Vitrectomy

Vitrectomy is a microsurgical procedure used to treat certain retinal disorders such as macular hole, epimacular membrane, retinal detachment, proliferative diabetic retinopathy, intraocular infections, and traumatic eye injuries.

Using specially designed instruments and techniques, the vitrectomy procedure involves removing the vitreous gel through a very small incision in the eye wall. The vitreous gel is replaced with a saline solution. Then, your surgeon will use a specially designed microscope that allows for a clear view of the vitreous cavity and retina at different magnification to perform any additional work if necessary, such as removal of scar tissue (epimacular membrane, traction detachment) or close a macular hole. This same-day surgical procedure is usually performed under local anesthesia and intravenous sedation.

The vitrectomy surgery has been a revolutionary advancement in technology that allows us to treat retinal diseases and prevent vision loss. Generally, a vitrectomy takes about 30 minutes to an hour depending on the type of operation, but may be significantly longer depending on the surgical indication and complexity of the case.

Techniques Used During Vitrectomy

In order to achieve optimum results, your surgeon may use several special techniques, including:

Intraocular Gases
These gases are used to flatten a detached retina and keep it attached as healing of laser around retinal tears occurs. Gas is also used to close macular holes. The advantage of intraocular gases is that they get absorbed by the body over the course of 1-2 weeks. Until about 50% of the gas instilled into the eye has disappeared on its own, vision is usually limited to the level of hand motion.

Patients must avoid travel to high altitudes and flying as long as the gas is still in the eye, because gas will expand under those circumstances and can cause dangerously high pressures in the eye. Also, patients usually will be required to keep their head in a certain position for an extended period of time to ensure the success of the treatment. Possible short- and long-term complications of intraocular gas are cataracts and glaucoma.

Silicone Oil
In some instances, silicone oil is used instead of intraocular gases, particularly when long-term support of the retina is needed. In contrast to the intraocular gases, silicone oil remains in the eye indefinitely unless it is surgically removed. Usually the oil is left in place for several months, but in certain instances it may be desirable to keep it in the eye for years. Vision is less affected by the silicone oil compared to intraocular gases.

Positioning is less critical, making this procedure more conducive for children and the elderly with neck or back problems. Risk factors include cataracts and glaucoma as well as possible damage to the cornea.

Endophotocoagulation
Lasers are often used during vitrectomy surgery to surround retinal tears and prevent future leakage of vitreous fluid under the retina. Laser is also used to treat damaged retina in proliferative diabetic retinopathy.

Microsurgical Instruments
There are several instruments used to remove scar tissue and foreign bodies such as forceps and scissors. There are hundreds of vitrectomy instruments available to assist surgeons. Most vitreoretinal tools are smaller than 1mm in diameter, making them some of the most precise and finely crafted instruments available today.

Lensectomy
A lensectomy is often performed when a cloudy natural lens (cataract) prevents the surgeon from clearly viewing the ocular structures behind it. It involves surgically removing the eye’s crystalline lens during the vitrectomy procedure. In some instances, a lensectomy may also be necessary to remove scar tissue during more complex retinal detachment procedures. The lens can be replaced with a clear lens implant either during the same surgical procedure or at a later date.

Risks and benefits of your procedure will be discussed with you at the time of your office visit.