a retinal detachment or using laser treatment.
• Your incisions are checked for any leaks. Generally, stitches are unnecessary, but occasionally, one may be given to close an incision.
• Antibiotic ointment is applied, and a patch and shield are placed over the eye.
• Afterward, you’ll be observed in the post-operative area. You can then go home.

During the procedure, your vitreous may need to be replaced with another substance, like air, gas, silicone oil, or a balanced saline solution. After a few days, this is replaced with aqueous humor, a fluid naturally produced by your eye.

• What Is The Vitrectomy Recovery Process Like?

  Following the surgery, you should do well, with little discomfort. A full recovery may take a week or more, depending on the procedures performed, and the type of bubble implanted. It is recommended that you stay close to home for two weeks, for follow-up exams. Here is additional information:

  • Your eye will be red and irritated, so you’ll have to administer antibiotic eye drops for a few days and mild steroid eye drops for three weeks.
  • You may have to keep your head in a downward position, particularly if retinal detachment or macular hole procedures were performed.
  • You should avoid strenuous, high-impact physical activity for one week.
  • You may have to avoid air travel if a gas bubble develops in your eye to prevent blindness. They usually disappear after a few days or months, depending on the type of gas.

• Are There Any Risks With A Vitrectomy?

  A vitrectomy is a safe, effective method to restore and preserve vision. However, it is still surgery, and rarely, there may be risks. Your retinal surgeon will discuss the procedure with you and your family. Among the potential risks are:

  • Retinal tears or detachment
  • Infection
  • Scar tissue
  • Cataract formation (in patients without prior cataract surgery)

  Should you experience serious symptoms, such as significant pain or loss of vision, alert your retinal surgeon immediately.