Sudden flashes of light, many new floaters, a dark curtain over vision or haziness from bleeding are signs of serious retinal issues. While medicines, injections and laser treatment may not fix some structural issues. In the case of blood, scar tissue or vitreous gel which is interfering with the retina’s proper function an ophthalmologist may recommend Vitrectomy Surgery.
The choice is based on diagnosis, urgency and present damage. This guide we present when Retina Surgery is needed, what takes place in the Vitrectomy Procedure, how it supports Retinal Detachment Surgery and what the recovery process is like.
What Is Vitrectomy?
The vitreous is a clear, gel-like substance that exists between the natural lens and the retina. The retina is the light-sensitive layer at the back of the eye. During Vitrectomy Surgery, the surgeon will remove some or most of this gel through small openings in the white part of the eye. This will create space to clear blood, release scar tissue, repair retinal tears, treat infection or flatten a detached retina.
In time what was removed from the eye is replaced by the eye’s own clear fluid. As for what we did in the operating room we may have put in air, a medical gas bubble or silicone oil. Also we may have used laser or freezing which we put to use to seal retinal breaks and support the healing.
When Is Vitrectomy Surgery Needed?
In some cases surgery is an option which we present to patients that have disease in the vitreous or retina which is affecting sight, which is blocking the surgeon’s view, or which is retina tissue. Some procedures are emergency in nature, while others we discuss with the patient when their vision starts to blur or distort which in turn starts to affect reading, driving, recognizing faces or performing daily work tasks.
| Condition | Why surgery may be considered | What may be done |
| Retinal detachment | The retina has separated from its supporting layer | Remove vitreous traction, repair tears and place gas or silicone oil |
| Vitreous haemorrhage | Blood blocks vision or hides the retina | Clear the blood and treat its source |
| Macular hole | An opening in the central retina affects detailed vision | Remove traction, peel a fine membrane and place gas |
| Epiretinal membrane | Scar-like tissue wrinkles the macula | Remove the vitreous and peel the membrane |
| Advanced diabetic retinopathy | Bleeding and scar tissue pull on the retina | Clear blood, release traction and apply laser |
| Eye injury or infection | Foreign material or infected vitreous threatens the eye | Remove harmful material and provide additional treatment |
These are among the commonly recognised reasons for operating on the vitreous and retina, although the treatment plan must always be based on an individual retinal examination.
Retinal Detachment and Retinal Tears
A retinal detachment will cause flashes, sudden floaters, a shadow or a missing area in the field of vision. It is considered an eye emergency for the reason retinal cells may experience permanent damage if separated from their normal post. Retinal Detachment Surgery aims to reattach the retina to the inner eye wall and repair the tear that made it possible for fluid to collect under it.
Not all detachments require the same procedure. Pneumatic retinopexy, a scleral buckle or a combined approach are options for some patients. For large, complex detaches which also may be associated with bleeding or caused by traction, we may turn to Vitrectomy Surgery. In this type of Retina Surgery the vitreous which is pulling on the tear is removed and we may use laser, gas or silicon oil to keep the retina in place.
The issue of Retinal Detachment Surgery urgency is based on the macula’s attachment status, the rate at which symptoms are appearing and the extent of the detachment. Timely assessment is key because the visual outcome is in part determined by the degree of retinal damage that has taken place.
Diabetic Retinopathy and Vitreous Haemorrhage
Advanced in diabetic retinopathy it can produce weak abnormal blood vessels which bleed into the vitreous. A small bleed may resolve or respond to other treatment, but dense or persistent hemorrhage can block vision and prevent retinal exam. Via the process of vitrectomy surgery the blood is removed, access to the retina is restored and laser treatment may be performed.
Diabetes also causes the growth of scar tissue which in turn pulls the retina away from the back of the eye. This is tractional retinal detachment. In such cases Retina Surgery is used to gently separate the scar tissue. When detachment is present or is in progress the treatment may also become a form of Retinal Detachment Surgery.
The timing of the Vitrectomy Procedure is very much a case by case issue. The retina specialist looks at ultrasound or scan results, the state of the other eye, past injection or laser treatments, the amount of traction present and how poor vision is affecting daily life.
Macular Hole and Epiretinal Membrane
The macula is what gives us our central vision for things like reading, recognizing faces and seeing fine detail. A macular hole may cause a blurred or blank spot in the center. An epiretinal membrane may cause straight lines to appear wavy or objects to look distorted. If these symptoms greatly impact daily life Vitrectomy Surgery may be advised.
