Surgery Overview
Vitrectomy is the surgical removal of the
vitreous gel from the middle of the
eye. It may be done when there is a
retinal detachment, because removing the vitreous gel
gives your eye doctor (ophthalmologist) better access to the
back of the eye. The vitreous gel may also be removed if blood in the vitreous
gel (vitreous hemorrhage) does not clear on its own.
During a
vitrectomy, the surgeon inserts small instruments into the eye, cuts the
vitreous gel, and suctions it out. After removing the vitreous gel, the surgeon
may treat the
retina with a laser (photocoagulation), cut or remove
fibrous or scar tissue from the retina, flatten areas where the retina has
become detached, or repair tears or holes in the retina or
macula.
At the end of the surgery,
silicone oil or a gas is injected into the eye to replace the
vitreous gel and restore normal pressure in the eye.
Vitrectomy is
always done by an eye doctor who has special training in treating problems of
the retina.
What To Expect After Surgery
Vitrectomy may require an overnight
hospital stay. But it may sometimes be done as
outpatient surgery. The surgery lasts 2 to 3 hours.
Your eye doctor will determine if the surgery can be done with
local or general anesthesia.
You may need to position yourself in a certain way at home for a while. Your doctor will tell you what position to lie in so that the gas or oil can push against the detachment.
Contact your doctor right away if you notice any signs of
complications after surgery, such as:
- Decreasing vision.
- Increasing
pain.
- Increasing redness.
- Swelling around the
eye.
- Any discharge from the eye.
- Any new
floaters,
flashes of light, or changes in your field of
vision.
Why It Is Done
Vitrectomy may be done to:
- Repair or prevent
traction retinal detachment, especially when it
threatens to affect the macula.
- Repair very large tears in the
retina.
- Reduce vision loss caused by bleeding in the vitreous gel
(vitreous hemorrhage) when bleeding is severe or when the blood does not clear
on its own after several months.
- Treat severe
proliferative retinopathy that causes severe scar
tissue formation or when growth of new blood vessels on the retina
(neovascularization) continues despite repeated laser treatment.
How Well It Works
Vitrectomy has been shown to greatly
improve
visual acuity in many people who have severe vitreous
hemorrhage that has not cleared on its own. A vitrectomy can decrease the risk
of severe bleeding in people who have begun to have bleeding into the vitreous
gel. It can also reduce the risk of severe bleeding in people with growth of
abnormal blood vessels in the
iris.
In general, surgery can restore
some vision that is lost as a result of traction retinal detachment and may help
prevent further detachment. But the results tend to be better when the
detachment has not affected the center of the retina (macula) and the
central vision it provides.
Risks
Vitrectomy may cause elevated pressure inside the
eye (intraocular pressure, or IOP), especially in people who have
glaucoma.
There are several other
serious, vision-threatening risks linked to vitrectomy. These
include:
- Further bleeding into the vitreous
gel.
-
Retinal detachment
.
- Fluid buildup in the
clear covering of the eye (corneal edema).
- Infection inside the eye (endophthalmitis).
What To Think About
One of the main uses of vitrectomy
is to remove blood from the middle of the eye, a condition called vitreous
hemorrhage. When vitreous hemorrhage occurs, some doctors may recommend waiting
several months to a year to see whether the vitreous gel will clear on its own
before they do a surgery that can have serious complications.
But if the hemorrhage is causing severe vision loss or is preventing
treatment of severe retinopathy, surgery may be done sooner rather than
later. Some studies have shown that long-term results are better with early
vitrectomy.
There are a few ways to repair a retinal
detachment. The chance that each surgery type can help restore good vision
varies from case to case. The cause, location, and type of detachment usually
determine which surgery will work best. Other conditions or eye problems may
also play a role in the decision.
You may
need more than one surgery to reattach the retina if scar tissue from the first surgery grows over the surface of your retina.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Adam Husney, MD, MD - Family Medicine |
|
Specialist Medical Reviewer
|
Carol L. Karp, MD - Ophthalmology |
|
Last Revised
|
August 7, 2011 |