Viterectomy Surgery

Vitrectomy surgery was developed in the early 1970's. Now, with highly refined instruments, vitrectomy surgery has come of age.

Vitrectomy surgery is extremely useful in the treatment of numerous ocular conditions and the list continues to grow. The first vitrectomy was for intraocular hemorrhage due to diabetic retinopathy and is still a very common reason for vitrectomy. In addition, preretinal and subretinal membranes can be removed with these techniques. Repair of retinal detachments, closure of macular holes, removal of foreign bodies and retained lens fragments, release of vitreous strands, removal of scar tissue, and improvement of many retinal vascular conditions, including diabetic macular edema, are among the common indications for this extremely useful procedure. Vitrectomy surgery often improves or stabilizes vision by removing blood or other debris, membranes, etc. that by themselves, or secondarily through traction on the retina, decrease the vision.

The surgery is done (with the eye left in place) under a microscope with an infusion line to maintain intraocular pressure and volume. A hand held light source and hand held instrumentation are placed through the pars plana. This anatomical area is uniquely designed for surgical access to the posterior structures of the vitreous and the retina. Incisions are made just behind the iris.

There are numerous instruments that are complimentary to the vitrectomy cutter, i.e. forceps, picks, irrigators, cannulas, laser probes, and various other instruments uniquely designed for manipulation of intraocular structures.

Vitrectomy surgery is sometimes done under general anesthesia, but increasingly it is done with local anesthetic and IV sedation. Surgery often takes an hour to an hour and a half or more. The recovery time and restoration of vision will depend upon the indications for surgery.

After the vitreous is removed, a salt solution is usually used as a replacement, but gas is sometimes used. Vitrectomy surgery is sometimes accompanied with placement of intraocular gas or air, after which the patient may be in a face down position to keep the retina in the proper position during healing. Laser photocoagulation is often applied during vitrectomy surgery and sometimes will be applied postoperatively. Other volume expanding materials can be used, such as silicone oil, which have some advantages over gas in that positioning is much less restrictive and visibility is greater; however, it generally requires removal several weeks or months following surgery.

The risks of vitrectomy surgery are real, but generally small and acceptable when indications are strong. Vision can sometimes be improved significantly, but seldom to normal. Improvement of vision often takes weeks or even months following surgery. Postoperative bleeding is common and often clears within several days, weeks, or sometimes months. A progressive cataract is common in patients over 50 years of age. We expect that 50 percent of these patients will require future cataract surgery within two years. Intraocular lenses are well tolerated in patients who require vitrectomy surgery and generally do not impede or alter our success rates. Infection, retinal detachment, recurrent membranes, or reopening of macular holes can occur. Glaucoma and even blindness can occur, but are rare. Most of the complications associated with vitrectomy are manageable. Though vitrectomy is common and routine, it is not trivial. A full discussion of all the risks, complications, alternatives, and postoperative expectations are to be discussed prior to surgery, but any time is appropriate.

The indications for vitrectomy surgery are increasing and the instrumentation continues to improve. We are deeply indebted to the pioneers of ophthalmology who have brought this procedure to modern medicine.

David V. Poer, M.D., F.A.C.S.