Vitrectomy

Overview  

A vitrectomy is a surgical procedure that involves the removal of the vitreous humor, a gel-like substance that fills the center of the eye. This procedure is commonly performed to address various eye conditions that affect vision, such as retinal detachment, macular holes, or complications related to diabetic retinopathy. 

During the surgery, the vitreous is carefully removed, providing the surgeon access to the retina, which is located at the back of the eye. The retina plays a critical role in vision by converting light into electrical signals that are sent to the brain. By removing the vitreous, the surgeon can make necessary repairs to the retina, such as sealing retinal tears or repositioning it if it has detached. 

Once the vitreous is removed, the eye is typically filled with a sterile saline solution, silicone oil, or a gas bubble to help maintain the eye’s shape and support the retina as it heals. The choice of replacement material depends on the specific condition being treated. Proper healing and vision recovery often require following post-surgical care instructions provided by the surgeon. [Text Wrapping Break] 

Types of vitrectomy  

The portion of your eye that is affected will determine the kind of vitrectomy you need.  

• Anterior vitrectomy: If you have vitreous leakage in the anterior segment of your eye, you might require an anterior vitrectomy. Your iris and lens are located in the anterior chamber, or the front portion of your eye. An anterior vitrectomy can be carried out by an ophthalmologist. A retina specialist could be required to perform a pars plana vitrectomy on your eye’s posterior chamber.  
• Posterior pars plana vitrectomy: Conditions affecting the rear (posterior) portion of your eye are treated with a posterior pars plana vitrectomy. The flat area of your eye’s ciliary body is called the pars plana. Your retina, choroid, sclera, and retinal pigment epithelium are located in the posterior. In addition, the vitreous cavity, which houses the vitreous, is located there.  

Reasons for undergoing the procedure  

A vitrectomy may be required for various eye conditions, especially those affecting the vitreous or retina. Common reasons include: 

• Retinal pulling or damage: Conditions that cause strain on or harm to the retina. 
• Vitreous cloudiness: Often due to vitreous hemorrhage or bleeding in the eye. 
• Drug or device delivery: To place therapeutic drugs or devices. 
• Difficult diagnoses: For eye conditions that are challenging to diagnose. 

Surgeons treat several retinal and macular conditions with vitrectomy, including: 

• Retinal detachment: When the retina pulls away from supporting tissue. 
• Macular hole: A hole in the center of the retina (macula). 
• Diabetes-related retinopathy: Abnormal growth and leakage of blood vessels in the retina. 
• Macular pucker: A wrinkle or crease in the macula. 
• Posterior vitreous detachment: When the vitreous gel pulls away from the retina. 
• Retinopathy of prematurity: Scar tissue forming from abnormal blood vessel growth in premature babies. 

Vitrectomy is also used for non-retinal conditions such as: 

• Eye injuries: Including scratches or punctures. 
• Endophthalmitis: A serious infection inside the eye. 
• Tumors: For biopsy or treatment of eye tumors. 
• Lens issues: To treat cataracts or dislocated lenses. 
• Drug delivery: For placing drugs like steroids, gene therapy, or antiviral medications. 

Risks  

There are dangers associated with any procedure. The following are potential dangers or issues with vitrectomy:  

• Bleeding.  
• Acquiring an infection.  
• Retinal tearing or detachment.  
• Getting a cataract that isn’t already there or having an existing one grow faster.  
• Experiencing low or high intraocular pressure.  
• Requiring more eye surgery.  
• Seldom, blindness or visual impairment.  

Before the procedure  

Your healthcare provider will advise you on when to stop eating, drinking, and taking your usual medications before surgery. You will need someone to drive you home, as most people are discharged on the same day. Additionally, an ultrasound may be done beforehand to help guide the placement of instruments during the procedure.  

During the procedure  

During the surgery, your doctor will continuously monitor your vital signs. To ensure comfort, your eye will be numbed with a local anesthetic, and you may also receive general anesthesia or IV sedation to help you sleep. An eye dilator will be used, and an eye speculum will keep your eye open throughout the procedure. The surgeon will make a small incision to remove the vitreous using specialized instruments, and if there are any leaking or problematic blood vessels, they may use a laser to address them.

Once the necessary repairs are made, your surgeon will replace the vitreous humor with silicone oil, a gas bubble, or sterile salt water. The duration of the surgery will depend on the complexity of the repair. More complicated procedures will take longer and may require extended recovery times, while simpler surgeries could be completed in about an hour.

After the procedure  

After a vitrectomy, you will spend some time in the recovery area before being discharged with detailed instructions from your surgeon. If a gas bubble or silicone oil is used during the procedure, you may need to maintain a face-down position for most of your recovery time. You’ll also leave the facility with an eye patch and prescribed medications like eye drops, along with clear guidelines on how and when to use them. Your provider will also inform you when you can resume any medications you had paused before the surgery. 

It’s crucial to follow the take-home instructions closely to ensure proper healing. You will need a driver to bring you to your next appointment, which typically occurs the day after surgery. Adhering to all post-surgery care instructions, including attending follow-up appointments, is essential for the success of your recovery.

Outcome  

You’ll need to take time off from work or school for about two to four weeks. It may take a few days or even weeks before you can drive, as you’ll need to ensure it’s safe to do so. 

Your healthcare team will guide you on how to properly hold your head while awake and how to sleep in a way that aids recovery. A neck pillow may be helpful for maintaining the correct position. 

Post-surgery care: 

• Eye sensations: Your eye may feel puffy or slightly irritated, with some redness and bruising. Be sure to use your prescribed medicated eye drops as directed. 
• Vision: Expect imperfect vision for a few days, but it will gradually improve over time. 

Special considerations: 

• If you have silicone oil in your eye: You might need a second surgery to remove it. 
• If saline or gas was used: Your eye will begin producing vitreous to replace the saline or gas. However, it can take several weeks for the gas bubble to dissipate. Initially, it may block much of your vision, but it will start clearing from the top down, and the edges might appear dark. 

If you have any concerns about your vision or recovery, don’t hesitate to call your healthcare provider.