When treating advanced retinal conditions, sometimes, surgical interventions are necessary to preserve or restore vision. Among these procedures, vitrectomy is one of the most sophisticated and effective options available in modern eye care. This article will help you understand what vitrectomy surgery is, who is a candidate, and what to expect if our Arizona Retinal Specialists suggest it.
What Is Vitrectomy Surgery?
Pars plana vitrectomy addresses problems within the vitreous cavity, also known as the space in the center of your eye filled with a gel-like substance called the vitreous humor. This gel helps maintain the eye’s round shape and allows light to pass clearly to the retina. However, certain conditions can affect the vitreous and the retina in ways that require surgical intervention.
Vitrectomy involves surgically removing the vitreous gel. Doing so gives access to the retina and other structures at the back of the eye, allowing the surgeon to perform various treatments that would otherwise be impossible. Depending on the diagnosis, saline, a gas bubble, or silicone oil will replace the removed vitreous.
When Vitrectomy Might Be Recommended
Retinal specialists may recommend vitrectomy for several eye conditions:
1. Retinal Detachment
When the light-sensitive retina separates from its supporting tissues, it can cause severe vision problems. Some detachments are treatable with laser or cryotherapy, but more complex cases may necessitate vitrectomy, especially when:
- The detachment happened some time ago
- Previous repair attempts were unsuccessful
- There are large or multiple tears
- Scar tissue has formed and is pulling on the retina
2. Diabetic Retinopathy Complications
Advanced cases can lead to vitreous hemorrhaging (bleeding into the eye) or tractional retinal detachment (scar tissue pulling on the retina). Vitrectomy for diabetic eye disease can:
- Remove blood that blocks vision
- Release the tension of scar tissue on the retina
- Create better access for additional treatments like laser therapy
Additional guide: Tips to Naturally Slow Down Diabetic Retinopathy Progression
3. Macular Hole
The macula is the central part of the retina and is responsible for detailed central vision. When a hole appears in this area, it distorts or clouds central vision. Vitrectomy surgery is the standard treatment for macular holes, allowing an eye doctor to:
- Remove the vitreous that may be pulling on the macula
- Place a gas bubble to help the hole close
- Sometimes remove membranes that may be contributing to the problem
4. Epiretinal Membrane
An epiretinal membrane is scar tissue on the retina’s surface. As it worsens, it can distort vision by contracting and wrinkling the retina. Vitrectomy allows for:
- Removal of the vitreous gel
- Peeling of the membrane from the retina’s surface
- Allowing the retina to gradually return to normal
5. Severe Eye Infections
In cases of endophthalmitis (a serious infection inside the eye), vitrectomy may be necessary to:
- Remove infected vitreous
- Obtain samples for laboratory testing
- Deliver antibiotics directly where needed
- Remove any foreign bodies that might be sources of infection
Vitrectomy: What to Expect
Knowing what happens during and after a vitrectomy can help alleviate concerns.
Before Surgery
- An eye exam with special imaging tests will help diagnose your condition.
- You’ll discuss expected benefits, potential risks, and alternative treatments.
- You’ll get instructions about medications and supplements to avoid, as well as fasting requirements, before undergoing vitrectomy surgery.
- Most vitrectomies are outpatient procedures, meaning you’ll go home the same day.
During Surgery
- You’ll be under local anesthesia with sedation, though general anesthesia is available in certain cases. You have nothing to worry about, as you won’t feel a thing.
- The surgeon will create small incisions, about the size of a needle tip, in the white part of your eye (the sclera).
- Through these tiny openings, the surgeon gently inserts specialized microsurgical instruments, including:
- A light source to illuminate the inside of the eye
- An irrigation tool to maintain the eye’s shape
- A cutting and suction tool to remove the vitreous
- Additional specialized instruments as needed for your exact condition
- The surgeon works while looking through a microscope, allowing for precise movements.
- After treating the problem, the surgeon replaces the vitreous with a saline solution, a gas bubble, or silicone oil.
- Modern vitrectomy is often “sutureless,” meaning the tiny incisions are self-sealing.
After Surgery
Recovery varies based on the procedure performed and the substitute used:
If a gas bubble replaces the vitreous:
- You’ll need to maintain your surgeon’s instructed head position for some time to stabilize the bubble’s position.
- The gas gradually dissipates as your eye’s natural fluid replaces it over several weeks.
- You cannot get on a plane or travel to high altitudes while the gas bubble is present.
- Your vision will be somewhat blurry until the gas absorbs.
If silicone oil replaces the vitreous:
- The oil may need to be removed in a later procedure.
- Your vision may be clearer than with gas, but still slightly blurred.
- You might see a horizontal line where the oil meets the natural fluid in your eye.
General recovery considerations:
- Eye redness, discomfort, and blurred vision are common during the healing process.
- You’ll use prescribed eye drops to prevent infection and reduce inflammation.
- Avoid strenuous activities, heavy lifting, and swimming until your doctor permits them.
- Follow-up appointments are necessary to observe your healing progress.
- Full visual recovery may take weeks to months, depending on your condition.
Advancements in Vitrectomy Surgery
Modern vitrectomy has benefited from remarkable technological advancements:
- Smaller Gauge Instruments: Today’s instruments are much finer than earlier versions, allowing for smaller incisions, less discomfort, and faster healing. Most surgeries now use 23, 25, or 27-gauge instruments (the higher the number, the smaller the instrument).
- High-Speed Cutters: Advanced cutting technology enables more controlled, error-free removal of the vitreous with less traction on the retina.
- Enhanced Visualization Systems: Improved microscopes, lighting, and digital imaging systems give surgeons a clearer view of delicate structures.
- Intraoperative OCT: Some operating rooms have optical coherence tomography (OCT) that allows surgeons to see cross-sectional images of the retina during surgery.
- Wide-Angle Viewing Systems (WAVs): These tools provide surgeons with a panoramic view of the retina, improving access to peripheral areas.
These technological advances have made vitrectomy safer, more effective, and less invasive than ever before.
Possible Risks and Considerations
While vitrectomy is generally safe and effective, it has potential risks like any other procedure. These include:
- Cataract development or progression (very common after vitrectomy)
- Elevated eye pressure or glaucoma
- Retinal detachment or tears
- Infection (endophthalmitis)
- Bleeding inside the eye
- Unsuccessful treatment requiring additional procedures
Your retina specialist will discuss these risks in the context of your condition and help you weigh them against the benefits of vitrectomy.
Working with Arizona Retinal Specialists
During your consultation, your doctor should explain:
- What vitrectomy can do for your condition
- Realistic expectations in terms of visual improvement
- The specific technique planned for your surgery
- Postoperative positioning requirements and restrictions
- The expected recovery timeline
You’re also encouraged to ask questions, whether it’s about the surgical process, what you can do and must avoid before surgery, recovery dos and don’ts, and any alternative treatments.
What We Learned Today (And How to Know More)
Vitrectomy is one of the most significant advances in treating complex retinal conditions. This sophisticated microsurgical technique has restored vision to countless patients who might otherwise have faced permanent visual impairment.
If you’re curious about your eligibility for this procedure, call 623- 474-3937 to consult one of our Sun City Arizona Retinal Specialists. With our very own award-winning Dr. Gholam Peyman contributing to vitrectomy system advancement, we’re home to some of the best vitrectomy surgeons in Phoenix and the world.
