PROCEDURES
Vitrectomy
Overview
The vitreous is a normally clear, gel-like substance that fills the center of the eye. It makes up approximately 2/3 of the eye's volume, giving it form and shape before birth. Certain problems affecting the back of the eye may require a vitrectomy, or surgical removal of the vitreous. After a vitrectomy, the vitreous is replaced as the eye secretes aqueous and nutritive fluids.
A vitrectomy may be performed to clear blood and debris from the eye, to remove scar tissue, or to alleviate traction on the retina. Blood, inflammatory cells, debris, and scar tissue obscure light as it passes through the eye to the retina, resulting in blurred vision. The vitreous is also removed if it is pulling or tugging the retina from its normal position.
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.
Special Techniques
The 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.
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.
Redness is common and gradually diminishes over time. Some patients may notice a patch of blood on the outside of the eye. This is similar to bruising on the skin and slowly resolves on its own.
When does the vision improve?
Because vitrectomy is performed for many different problems and often in conjunction with other eye surgeries, the recovery period varies with the individual. In some cases, such as macular hole surgery, the surgeon may place a gas bubble inside the eye that places gentle pressure on the macula. This may require special head positioning to keep the bubble positioned correctly.
Dilating drops (red cap bottle) may be prescribed that keep the pupil of the operated eye large, causing be light sensitivity.
Postoperative Instructions
- Since vitrectomy is often performed along with other procedures, postoperative instructions may vary. Some general guidelines are provided; however, please consult with your surgeon for specific instructions.
- Begin using any anti-inflammatory and antibiotic drops prescribed by your physician immediately after your eye patch has been removed.
- Wear the plastic eye shield when sleeping for the first 7 days following surgery. The shield should be worn for the first 3 days following surgery when showering.
- Avoid bending, stooping, lifting objects over 5 pounds, or any strenuous activity for one week (unless directed otherwise by your physician).
- Take Tylenol E.S. or gently apply ice compresses to the eye to relieve mild discomfort.
Follow any special instructions given by your physician for head positioning (this is not necessary in all cases).
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