Vitrectomy surgery involves microsurgery using very small incisions (less than a millimetre wide) into the eye for many retinal conditions. These retinal conditions include: retinal detachment, macular hole, epiretinal membranes, vitreous and retinal haemorrhages, diabetic retinopathy, penetrating eye injuries, intraocular foreign bodies, severe vitreous opacities, complex cataract surgery, dislocated lenses, severe eye infections (endophthalmitis), and rare types of glaucoma.
Vitrectomy surgery can clear blood and scar tissues from the vitreous cavity as well as floaters and debris in the vitreous. It is also used in repair of severe eye injuries and in retinal detachments. Once the vitreous is cleared, additional treatments such as the followings may be required:
Laser: to seal breaks in the retina and repair detached retina and also to prevent further retinal bleeding.
Cryotherapy: to seal breaks in the retina and help prevent retinal detachment.
Gas: gas bubble is often injected to hold the retina in place and prevent further bleeding until the laser and cryotherapy treatment re-attaches the retina. It may take from 1 week to 8 weeks to clear depending on the type of gas used. While the gas is clearing the vision will be poor and often you will have to posture face down for certain lengths of time depending on your condition. Requirements for posture face down is usually ½ – ¾ hour in each hour for 1-2 weeks after the operation to position the gas bubble. Flying in a plane is not allowed until the gas bubble clears as the pressure in the eye will increase due to high altitude. As the gas bubble clears you will notice a line of gas in your vision and the vision above the bubble will gradually get better over time. Gas bubbles may be used to repair retinal detachments and combined with laser and / or cryotherapy, and this is termed pneumatic retinopexy.
Silicone oil: this is used in certain cases of retinal detachment or other retinal problems which require longer term support than when gas is used. Patients can fly in a plane after surgery where silicone oil is used. The oil may be left in the eye for a period of time depending on your condition. In severe retinal detachments it is often left in for years. In most cases, the oil may be removed around 6 months to a year later.
Heavy liquid (perfluorooctane): this is a special heavy liquid used in vitrectomy surgery. It may be used during the operation, or left in the eye for a few weeks to hold the retina in place, in cases of giant retinal detachments. The heavy liquid will need to be removed with a subsequent vitrectomy surgery.
Cataract surgery: this may be performed concurrently with vitrectomy if the patient has a cataract or there was difficulty in removing the lens at the time of cataract surgery. An intraocular lens may be inserted.
Vitrectomy surgery usually takes around ¾ to 1 hour. This is usually performed under twilight sedation or general anaesthetic. Twilight sedation is safer, giving less nausea and allowing quicker recovery. The anaesthetist will assess you accordingly prior to the surgery. Vitrectomy surgery may be performed as an overnight stay or day surgery depending on your condition. Recovery from vitrectomy may be slow and can take several weeks or months for the eye to settle.
Vitrectomy is a safe and commonly performed procedure. Risks are rare but they include infection, haemorrhage, macular oedema, loss of vision, retinal detachment, anaesthetic risks, and other eye sympathetic uveitis. If complication develops then further surgery may be required. Whilst the aim is to improve vision and reduce distortion, improvement may be variable or difficult to achieve in all cases particularly in those with trauma, multiple surgeries, and long-standing poor vision. Cataract surgery is often required 6-12 months following vitrectomy surgery.