Vitrectomy
What is a Vitrectomy?
A vitrectomy is an operation to remove the vitreous humor, a clear transparent jelly, from the inside of the eye. The vitreous humor is situated behind the iris, the coloured part of the eye and in front of the retina, at the back of the eye. It has no real function other than providing packaging inside the eye.
Why is a Vitrectomy necessary?
The general indications for a vitrectomy are:
- Retinal detachment
- Macular hole
- Diabetic vitreous haemorrhage
- Removal of intraocular foreign body
- Endophthalmitis (a serious eye infection)
- Retrieval of a lens following complicated cataract surgery
How is the Vitreous Jelly removed?
Surgery is usually performed under a general anaesthetic; however, the procedure may be completed using a local anaesthetic when it is deemed necessary.
The surgeon makes three very small incisions through the sclera, the white of the eye. Instruments are passed through these incisions and they include a microscopic light source, a cutting device that cuts through and removes the vitreous in a controlled and gentle way and an infusion port which is required to replace fluid in the eye and maintain pressure within the eye during the procedure.
Once the jelly is removed the retina is repaired if necessary, any foreign bodies removed and, in the case of diabetes, any leaking blood vessels are sealed. The procedure usually takes 1-2 hours to perform.
Does the Vitreous Jelly get replaced?
No, the jelly does not naturally replace itself and a number of substitutes may be used at the end of surgery.
- Gas bubble (this is absorbed in about 2 months)
- Transparent oil, which is not absorbed and is surgically removed at a future date.
- Air (absorbed within a week) The eye produces its own clear fluid known as aqueous humor which, as the gas or air is absorbed, will gradually fill the vitreous chamber.
Risks
The procedure has a good success rate and complications are relatively unusual. However, bleeding, infection, retinal detachment and progression of cataract are potential complications.
There is a rare chance (1 in 1000) of getting a condition called sympathetic ophthalmitis, which means that there is an inflammation in the fellow (unoperated)eye.
Most patients who have a vitrectomy will need cataract surgery earlier than they otherwise would. For the vast majority of patients who undergo vitrectomy there is the prospect of some improvement in vision.
What to expect after your Vitrectomy
The most important factor determining your rate of recovery and final outcome is the pre operative condition for which the vitrectomy was performed. Your surgeon can advise you what to expect. Another important factor is your ability to comply with postoperative instructions / recommendations.
Expect your eye to be sensitive, red and swollen due to the nature of the surgery. Ice compresses placed gently on the swollen areas may help reduce the aching. You will be prescribed a combination of drops to instil on your discharge home.
These will help prevent infection, reduce inflammation and rest the eye following surgery. Drops to lower the pressure of the eye are also sometimes prescribed. You may need to use eye drops for several weeks following surgery.
If gas or oil has been inserted into the eye, usually for retinal detachment surgery, you will be advised to position with your head tilted downwards. This helps ensure that the gas or oil is lying against the area of retina which has detached encouraging it to heal in the correct place. You will be advised to posture for 50 min in every hour for 7-10 days. You will be given a follow up appointment in 1-2 weeks following surgery. Any improvement in vision will take place gradually, and it may be several months before optimal visual outcome is achieved.
If a gas bubble is inserted
If gas is inserted then vision will be poor until the bubble gradually absorbs. Looking down whilst holding objects just a few inches from the eye may produce clearer vision. As the bubble shrinks towards the bottom of the field of vision (about halfway) it may cause some glare or double vision. Patients should avoid lying on their back for long periods in order to minimise the possibility of the bubble coming forward, which can raise intraocular pressure or damage the cornea.
Avoid flying with air or gas in the eye
The reduced atmospheric pressure causes the gas bubble to expand, which can raise the pressure in the eye to dangerous levels.
If an oil bubble is placed in your eye
Silicone oil is a clear, viscous fluid, which is used in some patients instead of gas. Its main advantages are:
- Quicker visual recovery.
- No restriction in air travel.
- Less need for head positioning post op.
- Longer duration of effect.
However silicon oil is not absorbed but must be surgically removed.
If you develop a deep ache or throbbing. pain, which does not respond to over the counter painkillers, please contact the hospital urgently.
If you have any concerns please contact us in order to discuss them.
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