For a macular hole, we perform a Vitrectomy Procedure which includes removal of the vitreous and a very thin membrane from the retinal surface. Then a gas bubble is placed which gently presses against the macula as the hole closes. In case of an epiretinal membrane we do Retina Surgery which consists of peeling the tissue that causes the macula to wrinkle. Also, improvement in this case is usually a gradual process as retinal healing takes time.
Infection, Injury and Retained Lens Material
A serious case of intraocular infection which we term endophthalmitis may present very quickly. We may use antibiotics in injection form, surgery or a combination of both. In some cases we do Vitrectomy Surgery which removes the infected vitreous, gives us a sample for lab work and also we may see it as a way to reduce inflammatory material.
After a serious injury Vitrectomy Surgery may assist in removing a foreign object from your eye, blood, or damaged tissue from the eye. Also we may require it after clogged cataract procedures when the lens pieces have gone into the back of the eye. Each of these situations will require a unique plan as the retina, cornea, lens, and pressure in the eye will be affected.
How Is the Decision Made?
In the wake of a dilated eye exam and retinal imaging. We use optical coherence tomography which goes into great detail of the macula and also ultrasound which we turn to when there is blood or cataract which blocks retinal view.
The doctor will weigh the benefits of Vitrectomy Surgery against the pros of waiting and performing the operation. In some cases stability is achieved but in others which present with progressive detachment, heavy bleed or large scale traction Retina Surgery may be the better option. Also general health of the patient, the medicines they are on and their ability to follow post op instructions play a role in the decision for Vitrectomy Surgery.
Preparing for Surgery
Before the procedure the team goes over the objective, anesthetic to be used including gas or silicone oil. Patients present a full list of medications and do not discontinue prescribed treatments without advice. Fasting directions vary with the type of anesthesia.
Cataract treatment is a topic which may come up for Vitrectomy Surgery which in turn may speed up the clouding of the lens. Also it is for patients to arrange for a ride home as vision will be blurry.
What Happens During the Vitrectomy Procedure?
The surgeon uses microscopes, lights and fine instruments which pass through small incisions. From removing the vitreous to blood clearance, peeling of membranes, sealing of tears, laser treatment of abnormal vessels or flattening the retina, that is what the procedure includes.
At the conclusion of the Vitrectomy Procedure the eye may have fluid, air, gas or silicone oil within it. Gas will be absorbed over time; silicone oil may require a second procedure for removal. No stitches are put in all the time. Time in the operating room varies by the degree of the procedure’s complexity, also many patients go home the same day.
| Stage | What patients may experience |
| Before surgery | Retinal scans, medical review, consent and anaesthesia instructions |
| During surgery | Numbing medicine or anaesthesia and awareness of bright light in some awake patients |
| First day | Eye patch or shield, blurred vision, mild soreness and prescribed drops |
| First two weeks | Redness begins settling, follow-up examination and activity restrictions |
| Following weeks | Vision changes as gas absorbs and the retina heals |
| Longer term | Further checks for retinal stability, eye pressure and cataract |
Benefits and Realistic Expectations
Vitrectomy Surgery purpose is to address the structural cause of visual loss. It can remove blood, break up traction, repair a tear, close a macular hole or improve vision by reducing distortion from a membrane.
In the case of acute Retinal Detachment Surgery the primary benefit is that it may preserve what vision is left instead of restoring previous sight. For Retina Surgery in the setting of advanced diabetic disease we may also be able to stabilize an eye that has existing damage. Results will vary based on the diagnosis, the length of time the issue has been present and the health of the macula and optic nerve.
Risks and Possible Complications
Possible issues with Vitrectomy Surgery may include infection, bleeding, inflammation, pressure changes, cataract progress, new tears, recurrent detachment and further surgery. While in most cases severe visual loss does occur it is also rare..
Risk varies by diagnosis. For Membrane Peeling which is a type of Retinal Detachment Surgery. Prior to giving consent the doctor should go over the expected benefit, alternatives and what may happen if we do not treat. This is also a part of the pre op discussion for the Vitrectomy Procedure.
Recovery After Surgery
Vision tends to blur right after Vitrectomy Surgery. Eye may feel gritty, watery, or just slightly sore, also you may see red which will die down over weeks. Prescribed drops should be used precisely as direct.
