Vitrectomy

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Vitrectomy

Within your eye, about 80% of the total volume is made up of the vitreous gel – or vitreous humor – which is a clear, jelly-like substance. The vitreous gel fills everything, except for the lens at the front of the eye and the retinal lining at the back, allowing it to maintain the eye’s shape. It also provides a clear space for light to pass through the lens to reach the retina, where they’re converted into nerve signals that are then sent to the brain, enabling you to see.

However, for certain retinal conditions, or if the retina is obstructed, it may be necessary to perform a vitrectomy. This minimally invasive procedure involves the removal of some or all of the vitreous gel from the back of the eye. Found to be a very safe and effective method to preserve and restore vision, the retinal specialists at Retina Consultants of Charleston have extensive experience in performing this procedure.

Overview of Vitrectomy Surgery

The actual vitrectomy procedure has multiple parts and may take anywhere from 45 minutes to 2 hours to complete, depending on the situation. It’s performed under sterile conditions in an operating room at a hospital or an ambulatory surgery center.

Vitrectomy Surgery, Step-by-Step

1. Before the procedure, you’ll probably be given local anesthetic and sedation, although general anesthesia may be necessary. Most likely, you won’t have any discomfort or unpleasant visual sensations during the surgery.
2. Your eye is carefully cleaned using antiseptics.
3. The eye is “draped,” as sterile coverings are placed around the eye.
4. A smooth wire speculum is placed to gently hold the eye open.
5. The surgeon uses very small (25-gauge) instruments to make three microscopic incisions (about 0.5 mm) through the sclera, the eye’s white part. These incisions, which reduce surgical invasiveness and improve outcomes, typically provide access for:

• A light to illuminate the inside of the eye
• Fluid to be slowly added to the eye, as needed
• A vitrectomy probe

6. Surgery is performed under a microscope, while a vitrectomy probe is used to carefully remove the vitreous gel under direct visualization. This probe cuts small pieces of vitreous and suction then removes the cut section.
7. Depending on the surgical type, other steps, such as fixing a retinal detachment or doing laser treatment, will be done after the vitrectomy is completed.
8. Sometimes, the vitreous will be replaced with another substance, such as air, gas, silicone oil, or a balanced saline solution. After a few days, this replacement is replaced with aqueous humor, naturally produced by your eye.
9. Your incisions are checked for any leaking. While stitches are usually unnecessary, occasionally, one may be needed to close an incision.
10. Antibiotic ointment is applied, and a patch and shield are placed over the eye.
11. After surgery, you’ll be observed in the post-operative area. Then, you can expect to go home.

When Is a Vitrectomy Recommended?

Retinal Interference

The vitreous gel provides a pathway for light to reach the retina. But should interference, such as opacities or cloudiness, obstruct this connection, your normal vision can be affected. For example, there may be interference due to:

• A displaced or dislodged intraocular lenses (IOLs), tiny, artificial lenses implanted to replace those removed during cataract surgery
• Autoimmune diseases affecting the eye
• Bleeding into the vitreous, resulting from trauma, high blood pressure, or diabetic retinopathy
• Cataract surgery complications
• Eye infections or inflammation
• Severe floaters

The vitrectomy procedure is sometimes performed to remove any obstruction that is interfering with your retina’s ability to perform its function properly.

Retinal Scar Tissue

We may recommend a vitrectomy in the event your vision is affected due to scar tissue displacing or tearing your retina. Removing the vitreous gel decreases the tension placed on your retina, providing your doctor with better access. This procedure is generally performed for the following concerns:

• Macular holes, breaks or tears in the macula, the retina’s central part that controls sharp, straight-ahead vision. Typically, they form naturally with aging, as the vitreous fluid shrinks, pulling on the retina.
• Epiretinal membranes (ERMs), also known as macular puckers. Found on the retina’s inner surface, these membranes are semi-translucent and avascular, meaning having few or no blood vessels.
• Lamellar holes of the macula (LMH), small partial-thickness macular defects
• Vitreomacular traction (VMT), in which the vitreous gel is unusually attached to the retina, causing macular edema, or swelling
• Retinal tears or detachments

Vitrectomy Recovery

You can generally expect to do well after the procedure, with little discomfort. A full recovery may take a week or more, depending on the procedure, and if a gas or silicone oil bubble was implanted. As your eye will be red and irritated, 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 down afterward, particularly for retinal detachments and macular holes. You should also avoid strenuous or high-impact physical activity for the first week after surgery. We recommend staying close to home for two weeks, so you’re nearby for follow-up exams. If you develop a gas bubble in your eye, you may have to avoid air travel, as this may lead to irreversible blindness. Fortunately, gas bubbles should disappear after a few days or months, depending on the type of gas.

Potential Vitrectomy Risks and Complications

We perform many vitrectomies, and these procedures have come a long way, offering an effective and safe way to restore vision. Your surgeon will discuss the procedure with you and your family. Rarely, you may experience such risks as:

• Retinal tears
• Retinal detachment
• Infection
• Scar tissue
• Cataract formation, which develops when you haven’t undergone prior cataract surgery

Of course, if you experience serious symptoms, such as significant pain or loss of vision, contact your retinal surgeon immediately.