Vitrectomy

Vitrectomy. Stuart Westmorland

A vitrectomy is a micro-surgical procedure performed by a retinal specialist to remove the vitreous gel from the inside of the eye. Vitreous gel fills the inside cavity of the eye, taking up about two-thirds of the eye’s volume. Normally, the vitreous is clear and allows light to easily pass to the back of the eye. A vitrectomy is sometimes needed if bleeding occurs in the vitreal cavity, blocking clear vision.

A vitrectomy is performed in part to treat the following:

​​The Procedure

A vitrectomy is performed in a surgical outpatient clinic or hospital operating room and is generally performed under local anesthesia. The patient is also given mild sedation. The patient is awake for the procedure but does not feel pain and depending on the sedation given, does not remember the procedure.

The retinal specialist will insert instruments directly through the sclera, or outer coating of the eye. Special lights for illuminating the inside of the eye, lasers and tools can be put into these ports. During a vitrectomy, the vitreous fluid and gel is removed.

Depending on the medical problem, the eye is then filled air and gas. This may be done to help repair a retinal detachment or a macular hole.

Over a period of time, usually weeks or a few months, the gas is reabsorbed. As it is reabsorbed, vision may be blurry or distorted due to the bubble that the gas makes. As it shrinks, vision may change. As it is reabsorbed, the space is filled with aqueous humor, a fluid made by the eye that usually fills the front, anterior chamber of the eye.

After a vitrectomy, patients will have follow up visits with the doctor. Several different eye drops may be used to control pain, prevent infection and reduce swelling and inflammation.  Although vision improves quickly for most people, full visual recover sometimes takes several months. Flying should be avoided as changes in pressure can cause the gas to increase or expand and cause eye pressure to increase over normal acceptable levels. Although more rare now days, some people that undergo a vitrectomy must avoid looking up must keep their body more horizontal so that the bubble can help repair retinal damage.

In some cases, a silicone oil is used instead of gas. Although, there are several advantages such as faster healing and visual recovery, the silicone oil eventually must be removed requiring a second surgical procedure.

Possible Complications

In the hands of a skilled and highly trained retinal specialist, a vitrectomy is usually a fairly safe procedure. However, complications such as retinal detachment, glaucoma, bleeding and infection do occur.

Cataract develop almost always occurs after a vitrectomy and as a result, patients usually must undergo cataract surgery within months or in the next couple of years after a vitrectomy.

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