Vitrectomy
The human eye is a marvel of complexity, comprising various intricate structures that collaborate seamlessly to facilitate the gift of sight, allowing you to see images, movement, depth, and colors. Between the retina and the lens is a transparent, gel-like substance known as the vitreous humor. This transparent gel contributes to vision by providing a clear, direct pathway for light signals entering the eye to target the retina.
The vitreous can be subject to damage, whether by normal aging, or conditions involving retinal interference or scarring. In these cases, a surgical procedure, known as a vitrectomy, may be performed. Commonly performed at Illinois Retina Associates, a vitrectomy procedure involves the partial or full removal of the vitreous from the back of the eye. Our surgeons may also perform other surgeries during a vitrectomy.
Why a Vitrectomy May Be Necessary
By performing a vitrectomy, surgeons and retinal specialists are provided with direct, unobstructed access to the back of the eye, including the retina. A vitrectomy is often performed when patients have conditions or injuries that disrupt retinal function or those involving retinal scar tissue. Among potential causes of retinal function disruption are:
- Severe eye floaters – various shapes floating in your field of vision, moving with the direction of your eyes
- Inflammation or infections targeting the eye
- Intraocular lenses (IOLs) – tiny, artificial lenses implanted to replace biological lenses removed during cataract surgery, may become displaced or dislodged, causing visual interference
- Autoimmune conditions targeting the eye
- Bleeding within the vitreous may develop due to trauma, high blood pressure, or diabetic retinopathy
Vitrectomy for Retinal Scarring
Due to a condition called posterior vitreous detachment (PVD), aging causes the vitreous to gradually shrink, making it pull on the retina. This may lead to scar tissue developing and accumulating on the retina, which if untreated, may cause the retina to be displaced or torn. Your retina specialist may recommend a vitrectomy, as removing part or all of the vitreous may reduce retinal tension, while providing improved access to the retina and neighboring components. Conditions involving retinal scar tissue include:
- Macular holes
- Macular puckers, also referred to as epiretinal membranes
- Lamellar holes of the macula (LMH)
- Vitreomacular traction (VMT) – a condition involving the vitreous becoming unusually attached to the retina, resulting in macular edema (swelling)
- Retinal tears
- Retinal detachments, where the retina peels off the back wall
What To Expect With The Vitrectomy Procedure
A vitrectomy is performed under sterile conditions in an operating room at a hospital or ambulatory surgery center, usually taking between 45 minutes to 2 hours to be completed. This process is minimally invasive and generally safe, with patients typically experiencing very little pain and discomfort, if any.
Antiseptics will be used to carefully cleanse the affected eye. The eye is draped, with sterile coverings being placed around it, and removed upon the procedure’s completion.
The eye is gently held open with a smooth wire speculum. This procedure will generally call for either local or general anesthesia to be administered, to ensure comfort and eliminate any pain and discomfort. Your surgeon may opt to administer an anesthetic only in the area around the targeted eye, given intravenously. If so, your eyes will remain open, with your forehead secured with tape to minimize head movement, and you should speak only if necessary.
The surgeon, with the use of tiny instruments, perforates the sclera, the eye’s outer, white part, with three microscopic incisions (about 0.5 mm). These incisions achieve such goals as:
- Reducing surgical invasiveness
- Improving surgical outcomes
- Allow light to brighten the eye’s interior
- Enable fluid to be slowly added, as needed
- Let surgeons carefully remove the vitreous with a vitrectomy probe, which cuts small pieces, and remove them with suction.
The surgeon may replace your vitreous with air, gas, silicone oil, or a balanced saline solution. They may also perform other procedures, such as laser treatment, as needed. Once a few days have passed, this substance will be swapped out for aqueous humor, a fluid biologically made by your eye. Your incisions will be monitored for any leaks. While stitches are often unnecessary, a single stitch may be applied to seal an incision. You may have antibiotic ointment applied, and the affected eye will be covered with a patch and shield. After your procedure, you’ll undergo observation in the post-operative area, and you’ll then be able to leave.
What to Expect With Vitrectomy Recovery
While you can expect little pain or discomfort following a vitrectomy procedure, a full recovery may take a week or more, depending on the specific procedures and the implanted bubble type. Your doctor may recommend that you stay close to home for two weeks, for follow-up exams. You can expect the eye having undergone surgery to be reddened and irritated. As such, you’ll need to have antibiotic eye drops applied for a few days, as well as mild steroid eye drops for three weeks.
You may need to keep your head in a downward position, especially if you had a retinal detachment or macular hole procedure. It’s also advised that you do without strenuous, high-impact physical activity for a week. In addition, air travel should be avoided, as altitude changes may cause the gas in a bubble to expand, which could lead to blindness. However, depending on the gas type, this risk generally disappears after a few days or months.
Potential Vitrectomy Risks and Complications
Before the procedure, you and your family should discuss the procedure and its implications with your retinal surgeon. While considered safe and effective, a vitrectomy is a surgery, and while rare, there may be risks, including:
- Retinal tears or detachment
- Infection
- Scar tissue
- Cataract formation, specifically in patients who haven’t had cataract surgery
In the event you experience serious symptoms, like significant pain or vision loss, you must quickly let your retinal surgeon know.
Vitrectomy Surgery in Illinois and Indiana
Illinois Retina Associates is a leading retina-only ophthalmology practice in the Midwest devoted to diagnosing and treating the full spectrum of retinal, macular, and vitreoretinal conditions. Our retina specialists and surgeons are highly experienced in performing a wide array of advanced retinal treatments, including vitrectomy surgery. When you or a loved one visit our retina centers, rest assured that our experienced retina specialists and surgeons will develop a personalized treatment plan to ensure your recovery. Contact one of our 12 convenient locations today to schedule a consultation.