Vitrectomy: retina surgery

Vitrectomy is an eye surgery aimed at removing the vitreous gel, a jelly like substance that fills the eye's cavity. Removing the vitreous allows the surgeon to access the retina, the light sensitive layer at the back of the eye, and treat a wide range of conditions affecting it. During the surgery, the vitreous is replaced with a sterile saline solution, air, a special gas, or silicone oil, depending on the specific clinical need.

This procedure is recommended for various medical conditions affecting the retina and vitreous. Common indications include retinal detachment, a condition where the retina separates from its supporting layers, and macular hole, which is a defect in the center of vision. Vitrectomy also treats epiretinal membrane, a scar tissue that grows on the retinal surface and distorts vision, and significant intraocular hemorrhage in the vitreous, which can block vision. In cases of severe eye trauma, the surgery can help remove foreign bodies or repair retinal damage.

Before surgery, you will undergo a comprehensive eye examination by an ophthalmologist to assess your condition. You may be required to provide a full medical history, including a list of regular medications. In some cases, you might be advised to stop taking certain medications, such as blood thinners, before surgery, but this should only be done under a doctor's guidance. It is important to arrange for someone to accompany you on the day of surgery, as you will not be able to drive afterward.

The surgery is typically performed under local or general anesthesia. The surgeon makes three tiny incisions in the white part of the eye, through which delicate instruments are inserted. The vitrectomy instrument cuts and suctions out the vitreous gel. After the vitreous is removed, the surgeon performs the necessary retinal treatment, such as repairing tears, peeling membranes, or laser treatment. Finally, the eye cavity is filled with saline solution, air, gas, or silicone oil, as needed, to help the retina stay in place during healing.

Vitrectomy carries risks that differ in frequency and severity. Serious infection inside the eye is uncommon, but cataract formation or progression is common in eyes that still have their natural lens, especially in older adults. Cataract surgery may subsequently be needed.

Other risks include bleeding, changes in eye pressure, retinal tears or detachment and the need for further surgery. The retina may not recover or remain attached as expected, and the final vision is also limited by the underlying disease. Discuss the risks relevant to your operation with the surgeon.

After surgery, you may experience mild pain and blurred vision. If gas was inserted into the eye, vision will be blurry for several weeks until the gas is absorbed and replaced by the eye's natural fluid. In these cases, it is strictly forbidden to fly or ascend to high altitudes, until the surgeon confirms the bubble has fully disappeared. Inform every medical team about the bubble before anesthesia or pain relief. Nitrous oxide, including gas and air analgesia, must not be used while the bubble remains, because it can cause dangerous expansion and vision loss. Specific head positioning may be required for several days, as instructed by your doctor. You should avoid strenuous physical activity, exposure to dust or dirt, and getting water into the operated eye for a certain period. Eye drops should be used as directed.

After surgery, you will be asked to attend regular follow up appointments to ensure proper healing. It is crucial to seek urgent medical attention if you experience a sudden worsening of vision, severe and persistent eye pain, or signs of infection such as significant redness, swelling, or discharge from the eye. In cases where silicone oil was inserted, an additional surgery may be required to remove it after several months, once the retina has stabilized.