Reviewed by Dr Wilson Wong Jun Jie, Vitreoretinal and Refractive Surgeon of OasisEye Specialists | Last updated: August 2026
Quick answers
What is it? Vitrectomy (pars plana vitrectomy, PPV) is microsurgery to remove the vitreous gel from inside the eye, giving the surgeon direct access to treat the retina.
Who needs it? Patients with retinal detachment, macular hole, vitreous haemorrhage, epiretinal membrane, or diabetic eye disease causing vision loss.
How long does it take? 45 minutes to 2 hours for most cases; combined phaco-vitrectomy or complex retinal work may run longer.
How long is recovery? Activity restrictions last 4–6 weeks. Full visual recovery takes 3–6 months, especially if the macula was involved or silicone oil was used.
Can I fly afterward? Not while a gas bubble is in your eye — typically a 3–8 week ban depending on gas type. Silicone oil carries no flying restriction.
Key facts about vitrectomy
Vitrectomy is a common eye operation to treat retinal problems. Surgeons remove the vitreous gel and replace it with gas or silicone oil to help the retina heal. Most patients go home the same day.
The operation takes one to two hours. Recovery takes four to six weeks for basic activities. Most patients need to avoid flying until their gas bubble has gone.
What Is Vitrectomy Surgery, and Who Performs It?
Vitrectomy — formally pars plana vitrectomy (PPV) — is a microsurgical procedure in which a vitreoretinal surgeon removes the vitreous gel from the back of the eye to treat retinal diseases. It is performed as day surgery under local or general anesthesia in 45 minutes to 2 hours.
The vitreous is the clear, gel-like substance that fills the eye between the lens and the retina. When disease affects the retina — through bleeding, traction, or detachment — the vitreous must be removed to allow safe surgical access. Modern microincision vitrectomy surgery (MIVS) uses instruments as small as 27-gauge (0.4 mm) inserted through the pars plana, a thin region of the eye wall 3–4 mm behind the limbus.
Who Needs a Vitrectomy? Conditions Treated
Vitrectomy is used to treat retinal detachment, macular hole, epiretinal membrane (macular pucker), vitreous haemorrhage from diabetic eye disease, dropped lens nucleus during cataract surgery, vitreous floaters, myopic traction maculopathy, and proliferative vitreoretinopathy (PVR).
Your vitreoretinal surgeon may recommend vitrectomy for any of the following:
- Retinal detachment — the retina separates from the back of the eye, threatening permanent vision loss if untreated within hours to days.
- Macular hole — a full-thickness break in the central retina causing blurred or missing central vision.
- Epiretinal membrane (macular pucker) — scar tissue on the retinal surface causing visual distortion and reduced acuity.
- Vitreous haemorrhage — bleeding into the vitreous cavity, most commonly from proliferative diabetic retinopathy (PDR) or a retinal tear.
- Diabetic tractional retinal detachment (TRD) – in advanced proliferative diabetic retinopathy, fibrovascular membranes contract and mechanically pull the retina away from the back of the eye. Vitrectomy releases this traction, removes the membranes, and allows laser treatment of the ischaemic retina. Surgery is typically combined with anti-VEGF injection 3-5 days beforehand to reduce intraoperative
- Proliferative vitreoretinopathy (PVR) — scar tissue on both sides of the retina, often complicating retinal detachment repair.
- Dropped nucleus — a lens fragment falling into the vitreous during cataract surgery.
- Vitreous floaters (floaterectomy) — in patients with dense, vision-degrading floaters where conservative management has failed.
- Myopic traction maculopathy (MTM) — vitreoretinal traction distorting or detaching the macula in highly myopic eyes, sometimes combined with a macular buckle.
What Happens During a Vitrectomy? A Step-by-Step Overview
Vitrectomy is performed as day surgery under local or general anaesthesia. The surgeon makes three micro-incisions in the sclera, removes the vitreous with a high-speed cutter, treats the retina directly, and fills the eye with a tamponade agent — air, gas, or silicone oil — before closing.
Step 1 — Anaesthesia
Most vitrectomies in Malaysia are performed under local anaesthesia with sedation: a peribulbar or sub-Tenon’s block numbs the eye completely while sedation keeps you comfortable. General anaesthesia is reserved for children, complex cases, or patients who cannot remain still.
Step 2 — Creating access
Three micro-incisions are made in the sclera (the white of the eye) at the pars plana, typically using 23-gauge (0.6 mm), 25-gauge (0.5 mm), or 27-gauge (0.4 mm) instruments. One port carries the infusion line (balanced saline solution, BSS), one carries the light fibre, and one carries the vitreous cutter.
Step 3 — Removing the vitreous
The vitreous cutter oscillates at up to 10,000 cuts per minute, aspirating the vitreous gel in fine fragments. BSS flows simultaneously through the infusion cannula to maintain eye pressure and shape throughout.
