What is Vitrectomy Surgery?
A vitrectomy is a highly effective eye surgery that treats and repairs eye complications. It is the surgical removal of the vitreous humor, a clear, gel-like substance that gives the eye its 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 the following:
- Water
- Sugar
- Salt
- Collagen
- Amino acids
- Proteins
The vitreous humor also moves 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
Types of Vitrectomy Surgery
Here are the two types of vitrectomy procedures:
1. Posterior Pars Plana Vitrectomy
The posterior pars plana vitrectomy focuses on eye conditions in the back of the eye, where the retina and macula are located. These conditions include:
- Retinal detachment
- Vitreous hemorrhage
- Endophthalmitis
- Intraocular Foreign Body removal
- Macular Hole
A retinal specialist performs this type of vitrectomy.
2. Anterior Vitrectomy
The anterior vitrectomy corrects eye conditions located in 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?
Light must go through your eye and into your retina for you to see. Various diseases can affect the vitreous gel, which makes vision cloudy.
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 your 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 depends 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. It’s also recommended to:
- Remove makeup
- Leave your contact lenses at home
- Wear comfortable clothing and shoes
- Avoid eating at least 8 hours before your surgery
Your doctor may also perform an eye ultrasound before your surgery. This helps them view your retina more closely.
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 the 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.
Recovery typically lasts for 4 to 6 weeks. For a few days, your eye may be red and swollen, and your vision may be blurry. A vitrectomy typically does not cause severe pain but may cause a scratchy or gritty sensation that will subside over time.
If a gas bubble or silicone oil were used to replace the vitreous fluid, you might need to lay face down or in a proper position to promote healing.
Aftercare Instructions
Other aftercare instructions include:
- Avoid air travel, scuba diving, or hiking at high elevations until the gas bubble disappears (about a month)
- Use the eye drops and/or an antibiotic ointment your doctor prescribes to avoid infection and reduce inflammation
- Don’t do things that might cause you to move your head
- Get enough rest
Follow-up Appointments
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
Possible Risks of a Vitrectomy
Vitrectomy surgery is successful 90% of the time, and complications are rare. However, it does have risks, including:1
- Bleeding
- Infection
- Vision loss
- Retinal detachment
- Glaucoma (high intraocular pressure)
- Lens damage
- Change in refractive error
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 the 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.
For instance, eye doctors may recommend laser photocoagulation for those suffering from diabetic retinopathy. The use of ultrasound in vitrectomy procedures may also become an alternative approach.8
Summary
A vitrectomy is a surgery that removes the vitreous humor from the eye. It repairs emergent eye conditions. Vitreous humor is a gel-like substance that gives the eye its 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. Your eye doctor will explain all risks, benefits, and alternatives before deciding to proceed 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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