Vitrectomy Surgery Definition
Vitrectomy surgery is an operation through which the vitreous humour (a clear transparent jelly inside the eye) is removed. Located behind the iris and the lens, the vitreous acts like a space filer inside the eye.
Vitrectomy surgery is usually done to treat the following conditions:
- Retinal detachment to retinal tears (‘rhegmatogenous retinal detachment’)
- Macular holes and epiretinal membranes
- Diabetic vitreous haemorrhage
- Tractional retinal detachments due to advanced diabetic eye disease
- Foreign body removal
- Removal of lens nucleus following complicated cataract surgery
- Proliferative vitreoretinopathy
Vitrectomy Surgery Procedure
The surgery is generally performed under local anaesthesia although a full general anaesthetic may sometimes be used, especially in the younger patient. Three tiny incisions are made for three separate instruments. The incisions are placed in the pars plana of the eye.
A light pipe, an infusion port and a vitrectomy-cutting device pass through these incisions. The light pipe is very much the same as a high-intensity microscopic light. The infusion port maintains proper pressure and the cutting device removes the gel or other offending tissue in a gentle manner. This ensures that there is no significant traction on the retina allowing it to settle back well into it’s natural position.
Depending on the reason of the surgery, the process can take about 1 to 2 hours. Once the jelly is removed, the retina is repaired and leaking blood vessels are sealed. Laser treatment or cryotherapy (freezing treatment) is often used to create adhesions between the retina and the underlying tissue.
After the surgery is completed, the eye may be filled with various materials such as:
- Gas bubble
- Transparent oil (Silicon oil)
The eye produces its own aqueous humour that will gradually fill the vitreous chamber once the air or gas bubble is absorbed. If silicon oil is used, it is usually removed at a secondary operation a few weeks to months after the primary procedure.
Vitrectomy Surgery Recovery & Expectations
The rate of recovery depends on numerous factors, the most essential of which is the preoperative condition for which the surgery was performed. The surgeon advices about what to expect and it's vital to understand the surgeon's advice. Within a few weeks, patients can return to their normal activities. Full recovery may take a few months.
- Eyes may remain swollen, sensitive and red for few days and there is a scratchy feeling or occasional sharp pain. Ice compresses may help reduce the soreness and redness diminishes over time.
- Patients are prescribed a combination of eye drops to guard against infection, reduce inflammation and rest the eye. In some cases, drops to lower pressure on the eye are also required.
- If gas bubble or oil has been inserted, patients are advised to position their head downwards for at least 7 to 10 days for about 50 minutes every hour.
Risks and Complications
Vitrectomy enjoys a good success rate and complications are unusual. Infection, progression of cataract, retinal detachments are some of the potential complications. Most patients undergoing a vitrectomy surgery will need a cataract surgery in the future. There are extremely rare chances of developing an inflammation in the un-operated eye after the procedure, a condition termed ‘sympathetic ophthalmia’.