Vitrectomy Eye Surgery

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What is a Vitrectomy of the Eye?

A vitrectomy is a procedure performed on the eye in a surgery center. This type of eye surgery helps address problems associated with the eye’s retina and vitreous. In the back of the eye, the retina is responsible for receiving and organizing visual information. The vitreous is the gel-like fluid that is in your eye. 

If you undergo a vitrectomy, it may be for one of the following reasons:

  • To get rid of blood or other substances that prevent light from focusing correctly on the retina
  • To remove scar tissue that is wrinkling the retina and causing decreased visual acuity
  • To repair retinal tears 
  • To help resolve retinal detachment (when the retina becomes separated from the eye wall)
  • To extract a foreign object caught inside the eye from an injury or trauma 

During this procedure, the eye surgeon (or ophthalmologist) will take out some or all of the vitreous from the middle of your eye. The surgeon will then replace it with either a saline solution or an oil or gas bubble. 

While your eye heals, it substitutes this saline solution or bubble with aqueous humor (a natural fluid made by the eye). 

Like any type of surgical procedure, a vitrectomy can carry some risks of complications. For this reason, it is important to speak with your eye care specialist about all possible options and determine if a vitrectomy is the most suitable solution for you. 

When is a Vitrectomy Procedure Necessary?

An eye doctor may suggest a vitrectomy if you have been diagnosed with one of these eye health conditions, including:

  • Diabetic retinopathy, with bleeding or scar tissue affecting the retina or vitreous gel
  • Some cases of retinal detachment (when the retina pulls away from the eye wall)
  • Macular hole (a hole or tear in the macula, which forms part of the inside of the eye and is essential to central vision, color vision, and visual sharpness)
  • Macular pucker (wrinkles or creases in the macula)
  • Endophthalmitis (a type of severe eye infection)
  • Severe eye injury or trauma
  • Specific problems that arise during cataract surgery

These medical conditions can all result in loss of vision. If left untreated, some of these conditions can even lead to complete blindness. However, a vitrectomy can be a suitable option to restore lost vision in some cases. 

Your eye doctor will advise you on whether or not you need to undergo this type of surgical procedure. 

In some instances, such as diabetic retinopathy or retinal detachment, you could opt for other treatments. People with diabetic retinopathy could consider laser photocoagulation, while those with a detached retina may look into a pneumatic retinopexy (a type of laser procedure). 

If you have a complicated case of retinal detachment or an eye condition that results in bleeding into the vitreous, a vitrectomy may be the more likely treatment of choice. 

Types of Vitrectomy Surgery

Posterior Pars Plana Vitrectomy 

In this type of vitreoretinal surgery, your eye surgeon accesses the posterior segment of the eye to treat conditions like:

  • Retinal detachments
  • Vitreous hemorrhage (bleeding)
  • Endophthalmitis 
  • Macular holes 

The eye surgeon introduces surgical instruments into the eye through the pars plana (a “safe zone” in the sclera or white part of the eye) to remove the vitreous. By performing here in this area, the surgeon minimizes the risk of damage to the retina.

A posterior pars plana vitrectomy (PPV) is the most common approach. 

Anterior Vitrectomy

An eye surgeon may opt for this approach when the vitreous gel penetrates the pupil into the eye’s anterior (front) chamber. If the gel reaches this area of the eye, it could be due to:

  • Eye trauma or injury
  • Complex cataract, cornea, or glaucoma surgery 
  • Lens problem 

Although this type of surgical procedure is not common, it could prove essential in cases of leaking vitreous gel. An anterior vitrectomy can minimize the risks of complications and promote visual recovery. 

Some people may require a vitrectomy in both eyes. However, your eye doctor will only perform the surgery on one eye at a time. After the first eye has healed, you’ll be able to schedule the second surgery with your eye care specialist. 

What to Expect: Vitrectomy Surgery Steps

When you undergo vitrectomy surgery, your eye surgeon will make incisions in the eye wall and extract most vitreous with a suction tool. 

Based on your treatment plan, your doctor could also:

  • Apply a laser or freeze treatment for retinal reattachment or repair
  • Inject a gas or oil bubble to hold the retina in place
  • Substitute the vitreous with a clear fluid, e.g., silicone oil 

Your doctor may give you local anesthetic eye drops for the eye surgery. You may also be under general anesthesia. You should speak with your surgeon in advance to determine the best anesthesia option. 

