VITRECTOMY

What is a Vitrectomy?

Vitrectomy is a procedure to remove some or all of the vitreous humour from the eye and replaces it with another solution.

Vitreous humour is a gel-like substance made of at least 98% water.

What Conditions Does the Vitrectomy Help?

Vitrectomy treats various problems with the retina and vitreous including:

Diabetic Vitreous Hemorrhage
Retinal Detachment
Epiretinal Membrane
Macular Hole
Proliferative Vitreoretinopathy
Endophthalmitis
Intraocular Foreign Body Removal
Retrieval Of Lens Nucleus Following Complicated Cataract Surgery

Why is the Vitrectomy Required?

The vitrectomy is required because you have one or more of the conditions above. These conditions need surgery or they will not get better.

Who is the Vitrectomy Suitable For?

Most patients are suitable for vitrectomy. Even if you have had a previous vitrectomy, sometimes another may be required.

Preparation Before the Vitrectomy

Preparation for Vitrectomy may involve:

Stopping medications before the procedure.
Not eating anything after midnight before your surgery.
Not using eye make-up the day of the surgery.

Ask your Ophthalmologist what specifically you should do before your surgery.

Day of the Vitrectomy

Your Ophthalmologist may want to use special instruments to shine a light in your eye and examine your retina prior to surgery.

Vitrectomy can take from one to several hours, depending on the severity. You may have the option to stay awake and use numbing drops or anaesthetic injections around your eye, or you might get general anesthesia.

On the day of your Vitrectomy expect the following steps:

Dilatation for your eye exam
Retinal ultrasound examination
Medication to help you relax
Anesthetic eye drops and injections to make sure you feel nothing

During a Vitrectomy procedure, the pathology e.g. Retinal Detachment or Macula Hole, is repaired from inside the eye.

The procedure involves:

Making small cuts in the sclera, the white part of your eye.
Placing the instruments into the eye.
Removing the vitreous gel, blood, any scar tissue or foreign material.
Repairing your eye as needed, such as Pan-Retinal Photocoagulation Laser Therapy to fix a tear in your retina.

Before finishing the procedure your eye doctor may:

inject a gas bubble into your eye to help keep your retina in place or
replace the vitreous with some other sort of fluid, like silicone oil or saline.

The gas bubble will then push back the retinal detachment into place. The bubble can also push the macular hole closed with a potential improvement in visual function.

At the end of your Vitrectomy your Ophthalmologist may:

Close your surgical incisions with stitches, but stitches are often unnecessary.
Add an antibiotic ointment on your eye to help prevent infection.
Cover your eye with a patch.

Scleral Buckle Surgery for Retinal Detachment

A variant of Vitrectomy is Scleral Buckle Surgery.This surgery can be used to close the retinal hole or break and flatten the retinal detachment.

The procedure uses a thin silicone band (scleral buckle) that is sutured in place around the outer circumference of the eye beneath the muscles that move the eye.

This is invisible once the eye has healed, and works by counteracting the force pulling the retina out of place.This allows the Detached Retina to settle back to its normal position against the wall of the eye.

A temporary gas bubble may be injected into the vitreous space inside the eye to keep the retinal tear closed against the wall of the eye.

Immediately After the Vitrectomy

You can expect some discomfort after surgery. Your ophthalmologist will prescribe eye drops for you and advise you when to resume normal activity.

Plan to have someone take you home after surgery.

Your eye will be red and sore and your vision will be blurry until the gas is gone, which can take up to three weeks.

Until you are told the gas bubble is gone you should avoid:

Travel by airplane
High altitudes.
Using nitrous oxide.

Where the vitreous gel is replaced with a gas bubble. Your body’s own fluids will gradually replace the gas bubble. This can take days or longer depending on the type of gas used.

In cases of advanced Retinal Detachment, where long-term pressure on the retina is required, silicone oil or heavy liquid may be used.

What Should I Expect After the Vitrectomy?

If a gas bubble was placed in your eye, you may be required to maintain a certain head position for several days in order for the gas to place pressure on the area of Retinal Detachment.

Until recently, patients undergoing Macular Hole surgery were required to spend up to two weeks after the operation in a face-down position. This is known as “posturing”, and it was thought to be essential for closure of the hole.

It was also very unpopular with patients! However, recent research suggests that prolonged posturing is unnecessary, and most surgeons now limit the amount of time a patient is required to spend face down to no more than a few days.

Stages of Recovery After the Vitrectomy

While the gas bubble is in the eye vision will be poor, and will only start to recover once the gas has reabsorbed, over the course of 2-3 weeks.

What are the Possible Risks of Vitrectomy?

Most people do well with their Vitrectomy, but complications do sometimes happen. Your risks may depend on your age, your medical conditions, and the specifics of your eye problem.

Haemorrhage and infection in the eye are rare but potentially serious complications, which may cause permanent loss of vision or even loss of the eye.

Over 90% of holes will close after a single surgery, however, a second operation is sometimes required. This may be due to scarring of the retina called proliferative Vitreoretinopathy (PVR). This scar may pull on the retina causing it to tear and re-detach. If the retina cannot be reattached, the eye will continue to lose sight and ultimately becomes blind.

Other risks of the procedure include: