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Summary

A vitrectomy is performed to remove the vitreous (a gel-like substance inside the eye) and replace it with another fluid. It is done to improve vision problems caused due to debris or blood clot or scar tissue in the eye. Your doctor will conduct medical tests to check your eye and ascertain you are otherwise healthy enough to undergo this surgery. You may require fasting before the surgery.

A vitrectomy is done under local anaesthesia. That means you will be awake during the procedure. An eye patch will be given to you after the surgery to comfort and protect your eye. Also, you will be given antibiotic eye drops and painkillers to provide relief from pain and prevent infections. A follow-up appointment will be needed after two weeks and then after eight weeks of the surgery. 

  1. What is a vitrectomy?
  2. Why is vitrectomy recommended?
  3. Who can and cannot get vitrectomy?
  4. What preparations are needed before vitrectomy?
  5. How is vitrectomy done?
  6. How to care for yourself after vitrectomy?
  7. What are the possible complications/risks of vitrectomy?
  8. When to follow up with your doctor after a vitrectomy

Vitrectomy is the surgical removal of the vitreous, a clear, gel-like substance, from the eye. After the surgery, the vitreous is replaced with either silicone oil, saline, or a gas bubble.

The vitreous is located in the middle of the eyeball, behind the lens of the eye. Light passes through the vitreous to reach the retina (located behind the eye). The retina then uses this light to transfer visual information to the brain.

In some conditions, blood and some debris may block the passage of light. Moreover, certain scar tissues in the vitreous can also tear or displace the retina. These lead to impaired vision. In such situations, a vitrectomy is performed to improve the access of light and reduce the tension on the retina.

The following types of vitrectomy are performed:

  • Posterior pars plana vitrectomy: This type of surgery is performed to treat conditions related to structures in the back of the eye, such as the retina.
  • Anterior vitrectomy: Rarely, the vitreous solution may cause leakage in the front portion of the eye. In such conditions, an anterior (front) vitrectomy is performed.

Eye doctors recommend vitrectomy in the following conditions:

  • Eye infections or a severe injury to the eye
  • Macula (a hole is formed in the central part of the retina)
  • Problems arising after a cataract surgery
  • Diabetic retinopathy (a complication of diabetes that affects the eyes)
  • If a wrinkle forms in the central part of your retina
  • Vitreous detachment (vitreous separates from the retina)
  • Retinal detachment (a major complication where the retina detaches from the back of the eye)

Some common symptoms of the above conditions are as follows:

  • Blurred vision
  • Vision loss 
  • Black spots or light flashes 
  • Eye pain 
  • Double vision 
  • Eye floaters (deposits or condensation in the vitreous)
  • A curtain-like shadow over the visual field
  • Sparkles of light in one or both the eyes

There are no true contraindications to vitrectomy.

Before the surgery, you will need the following preparation:

Medical tests: The doctor will check your eye and overall health. You may need these eye tests before the surgery:

  • Dilated eye exam
  • Slit-lamp examination
  • Fluorescein angiography
  • Ocular coherence tomography (OCT)
  • Retinal photography 
  • Ultrasound

To check for any damage due to traumatic injury to the eye, the following tests are performed: 

Food and medication: 

  • You will be asked to not eat anything for 8 hours before the surgery. The fasting may also start from midnight depending on the scheduled time of the surgery.
  • If you are using eye drops, then they can be continued even on the day of the procedure. 
  • Your doctor will decide if you should continue with the regular medications until the surgery is performed.
  • If you are on any medicine for heart problems, blood pressure, breathing issues, seizures or anxiety, you can take it with some amount of water. 
  • You will be asked to stop medicines like cholesterol-lowering medicines, vitamins or birth control pills until the surgery is performed.

If you smoke, your healthcare practitioner will ask you to stop smoking as it can delay your healing after the surgery.

You will be asked to sign a consent form before the surgery and will be asked to get someone to drive you home after the procedure.

