Vitrectomy

What is vitrectomy?

A vitrectomy is a type of eye surgery to treat certain problems with the retina and vitreous. During the procedure, your surgeon removes the vitreous and replaces it with another solution. The vitreous is a gel-like substance that fills the back part of your eye. 

The retina is a layer of nerve cells that lines the inside of the back of your eye. These cells use light to send visual information to your brain. Normally, the vitreous is clear. This lets light pass through your eye and reach your retina.

Certain problems can cause blood and debris to block light entering your eye. Scar tissue in your vitreous can also displace or tear your retina. This can affect your vision. Surgeons sometimes do vitrectomy for a detached retina. Removing the vitreous gives better access to your retina. It also reduces the tension on your retina.

During vitrectomy, your surgeon (an eye care provider called an ophthalmologist) uses small tools to cut the vitreous and suction it out. Then your eye care provider does any other needed repairs, such as fixing a hole in your retina. They may place sterile saline, a gas bubble, or a clear liquid called silicone oil into your eye. Gas and silicone oil helps the retina stay in its correct position.

Why might I need a vitrectomy?

You might need a vitrectomy if you have one of these eye problems:

• Diabetic retinopathy

• Retinal detachment

• Vitreous hemorrhage

• Infection inside your eye

• Severe eye injury

• A hole in the central part of your retina (macula)

• A wrinkle in the central part of your retina

• Certain problems after cataract surgery

All of these health problems can cause vision loss. If not treated, some of them can even result in blindness. In some cases, vitrectomy can restore lost vision. You might need a vitrectomy done in an emergency, such as an eye injury. In other cases, your eye care provider might schedule your surgery in advance.

But a vitrectomy may not be your only choice if you have one of these health problems. If you have diabetic retinopathy, for instance, your eye care provider might advise a procedure called laser photocoagulation instead.

If you have a detached retina, you might be able to have laser treatment, a procedure called pneumatic retinopexy, or an operation called scleral buckling. But you may be more likely to need a vitrectomy if you have a complex retinal detachment. Or if your eye condition has caused bleeding into your vitreous. Ask your eye care provider about the benefits and risks of all of your treatment choices.

What are the risks of vitrectomy?

Most people do well with vitrectomy. But complications do sometimes happen. Your risks may depend on your age, your health conditions, and the specifics of your eye problem. Some risks of the procedure include:

• Infection

• Excess bleeding

• High pressure in the eye

• New retinal detachment caused by the surgery

• Lens damage

• Increased rate of cataract formation

• Problems with eye movement after surgery

• Change in refractive error

There is also a risk that the surgery will not successfully fix your original problem. If this is the case, you might need a repeat surgery.

How do I get ready for a vitrectomy?

Ask your eye care provider what you need to do to get ready for vitrectomy surgery. Ask if you need to stop taking any medicines before the procedure. Follow any directions you are given for not eating or drinking before your surgery.

Your eye care provider may want to use special tools to shine a light in your eye and examine your retina. You will need to have your eyes dilated for your eye exam. You also might have an ultrasound of your eye, which helps your eye care provider view the retina.

What happens during a vitrectomy?

Talk with your eye care provider about what to expect during your surgery. The details of the surgery may differ a bit. A healthcare provider specially trained in eye surgery will do your surgery. In general, you can expect the following:

• You may be awake during the surgery. You will be given a medicine to help you relax. In this case, your eye care provider may use a shot (injection) to make sure you don’t feel anything.

• In other cases, you may have general anesthesia to put you to sleep. If this is the case, you will sleep deeply during the surgery. You won’t remember it afterwards.

• Your eye care provider will expose your eye.

• They will make small cuts in the white part of your eye (sclera).

• They will remove the vitreous and any scar tissue or foreign material.

• They will do other repairs to your eye as needed. For instance, they might use a laser to fix a tear in your retina. In some cases, your eye care provider may inject a gas bubble or silicone oil into your eye to help keep your retina in place.

• Your eye care provider may replace the vitreous with some other sort of fluid, such as silicone oil or saline.

• They may close your surgical cuts (incisions) with stitches. But stitches are often not needed.

• An antibiotic ointment may be placed on your eye to help prevent infection.

• Your eye will be covered with a patch.

What happens after a vitrectomy?

Ask your eye care provider about what you should expect after your surgery. In most cases, you will be able to go home the same day. Plan to have someone drive you home after the procedure.

Be sure to follow your provider’s instructions about eye care. You may need to take eye drops with antibiotics to help prevent infection. Your eye may be a little sore after the procedure. But you should be able to take over-the-counter pain relievers. You may need to wear an eye patch for a day or so.

If you had a gas bubble placed in your eye during your vitrectomy, you will need to follow specific directions about positioning after the surgery. To prevent complications, you will also need to not do any air travel or travel to high altitudes until the bubble is gone. Ask your eye care provider when it will be safe for you to fly or travel to high altitudes again.

You will need close follow-up with your eye care provider to see if the procedure was effective. You may have a scheduled appointment the day after the procedure. Be sure to tell your eye care provider right away if you have decreasing vision, increasing pain, or swelling around your eye. If silicone oil is injected into your eye during surgery, you may need another surgery a few months later to remove it from your eye.

Your vision may not be completely normal after your vitrectomy. This is even more likely if your condition caused lifelong (permanent) damage to your retina. Ask your eye care provider about how much improvement you can expect.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure