font size

Surgery

Vitreous Surgery (Vitrectomy)

click > view larger

Vitrectomy

click > view larger

Vitrectomy: View Through Operating Microscope

Occasionally, a retinal detachment is complicated or severe, and cannot be treated adequately with either standard scleral buckling surgery or pneumatic retinopexy. In such cases, vitreous surgery to reattach the retina may be necessary. Vitreous surgery is performed in an operating room under local or general anesthesia. The vitreous is removed and, therefore, this procedure is called vitrectomy. The surgeon uses a fiber optic light to illuminate the inside of the eye and other instruments inside the eye, such as a forceps and scissors, to do the surgery. The vitreous is replaced during the operation with either clear fluid that is compatible with the eye, or with gas that completely fills the eye. Over time, the fluid (or gas) is absorbed by the eye and is replaced by the eye’s own fluid; the eye does not replace the vitreous get itself. The lack of vitreous gel does not affect the functioning of the eye.

The most common conditions requiring vitrectomy are retinal detachment, vitreous hemorrhage with retinal detachment, proliferative vitreoretinopathy, giant retinal tear, diabetic retinopathy with vitreous hemorrhage and/or traction retinal detachment, epiretinal membrane (macular pucker), intraocular infection: endophthalmitis, trauma and intraocular foreign body, and macular hole). Each of these conditions will be discussed in the following sections.

In a vitrectomy, instruments are passed through the sclera into the vitreous cavity. A variety of instruments can be used to remove the vitreous gel and any scar tissue that may be growing on the surface of the retina. A laser probe can be inserted into the eye so that a laser treatment can be done during surgery.

Vitrectomy can be combined with the placement of a scleral buckle. Usually, air, gas, or silicone oil is placed in the vitreous cavity. These materials hold the retina in place against the back wall of the eye while the laser scars are forming. After this surgery, it may be important for the patient to maintain a certain position of the head, which is often a face-down (prone) position. Eventually, the gas is absorbed and replaced by fluid produced by the eye. If silicone oil has been used, in some cases, it must be removed at a later time with another surgical procedure. Vitreous surgery usually lasts one to two hours but, with very severe and difficult problems, may take longer. Following surgery, the patient may experience some discomfort and a scratchy sensation in the eye, but significant pain is unusual. If it occurs, the surgeon should be told promptly.