A vitrectomy is a surgical procedure that removes the vitreous humour from the eye enabling your ophthalmologist the ability to treat numerous retinal conditions and prevent further vision loss.

The vitreous humour is a transparent gel which fills the back of the eye, behind the lens and in front of the retina. It is strongly anchored to the front of the eye and weakly attached to the optic nerve and retinal blood vessels at the back of the eye.

The vitreous can be replaced with saline solution or a gas bubble; both of which are naturally replaced by the eye's own clear fluid over time. Alternatively, some patients conditions will require silicone oil to be inserted into the eye to keep the retina attached; this will result in a secondary operation as the oil does not reabsorb into the body.

Vitrectomy surgery is used to treat many different retinal disorders including:

  • Proliferative diabetic retinopathy
  • Macular Hole
  • Epiretinal membrane
  • Retinal detachment
  • Traumatic eye injuries

Surgery is performed as an outpatient procedure under either a local or general anaesthetic. During a vitrectomy, the surgeon inserts small instruments into the eye, cuts the vitreous gel, and suctions it out. The fluid that has accumulated underneath the retina can be drained away and the surgeon may treat the retina with a laser (photocoagulation) or cryotherapy, cut or remove fibrous or scar tissue from the retina, flatten areas where the retina has become detached, or repair tears or holes in the retina or macula.

To replace the vitreous a gas bubble may be injected into the eye. This gas holds the retina in place whilst healing occurs. The gas dissolves after varying periods. Whilst the gas is in the eye it usually blocks vision quite substantially. In addition a person with gas in their eye may not travel to high altitude, nor may they fly. Vitrectomy with gas injection may also cause a cataract to form. Frequently the pressure of the eye may need to be controlled.

The operation will take a few hours due to the delicate microscopic procedure being under taken and the incisions in the sclera where the probe, light and instruments were inserted will self seal removing the need for sutures.

Sometimes it becomes necessary to do another or additional procedure called scleral buckling. In this technique a silicone strap is placed around the eye and tightened slightly. It alleviates the pulling forces on the retina and allows the retina to remain attached. Cryotherapy is used once fluid under the retina has been drained away and occasionally small gas bubbles are injected to help reattach the retina. The strap stays on the eye permanently like a splint. It is not visible nor is it felt by the patient. Scleral buckling possibly has a slightly higher rate of maintaining retinal reattachment than vitrectomy alone but typically it also results in the eye becoming shorter sighted than it was before. Vitrectomy and scleral buckling are often combined. Typically, an eye that has had a scleral buckle will be quite red and sore for a while and it may take up to 2-3 months for the eye to appear normal from the outside.

Some retinal detachments can be more severe. In these, scar tissue forms on the surface of the detached retina, tangling the retina. The surgeon will then need to dissect the scar tissue and apply laser, and do a scleral buckle. The eye will then be filled with gas or with liquid silicone, silicone oil. The silicone will be left inside the eye for periods up to 12 months but fortunately it is possible to see through it. Occasionally other special liquids are used either during or after surgery to help in reattaching the retina.

The main problem with retinal reattachment surgery is the risk of redetachment. Risks vary depending on the type of detachment. Overall, there is roughly a 95% chance of reattaching a retina with one operation but for more severe detachments this figure reduces sharply. There are occasional eyes in which even multiple operations do not result in a reattached retina.

Although vitrectomy procedures are sometimes performed through incisions made near the front of the eye, most vitreoretinal surgeons enter through a part of the eye known as the pars plana. This is why the procedure is often referred to as a trans pars plana vitrectomy (TPPV). Entering the eye through this location avoids damage to the retina and the crystalline lens.

Visual recovery after surgery varies greatly with each patient, dependant on the underlying condition requiring vitrectomy. Many factors contribute to good vision including the cornea, lens, and vitreous as well as the health of the retina and macula and optic nerve. If a gas bubble is present in the eye, a vision will be poor until the gas is reabsorbed.

Following vitrectomy surgery it may take some time for a patient's vision to reach their best vision. Despite increasingly advanced surgical techniques, it may not be possible to improve vision in some patients with severe retinal disease.

With the use of modern surgical techniques the risks of vitrectomy surgery is low; however, with any surgery, sporadic complications may occur. Infections or haemorrhage in the eye are potentially serious complications that can cause permanent vision loss if treatment is delayed. Retinal detachment may occur as a result of vitrectomy and may require additional surgery to correct. Cataract formation may occur in the operated eye or a possible increase in eye pressure may result. All of these rare complications will be discussed by your ophthalmologist and the best form of treatment path for your eye/s will be taken. Please do not hesitate to contact Dr Vote at the Launceston Eye Institute for further information or concerns you may have involved with vitrectomy surgery or retinal disease/disorders.


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