Vitrectomy

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What is vitrectomy?

A vitrectomy is a type of eye surgery to treat certain 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 back part 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. This lets 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. It also reduces the tension on your retina.

During vitrectomy, your surgeon (an eye doctor called an ophthalmologist) uses small tools to cut the vitreous and suction it out. Then your eye doctor does any other needed repairs, such as fixing a hole in your retina. He or she may place sterile saline, a gas bubble, or a clear liquid called silicone oil into your eye. This helps the retina stay in its correct position.

Why might I need a vitrectomy?

You might need a vitrectomy if you have one of these 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 health 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, such as an eye injury. In other cases, your eye doctor might schedule your vitrectomy in advance.

But a vitrectomy may not be your only option if you have one of these health problems. If you have diabetic retinopathy, for example, your eye doctor might advise 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. But you may be more likely to need a vitrectomy if you have a complex retinal detachment. Or if your eye condition has caused bleeding into your vitreous. Ask your eye doctor about the benefits and risks of all of your treatment options.

What are the risks of vitrectomy?

Most people do well with vitrectomy. But complications do sometimes happen. Your risks may depend on your age, your health conditions, and the specifics of your eye problem. Some risks of the procedure include:

Infection
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 fix your original problem. If this is the case, you might need a repeat surgery.

How do I get ready for a vitrectomy?

Ask your eye doctor what you need to do to get ready for vitrectomy surgery. Ask if you need to stop taking any medicines before the procedure. Follow any directions you are given for not eating or drinking before your surgery.

Your eye doctor may want to use special tools to shine a light in your eye and examine your retina. You will 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.

What happens during a vitrectomy?

Talk with your eye doctor about what to expect during your surgery. The details of the surgery may differ a bit. A doctor specially trained in eye surgery will do your surgery. In general, you can expect the following:

You may be awake during the surgery. You will be given a medicine to help you relax. In this case, your eye doctor may use a shot (injection) to make sure you don’t feel anything.
In other cases, you may have general anesthesia to put you to sleep. If this is the case, you will sleep deeply during the surgery. You won’t remember it afterwards.
Your eye doctor will expose your eye.
Your eye doctor will make a small cut in the white part of your eye (sclera).
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 may replace the vitreous with some other sort of fluid, such as silicone oil or saline.
Your eye doctor may close your surgical cuts (incisions) with stitches. But stitches are often not needed.
An antibiotic ointment will be placed on your eye to help prevent infection.
Your eye will be covered with a patch.

What happens after a vitrectomy?

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 directions about positioning after the surgery. To avoid complications, you will also need to not do any air travel until the bubble is gone. 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 if 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, over time you may need another surgery to remove it from your eye.

Your vision may not be completely normal after your vitrectomy. This is even more likely if your condition caused lifelong (permanent) damage to your retina. Ask your eye doctor about how much improvement you can expect.