This surgery is performed in the following manner:

  • You will need to change into hospital clothes for the surgery.
  • You will be given topical anaesthesia (eye drops) or injection in your eyes so that you do not feel anything in your eye during the surgery. You will be awake during the procedure. 
  • Alternatively, you will be given general anaesthesia to make you fall asleep during the surgery. 
  • The surgeon will make an incision on the outer layer of your eye to get access to your eye. 
  • Then, he/she will cut the sclera - the white portion of your eye - and remove the vitreous and any foreign material or scar tissue. 
  • The surgeon may also fix other problems in your eye. For example, if you have a retinal tear, the doctor will use a laser to repair it or inject a gas bubble to keep your retina in its position. 
  • Then, the surgeon will replace the vitreous with some fluid, e.g., saline or silicone oil. 
  • He/she will close the incisions using stitches, and apply an antibiotic ointment over the site to prevent infections. 
  • Finally, the doctor will cover your eye with an eye patch.

In most cases, patients are sent home on the same day after the surgery, usually in an hour or less. You will need to wear an eye patch for one day.

It is normal to feel a gritty sensation or have redness in your eye for a while after the surgery. This is due to the stitches on the outer layer of the eye. Sometimes, it may last up to four weeks. The following care tips should be followed after the surgery:

  • Only wear the eye patch outside the house for comfort and protection. You don't need to wear it inside. You can wear dark glasses if bright light bothers you. 
  • If a gas bubble is injected in your eye, you may need to remain in the position your doctor advises you on for a set amount of time. You will be asked not to drive, exercise or work during this phase.
  • You will need painkillers to relieve the soreness in your eye after the surgery. 
  • You will also have to put antibiotics eye drops in your eye to prevent infection.
  • Avoid vigorous sneezing, coughing, or pounding
  • Avoid doing strenuous activities. Though, you can start with light work initially. 
  • Avoid lifting heavy objects for two weeks. 
  • Avoid swimming for 12 weeks.
  • Do not bend below your waist.
  • You can walk up and down the staircase at a steady pace or go for a daily walk.
  • Use baby shampoo to wash your hair.
  • To prevent soap or shampoo from getting into your eyes, wash your hair sitting against the sink with your head tilted back, and hair drawn towards the sink, like a hair wash in a salon.
  • You can watch television after surgery. 
  • If you can see properly, you can also read after the surgery.
  • You can resume your normal diet after the surgery.
  • Ask your doctor when you can resume work after the surgery. 
  • If you can see properly, the doctor may ask you to resume driving. Though, avoid air travel after the surgery. You can ask your doctor when you can fly again.

Vitrectomy helps to improve your vision. The success rate of vitrectomy surgery is about 90%. Rarely, there may be any serious complications associated with this surgery.

When to see the doctor?

Visit or call your doctor if you have the following problems:

  • Vision loss 
  • Increasing redness of the eye 
  • Excessive pain 
  • Discharge from the eye

The possible risks after vitrectomy are as follows:

  • Infection 
  • Damage to the lens
  • Change in refractive error leading to myopia or hypermetropia
  • Increased pressure in the eye 
  • Excessive bleeding 
  • Retinal detachment that requires surgery for repair.
  • Increased rate of cataract formation

You will need a follow-up meeting after two weeks and then later at eight weeks after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; What is vitrectomy?
  2. Hull University Teaching Hospitals [internet]: NHS Foundation Trust. National Health Service. U.K., Vitrectomy
  3. American Society of Retina Specialists [Internet]. Illinois. US; Vitrectomy
  4. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Vitreous Hemorrhage.
  5. Diabetes UK [Internet]. London. UK; Diabetic Retinopathy.
  6. American Academy of Ophthalmology [internet]. California. US; Retinal Detachment: What Is a Torn or Detached Retina?
  7. National Eye Institute [Internet]. Bethesda (MD). National Institute of Health: U.S. Department of Health and Human Services; Retinal Detachment
  8. Omari A, Mahmoud TH. Vitrectomy. [Updated 2020 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  9. UW Health: American Family Children's Hospital [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; Scleral Buckle and Vitrectomy
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