Vitrectomy- Advanced Surgery for Retinal Issues

Indications of Vitrectomy Surgery

• Retinal pathologies, such as retinal tears, retinal holes, and detached tissues. 
• Endophthalmitis, i.e., inflammation of the inner eye. 
• Macular diseases, including macular edema and macular holes. 
• Vitreous hemorrhage, i.e., bleeding and scar tissue formation in the vitreous humor. 
• Penetration of an intraocular foreign object. 
• Dislocated lens fragments in vitreous or penetrating injury that leads to vitreous hemorrhage or retinal detachment. 
• Vitreomacular traction syndrome or epiretinal membranes. 

How to prepare for Vitrectomy? 

Once the diagnosis is complete, the doctor will plan the treatment and provide detailed instructions to the patient to prepare him/her for the surgery. The risks, benefits, and alternatives are also presented to the patient, and written consent is taken to proceed with the surgery. 

The preparation steps will include the following- 

• Typically, the patients are asked to eat and drink nothing 8 hours before the surgery. 
• The physician or anesthesiology team will advise whether or not to take specific medications before or on the day of surgery. 
• Medicines that are critical for the heart, breathing, blood pressure, seizures, or anxiety can be taken with a small amount of water. 
• Blood thinners should be taken after consulting the physician and anesthesiology team. 

On the day of surgery, the patient will be asked to arrive early at the treatment center. The medical team at the center will admit the patient and ask to complete some formalities before the surgery. 

• The patient is asked to change clothes before the surgery. 
• An IV line, EKG patch, and oxygen monitor will be placed to administer medications and monitor the patient’s vital signs before and during the surgery. 

Risks & Complications of Vitrectomy Surgery

The risks and chances of complications associated with vitrectomy depend on the patient’s age, medical condition, and severity of the condition. Some risks and complications that may arise include the following-

• Eye infection

• Bleeding in the eye

• Increased eye pressure (glaucoma)

• Detachments in the retina

• Damage to the natural eye lens

• Cataract formation

• Problems with eye movement

• Change in refractive error

Some of these problems resolve on their own, whereas others require further intervention. So, make sure that you follow the doctor’s instructions and take proper care of the eyes.

What to expect after the vitrectomy?

Immediately after the surgery, the patient won’t feel anything until the effects of anesthesia wear off. As each case is different, it will be best to ask the doctor about what to expect after the procedure. 

Typically, the patient will be discharged on the same day as the surgery is performed on an outpatient basis. It is advisable to have someone accompany you as you won’t be able to drive yourself. The doctor will prescribe antibiotic medications, painkillers, anti-inflammatory medicines, and other essential medications before discharge. 

The eyes will be swollen and red after the surgery. The swelling will subside in a few days, but the redness may persist for several weeks. Initially, the vision will also be blurry and improve in the following days gradually. You will be advised to come back for a follow-up on the next day. 

Benefits of Vitrectomy

Undergoing vitrectomy is essential to preserve vision in the patient. The surgery will be beneficial for the patients in the following aspects as well- 

• The vision-blocking vitreous opacity will be removed, which will allow the patient to see clearly. 
• If the retinal tissues experience abnormal traction, the surgery can address that and allow the surgeon to repair retinal tears and holes. 
• Vitrectomy and retinal membrane removal also allow the retina to get back to its original shape and improve vision. 
• In severe cases of retinal hemorrhage, detachment, or other conditions, only vitrectomy can help to preserve the vision. 

Note– In some cases, diagnostic vitrectomy is also performed to diagnose vitreoretinal conditions. 

Types of Vitrectomy Surgery

Posterior or Pars Plana Vitrectomy

It is the most common approach to vitrectomy. When the surgery is being performed to address the diseases of the posterior segment of the eye, it is called posterior or pars plana vitrectomy. It involves the removal of some or all of the vitreous humor to get access to the deeper components of the eye. 

Anterior Vitrectomy 

As the name suggests, this surgery involves addressing the problem in the anterior chamber of the eye. This approach is chosen when the vitreous gel passes through the pupil and leads to vision problems. The vitreous gel can reach the front part of the eye due to an injury, lens problem, or as a complication of cataract or glaucoma surgery. 

Recovery & Results of Vitrectomy

The recovery period after vitrectomy will be around 2 to 4 weeks. The doctor or his/her team will give you detailed instructions for post-surgery care. 

• Wear an eye patch on the day of surgery to prevent dust, dirt, smoke, and other particles from entering the eye. 
• Use the prescribed medications as directed by the doctor to reduce the risk of post-surgery complications. 
• Do not drive or perform strenuous physical activities, such as exercise or heavy lifting, while the eyes are healing. 
• If an eye bubble is placed in the eye, the doctor may suggest keeping the head in a certain position. Make sure to comply with this. 
• Avoid flying in an aeroplane or travelling to higher altitudes, as it can affect the bubble in the eye. 
• Visit the doctor as suggested for follow-ups to monitor the recovery and success rate of the procedure. 
• If silicone oil is injected into the eye during vitrectomy, you may need another procedure to remove the oil. 
• If the eye problem has caused irreversible damage, your vision may not be restored with the procedure. 

Severe complications after vitrectomy are rare, and the success rate of the procedure is higher than 90% in most cases.