VitrectomyThe Vitreous Is Normally A Clear, Jelly-Like Fluid That Fills The Inside Of The Eye. Various Disease States Can Cause The Vitreous To Cloud, Fill With Blood Or Even Harden So That Light Entering The Eye Will Be Misdirected And Not Reach The Retina Properly.
DefinitionA Vitrectomy Is A Surgical Procedure That Removes The Vitreous In The Central Cavity Of The Eye So That Vision Can Be Corrected. It Is Beneficial In Many Disease States Including Diabetic Eye Disease (Diabetic Retinopathy), Retinal Detachments, Macular Holes, Macular Pucker And Vitreous Hemorrhage.
Some Of The Most Common Eye Conditions That Require Vitrectomy Include: -
- Complications From Diabetic Retinopathy Such As Retinal Detachment Or Bleeding
- Macular Hole
- Retinal Detachment
- Pre-Retinal Membrane Fibrosis
- Bleeding Inside The Eye (Vitreous Hemorrhage)
- Injury Or Infection
- Certain Problems Related To Previous Eye Surgery
The Retinal Surgeon Performs The Procedure Through A Microscope And Special Lenses Designed To Provide A Clear Image Of The Back Of The Eye. Several Tiny Incisions Just A Few Millimeters In Length Are Made On The Sclera.
The Retinal Surgeon Inserts Microsurgical Instruments Through The Incisions Such As: -
- Fiber Optic Light Source To Illuminate Inside The Eye
- Infusion Line To Maintain The Eye's Shape During Surgery
- Instruments To Cut And Remove The Vitreous.
Vitrectomy Is Often Performed In Conjunction With Other Procedures Such As Retinal Detachment Repair, Macular Hole Surgery, And Macular Membrane Peel. The Length Of The Surgery Depends On Whether Additional Procedures Are Required And The Overall Health Of The Eye.
During Vitrectomy Surgery, The Retinal Surgeon May Use A Variety Of Special Techniques To Achieve The Desired Results, Including: -
- Intraocular Gases (Usually Either Perfluropropane (C3F8) Or Sulfur Hexafluoride (SF6)) When Mixed With Sterile Air Have The Property Of Remaining In The Eye For Extended Periods Of Time (Up To Two Months). They Are Eventually Replaced By The Eyes Own Natural Fluid. Gas Is Useful For Flattening A Detached Retina And Keeping It Attached While Healing Occurs. Gas Injection Is Also Used To Close Macular Holes. It Is Frequently Necessary To Maintain A Certain Head Position Following Surgery When Gas Is Used Vision In A Gas Filled Eye Is Usually Rather Poor Until At Least 50% Of The Gas Is Absorbed. Possible Complications Of Intraocular Gas Include Progression Of Cataracts And Elevated Eye Pressure (Glaucoma). It Is Unsafe To Fly In A Plane While Gas Remains In The Eye.
- Silicone Oil Is Sometimes Used Instead Of Gas To Keep The Retina Attached Postoperatively. Silicone Remains In The Eye Until It Is Removed (Often Necessitating A Second Surgery At A Later Date). This Technique Is Advantageous When Long Term Support ("Tamponade") Of The Retina Is Required, For Instance In The Repair Of Very Complicated Retinal Detachments. Unlike Gas, Patients Are Still Able To See Through Clear Silicone Oil. Positioning Is Less Critical With Silicone Oil, Therefore, It May Be Used In Patients Unable To Position Postoperatively (I.E. Children). Like Gas, Silicone Oil Can Promote Cataracts, Cause Glaucoma, And May Damage The Cornea.
- Endophotocoagulation Is The Use Of Laser To Treat Intraocular Structures. This Modality Is Often Used To Treat Retina Tears In The Setting Of Retinal Detachment. Endophotocoagulation Is Frequently Used To Treat Proliferative Diabetic Retinopathy As Well.
- Microsurgical Instruments Such As Forceps, Scissors And Picks May Be Used To Manipulate Intraocular Structures Such As In The Removal Of Scar Tissue And Foreign Bodies. Literally Hundreds Of Vitrectomy Instruments Are Available To Assist In Different Surgical Maneuvers. Most Of These Vitreoretinal Tools Have A Diameter Of Less Than 1mm, Making Them Some Of The Most Precise And Finely Crafted Instruments In The World Today.
- Endoscopy Allows The Surgeon To View The Inside Of The Eye On A Television Monitor While Treating Intraocular Structures. It Is A Helpful Technique When The Cornea Or Lens Are Cloudy And Do Not Allow A Clear View Through The Operating Microscope.
- Scleral Buckling Is Sometimes Combined With A Vitrectomy Procedure To Add Additional Support To The Re-Attached Retina (See Retinal Detachment Page).
