Vitreoretinal surgery

What is Vitrectomy surgery?

Vitrectomy surgery is a general term for surgery that applies to surgery at the back of the eye. It is used for a variety of conditions, from retinal detachments, macular holes, epiretinal membranes to vitreous debris and foreign bodies.

What anaesthetic is used?

In the most part we use local anaesthetic surgery, patents feel little or no pain, however some patients can feel pressure on the outside of the eye. The anaesthetic is given in a separate room and then the patent is taken into the main operating theatre.

How is the operation performed?

At the start of the operation

At the start of the operation

At the end of the surgery

At the end of the surgery

The operation starts like a cataract surgery, we do some checks and then the eye – and the lashes is bathed with a sterile solution. A clear drape is then placed over the eye and a small clip is placed to keep the eye lids open. Three Blue trochars are then inserted into the white of the eye. These are very small being less than 1mm in diameter. We use to trochars to place an infusion into the eye – to maintain pressure and to place a light source and cutting instrument. In this way we can illuminate the vitreous and then remove it from the eye.

How do you remove scars / membranes from the eye?

Scars are first stained using a special surgical dye, they can then be seen clearly and are removed with micro-forceps.

Does the eye react to removal of the vitreous?

The vitreous is important for the normal development of the lens in the eye. From then it is less important. To keep normal pressure the eye pumps fluid into the vitreous cavity, this continues to pump even when the vitreous is removed.

What are the complications with vitrectomy surgery?

As with all surgery vitrectomy surgery has complications. The major problems are infection (1:500), haemorrhage (1:1000) and retinal detachment (1:100). Using the modern instruments the incidence of retinal detachment has dropped and several reports found no detachments following standard vitrectomy surgery. If complications happen – they can often be treated with more surgery or antibiotics so visual loss is rare.

What about cataract?

Cataracts occur rapidly following vitrectomy surgery with 70% of patients requiring cataract surgery at one year – for most patients who have not had cataract surgery – we combine cataract and vitrectomy surgery together as we have found that this gives the best visual results.

How quickly do I recover?

Many patients recover reasonably quickly following surgery. If no sutures have been used during the operation the eye can feel comfortable within 24 hours. It often however feels gritty and sometimes dry for a while post surgery. A bubble of air is used to stabilise the pressure in the eye post surgery and this can look like a ball, disc or plate. This typically disappears after one week, the exception is with a macular hole where a long acting (3 week) gas if often used. One should not fly or have a general anaesthetic while there is gas in the eye.

In terms of the vision this can improve very quickly if the vitrectomy is for floaters, however it can take up to 18m fort the vision to fully recover following macular hole surgery.

Do I need drops following surgery?

Typically following vitrectomy surgery you will be prescribed an antibiotic and anti-inflammatory mix and a pressure drop. These help to reduce post operative infection and inflammation as well as reducing any post surgery pressure spikes.

Are there any dos and don’ts?

  • Don’t rub the eye, and don’t get the eye wet (shower or swimming) for two weeks
  • Do take the drops and do wear the shield at night.

Should I have surgery?

We typically recommend surgery if the eye’s visual symptoms bothers you on a regular basis. If it is just mild or intermittent we may be able to wait.