Vitrectomy

What is the vitreous?

The vitreous is a clear jelly-like substance inside the eye. It is behind the iris (coloured part of the eye) and the lens and in front of the retina (back of the eye).

What is a vitrectomy?

Vitrectomy is a surgical procedure to remove the vitreous.

When is a vitrectomy required?

If you have the following conditions, you may require a vitrectomy:

Retinal detachment

Macular hole

Epiretinal membrane

Vitreomacular traction

Diabetic related eye conditions

Complicated cataract surgeries

Injury to the eye – eg. foreign body going into the eye

Vitreous biopsy to diagnose other eye conditions.

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Does the vitreous gel get replaced after removal?

The vitreous does not naturally replace itself but at the end of the surgery the following is inserted into the eye:

Gas bubble (typically ranges from 2 – 10 weeks for it to naturally absorbed itself)

Special silicone oil which is not absorbed but will need another surgery to remove it.

Air (typically ranges from 7-10 days to naturally absorbed itself)

Saline solution.

After the gas or air is absorbed, the eye naturally produces a clear fluid called aqueous fluid that fills up the eye.

What are the risk of having a vitrectomy?

Cataract progression

Further retinal detachment

Raised eye pressure

Bleeding inside the eye

Infection

Blindness or loss of eye (very rare)

Need for further treatment or surgery

Summary of the process of the surgery:

Pre-operative assessment to discuss about the surgery in detail and ensure you are fit for the surgery.

Normally an outpatient procedure – which means you come and go home on the same day

Anaesthesia choice is dependable on patient or complexity of eye condition. Most procedures are done as local anaesthetic (you are awake but with an anaesthetic injection to numb the eye) or general anaesthetic (you are put to sleep).

During the surgery, the eyelid will be held opened with a speculum (wire frame) and the other unoperated eye will be covered.

Three tiny incisions are made into the white part of the eye and connected to an infusion tube to maintain the eye shape.

A light source and microscopic cutting device will be inserted to remove the vitreous gel and repair the eye condition.

A microscope is used to view the eye during the procedure.

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Post operative instructions:

If gas or oil has been inserted into the eye, you will have to position your head to ensure the gas or oil is in contact with the retina in order to encourage healing. You may be advised to maintain this position for up to 45 minutes per hour for 7 to 10 days. The surgeon will explain to you how you will need to position.

You will also be given anti-inflammatory and antibiotic eye drops to use for up to 4 weeks to help the eye settle.

You are normally reviewed the following day in the morning at 8am in a designated place. If the eye stable, the next visit will typically be 2 weeks.

It is important that you do not fly with a gas in the eye. This can cause the gas in the eye to expand which can raise the pressure in the eye causing pain and blindness.

Simple painkillers (eg. paracetamol or ibuprofen) can be used to relieve discomfort.

Wear the plastic eye shield provided when sleeping for at least 2 weeks after the surgery.

Avoid strenuous activity for 4 weeks

Other FAQs:

How do I maintain a face-down position?

You can maintain this position by lying on the bed with pillows for support. Pillows should be placed under the hips and ankles or special wedges can be purchased if longer periods of positioning are required. You may prefer to sit at a table and use pillows for support.

 How much time off work will I need? 

Most people will need at least 2 to 4 weeks off work after surgery. This is dependable on the work that you do.

Will my eye be sore following surgery?

It is normal to experience some discomfort and red eye in the eye after surgery but this usually is relieved with simple painkillers.

How soon will I see after surgery?

Vision in the operated eye will usually be very blurred for the first few weeks but will slowly improve. The final visual result may take several weeks or months and you may require new glasses.

How long before I can wash my hair?

You are able to wash your hair as required as long as you DO NOT let any water or shampoo/conditioner into the eyes. To prevent this from happening; face away from the water stream, keep your head tilted back and eyes closed whilst rinsing.

When can I wear make-up again following surgery?

No eye make-up for 2 to 4 weeks following surgery.

If I am using other drops such as lubricating or anti-glaucoma drops, will it interfere with the post-operative drops?

No. If your doctor has prescribed other drops prior to your surgery, you should continue using them unless advised differently.

When can I drive again?

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You can drive after 2-4 weeks depending on the vision of the non operated eye and how you are adjusting to your vision after the surgery. Please ask your surgeon for advice.

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References:

American Society of Retinal Specialists (ASRS) Retinal Health Information and Fact Sheets.

Available at https://www.asrs.org/patients/retinal-diseases

British & Eire Association of Vitreoretinal Surgeons (BEAVRS) Patient Information.

Available at https://beavrs.org/patient-information