What is a Vitrectomy?
A vitrectomy is the surgical removal of the vitreous humor, a clear, gel-like substance that gives the eye shape and allows light to reach the retina.
The vitreous humor is the largest structure of the eye and makes up 80% of its volume. It is composed of water, sugar, salt, collagen, amino acids, and proteins that nourish the eye. The vitreous humor is also critical in moving oxygen from the front to the back of the eye.2
Damage to the vitreous humor can lead to vision loss and other health complications, including:
- Detached retina
- Vitreous degeneration
- Vitreous hemorrhage
- Retinal tear
- Macular hole
A vitrectomy is a highly effective eye surgery that treats and repairs eye complications. After removing the vitreous gel, it is replaced with either an air or gas bubble, silicone oil, or artificial saline solution. The body naturally replaces the artificial solution with its own aqueous humor 24 to 48 hours after surgery.3
There are two types of vitrectomy procedures: posterior pars plana vitrectomy and anterior vitrectomy.
The posterior pars plana vitrectomy focuses on eye conditions in the back of the eye, where the retina and macula are located. A retinal specialist performs this type of vitrectomy.
The anterior vitrectomy corrects eye conditions located at the front of the eye, such as:
- Severe eye trauma
- Complications from cataract, glaucoma, or cornea surgery
- Lens problems
This type of vitrectomy procedure is less common. A licensed ophthalmologist performs this surgery.
Who Needs a Vitrectomy?
A vitrectomy treats and repairs eye conditions that affect the retina and vitreous, including:
- Diabetic retinopathy (abnormal bleeding or scar tissue)
- Macular hole (a hole in the macula that is responsible for central vision)
- Eye infection
- Macular pucker (creases or wrinkles in the macula)
- Severe eye trauma or injury
- Complications from cataract surgery
- Retinal detachment
Before recommending a vitrectomy, eye doctors and retina specialists consider several factors. They determine if:
- The eye condition is affecting vision
- Spontaneous or natural healing is unlikely
- The benefits of the surgery outweigh the risks
- The likelihood of potential complications
Cost
The average cost of a vitrectomy in the United States is between $8,000 to $14,000. The price is dependent on health insurance coverage and the complexity of the surgery. Cost can also increase if hospitalization is required.5
Insurance typically covers a vitrectomy if it is considered medically necessary.
Vitrectomy Procedure: What to Expect
Most vitrectomy procedures occur in an outpatient setting. This allows people to go home the same day after the procedure.
Other procedures typically accompany a vitrectomy to repair and treat the underlying cause of the eye condition.
The surgery duration may range from one to several hours, depending on the treatment plan and surgery goals.
Preparing for Surgery
Educating yourself about your eye condition will help you prepare for surgery. Confirm what your insurance plan covers to avoid surprise costs.
Questions to ask your eye doctor before surgery include:
- Do I need to stop taking any medications or supplements before surgery?
- Do I need to fast before surgery?
- Will I receive conscious sedation or general anesthesia?
- How long is recovery?
- Do I need someone to care for me after surgery?
- How will I know if the surgery was successful?
If it is an outpatient surgery, make sure you have a designated driver to take you home. Removing makeup, leaving your contact lenses at home, and wearing comfortable clothing and shoes are also recommended.
During Surgery
You will receive an intravenous (IV) line for conscious sedation or general anesthesia. An IV allows the healthcare professional to administer the medication quickly and effectively.
They will closely monitor your vitals (heart rate, breathing rate, blood pressure) as they administer anesthesia. They will also administer medicated eye drops to numb the eye.
During surgery, the eye doctor will use small tools and a microscope to create tiny incisions into the sclera (white of the eye). Depending on the treatment plan, the steps of the surgery typically include:
- Remove the vitreous fluid with a suction tool
- Remove scar tissue
- Use a laser to reattach or repair the retina
- Remove cataract
- Insert a gas or air bubble to keep retina in place
- Replace vitreous fluid with artificial saline solution or silicone oil (the body will naturally reproduce aqueous 24 to 48 hours after surgery)
After Surgery
After surgery, a patch will cover your eye to help it heal. Staff will monitor you in a separate room until you are awake and able to stand on your own.
After surgery:
- If a gas bubble or silicone oil were used to replace the vitreous fluid, you may need to lay face down or in a proper position to promote healing
- Air travel, scuba diving, or hiking at high elevations are not advised until the bubble disappears (about a month)
- The recovery period typically lasts 4 to 6 weeks
- You will wear an eye patch while the eye heals
- The eye may be red and swollen for a few days
- Vision may be blurry for a couple of days before improving
- To avoid infection and reduce inflammation, your doctor might prescribe eye drops and/or an antibiotic ointment that you will use daily
A vitrectomy typically does not cause severe pain, but it may cause a scratchy or gritty sensation that will subside over time.
Your doctor will confirm a follow-up appointment schedule before you leave the surgery center. It typically includes at least six visits post-surgery:7
- 1st visit: 1 day after surgery
- 2nd visit: 1 week later
- 3rd visit: 2 to 3 weeks later
- 4th visit: 4 to 6 weeks later
- 5th visit: 3 months later
- 6th visit: 6 months later
What are the Risks of a Vitrectomy?
While vitrectomy surgery is successful 90% of the time and complications are rare, it does have risks, including:1
- Bleeding
- Infection
- Vision loss
- Retinal detachment
- Glaucoma (high intraocular pressure)
People over 50 years old are at a higher risk for developing a cataract (cloudy lens) after vitrectomy surgery.
Your doctor will cover procedure risks and complications before vitrectomy surgery. This can help determine if potential benefits outweigh the risks.
Alternative Treatment Options
A traditional vitrectomy is currently the gold standard for treating many eye conditions.
However, ongoing clinical studies are looking for alternative treatment options. The use of ultrasound in vitrectomy procedures may become an alternative approach.8
Summary
A vitrectomy is surgery that removes the vitreous humor from the eye. It repairs emergent eye conditions. The vitreous humor is a gel-like substance that gives the eye shape and nutrients.
During surgery, the doctor removes the vitreous fluid and replaces it with a bubble (air or gas), artificial saline solution, or silicone oil. After eye surgery, the body will naturally replenish the aqueous fluid.
Vitrectomy surgery is 90% effective and complications are rare. However, risks include bleeding, infection, retina damage, and glaucoma. Your eye doctor will explain all risks, benefits, and alternatives before deciding to move forward with surgery.
The recovery period for a vitrectomy is 4 to 6 weeks. Your eye doctor will tell you when you can return to normal activities.
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