Vitrectomy is a surgical procedure in which the vitreous gel that fills the posterior chamber/cavity of the eye is removed to treat eye problems associated with retina or the vitreous. This surgery offers better access to the retina of the eye for different treatments like repair of retinal detachments, removal of scar tissue and treatment of macular holes.
Once vitrectomy is complete, the ophthalmologist or eye surgeon will replace the natural vitreous gel with either a saline solution or gas bubble or silicone oil. This helps the retina to stay in position.
Figure1. Vitrectomy surgery- schematic
Complications Related To Vitrectomy Surgery
Complications and risks are part of vitrectomy surgery. Like any other surgery, vitrectomy too involves some risks and complications:
Cataract: Is the most common sequelae after vitrectomy surgery. After vitrectomy surgery cataract progresses at a higher rate than eyes which have not undergone vitrectomy surgery.
Retinal tears: can form during the surgery which will be treated with the laser during surgery. At the end of vitrectomy surgery, the retinal periphery is carefully inspected to look for any retinal tears that were unnoticed.
Retinal detachment- preventable by careful examination at the end of surgery for retinal tears and treating them with the laser.
Eye infection/ endophthalmitis
Bleeding
Glaucoma – increased intraocular pressure (IOP). Vitrectomy surgery per se does not cause glaucoma but the intraocular tamponading agents left in the eye sometimes at the end of surgery like silicone oil and expansile gases like sulfur hexa fluoride (SF6) and perfluoropropane (C3F8) can cause glaucoma. All the patients post vitrectomy surgery are routinely evaluated for intraocular pressure at each follow-up visit.
Advances in techniques, tools, and understanding of complex eye diseases have made vitrectomy surgery more successful in recent times.
What is the difference between vitrectomy surgery and Vitreoretinal surgery?
Vitrectomy refers to the clearing of the vitreous gel from the inside of the eye. Most of the retinal diseases require many more procedures after vitrectomy is done to treat the condition. All the additional procedures performed after vitrectomy was done together form vitreoretinal surgery. Therefore, vitrectomy is only a part of the whole vitreoretinal surgery.
Macular hole:
After vitrectomy requires simple ILM peeling (thin superficial acellular layer over the retina that is removed with forceps), large holes sometimes require inverted ILM peeling with stuffing of the peeled ILM inside the hole followed by gas injection.
Figure 2. ILM peeling for macular hole
Retinal detachment (rhegmatogenous):
After vitrectomy requires the fluid gas exchange to remove the subretinal fluid to attach the retina. After fluid gas exchange laser photocoagulation around all the retinal breaks and weak areas in the retinal periphery is done. This is followed by gas or oil injection.
Diabetic retinal detachment (tractional retinal detachment):
After vitrectomy requires membrane peeling (refers to all the techniques to remove the membranes pulling the retina), achieving haemostasis (controlling bleeding commonly encountered during surgery) followed by laser photocoagulation (pan-retinal) followed by gas or oil injection.
Essentially all the procedures performed after vitrectomy to address the disease together are called vitreoretinal surgery.
What to Expect After Vitrectomy Surgery?
Vitrectomy surgeries are performed by retina specialists, ophthalmologists with special training in the management of vitreoretinal diseases. Vitrectomy surgeries are done as a day care surgical procedure. Day care surgical procedure involves admission to the hospital for a period of 5 to 6 hours during the day and the patients are discharged at the end of the day. Overnight stay is never required in a day care surgery and most of the eye related surgeries are performed as day care surgeries.
After the surgery, the eye is patched with a protective bandage and shielded to protect from any type of eye injury.
Aftercare is essential for the successful outcome of the surgery which includes:
Travel safety:
After complete eye checkup, patients can leave the hospital and go home in an hour. However, as the surgery involves the use of light sedation, you will need a family member or driver to take you back home.
Eye patch:
As per the ophthalmologist’s instruction do not forget to wear the eye patch for the first night or as directed by the eye doctor after surgery. If your eye patch is removed by the ophthalmologist one day after surgery, you might not need to wear the eye patch yourself.
Eye protection:
It is recommended to wear your sunglasses or prescription glasses during the day. Wear the eye shield over the operated eye at night and when sleeping for the first week after vitrectomy surgery. Avoid travelling by flight for a few days post operation.
Figure 3: Post-operative eye shield to be worn at night for 1 week after surgery
Position:
If the gas bubble or silicone oil is used in eye treatment, your ophthalmologist will ask you to follow certain important instructions. These include head positioning like face-down or time duration for which you need to follow the instructions; do not ascend to higher altitudes, etc. It is essential to follow these instructions as the oil or gas bubble helps to press the eye retina back to its normal position until the eye heals.
Figure 4. Face down / prone positioning after vitrectomy surgery
On your first postoperative visit, your eye surgeon and the hospital staff will review instructions related to positioning, medications, drops, use of the eye patch, and routine activities. Driving after vitrectomy surgery is best avoided for two weeks. It is better to wait for complete visual recovery and take your doctor’s permission before resuming driving.
Recovery is better with good quality postoperative care. Although the removal of the vitreous gel and a vitrectomy surgery has little to no effect on the overall eye health, it is best to take proper care of the eye. Surgery for some eye diseases like macular holes that were once considered incurable is routinely performed with excellent results due to vitrectomy.
Visual recovery after vitrectomy / vitreoretinal surgery
Visual recovery depends on the type of the disease, presenting vision and the vision just before the onset of the disease as well as the time lapse between the onset of symptoms and the day when the surgery is performed.
For example, for all the retinal detachments, rhegmatogenous as well as diabetic tractional retinal detachments duration of visual loss is an important factor in better visual recovery. Earlier the surgery is performed the better.
Similarly in macular hole surgery the size of the macular hole and the duration of macular hole are important factors in estimating the visual recovery. The smaller the macular hole and less is the loss of visual acuity the better are the chances for complete visual recovery.
Visual recovery after vitreoretinal surgery depends on various other factors and varies from case to case and it is best discussed with the retina specialist before the surgery.
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