Vitrectomy:      Information and advice for patients

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What is vitreous and what does vitrectomy mean?

 

The vitreous is a clear jelly-like substance inside the eye. It lies behind the iris (the coloured part of the eye) and the lens, and in front of the retina (back of the eye). A vitrectomy is a surgical procedure to remove the vitreous humour.

 

 

What are the conditions that require a  vitrectomy?

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A vitrectomy may be necessary for a number of reasons:

1. A vitrectomy is often the first part of a retinal operation. For example, if you need a surgical repair for a detached retina a vitrectomy may be required.

2. For diabetic eye conditions where blood vessels from the retina leak and bleed into the clear vitreous jelly, greatly reducing vision.

3. Macular problems either due to epiretinal membrane or macular holes.

4. After a trauma (accident) to the eye – e.g. to allow a foreign body to be removed from the vitreous jelly or from the retina.

5. To take a biopsy (a sample of tissue) from the eye for examination in the laboratory – e.g. to diagnose a serious eye infection.

 

Does the vitreous get replaced?

 

The jelly does not naturally replace itself instead the eye will eventually replace it with its natural fluid. At the end of surgery one of the following is left in the eye:

1. Gas/air bubble (this is absorbed in 2-10 weeks depends on the gas)

2. A special oil or heavy liquid which is not absorbed and is surgically removed at a future date

3. Saline solution

The eye produces its own clear fluid known as aqueous which, as the gas or air is absorbed, will gradually fill the vitreous cavity.

 

What is the risk of complications?

 

Vitrectomies have been commonly performed and perfected for over 30 years. However, certain risks do exist. They include:

• Cataract progression

• Retinal detachment
• Raised pressure in the eye
• Bleeding inside the eye

• Infection
• Blindness or loss of eye (extremely rare)
• Need for additional treatment and/or surgery

 

Pre-operative assessment

 

Before your operation you will be asked to attend for pre-operative assessment. Sometimes this can take place at the same visit as your clinic appointment.

At pre-operative assessment you will be assessed about your readiness for the procedure and if there is anything that will need to be addressed /optimised before the surgery.

The vitrectomy procedure is normally performed as an outpatient procedure. Sometimes, an overnight stay in the hospital is required.

Local (awake) or general anaesthesia may be used. The eyelid will be held opened using a speculum (wire frame). A clean sheet (Drape) will cover the face to allow a clean field of work, there will be plenty of air flow underneath and it is usually well tolerated.

The procedure begins by making 3 tiny incisions in the white part of the eye and connecting an infusion tube to maintain eye inflation. Next, a light source and microscopic cutting device and are inserted which will gently remove the vitreous. The surgeon will use a microscope to view the eye whilst performing the procedure, the entry sites might need to be sutured depends on the case.

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What to expect after vitrectomy?

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Expect your eye to be sensitive and red due to the nature of the surgery. There will be some discomfort.

If gas has been inserted into the vitreous chamber, your vision will be poor until the bubble gradually absorbs.

The most important factor determining your rate of recovery and final outcome is the pre-operative condition for which the vitrectomy was performed. Your surgeon can advise you what to expect.

You will be prescribed a combination of drops to administer on your discharge home.

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Postoperative instructions:

 

Since vitrectomy is often performed along with other procedures, postoperative instructions may vary.

Some general guidelines are provided however, please consult with your surgeon for specific instructions.

 

If gas or oil has been inserted into the eye, you will be advised how to position your head. This helps ensure that the gas or oil is in contact with the affected retina, in order to encourage healing. You may be advised to maintain this position for up to 45 minutes of every hour for 3-14 days.

 

No flying with gas in the eye (2-10 weeks). The reduced atmospheric pressure causes the gas bubble to expand, which can raise the pressure in the eye to dangerous levels.

 

Begin using any anti-inflammatory and antibiotic drops prescribed by your surgeon immediately after your eye patch has been removed.

Take simple analgesia (e.g. paracetamol) to relieve discomfort.

 

Wear the plastic eye shield when sleeping for the first 14 days following surgery.

 

Avoid strenuous activity for four weeks (unless directed otherwise by your surgeon).

 

Will I get a follow-up appointment?

 

You may be reviewed one day after the operation, and then 1-2 weeks after the procedure, where the doctors will check the pressure in your eye and see how well you have responded to the treatment.

 

What if something happens before my appointment?

 

If you experience any of these symptoms after vitrectomy procedure, please contact the private hospital or your local NHS hospital Accident and Emergency department:

• Your vision becomes more blurred.

• Your eye becomes more red.

• Your eye becomes more painful.