Vitrectomy

1996: A movie called Gray’s Anatomy was released. The film was unusual in the sense that it was a film monologue about an actor who tries all possible means to evade one surgery. Curious to know this dreaded surgery on which the entire movie revolves? It’s none other than Vitrectomy…

 

What is the Vitreous?

 

The vitreous is a transparent, gel like substance which is present inside your eye. It occupies about 2/3rd of your eye’s volume. This gives your eye form and shape.

 

What is Vitrectomy?

 

Vitrectomy is a surgical procedure which involves the removal of vitreous gel (a fluid which is present inside your eye) from the middle of your eye.
 

When is Vitrectomy performed? (Indications)

Vitrectomy is usually done when a foreign material invades the interior of your eye, causes shadows to be formed on your retina (the screen at the back of your eye) and thus distorts your vision. It may also be done to remove scar tissue or relieve any traction on the retina. The foreign material may be blood or particles due to detachment of the vitreous.

 

 

Generally, following are the indications:

• Diabetic vitreous hemorrhage (bleeding because of damage to blood vessels due to diabetes)
• Retinal detachment
• Proliferative vitreoretinopathy ( a complication of retinal detachment in which there is scarring of your retina)
• Macular (the central portion of the retina) hole
• Epiretinal Membrane or macular pucker (a thin layer of scar tissue on the retina)
• Endophthalmitis (Inflammation inside the eye usually due to infection)
• Foreign Body inside the eye
• Certain problems related to a previous eye surgery

 

How is Vitrectomy performed?

Usually vitrectomies are performed under general anesthesia. In some situations, if you are unfit to receive general anesthesia, the surgery may be done under local anesthesia.

The surgery is performed through a microscope and with the help of special lenses that can provide a clear image of the inside of your eye.

Three small cuts (a few millimeters in length) are made on your sclera (the white portion of your eye) to make openings for various instruments that will be put in for use during the surgery. These instruments are:

a. The Light Pipe: This fiber optic light source acts as a flashlight for illumination inside the eye.
b. Infusion Port: To replace the eye’s fluid with a saline solution so that pressure is maintained in the eye.
c. Vitrector: This is like a cutting device which removes the gel in the eye in a controlled manner so that the delicate retina is protected.

Once the vitreous fluid is removed, a saline liquid is injected so as to replace the vitreous humour.

Vitrectomy is usually performed along with other operations like repair of retinal detachment, macular hole or macular membrane peel.

Along with Vitrectomy, various other techniques may be used like:

• Gas Bubble:  A gas bubble is placed inside your eye to help seal a macular hole.

 

 

• Laser: Laser may be used to stop small blood vessels in your retina from bleeding.
• Silicone Oil: After reattachment procedure is done, your eye is filled up with silicone oil to keep the retina in its position.

The duration of your surgery will differ depending on the procedure that is being performed with the vitrectomy.
 

What are the complications of a Vitrectomy?

Bleeding

Infection

Retinal detachment

Progression of Cataract
 

What can I expect after the surgery?

Your eye will be patched after the surgery.

It is common to feel some discomfort or scratchy feeling for a few days after the surgery. There may also be some swelling around your eye and redness on the outside of your eye. Your vision may be blurry for about a week or so.

Cold compresses gently placed on the swelling will help reduce the swelling and soreness. You can ask your doctor for pain medications.

If your surgery involved the placing of a gas bubble, you may be advised certain head positioning to keep the bubble in place.

The recovery period will vary depending on your condition and other surgeries that have been done with it. However, most patients notice an improvement in their vision in about 1 week.
 

What precautions do I need to take after the surgery?

Avoid bending, lifting heavy objects, or performing any strenuous activities for a week.

You can use pain relievers or ice compresses to soothe your discomfort.

Use the antibiotic and anti-inflammatory eye drops as prescribed.

Wear a plastic eye shield for the first seven days while sleeping.