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Vitrectomy
What is vitrectomy?
A vitrectomy is a surgical procedure undertaken by a specialist where the vitreous humor gel that fills the eye cavity is cleared to provide better access to the retina.
The vitreous humor serves as a framework or support for the eye. In normal eyes, the vitreous is crystal clear and fills the eye from behind the iris and lens till the optic nerve. This area comprises two-thirds of the volume of the eye and is called the vitreous cavity. The vitreous cavity lies in front of the retina and choroid.
Removal of this vitreous allows for the ease of a variety of retinal procedures.
There are different types of Vitrectomies
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Anterior Vitrectomy
In rare cases, following complex cataract/cornea/glaucoma surgeries, the vitreous gel comes through the pupil into the front portion of the eye. This must be cleared to reduce inflammation and to prevent the cornea from decompensating and to reduce the risk of future retinal problems.
Pars Plana Vitrectomy
What is Pars Plana Vitrectomy Surgery?
A vitrectomy performed by a retina specialist for diseases of the posterior segment is called a posterior or pars plana vitrectomy. Three self-sealing openings or ports are created in the eyeball to access the vitreous, which is removed using high-speed cutters with a light source providing illumination inside the eye.
Once a pars plana vitrectomy is complete, saline or a gas bubble or silicone oil may be injected into the vitreous gel to help hold the retina in position.
When such a vitreous substitute is used, a period of postoperative positioning (typically face-down) by the patient helps the retina heal.
Common indications of a vitrectomy are
- Retinal detachment due to breaks in the retina, diabetes or trauma.
- Endophthalmitis- inflammation of the inner coats of the eye, including the vitreous.
- Macular conditions- like a hole or an obscuring membrane. The macula is the most sensitive portion of the retina.
- Vitreous hemorrhage- bleeding into the vitreous commonly due to diabetes.
- Penetration of an intraocular foreign body following trauma.
Preoperatively, after a thorough examination by your retinal specialist, you will be asked to do a few scans. These scans involve:
A clinical photograph of your retina.
An aid to assess the back portion of your eye through ultrasound imaging in case the retinal view is hazy (ocular ultrasound)
A detailed pictorial representation of the layers of your macula (OCT macula).
Once your procedure is planned, your treating doctor will inform you whether additional procedures will be combined with the vitrectomy, such as cataract surgery, or placement of an encircling buckle (to straddle the vitreous base), depending on the indication of surgery.
Our physician and anesthesiology team will evaluate you for fitness after a basic assessment. They will advise you on whether to continue with your regular medications, if any, on the day of surgery, which is done as a daycare procedure.
On the day of surgery, anaesthesia is achieved with an injection near the eye to prevent pain sensation and eye movement during the surgery. The eye is painted externally and irrigated with a povidone-iodine solution of optimum strength, and a sterile drape is applied to ensure asepsis. The surgery typically takes 60 to 120 minutes, depending on the complexity of the surgery.
Postoperatively, the eye is patched to protect from injury. Your surgeon will give you instructions on how to do any required head positioning (such as face-down) and how long you should continue it. Postoperative drops and oral medication are usually prescribed before discharge.
Remember your compliance with the postoperative instructions is the key to the success of this procedure!
FAQ
What happens in a vitrectomy surgery?
The duration of a vitrectomy surgery can be from around one to many hours, depending upon the medical condition that is being treated. Before the vitreoretinal surgery begins, the surgeon will give an option between staying awake or using numbing shots in the eye that needs treatment.
However, in many cases, you might be put under the influence of general anaesthesia that puts you to sleep before the vitrectomy surgery begins. Below we have mentioned the steps that are performed during a vitreoretinal surgery:
- The surgeon will make a small incision in the outer layer of the patient’s eye.
- The incision is made through the sclera (white part of the eye).
- In the next step, the vitreous fluid is removed by using a microscopic cutting tool. Amid this step, the eye is filled with liquid which is equivalent to a normal eye fluid.
- In the last step, the surgeon removes any debris or scar tissues present in the eyes.
Once all the fluid is removed via vitrectomy surgery, the surgeon will make other repairs that your eyes might need. When your eyes seem fit and healthy, your eyes will be filled with silicone oil or saline.
Like any other surgery, the surgeon will put stitches to close the cuts in the eyes; however, it is not required in most cases. The eye will be treated with an eye ointment and will be covered with an eye patch.
What happens in the recovery period after the vitreoretinal surgery?
Once vitreoretinal surgery is completed, your concerned doctor will prescribe some eye drops to prevent any kind of eye infection. However, if the eye still feels irritable or sore, they will recommend some pain relievers for instant relief. Lastly, after every surgery, the doctor would recommend you fix appointments for regular eye check-ups for the next couple of weeks.
What is the process of pars plana vitrectomy surgery?
As mentioned above, PPV or pars plana vitrectomy surgery is a medical technique that enables smooth access to the posterior segment in order to treat several eye conditions like macular holes, retinal detachment, endophthalmitis, vitreous haemorrhage, and more.
- In the first step of this pars plana surgery, the vitreous gel is removed from the back of the eye.
- In the next step of pars plana surgery, several microsurgical illuminating devices, tools, and lenses are used to achieve the goal of the surgery.
- Pars plana vitrectomy surgery is usually performed under the influence of anaesthesia, and patients can leave in about 2-3 hours.
What are common complications after pars plana vitrectomy surgery?
Some post-surgery complications after pars plana vitrectomy surgery are:
- Cataract progression is one of the many complications of pars plana vitrectomy surgery.
- Another complication of pars plana surgery is the risk of retinal detachment and bleeding.
- High eye pressure
- Eye inflammation
- Eye infection
What are some recovery tips after vitrectomy surgery?
- For a few days, avoid activities like reading, driving, exercising, etc.
- Use eye drops prescribed by your doctor to prevent any further discomfort.
- In some cases, the doctor might ask the patient to lay face down to accelerate the process of healing.
Do not ignore eye trouble!
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