Vitrectomy

Vitrectomy is often part of another eye treatment e.g. when surgical repair is required for the retina when is detached. Your consultant ophthalmologist may recommend a vitrectomy if you have one of these conditions:

• Diabetic retinopathy, with bleeding or scar tissue affecting the retina or vitreous gel
• most forms of retinal detachment (when the retina lifts away from the back of the eye)
• Macular hole (a hole or tear in the macula)
• Macular pucker (a membrane which wrinkles or creases in the macula)
• Infection in the eye called endophthalmitis
• Severe eye injury
• Certain problems from cataract surgery

Following a detailed assessment, your Consultant Ophthalmic Surgeon will discuss the best course of treatment for you. The consultant will be the same person who carries out your procedure and your checks at follow-up appointments. The consultation process is very detailed and can take up to 3 hours. Tests and investigations are performed by nurses, optometrists and technicians. You will be provided further information about the procedure and shown video animations.

You will then be seen by an experienced fellowship-trained consultant who will evaluate your eyes and come to a final decision. The consultant will inform you about what options there are for your eye and explain the process further with expectation of outcomes following surgery. You will be provided with an informed consent.

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A vitrectomy is performed in an operating theatre using a local anaesthetic. Three tiny openings are made in the sclera and delicate instruments are inserted into the eye. Vitreous cutters, forceps and scissors remove the vitreous gel and scar tissue that may be growing on the surface of the retina. A fibreoptic illuminator is used to light the inside of the eye during the operation.

The vitreous gel is replaced by either saline solution, air, or gas, all of which are replaced by the eye’s own fluid over time. The vitreous does not grow back and the eye is able to function well without it. Sometimes, silicone oil or heavy liquid is inserted into the vitreous cavity at the end of the procedure and this will require another operation for its removal at a later date. Occasionally, a silicone band is encircled around the eyeball to assist with reattachment of the retina.

Your consultant ophthalmologist will prescribe medicine to help relieve pain. You will also be given eye drops to use for up to 4 weeks. Visual recovery after surgery varies greatly from patient to patient, depending on the underlying condition for requiring a vitrectomy and the type of substance inserted into the vitreous cavity at the end of the surgery.

If gas or oil has been inserted into the vitreous chamber you may be advised to position your head tilted downwards. This helps to make sure that the gas or oil is lying against the area of the retina which has been treated. Your surgeon will specify the duration required. You will not be able to fly for 6 weeks if you have gas in your eye. Your follow-up appointments are usually booked within 1-2 weeks after surgery. It is common after vitrectomy for a cataract (clouding of the lens) to develop. At some stage you are therefore likely to need cataract surgery. The possibility and timing of this secondary surgery will be discussed before vitrectomy treatment.

Severe complications are rare and anatomic success for vitrectomy is over 90% for many conditions. Advances in instrumentation, techniques, and understanding of diseases of the vitreous and retina have made vitrectomy and retina surgery more successful.

Surgery for diseases that were once incurable, such as macular hole, is now routinely performed with excellent results. The list of indications for vitreous surgery continues to grow. The ability to directly work on or near the retina holds great promise for the future, not only to prevent vision loss, but to restore and enhance our ability to see.

There is a 5-10% risk of needing further retinal surgery after vitrectomy. The risk of developing a cataract is approximately 30-40%.

This can vary depending on how well you respond to healing. We know some patients obtain good vision within 24 hours but in others it may take a little longer.

If you have had High Performance Lenses (Trifocal, Polyfocal or Accommodative), implanted, there may be a period of adaptation before you are able to see well.

Usually one or two days. You may return to work as soon as you are comfortable. Make sure you are able to take your eye drops regularly as instructed.

When your vision is clear and you are comfortable. You must be able to read a number plate at 25 meters. Your doctor will advise you if you meet the visual standards for driving.

After 4 weeks

You may return to all sporting activity after TWO weeks. For contact sports, you are advised to use protective eye glasses. Polycarbonate sports glasses are recommended.

There are no restrictions to flying and you should be able to fly within a day of surgery.

There are no restrictions and you may return to these activities the following day. You must keep away from smoky and dusty environments and do not forget to wash your hands before using your eye drops.

Mascara should be avoided for 2 weeks
All other make-up can be used 2 days following surgery.