Vitrectomy is a surgical operation to remove some or all of the vitreous humor from the eye in order to treat eye conditions such as retinal detachment, macular pucker, diabetic retinopathy etc.
The vitreous humor is the clear gel that fills the space between the lens and the retina of the eyeball helping to protect the eyes and keep the retina in place.
Once vitrectomy is complete, saline, a gas bubble or silicone oil may be injected into the vitreous gel to help hold the retina in position.
Conditions in which vitrectomy is indicated include:
Retinal detachment – Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field. This may be described as a curtain over part of the field of vision. In about 7% of cases both eyes are affected. Without treatment permanent loss of vision may occur.
Macular pucker – A macular pucker, also called epiretinal membrane is scar tissue that has formed on the eye’s macula, located in the center of the light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular pucker can cause blurred and distorted central vision.
Diabetic retinopathy – Diabetic retinopathy, also known as diabetic eye disease (DED), is a medical condition in which damage occurs to the retina due to diabetes mellitus. Diabetic retinopathy is caused by damage to the blood vessels in the tissue at the back of the eye (retina). Often diabetic retinopathy is treated in early stages with a laser in the physician’s office to prevent these problems. When bleeding or retinal detachment occur, vitrectomy is employed to clear the blood, membranectomy removes scar tissue, and injection of gas or silicone with scleral buckle may be needed to return sight. Diabetics should have an eye exam yearly.
Macular holes – The normal shrinking of the vitreous humor with aging can occasionally tear the central retina causing a macular hole with a blind spot blocking sight.
Vitrectomy is usually done in an outpatient surgery center and the procedure is performed under general anesthesia or local anesthesia. There are different types of vitrectomies.
- Posterior Pars Plana Vitrectomy: Vitrectomy was originated by Robert Machemer with contributions from Thomas M. Aaberg, Sr in late 1969 and early 1970. The original purpose of vitrectomy was to remove clouded vitreous humor—usually containing blood.
The success of these first procedures led to the development of techniques and instruments to remove clouding and also to peel scar tissue off the light sensitive lining of the eye—the retina—membranectomy, to provide space for materials injected in the eye to reattach the retina such as gases or liquid silicone, and to increase the efficacy of other surgical steps such as scleral buckle.
The development of new instruments and surgical strategies through the 1970s and 1980s was spearheaded by surgeon/engineer Steve Charles, M.D. More recent advances have included smaller and more refined instruments for use in the eye, the injection of various medications at the time of surgery to manipulate a detached retina into its proper position and mark the location of tissue layers to allow their removal, and for long term protection against scar tissue formation.
- Anterior Vitrectomy: Anterior vitrectomy entails removing small portions of the vitreous humor from the front structures of the eye—often because these are tangled in an intraocular lens or other structures. The goals of anterior vitrectomy are to remove the vitreous from the anterior chamber, to clear any vitreous from the entry incisions and to allow an IOL (intraocular lens) to be placed.
Additional surgical steps involved as part of modern vitrectomy surgeries may include: fluid/air exchange, silicone oil injection. photocoagulation, cataract surgery, etc.
Vitrectomy Risks and Complications
As with any surgical procedure, there are risks of complications following vitrectomy. They include:
- Cataract – A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataract is the most frequent complication. Many patients will develop a cataract within the first few years after surgery.
- Bleeding – There may be bleeding in the eyes following the surgery.
- Retinal edema – This occurs when fluid collects on or under the macula of the eye (a yellow central area of the retina) and causes it to thicken and swell. In most cases, the retinal edema can be managed with over-the-counter medication. In severe cases, this swelling can be treated with intra-ocular injections.
- Endophthalmitis – This refers to inflammation of the fluids in the eye.
The cost of a vitrectomy depends on multiple factors, such as the surgeon, the type of anesthesia used, and whether someone is using insurance. A person’s specific insurance plan plays a role in the total cost of the procedure. In the United States, the estimated national average cost of a vitrectomy is about $13,500.
Patients use eye drops for several weeks, or longer, to allow the surface of the eye to heal. In some cases, heavy lifting is avoided for a few weeks.
A gas bubble may be placed inside the eye, to keep the retina in place. If a gas bubble is used, sometimes a certain head positioning (posturing) has to be maintained, such as face down or sleeping on the right or left side. The gas bubble will dissolve over time, but this takes several weeks. Flying should be avoided while the gas bubble is still present.
Problems such as return of the original condition, bleeding, or infection from the surgery may require additional treatment or can result in blindness. In the event that the patient would need to remain face down after surgery, a vitrectomy support system can be rented, to help aid during the recovery time. This particular equipment may be used for as little as five days to as long as three weeks.
In general, the full recovery process for vitrectomy surgeries takes between 4 to 6 weeks.
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