What is VITRECTOMY?
The vitreous is normally a clear, gel-like substance that fills the centre of the eye. It makes up approximately 2/3 of the eye’s volume and is important for the growth of the eye before birth. Certain problems affecting the back of the eye may require a vitrectomy, which is the surgical removal of the vitreous. After vitrectomy, the vitreous is replaced by natural aqueous and nutritive fluids of the eye.
What are the indications for vitrectomy?
Vitrectomy may be performed to clear blood and debris from the eye; to remove scar tissue, or to alleviate traction on the retina. Blood, inflammatory cells, debris, and scar tissue obscure light as it passes through the eye to the retina, resulting in blurred vision. The vitreous is also removed if it is pulling or tugging the retina from its normal position. Some of the most common eye conditions that require vitrectomy include:
- Complications from diabetic retinopathy such as retinal detachment or bleeding
- Macular Hole
- Retinal Detachment
- Epiretinal Membranes
- Bleeding inside the eye (vitreous haemorrhage)
- Injury or infection
- Certain problems related to previous eye surgery
How is vitrectomy performed?
Vitrectomy is normally performed as an outpatient procedure and under local anaesthesia. If you have concerns about having local anaesthesia or you live alone, then feel free to discuss the situation with your doctor.
The procedure involves inserting 3 tiny ports into the white of the eye. Each port is less that 2 mm in diameter. One port is dedicated for infusion of fluid into the eye to maintain constant eye pressure. Next port for a light source and the third to insert a cutting device to remove the vitreous. The surgeon will use a microscope to view the eye whilst performing the procedure. After the vitreous is removed, the surgeon will perform any retinal surgery or other steps necessary to achieve the aims of the operation. At the end of the operation, the eye will be refilled with one of the following substitutes depending on your condition:
- Special saline solution that closely resembles the natural vitreous fluid in your eye.
- Gas or filtered air to keep the retina supported. This may remain in the eye at predetermined durations depending on the type of gas used. Your surgeon will advise you on that.
- Silicone oil to support the retina. This usually requires removal with surgery at a later date.
An antibiotic and steroid injection will be given at the end of the procedure. The entire surgery may take between 30 minutes to 2 hours depending on its complexity.
What are the risks of vitrectomy?
Like any operation on the eye, there are certain risks involved and they include:
- Bleeding inside the eye
- Cataract formation or progression
- Raised eye pressure
- Retinal tears and detachment
- Blindness or loss of vision (extremely rare)
- Need for additional treatment and/or surgery
What to expect after vitrectomy?
You will have a patch over the eye. It is best to leave the patch on until the next morning. You may remove the patch and clean the eye with a clean gauze or cotton wool and clean water from the kettle boiled the night before.
Expect your eye to be sensitive, red and swollen for few days after the surgery. Scratchy feeling or occasional sharp pain is normal. You may take a Paracetamol or Ibuprofen if you cannot tolerate the pain. If gas or oil is inserted into the eye, your surgeon will give you instructions on how to posture after the operation. If gas is inserted into your eye, you are not allowed to travel by air as the gas bubble will expand in the airplane and this can lead to a rise in eye pressure. You will be given eye drops to use the day following the surgery and sometimes a short course of tablets. Wear the plastic shield when sleeping for the first 7 days following surgery. Avoid strenuous activity for one week or so as instructed by your surgeon.
“I shut my eyes and all the world drops dead; I lift my eyes and all is born again.” Sylvia Plath