- Lensectomy Is The Removal Of The Eye's Crystalline Lens During A Vitrectomy Procedure. This Is Sometimes Performed When There Is A Cataract (Clouding Of The Lens) Which Prevents The Surgeon From Adequately Visualizing The Internal Structures. A Lensectomy May Also Be Necessary To Gain Access To And Remove Scar Tissue During Complicated Retinal Detachment Or Diabetic Retinopathy Procedures. The Natural Lens Can Be Replaced With A Clear Lens Implant At A Later Date Or During The Same Surgical Procedure. Lensectomy Is Usually Performed Using High Frequency Ultrasound (Phacoemulsification) Similar To Routine Cataract Surgery.
Vitrectomy Surgery Is A Major Medical Advance Which Allows Us To Treat Retinal Diseases And Prevent Vision Loss For Patients Who, In Previous Years, May Have Gone Blind Without This Technique. A Vitrectomy Procedure Usually Takes About 1-2 Hours But May Take Longer In Complex Cases Or When Combined With A Scleral Buckle Or Lensectomy. Risks Of Surgery Include Infection, Bleeding, Cataract, Glaucoma, And Detachment Or Re-Detachment Of The Retina. Any Of These Complications Can Result In Severe Visual Loss Or Even Loss Of The Eye Itself. It Is Important That You Discuss The Potential Risks And Benefits Of This Procedure With Your Surgeon Before Making A Decision Regarding Treatment.
Special TechniquesThe Retinal Surgeon May Use Special Techniques Along With Vitrectomy To Treat The Retina. Your Surgeon Will Determine If Any Of These Are Appropriate For Your Eye: -
- Sealing Blood Vessels - Laser Is Sometimes Used To Stop Tiny Retinal Vessels From Bleeding Inside The Eye
- Gas Bubble - A Small Gas Bubble May Be Placed Inside The Eye To Help Seal A Macular Hole.
- Silicone Oil - After Reattachment Surgery, The Eye May Be Filled With Silicone Oil To Keep The Retina In Position.
What To Expect After Surgery
The Eye Is Patched After The First Postoperative Checkup. This Can Usually Be Removed The Same Evening At Bedtime. Since The Anesthesia Numbs The Lids And Temporarily Prevents Blinking, It Is Very Important To Keep The Eye Patch On Until You Are Able To Blink The Eye Normally. Begin Using Drops After The Patch Has Been Removed.
Vitrectomy RisksVitrectomies Have Been Commonly Performed And Perfected For Over 30 Years. However, Certain Risks Do Exist. They Include: -
- Retinal Detachment
- Development Of Glaucoma (Increased Pressure In Eye)
- Cataract Formation Or Progression
- Bleeding And/Or Infection Inside Or Outside Of Eye
- Red Or Painful Eye
- Loss Of Depth Perception, Blurring Of Vision, Double Vision, Or Blindness
- Swelling Of Layer Under The Retina (Choroidal Effusion)
- Change In Focus, Requiring New Spectacle Lenses (Refractive Changes)
- Wrinkling Of Retina (Macular Pucker)
- Swelling Of The Center Of Retina (Cystoid Macular Edema)
- Loss Of Night Vision Or Distortion Of Vision
- Loss Of Eye (Extremely Rare)
- Need For Additional Treatment And/Or Surgery
Retinal Detachment During Or After The Procedure Is The Most Common Risk. Dr. Deupree Is Prepared For This To Happen And Can Repair The Detachment By Inserting Gas That Applies Pressure On The Retina Before Completing The Case.
How Should The Eye Feel?
It Is Common To Experience Some Discomfort Immediately After The Surgery And For Several Days Afterward. This Is Primarily Related To Swelling On The Outside Of The Eye And Around The Eyelids. A Scratchy Feeling Or Occasional Sharp Pain Is Normal.
Ice Compresses Gently Placed On The Swollen Areas (Ice Or Frozen Vegetables Placed Inside A Resealable Plastic Bag Work Well) Reduce The Aching And Soreness. Tylenol E.S. Is Also Helpful For Minor Aching.
FAQQ: May I Read Or Watch TV. After Surgery?
A: Yes. Using Your Eye Following Surgery Will Not Damage Or Hurt The Eye.
Q: Do I Need To Wear Sunglasses?
A: Sunglasses Are Recommended For Everyone, But Are Especially Encouraged After Surgery. We Recommend Wearing Sunglasses With 100% UV Protection.
Q: How Long Will My Vision Remained Blurred After Surgery?
A: This Is Dependent On Many Individual Factors Such As Your Overall Eye Health And The Procedures Performed Along With The Vitrectomy. Most Patients Notice That Their Vision Begins To Improve Approximately 1 Week After Surgery.
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