Vitrectomy

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Vitrectomy

Within your eye, a clear, jelly-like substance known as the vitreous (also called vitreous gel or humor) is the largest structure, filling an estimated 80% of its volume. All of the interior eye is filled, with the exceptions of the lens at the front and the retinal lining at the back. Besides maintaining the eye’s shape, the vitreous offers a clear pathway for light entering the lens to reach the retina, allowing it to transform into electrical signals that then travel to the brain, enabling sight.

In the event you develop certain retinal disorders, or if blockages affect the retina, your ophthalmologist may recommend you undergo a minimally invasive surgery called a vitrectomy. It involves the partial or complete removal of the vitreous from the back of the eye. Found to be a very safe and effective method to preserve and restore vision, the retinal specialists at Retina Consultants of Charleston are knowledgeable and experienced in performing this procedure.

Vitrectomy Surgery: The Process Detailed

The actual vitrectomy procedure has multiple parts and depending on your situation, it may require 45 minutes to 2 hours to be fully completed. It’s performed under sterile conditions in an operating room at a hospital or an ambulatory surgery center.

Vitrectomy Surgery, Step-by-Step

1. Before the procedure, you’ll probably be given local anesthetic and sedation, although general anesthesia may be necessary. Discomfort and unpleasant visual sensations usually are absent throughout this procedure.
2. The eye requiring treatment is carefully cleaned with provided antiseptics.
3. The eye is “draped” with sterile coverings situated around the afflicted eye.
4. A smooth wire speculum, a wire device with curved ends that fits into a surgical site, is utilized to gently hold the eye open.
5. Employing very small (25-gauge) instruments, the surgeon makes three microscopic incisions (about 0.5 mm) through the sclera, the eye’s white part. These incisions decrease surgical invasiveness and improve outcomes.

• Access is provided to allow light to brighten the eye’s interior.
• Fluid is slowly introduced into the afflicted eye, as necessary.
• A vitrectomy probe can be inserted.

6. With the aid of a microscope, and under direct visualization, a vitrectomy probe carefully removes the targeted vitreous. This probe cuts tiny pieces of vitreous and then suction is utilized to take away the cut fragments.
7. Depending on the surgical type, other steps, such as fixing a retinal detachment or doing laser treatment, will be done after the vitrectomy is completed.
8. Sometimes, the vitreous will be replaced with another substance, such as air, gas, silicone oil, or a balanced solution of saline. Once a few days have passed, this temporary substance is substituted with aqueous humor, which your eye naturally produces.
9. Your incisions are checked for any leaking. Stitches are generally not needed, although one may be required to seal an incision.
10. You’ll have an antibiotic ointment applied, followed by a patch and shield being laid over the specific eye.
11. Following the procedure, you’ll be observed in the post-operative room or area. Then, you can expect to go home.

When Is a Vitrectomy Recommended?

Retinal Interference

One role of the vitreous is to ensure an unobstructed pathway for any light to make contact with the retina. Opacities, cloudiness, and other types of interference can block this connection, causing concerns for your healthy vision. For example, there may be interference due to:

• Should you undergo cataract surgery, your natural eye lenses are replaced with intraocular lenses (IOLs), tiny, artificial lenses. These IOLs may be dislodged or displaced, leading to vision issues.
• Autoimmune diseases affecting the eye
• Blood may leak into the vitreous, whether from trauma, high blood pressure, or diabetic retinopathy, a common diabetic complication
• Complications associated with cataract surgery
• Eye infections or inflammation
• Severe floaters

The vitrectomy procedure is sometimes performed to remove any obstruction that is interfering with your retina’s ability to perform its function properly.

Retinal Scar Tissue

We may recommend a vitrectomy in the event your vision is affected due to scar tissue displacing or tearing your retina. Removing the vitreous gel decreases the tension placed on your retina, providing your doctor with better access. This procedure is generally performed for the following concerns:

• Macular holes, breaks or tears in the macula, the retina’s central part that controls sharp, straight-ahead vision. Typically, they form naturally with aging, as the vitreous fluid shrinks, pulling on the retina.
• Epiretinal membranes (ERMs), also known as macular puckers. Found on the retina’s inner surface, these membranes are semi-translucent and avascular, meaning they have few or no blood vessels.
• Lamellar holes of the macula (LMH), small partial-thickness macular defects
• Vitreomacular traction (VMT) involves the vitreous becoming abnormally attached to the retina, causing macular edema (swelling)
• Retinal tears or detachments, potentially vision-threatening conditions

What to Expect With Vitrectomy Recovery

For the most part, you should expect your full recovery to take a week or more. This time accounts for the specific procedure type, and replacement substance implanted within the bubble. To relieve potential eye redness and irritation, you must administer antibiotic eye drops for a few days, and mild steroid eye drops for three weeks.

Don’t be surprised — specifically with a macular hole or retinal detachment — if your ophthalmologist has you maintain a downward head position. You might need to refrain from strenuous, high-impact physical activity for a week. For two weeks after the procedure, you may want to stay close to home, so that you’re available for follow-up exams. Air travel may have to be avoided, as you could develop a gas bubble in your eye, leading to irreversible blindness. Gas bubbles typically disappear on their own in a few days or months, although this may depend on the type of gas administered.

Potential Vitrectomy Risks and Complications

Our vitreoretinal surgeons perform multiple vitrectomies. Over the years, this procedure has dramatically advanced, providing a safe, effective technique to restore and maintain vision. Before your operation, your surgeon will speak with you and your family. While rare, there may be certain risks, including:

• Retinal tears, when the retina peels away from its normal location
• Retinal detachment, a medical emergency, involving the retina partially or fully moving out of position
• Cataract formation, especially if you haven’t undergone cataract surgery
• Infection
• Scar tissue

With the development of serious symptoms, such as significant pain or vision loss, you need to alert your retinal surgeon as soon as possible.