Heavy lifting, strenuous exercise, swimming, eye rubbing and driving are off until the surgeon gives the ok. Recovery after Retina Surgery is variable because of differences in gas used, positioning requirements and the pre existing health of the patient.
Gas Bubble and Positioning Precautions
When anesthetized the patient may have to assume a specific head position which in turn will direct the bubble to the affected area. The position of the head is determined by the site of the retinal issue and as always the anesthesiologist’s instructions are to be followed.
Flying and high altitude travel is out of the question while gas is present as it may raise intraocular pressure. Also report to doctors and anesthetists of the issue as nitrous oxide may cause expansion of the bubble. These are very important points to note post Retinal Detachment Surgery and any Vitrectomy Procedure which uses gas.
How Soon Can Vision Improve?
After Vitrectomy Surgery there is not a set recovery time. Vision will stay blurred while gas is present which will improve as the bubble goes down. At even no sign of gas retinal recovery may take weeks or months.
The results of Retina Surgery are based on macular involvement, disease duration, diabetes control and health of the optic nerve. While we may see successful repair of the retina which does not always translate to perfect vision, in particular after advanced Retinal Detachment Surgery. Follow up is very important to detect pressure changes, cataract, bleeding, or a return of the detachment.
When Should Urgent Help Be Sought?
Severe and increasing pain, sudden change in vision, great redness or swelling, colored discharge, new flashes, many new floaters or another curtain like shadow require prompt contact with the eye hospital. Nausea which presents with eye pain may also be a sign of raised intraocular pressure. These symptoms should not be waited for until your next routine visit.
Vitrectomy Care at ASG Eye Hospital
At our ASG Eye Hospital we begin vitrectomy surgery assessment with a detailed retinal exam. The specialist goes over scans, symptoms and visual needs before explaining which of the following may be appropriate: watchful waiting, injections, laser, Retina Surgery or a combined treatment. Also we report at ASG Eye Hospital that we have retinal detachment, diabetic retinopathy, macular holes, internal bleeding and serious retinal disorders listed among the conditions for which we may consider vitreoretinal treatment.
Patients that are to undergo detachment repair should ask regarding urgency, gas or silicone oil use, positioning and what to expect visually. Before the Vitrectomy Procedure it is important for the family to understand the plan which in turn helps in the recovery.
Also Read : Vitrectomy Surgery Recovery: Healing Time, Aftercare and Vision Improvement
Frequently Asked Questions
1. Is Vitrectomy a Major Eye Operation?
Yes. Vitrectomy Surgery which is a specialized field of ophthalmic care is performed within the eye. We use very small tools for this which is a great advance from the past. That said, careful pre and post operative assessment, sterile field and follow up with a retinal specialist is a must.
2. Is the Operation Painful?
Local anaesthetic is what we use most of the time, in some cases sedation or general anaesthesia may be appropriate. Patients may notice light or movement in the room but should not see the surgery. Post procedure there is to be expected some tenderness, if you do experience severe or increasing pain that is a reason for an urgent review.
3. Why Is Gas Placed Inside the Eye?
A gas bubble gives temporary internal support. It is able to hold a retinal tear or macular hole in the right position for healing. In the case of Retinal Detachment Surgery which includes the use of gas, positioning instructions and flying restrictions are a must.
4. Can the Vitreous Grow Back?
No. After the Vitrectomy Procedure which is performed by the gel is out of the picture. What the eye does is to fill in the removed volume with what is essentially clear water which it produces and that is enough for the eye to maintain its shape.
5. Will Vision Become Normal?
The aim is to restore, improve or preserve vision. The outcome is based on the health of the retina prior to treatment. Long term detachment, macular damage, diabetic retinopathy and optic nerve disease may limit what the surgery is able to do even if it is successful.
6. Can a Cataract Develop Afterwards?
Yes. Cataracts are a common issue in which the natural lens of the eye is affected. Also the doctor may bring up that it is a possibility of a later intervention or that we may go for a combined procedure.
7. Is Every Retinal Detachment Treated With Vitrectomy?
No. Pneumatic retinopexy, scleral buckle, vitrectomy or a combination of the procedures may be used. What is detached, the pattern of the detachment, status of the lens and presence of scar tissue helps determine the best Retinal Detachment Surgery.
