Vitrectomy is a microsurgical procedure that involves the removal of the vitreous fluid. The vitreous fluid is a clear gel-like fluid present in the centre of the eye. It is responsible for giving shape to the eye and maintaining eye pressure. Anterior Vitrectomy refers to the procedure where only small portions of the vitreous are removed, from the front structures of the eye. This procedure is performed in case of a traumatic cataract removal and secondary intraocular lens placement. The Pars Plana Vitrectomy refers to a group of procedures that involve the deeper end of the eye. During this procedure, almost all of the vitreous fluid is removed. It is carried out in cases of various retinal disorders, eye injuries, haemorrhage, etc.
What are the reasons behind a vitrectomy surgical procedure?
How a vitrectomy surgical procedure is performed?
- The vitreous fluid is removed in order to cure or prevent continued vision loss resulting from retinal damage, cause by bleeding, injury, or infection, inside the eyeball
- Such conditions could arise due to sickle cell disease, complications of cataract surgery, glaucoma and various retinal disorders like macular hole, eye floaters, proliferative diabetic retinopathy, traumatic eye injuries, retinal detachment, macular pucker, and vitreous haemorrhage
- During a Vitrectomy procedure, the eye is held open and in place with the help of a special speculum. Incisions are generally made through the pars plana
- Pars plana is a region of the eye that has no specific function in a fully-developed (post-fetal) eye. It is thus considered to be a safe place for incisions
- Three incisions are made to enable three instruments to enter the eye
- One incision is used to insert a tube, an infusion line that supplies a fluid that replaces the vitreous fluid being removed, in order to maintain constant eye pressure
- The second incision is used to insert a microscopic cutting device, which cuts the vitreous fluid into tiny bits and aspirates (sucks out) the vitreous
- The third incision is used to insert a microscopic illuminator, a high intensity fiber optic light source, which will light up the interior of the eye, in order to give a clear view
- The surgeon then uses a special operating microscope with contact lenses, to get a clear view of the inner eye, at varying magnifications
- The fluid used for replacing the aspirated fluid, closely resembles the natural vitreous fluid and contains certain factors that promote the development of the vitreous
- Small, self-absorbing stitches are then used to close the incisions
- Depending upon the condition to be treated, other procedures are carried out. Other instruments like forceps, scissors, pics, or lasers can be used for cauterising blood vessel leaks, removing scar tissue or foreign bodies. In case of macular holes and retinal detachments, various substances like sterile air, gas, or silicone oil, are inserted as a replacement to the vitreous to flatten the detached retina, thereby allowing its reattachment and to close up macular holes, allowing it to heal.
The surgical procedure is performed by an ophthalmologist
, who is specialised in vitreoretinal surgery. The length of the surgery is generally 1-3 hours. However, the time period varies, and it is dependent upon the complications and other surgical procedures (if any) involved.
Preparations needed before a vitrectomy surgical procedure
Risks and complications during vitrectomy surgical procedure
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Local anaesthesia may not be used however do inform the physician if you are allergic to any local anaesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines
The possible risks and complications during the surgery are:
Risks and complications after vitrectomy surgical procedure
Post Vitrectomy surgical procedure, the following complications may arise:
Post-operative care needed after vitrectomy surgical procedure
- Development of glaucoma
- Vision loss (extremely rare)
- Recurrent retinal detachment
- Loss of depth perception, blurred vision or double vision
- Loss of night vision
- Refractive changes
- Choroidal effusion (swelling of layer under the retina due to fluid build-up)
- Macular pucker (wrinkling of retina)
- Cystoid macular edema (fluid in the macula, leading to swelling)
Vitrectomy is often performed along with other procedures thus, the post-operative instructions may vary from patient to patient. Some of these instructions include:
- Regular use or application of the prescribed anti-inflammatory and antibiotic drops, once the eye patch has been removed
- A plastic eye shield should be worn, to avoid any water from entering the eye
- Avoid bending, stooping, lifting heavy objects, or performing any other strenuous activity
- Follow the special instructions given by the physician, regarding positioning of the head
- Avoid air travel
- Use warm compress over the eyes to relieve discomfort