Step 4 — Treating the retina
With the vitreous cleared, the surgeon addresses the underlying problem: peeling an epiretinal membrane or internal limiting membrane (ILM) using fine forceps stained with chromovitrectomy dyes (brilliant blue G or triamcinolone), applying endolaser to seal retinal breaks, draining subretinal fluid, or mechanically unfolding and reattaching a detached retina.
Step 5 — Tamponade: filling the eye
The vitreous cavity is filled with a tamponade agent that holds the retina in place while it heals. The choice depends on the condition treated, expected healing time, and your ability to position your head after surgery.
| Tamponade | Type | Duration | Flying ban | Notes |
|---|---|---|---|---|
| Air | Gas | 5–10 days | ~10 days | Short tamponade; simpler cases |
| SF6 (20%) | Gas | 2–3 weeks | ~3 weeks | Most common for macular holes |
| C2F6 (16%) | Gas | 4–5 weeks | ~6 weeks | Medium duration tamponade |
| C3F8 (14%) | Gas | 6–8 weeks | ~8 weeks | Longest-acting intraocular gas |
| Silicone oil | Oil | Until surgically removed | No restriction | Complex detachments; requires 2nd procedure |
Vitrectomy Combined with Cataract Surgery — Should You Have Both at Once?
Combined phaco-vitrectomy — cataract removal and vitrectomy in the same operation — is recommended when an existing cataract clouds the surgeon’s view, or when vitrectomy would otherwise cause a cataract within 1–2 years. One operation means one anaesthetic, one recovery period, and lower total cost.
Vitrectomy significantly accelerates cataract progression: most patients develop a visually significant cataract within 1–2 years of vitrectomy.
Vitrectomy Recovery: A Week-by-Week Timeline
Recovery after vitrectomy involves activity restrictions for 4–6 weeks, with most patients returning to light work in 1–2 weeks. Full visual recovery takes 3–6 months. The exact timeline depends on the tamponade used and whether the macula was involved.
| Timeframe | What happens | What you can do |
|---|---|---|
| Day 1–3 | Eye patch off, antibiotic + steroid drops begin, first review | Rest, no bending, no lifting |
| Week 1 | Positioning (if gas), blurred vision expected, follow-up visit | No driving, no flying, no strenuous activity |
| Weeks 2–4 | Gas bubble shrinking, vision gradually improves top-down | Light desk work possible from Week 2 |
| Month 1–3 | Gas fully absorbed (SF6 by Week 3, C3F8 by Week 8) | Driving resumes once VA adequate; glasses review |
| Month 3–6 | Full visual recovery; silicone oil removal if applicable | Most patients back to normal activity |
Activity restrictions — numbered checklist
Follow these in order of importance during your gas tamponade period:
- Do not fly or travel to high altitude while gas is present — gas expands with reduced atmospheric pressure and can dangerously raise eye pressure.
- Do not drive until your surgeon confirms the gas has cleared and your vision in both eyes is adequate.
- Maintain prescribed head positioning for the specified hours per day — face-down, side-lying, or upright depending on your condition and as advised by the surgeon. Positioning compliance directly affects surgical success.
- Avoid strenuous activity, heavy lifting, and bending at the waist for at least 4–6 weeks.
- Avoid swimming, pools, and sea water for at least 6 weeks to reduce infection risk.
- Instill antibiotic and steroid eye drops exactly as prescribed, typically for 4–6 weeks.
Clinical note: Positioning compliance is one of the strongest modifiable predictors of anatomic success in macular hole surgery. Studies report closure rates above 95% with full compliance, falling to 75–80% with partial compliance (Steel & Lotery, Eye 2013).
Will My Eye Collapse If the Vitreous Is Removed?
No. The eye does not collapse after vitrectomy. The tamponade agent — air, gas, or silicone oil — temporarily maintains the eye’s shape and pressure. As gas dissolves, the eye refills naturally with aqueous humour, a clear fluid produced continuously by the ciliary body.
Eye pressure is measured at every post-operative visit. A transient rise is possible with gas or silicone oil tamponade, which is why your drops schedule and follow-up visits are essential even if your eye feels comfortable.
Vitrectomy vs Scleral Buckle — What Is the Difference?
A scleral buckle indents the eye wall from the outside to relieve retinal traction — no internal entry required. Vitrectomy works from the inside, directly releasing traction and reattaching the retina. Buckles are preferred for young myopic patients with simple peripheral detachments; vitrectomy suits posterior breaks, PVR, and complex cases.
The two procedures are not mutually exclusive — combined vitrectomy and scleral buckle (the ‘360-degree buckle plus PPV’) is used for the most complex or recurrent detachments to maximise anatomical success.
Anatomic success rates: Primary vitrectomy achieves retinal reattachment in over 90% of cases for most indications (American Society of Retina Specialists, 2023). In centres of excellence, single-surgery success for primary retinal detachment exceeds 85–90% (Heimann et al., Ophthalmology 2007).