Potential Vitrectomy Side Effects

Because of refined techniques and more knowledge, a vitrectomy has a high rate of success. However, side effects can occur. For example, you may experience:

  • Eye discomfort 
  • Eye pain (in rare cases)
  • A scratchy, sandy, or gritty sensation 
  • Increased eye pressure 
  • Bleeding 

You should speak with your eye doctor about all possible side effects. 

Vitrectomy Complications & Risks

Most people who undergo a vitrectomy do not experience complications. However, the risk is present and can increase if you are older or have an underlying medical condition. The severity of your eye health problem may also influence whether you develop complications or not. 

If you decide to have a vitrectomy, some complications that could occur include:

  • Infection 
  • Excess bleeding 
  • High eye pressure 
  • New retinal detachment due to the surgery
  • Lens damage 
  • Higher rate of cataract formation 
  • Eye movement problems after surgery 
  • Changes in refractive error 

Also, you should remember that the surgery may not be able to resolve your original problem. Should this happen, you might have to repeat the surgery.

People who underwent cataract surgery with a lens implant should not have to worry about a vitrectomy causing damage to the new lens. 

Vitrectomy Recovery Time

A vitrectomy is a type of microsurgical procedure performed on the eye. For this reason, recovery is essential. 

If you follow post-op care instructions correctly, you will minimize your risk of complications and ensure a healthier and speedy healing process. While recovery time will vary, most people will begin to be better within 2 to 4 weeks of the eye surgery. 

How Long After a Vitrectomy Will I Have Clear Vision?

To determine whether the vitrectomy was effective, you will require a follow-up eye exam with your eye care specialist. The scheduled appointment may take place the day after the surgery. 

Your doctor will be able to tell you how well your post-op care is progressing. However, as each case is unique, you may not report clear vision until 2 to 4 weeks have passed. 

It is also important to remember that the original eye condition may have caused permanent damage to the retina. This means that a complete, clear vision may not be possible. 

Finally, if your eye doctor placed silicone oil in your eye, you will need another surgery to remove it. This could delay the recovery process. 

You should speak with your eye doctor before undergoing surgery about what improvements to expect.

What Not to Do After a Vitrectomy 

When you have a vitrectomy, it is extremely important to follow post-op care instructions. When you do, you lower your likelihood of serious complications or eye problems. 

Here is a list of items and tasks that you should not do after a vitrectomy:

  • Drive home after the procedure or during the recovery process
  • Take a flight without prior approval from your eye doctor 
  • Make sudden or quick movements with the head
  • Heavy lifting 
  • Lie on your back (your doctor may recommend a facedown position)
  • Take aspirin or blood thinners without prior approval from your eye doctor 
  • Take off the eye patch without prior approval from your eye doctor

Eye surgeons can now perform many vitrectomies with self-sealing, no-stitch incisions that measure the approximate width of an eyelash. 

How Much Does a Vitrectomy Cost?

In the United States, the costs of a vitrectomy may range between 7700 and 14500 dollars. 

However, these costs will vary depending on your health insurance plan and the eye surgeon selected to perform the procedure. You should speak with your ophthalmology clinic to receive a quote for the surgical procedure. 

A vitrectomy has a success rate of more than 90% for many conditions, and the risk of severe complications is extremely minimal.

Resources
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Boyd, Kierstan. “What Is Vitrectomy?” American Academy of Ophthalmology, 22 Apr. 2021, www.aao.org/eye-health/treatments/what-is-vitrectomy.

“Pars Plana Vitrectomy.” EyeWiki, 26 Mar. 2021, eyewiki.aao.org/Pars_Plana_Vitrectomy.

“Vitrectomy.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/wellness-and-prevention/vitrectomy.

“Vitrectomy.” Mdsave.com, www.mdsave.com/procedures/vitrectomy/d482fbcd#:~:text=How%20Much%20Does%20a%20Vitrectomy,their%20procedure%20upfront%20through%20MDsave.

“Vitrectomy.” National Eye Institute, U.S. Department of Health and Human Services, www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinal-detachment/vitrectomy.

“Vitrectomy.” The American Society of Retina Specialists, www.asrs.org/patients/retinal-diseases/25/vitrectomy.

“Vitrectomy.” Vitrectomy | Michigan Medicine, www.uofmhealth.org/health-library/tf1464.

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