Vitrectomy Surgery Overview
Vitrectomy is a microincisional surgery that involves the removal of some or all of the vitreous gel that is found in the eye. The surgical technique and instrumentation have improved dramatically over the years and vitrectomy is an extremely effective and safe way to restore vision in many situations. Most of the time a vitrectomy is one of a series of steps performed to fix a vision threatening problem.
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At Vitreoretinal Consultants of NY, we are dedicated to providing exceptional retinal care to patients across the Greater NYC Metropolitan Area, including Queens and Manhattan, as well as Nassau, Suffolk, Rockland, and Westchester counties. For us, nothing is as important as your eyesight. Contact us with any questions, or schedule an appointment with VRC today.
When is a Vitrectomy recommended?
The surgeons at Vitreoretinal Consultants of NY will recommend vitrectomy for various conditions. Some conditions that may require vitrectomy are situations where the normally clear vitreous has opacities or cloudiness that interferes with clear vision.
Some examples of opacities in the vitreous:
- Bleeding into the vitreous from diabetic retinopathy, high blood pressure or trauma
- Complications of cataract surgery where remnants of the cataract remain in the eye
- Dislodged or displaced intraocular lens
- Infections of the eye
- Inflammatory or autoimmune diseases that affect the eye
- Severe floaters
There are also conditions where the vitreous gel is causing disruption to the retina. The vitreous is quite thick and sticky; occasionally problems arise when it pulls on the retina and vitrectomy is needed.
- Macular holes
- Epiretinal membranes
- Lamellar holes of the macula
- Vitreomacular traction causing macular edema
- Retinal tears
- Retinal detachments
What to Expect During Vitrectomy Surgery
Surgery is done under sterile conditions in an operating room at a hospital or an ambulatory surgery center.
The basic steps of a vitrectomy include:
- Most vitrectomy surgery is done with local anesthetic and sedation. There are situations when general anesthesia is used. There should be no discomfort or unpleasant visual sensations during the surgery.
- The eye is carefully cleaned using antiseptics; usually a dilute solution of Betadine.
- The eye is ‘draped.’ Sterile coverings are placed around the eye.
- A smooth wire speculum gently holds the eye open.
- The surgeon makes 3 microscopic incisions (about 0.5 mm) through the sclera (white part of the eye).
- The three incisions are typically used for 1. Access for a light to help visualize the inside of the eye, 2. Access for fluid to be slowly added to the eye as needed and 3. Access for a vitrectomy probe.
- Surgery is performed under a microscope and a vitrectomy probe is used to remove the vitreous gel carefully under direct visualization. The vitrectomy probe will cut small pieces of vitreous and then use suction to remove the cut section from the eye
- Depending on the type of surgery being performed other steps such as fixing a retinal detachment or doing laser will be done after the vitrectomy is performed.
- Sometimes a replacement for the vitreous will be placed in the eye; options include balanced saline solution, gas, air or silicone oil
- The incisions are checked for any leaking and occasionally a stitch is needed to close an incision. Most of the time no stitches are needed.
- Antibiotic ointment is applied and then a patch and shield are placed over the eye.
- After surgery, the patient is expected to go home after being observed in the post operative area.
Fortunately most patients are comfortable after vitrectomy surgery but full recovery does often take a week or longer. The eye will be red and irritated for several days. Depending on the specifics of the surgery, especially if a gas or silicone oil bubble was needed, the visual recovery may take some time. During the first week antibiotic eye drops will need to be administered and there is typically a mild steroid eye drop used for the first 3 weeks after surgery. In some cases there will be specific instructions on how to best position after surgery. Not all vitrectomy requires special positioning but for retinal detachments and macular holes it may be required.
For the first week after surgery we ask that patients avoid any strenuous or high impact activity.
Vitrectomy Risks and Complications
Although vitrectomy is extremely safe, like all surgery, there are risks. Some, but not all, of the rare but potential risks are listed below. A detailed discussion with your surgeon is very important.
- Retinal Tears
- Retinal Detachment
- Scar tissue formation
- Cataract formation (In patients without prior cataract surgery)
If there is any significant pain, loss of vision or any concerning symptoms it is best to contact the surgeon right away
Vitreoretinal Surgery: FAQ
Fortunately the vast majority of vitrectomy surgery is done with local anesthesia. Anesthetic is given around the eye by your surgeon while an anesthesiologist administers intravenous medication. There is no pain associated with the numbing of the eye. This type of anesthesia is used primarily because it allows the surgery to be done in total comfort; the patient does not feel any pain, does not need to worry about moving the eye during surgery and has no visual stimuli that may be disturbing. In rare cases general anesthesia can be used.
A vitrectomy on its own takes about 30 minutes. However most vitrectomy surgery is done as part of a more involved procedure; therefore the duration of surgery can be 45 minutes up to 2 hours for complicated retinal detachments.
Head down positioning may be recommended for certain conditions like macula holes and retinal detachments. Positioning recommendations are made specifically for any individual patient and should be discussed prior to and after surgery.
The vitreous gel is an important part of the eye that is involved in the normal development of vision. It can be safely removed and has been done for decades. Although the vitreous gel is not replaced there is other fluid, called aqueous, that is produced by the eye that replaces the vitreous gel.
We recommend that you do not travel far from home for the first 2 weeks after surgery. It is safer to be close by for follow up exams. If your eye has a gas bubble after surgery you will be advised to avoid air travel until the bubble goes away. This is really important since air travel has the potential to cause irreversible blindness if there is a gas bubble in place. Fortunately a gas bubble always goes away. Depending on the type of gas used it may take a few days up to a couple of months.
For more information, please visit the American Society of Retina Specialists website.