Frequently Asked Questions About Vitrectomy
These are the questions patients most commonly ask before and after vitrectomy surgery in Malaysia, together with direct answers.
Most vitrectomies take 45 minutes to 2 hours. Combined phaco-vitrectomy or cases requiring membrane peeling, laser, and fluid-gas exchange may take longer. Your surgeon will give a specific estimate at your pre-operative consultation.
Vitrectomy is not painful during the procedure — the eye is fully numbed with a peribulbar or sub-Tenon’s block. Afterward, most patients describe only a mild gritty or pressure sensation. Significant pain is uncommon and should be reported promptly, as it may signal raised eye pressure.
Vitrectomy is highly effective. According to the American Society of Retina Specialists (ASRS), anatomic success — the retina remaining properly reattached — exceeds 90% for most conditions. Visual outcome depends on whether the macula was involved and how long the retina was detached before surgery.
Key statistic: Anatomic success after vitrectomy for primary retinal detachment exceeds 90% in experienced hands. Macular hole closure rates using SF6 gas and ILM peeling exceed 90–95% (AAO Preferred Practice Pattern, 2023).
No — not while a gas bubble is in your eye. Reduced atmospheric pressure at altitude causes the gas to expand, which can spike eye pressure dangerously. Flying is safe once gas has fully dissipated: approximately 10 days for air, 3 weeks for SF6, 6 weeks for C2F6, and 8 weeks for C3F8. Silicone oil carries no flying restriction.
You cannot drive while a gas bubble is present or while your operated eye has substantially reduced vision. Most patients with gas tamponade can resume driving at 6–8 weeks, once the bubble has cleared and visual acuity is adequate in both eyes. Your surgeon confirms this at a follow-up visit.
Activity restrictions — no flying, no driving, positioning, no strenuous exercise — last 4–6 weeks. Full visual recovery takes 3–6 months, particularly if the macula was affected or silicone oil was used. Follow-up visits are typically at Day 1, Week 1, Month 1, and Month 3.
At private ophthalmology centres in Kuala Lumpur, vitrectomy surgical fees range from approximately RM 12,000 to RM 18,000, depending on complexity, tamponade used, and whether cataract surgery is combined. This excludes anaesthesia, facility, and post-operative care. Medical insurance coverage varies — confirm with your insurer before surgery.
Vitrectomy is safe in experienced hands, but risks include: cataract formation in phakic eyes (very common, within 1–2 years), raised intraocular pressure with gas or oil tamponade, re-detachment (~5–10%), endophthalmitis (serious infection, ~0.03–0.05%), and macular oedema (uncommon). Your surgeon will discuss the specific risk profile for your case.
Some patients require updated glasses once vision stabilizes at the 3-month mark. If silicone oil was used, a second procedure to remove it is typically planned 3–6 months after the initial surgery, once the retina has healed. Oil removal is a short, well-tolerated operation.
Laser vitreolysis uses a YAG laser to fragment vitreous floaters without surgery, but its effectiveness is limited to specific floater types — it is not suitable for dense or posterior floaters. Floaterectomy (vitrectomy) removes floaters more completely but carries the risks of any intraocular surgery. Your surgeon will advise which approach suits your floaters. OasisEye Specialists does not offer Laser vitreolysis.
When to See a Vitreoretinal Surgeon — Urgent Warning Signs
Seek same-day urgent assessment if you notice a sudden shower of new floaters, flashing lights, a shadow or curtain across your vision, or sudden painless loss of vision. These are signs of a retinal tear or detachment — a time-sensitive emergency where every hour matters.
Do not wait for a routine appointment. Retinal detachment extending to the macula causes permanent central vision loss within 24–72 hours of macular involvement. Early assessment gives you the best chance of preserving central vision.
Urgent symptoms requiring same-day review:
- Sudden shower of new floaters, especially with flashing lights
- A dark shadow, curtain, or veil across part of your visual field
- Sudden, painless loss of central or peripheral vision
- Blurred vision that does not resolve within 24 hours
References and Further Reading
- American Society of Retina Specialists (ASRS). Retinal Detachment patient information. asrs.org. Accessed July 2026.
- American Academy of Ophthalmology. Preferred Practice Pattern: Posterior Vitreous Detachment, Retinal Breaks and Lattice Degeneration. aao.org. 2023.
- Heimann H, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment. Ophthalmology. 2007;114(12):2142–2154.
- Steel DHW, Lotery AJ. Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye. 2013;27(Suppl 1):S1–S21.
- Wong CW, et al. Myopic traction maculopathy: an update. Clinical and Experimental Ophthalmology. 2015;43(9):838–848.
- Bhende M, et al. Vitrectomy for vitreous floaters: outcomes and patient satisfaction. Eye. 2013.
- Stalmans P, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. NEJM. 2012;367:606–615.
This article is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified vitreoretinal surgeon about your specific condition. Clinical details may vary depending on individual patient factors, surgeon technique, and available equipment.
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