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Patient Education: Vitrectomy

 

What is the vitreous?

The vitreous fills the central cavity of the eye.  It is attached to the retina, the thin layer of tissue lining the back of the eye.  The retina is the "seeing" tissue of the eye.  When light hits the retina, a picture is taken and sent to the brain through the optic nerve.

The retina has two parts - the peripheral retina and the macula.  The macula is used to see very fine, central detail.  The peripheral retina gives us our side vision.  The vitreous is most strongly attached to the retina at the sides of the eye.  It is also attached to the optic nerve, the macula and the large retinal blood vessels.

What is a vitrectomy?

Vitrectomy is a form of eye surgery that treats disorders of the retina and vitreous.  It is a microsurgical procedure in which the vitreous is removed with a miniature handheld cutting device and replaced with a special saline solution similar to the liquid being removed from the eye.

A vitrectomy may be combined with another surgical procedure, such as repairing a retinal detachment or removing a cataract.

When is a vitrectomy required?

A vitrectomy is required for a variety of conditions. They include:

  • Haemorrhage (blood) that prevents the passage of light through the eye to the retina
  • Diabetic traction retinopathy – bleeding and scar tissue forming in the eye of a diabetic patient
  • Proliferative vitreoretinopathy – formation of scar tissue following severe retinal detachment
  • Infection inside the eye (endophthalmitis)
  • Epiretinal Membranes
  • Macular Hole surgery
  • Trauma
  • Intraocular foreign body
  • Complications following cataract surgery

How is a vitrectomy performed?

A vitrectomy is performed in our day surgery, usually under a local anaesthetic. 

23 gauge microsurgical instruments are placed into the eye through three small incisions in the sclera (the white part of the eye).  The vitreous gel is removed from the centre of the eye.  During the course of the surgery, a fluid, which is similar to the fluid naturally produced by cells inside of the eye, is used to replace the vitreous. 

A variety of instruments may be used to remove the vitreous gel and perform other procedures, such as laser probes to repair tears, and instruments to peel off scar tissue growing on the surface of the retina.

Vitrectomy surgery can take 30 minutes or longer depending on the severity of the eye problem.  

This surgery is sutureless. New smaller gauge instrumentation has made it possible to perform vitrectomy surgery without using any sutures.  A cannula system is used to introduce various instruments into the eye.  At the end of surgery, the cannula system is withdrawn and the small incision sites self seal without needing any sutures.

The benefits of sutureless surgery include minimal conjunctival scarring, less post–operative inflammation and discomfort, quicker healing time, and shorter operating times.

What other procedures may be necessary?

A vitrectomy can sometimes be combined with a scleral buckle for retinal detachment.

Air, gas, silicone oil, or heavy liquid may be placed into the vitreous cavity.  These materials help to hold the retina in place.  If silicone oil or heavy liquid is placed into the eye, it may need to be removed at a later date.  The air or gas is absorbed by the body and replaced by fluid produced by the eye.  It takes between one and eight weeks for the air or gas to be absorbed.

To achieve the best outcome post vitrectomy surgery, you may be asked to "face down" or "posture" for up to a week following surgery.  For information on equipment hire to assist in posturing please visit: www.vitrectomy.com.au or www.retinarecovery.com.au.

What will my eye be like following surgery?

Any significant pain following surgery is not common.  You may experience some discomfort and a scratchy sensation in the eye.  This usually settles very quickly.  If the eye becomes very painful, you must notify your surgeon immediately. 

The Day Surgery will give you post operative instructions when you are discharged.  You will be discharged with an eye pad on, which needs to be removed in our clinic the following day.  You will be required to use eye drops post operatively.

If a gas bubble has been placed into your eye, do not to fly in an aeroplane or climb high altitudes until the gas bubble has gone.  A rapid increase in altitude can cause a dangerous rise in eye pressure.  If gas is used, your vision will be poor until the gas is absorbed by the body.

What are the risks of vitrectomy surgery?

Some of the risks of vitrectomy include:

  • Infection
  • Bleeding
  • Retinal detachment
  • Increase in eye pressure
  • Formation of cataract

Will my vision improve following vitrectomy surgery?

Visual improvement following vitrectomy surgery will depend on the severity of your eye problem before the surgery.  If your eye problem caused permanent damage to your retina before the vitrectomy, then the improvement following surgery may not be significant.  Surgery is sometimes performed to save the eye only, rather than to achieve an improvement in vision.  Your ophthalmologist will discuss your situation with you and how much vision you can expect to gain.