Vitrectomy is a surgery performed by a specialist vitreoretinal surgeon, where the gel of the eye, known as a vitreous fluid, which fills the eye cavity is surgically removed to provide better access to the retina. This allows a variety of surgeries, including scar tissue removal, laser repair of holes and retinal tears during retinal detachment, and treatment of macular holes. Once the surgery is complete, saline, air bubble, special gas or silicone oil can be injected to keep the retina in place.
Pars Plana Vitrectomy:
The vitreous body is thought to serve as a supportive framework for the eye during birth and until adulthood. In normal eyes, the vitreous is crystal clear throughout our adult life, filling the eye cavity from the front (iris and lens) to the back of the eye (optic nerve). This cavity together with the retina and underlying tissues create what we surgically call a posterior pole or segment.
The vitrectomy for posterior pole diseases is called posterior vitrectomy. This kind of surgery should be done by a specialist ophthalmologist vitreoretinal surgeon.
In rare cases, the vitreous passes from the pupil to the anterior chamber of the eye.
This can happen:
• After eye trauma (injury)
• During complex cataract, corneal or glaucoma surgery
• As a result of lens problems
Because vitreous leakage can lead to various problems, anterior vitrectomy may be performed to minimize the risk and restore vision safely. Almost all ophthalmologists who have undergone surgery training can perform anterior vitrectomy.
Facts about vitrectomy surgery:
The retinal surgeon chooses the best equipment to use in each case from a wide variety of vitrectomy instruments. Since the first vitreous surgery was carried out in the 1970s, the tendency has been to use smaller and thinner microsurgical equipment.
Many vitrectomy procedures can now be performed without stitches with minimal atraumatic incisions about half a millimetre in size, which is approximately the width of an eyelash. Although it has some limitations, small-gauge vitreous surgery is generally considered more comfortable than surgery with larger equipment and offers faster visual recovery in many cases.
Unless the patient has serious illnesses, almost all vitrectomy surgeries can be performed either in a hospital or in a special centre such as Day Care Units. They have minimal pain and require only minimal local or drops for anaesthesia.
The eye is numbed so that the patient is comfortable during the procedure. Intravenous medication, or in rare cases general anesthesia, can be used for additional relaxation.
A surgical microscope with a special lens allows a wide view of the inside of the eye to the surgeon as well as an enlarged and detailed view.
This allows easy access to the retinal detachment, membranes and scar tissue. Often specialized techniques such as silicone and laser are used.
The eye remains filled with special fluid or an air bubble, special gas or silicone oil. It takes a period of post-operative positioning of the head (usually with face down) from the patient to assist with retinal healing.
Complications of surgery are rare, but include infection, bleeding, high or low eye pressure, cataracts, retinal detachment, and vision loss that occur at a very low rate and can be successfully treated with the above techniques.
Vitrectomy can cure various conditions. Surgery is usually done when these 4 conditions are met:
• When the patient is threatened with vision loss.
• The severity of the condition or natural history makes it impossible for automatic or non-surgical treatment.
• The potential benefits outweigh the potential risks of surgery
• The patient understands the risks and benefits of treatment, as well as alternatives
The goals of surgery are:
• The treatment of the pathology that causes vision loss
• To reduce the chance of recurrence and
• To minimize the risk of complications