A vitrectomy is a type of eye surgery to treat various problems with the retina and vitreous. During the surgery, your surgeon removes the vitreous and replaces it with another solution. The vitreous is a gel-like substance that fills the middle portion of your eye.
The retina is a layer of cells at the back of your eye. These cells use light to send visual information to your brain. Normally, the vitreous should be clear, so light can pass through your eye and reach your retina.
Certain problems can cause blood and debris to block this light. Scar tissue in your vitreous can also displace or tear your retina. All of this can impair vision. Surgeons sometimes do vitrectomy for a detached retina. Removing the vitreous gives better access to your retina and decreases the tension on your retina.
During vitrectomy, your surgeon (an eye doctor called an ophthalmologist) uses small instruments to cut the vitreous and suction it out. Then your eye doctor does any other needed repairs, like repairing a hole in your retina. He or she may place air or other gas into your eye to help the retina stay in its proper position.
You might need a vitrectomy if you have one of the following eye problems:
- Diabetic retinopathy
- Retinal detachment
- Vitreous hemorrhage
- Infection inside your eye
- Severe eye injury
- A hole in the central part of your retina (macula)
- A wrinkle in the central part of your retina
- Certain problems after cataract surgery
All of these medical problems can cause vision loss. If not treated, some of them can even result in blindness. In some cases, vitrectomy can restore lost vision. You might need a vitrectomy done in an emergency — an eye injury, for example. In other cases, your eye doctor might schedule your vitrectomy in advance.
Vitrectomy may not be your only option if you have one of these medical problems, though. If you have diabetic retinopathy, for example, your eye doctor might recommend a procedure called laser photocoagulation instead.
If you have a detached retina, you might be able to have laser treatment or a procedure called pneumatic retinopexy. However, if you have a complicated retinal detachment, or if your eye condition has caused bleeding into your vitreous, you may be more likely to need a vitrectomy. Ask your eye doctor about the benefits and risks of all your treatment options.
Most people do well with their vitrectomy, but complications do sometimes happen. Your risks may depend on your age, your medical conditions, and the specifics of your eye problem. Some risks of the procedure include:
- Excess bleeding
- High pressure in the eye
- New retinal detachment caused by the surgery
- Lens damage
- Increased rate of cataract formation
- Problems with eye movement after surgery
- Change in refractive error
There is also a risk that the surgery will not successfully repair your original problem. If this is the case, you might need a repeat surgery.
Ask your eye doctor what you need to do to prepare for vitrectomy surgery. Ask whether you need to stop taking any medicines before the procedure. You will need to avoid eating anything after the midnight before your surgery.
Your eye doctor may want to use special instruments to shine a light in your eye and examine your retina. You may need to have your eyes dilated for your eye exam. You also might have an ultrasound of your eye, which helps your eye doctor view the retina.
Talk with your eye doctor about what to expect during your surgery. The details of the surgery may differ somewhat. A doctor specially trained in eye surgery will do your operation. In general, you can expect the following:
- You may be awake during the surgery. You will receive a medicine to help you relax. In this case, your eye doctor may use anesthetic eye drops and injections to make sure you don’t feel anything.
- In other cases, you may have anesthesia to put you to sleep. If this is the case, you will sleep deeply through the surgery and won’t remember it afterwards.
- Your eye doctor will expose your eye, making an incision in the outer layer of your eye.
- Your eye doctor will make a small cut in the sclera, the white part of your eye.
- Your eye doctor will remove the vitreous and any scar tissue or foreign material.
- Your eye doctor will do other repairs to your eye as needed. For example, he or she might use a laser to fix a tear in your retina. In some cases, your eye doctor may inject a gas bubble into your eye to help keep your retina in place.
- Your eye doctor will replace the vitreous with some other sort of fluid, like silicone oil or saline.
- Your eye doctor may close your surgical incisions with stitches, but stitches are often unnecessary.
- An antibiotic ointment will be placed on your eye to help prevent infection.
- Your eye will be covered with a patch.
Ask your eye doctor about what you should expect after your surgery. In most cases, you will be able to go home the same day. Plan to have someone drive you home after the procedure.
Be sure to follow your eye doctor’s instructions about eye care. You may need to take eye drops with antibiotics to help prevent infection. Your eye may be a little sore after the procedure, but you should be able to take over-the-counter pain relievers. You may need to wear an eye patch for a day or so.
If you had a gas bubble placed in your eye during your vitrectomy, you will need to follow specific instructions about positioning after the surgery. To avoid complications, you will also need to avoid air travel for a period after the procedure. Ask your eye doctor when it will be safe for you to fly again.
You will need close follow-up with your eye doctor to see whether the procedure was effective. You may have a scheduled appointment the day after the procedure. Be sure to tell your eye doctor right away if you have decreasing vision or increasing pain or swelling around your eye. If silicone oil is injected into your eye during surgery, you may eventually need additional surgery to remove it from your eye.
Your vision may not be completely normal after your vitrectomy, especially if your condition caused permanent damage to your retina. Ask your eye doctor about how much improvement you can expect.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Retinal detachment, Up To Date
Haupert, Christopher, L., MD,Walton--Ziegler, Olivia, MS, PA-C