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Vitrectomy Surgery

Vitrectomy Surgery

What is it?

The vitreous is a normally clear, gel-like fluid that fills the centre cavity of the eye. It makes up about 2/3 of the eye’s volume, providing a clear transparent space to see through. Certain problems affecting the back of the eye may require surgical removal of the vitreous. This is called a vitrectomy.

FIGURE 1: ANATOMY OF THE EYE
Eye Anatomy

 

 

What is Involved During a Vitrectomy?

Before a vitrectomy is performed the eye is anaesthetized; you are awake but your eye is completely numb. An anaesthetist is present and can give medication to combat anxiety or make you sleepy.

 

 

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Vitrectomy Surgery

An operating microscope is used to see the retina and other structures inside the eye.

Tiny incisions that are under a millimetre in length are made in the sclera (the white of the eye). Special instruments are then inserted through the incisions into the vitreous cavity. 

These instruments include:

  • a fibre optic light source to illuminate the inside of the eye
  • an infusion line to maintain the eye’s shape during surgery
  • instruments to cut and remove the vitreous
Vitreous is then removed and other procedures are performed as required to fully treat your condition.

Vitreous that has been removed from the eye is replaced with a clear salt solution; such fluid comprises 99% of the natural vitreous fluid; the part that makes it a gel is a very small part. It is then naturally replaced by the body over the course of several hours. In some cases, depending on exactly what your particular problem is, a special synthetic gas or silicone oil may be applied inside the eye. If synthetic gas is used it is absorbed over time and replaced with the eye’s natural fluid called aqueous. If silicone oil is used it may have to be removed at a later date but often can stay in long term.

The procedure usually takes about one hour; however, it may take longer or shorter than this depending on what other condition is present that requires treatment. Stitches are not normally required.

Cataract Removal: If a cataract is present, the surgeon may remove the cataract during the vitrectomy, but this will depend on the circumstances of your case.

What Eye Conditions Require a Vitrectomy?

Some of the most common eye conditions that require a vitrectomy are:

  • Diabetic retinopathy
  • Retinal detachment
  • Annoying Floaters
  • Macular hole
  • Epiretinal membrane
  • Vitreous haemorrhage

It is important to note that these conditions are all very different and the outcome depends on the underlying disease. For instance, removing annoying floaters is technically very straightforward and the recovery time is very quick; diabetic retinopathy, on the other hand, can be very severe and the vision may still be significantly limited even following successful surgery.

What Happens after a Vitrectomy?

You will be able to go home on the day of surgery (it is day stay surgery) and a patch will be placed over the eye. This is usually removed at the first post-operative visit the next day.

Antibiotic and anti-inflammatory drops will be given. You will also be given tablets for pain relief if you require them.

It is usual to have some discomfort but not pain for several days after surgery. Your eye may be red and there may be mild swelling around the eye.

Avoid bending, strenuous tasks or heavy lifting for one week after surgery, and don’t go swimming (especially without goggles) for six weeks following surgery.

Depending on the eye condition for which you were treated, you may be required to lie in a certain position for a period of time following the vitrectomy because you have gas in your eye. If intraocular gas has been used it is vital to avoid air travel for as long as there is gas in the eye (your surgeon will advise you how long this will be) because changes in air pressure can damage the eye. A red bracelet will also be given to you to wear to alert any other doctors to the fact that you have gas in your eye temporarily, as it may interfere with some anaesthetic agents.

How Long Does it Take for Vision to Recover?

This can vary from days to weeks and even months depending on the eye condition that was treated.

Possible Complications of Vitrectomy

As with all surgical procedures there are some risks associated with a vitrectomy, although the risks are small. Possible complications could include infection of the eye that may require treatment with antibiotics, bleeding that may require a reoperation, retinal detachment (which again requires reoperation) and complications related to the anaesthesia, whether local or general, although all these are rare. Although it is very rare, severe complications of surgery could cause blindness.

It is common for cataract to develop after a vitrectomy; especially if you are over the age of 50 years or already have early cataract; you may well develop a cataract that may require surgery at some point.