Vitrectomy – Retinal surgery

Vitrectomy is an eye surgery technique used to treat diseases of the retina and vitreous humor at the back of the eye. During this operation, your surgeon may:

• Remove scar tissue that is wrinkling or tearing the retina, causing poor vision.

• Remove blood or any other opaque substance that prevents light from focusing properly on the retina.

• Helping to reattach a retina that has detached (separated) from the wall of the eye.

• Removing a foreign object stuck in the eye following an injury.

During a vitrectomy, the ophthalmologist removes the vitreous humor from the back of the eye. This vitreous humor is then replaced with saline solution. At the end of the procedure, the saline solution is aspirated and replaced with either an air or gas bubble, or silicone oil.

After the operation, during the healing phase, your eye will gradually replace the air or gas with a new vitreous fluid, a physiological liquid without collagen fibers. If healing is done under silicone, it will then need to be removed.

For which diseases is a vitrectomy performed?

Your ophthalmologist may recommend a vitrectomy for the following conditions:

• A detached retina – Emergency surgery.

• An epiretinal membrane.

• A macular hole.

• A vitreous hemorrhage.

• A complicated diabetic retinopathy.

• A post-operative cataract touch-up with fragile areas.

• A cataract implant replacement.

• A serious eye infection (endophthalmitis) that is not progressing favorably.

Operation – What happens during a vitrectomy?

• Vitrectomy is usually performed on an outpatient basis; you will not spend the night in the hospital.

• The procedure is preferably performed under regional anesthesia: your eye will be numb and part of your face will be deprived of sensation. The anesthesiologist will administer sedation, and you will be relaxed and slightly detached from your surroundings.

• The operation lasts from 15 minutes for a simple membrane to 1 hour 30 minutes for a complex detachment.

• During the operation, the ophthalmologist inserts 3 guides the size of a fine needle into the sclera (white of the eye). These will be used to pass the instruments through.

• He uses a microscope and a lens to see your vitreous humor and the back of your eye.

• Your surgeon will use extremely fine instruments to perform one or more of these steps.

The operation

• Vacuum the entire glass surface.

• To peel away a membrane or scar tissue on the retina.

• Remove any foreign object that should not be in the eye

• To reattach the retina to the back of the eye.

• Cauterize the torn retina with a laser or a cold probe.

• To vacuum up fallen cataract fragments.

• Injecting a bubble of air or gas into the eye to help the retina stay stuck (the bubble disappears on its own).

• Inject a bubble of silicone oil into the eye (the oil is removed later during a second procedure).

• In the absence of silicone oil, the procedure generally does not require absorbable sutures. However, if a small leak persists, the surgeon will place an absorbable stitch as a precaution.

• After the operation, you will be monitored in the recovery room for a few minutes and then in the outpatient surgery unit to recover from the anesthesia. You will then be able to go home.

Recovery – What happens after a vitrectomy?

• You will leave with a bandage and a protective shield over your eye. Post-operative treatments should begin the day after the procedure. These mainly consist of eye washes and antibiotic/anti-inflammatory eye drops.

• Pain is very rare after a vitrectomy, but a sensation of a foreign body, itchy, or gritty eyes, as if something were inside your eye or under your eyelid, is common. This sensation will disappear with medication and time.

Case and bandage

• You will need to wear a protective eye shield at night for one week to avoid accidentally scratching your eye. During the day, you can wear your regular glasses or sunglasses.

Positioning

• If a gas bubble has been placed in your eye to reattach the retina, your surgeon will ask you to keep your head in a face-down (or face-to-side) position for a certain amount of time.

• You will be told how long you need to stay in this position. It is very important to follow these instructions for proper healing.

• You cannot fly, go to the mountains, or go scuba diving until the gas bubble has disappeared. A rapid change in altitude can increase the size of the bubble, causing significant ocular hypertension.

Work stoppage