What is a Vitrectomy (Vitreous / Retinal Surgery)?
A vitrectomy essentially means your Vitreo-Retinal surgeon (eye doctor trained in this surgery) needs to remove the vitreous (jelly inside your eye) for your eye problem. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye.
Who needs a vitrectomy?
Many conditions will require your vitreo-retinal (VR) surgeon to perform a vitrectomy. This may include:
- Retinal detachment
- Vitreous Haemorrhage (Bleeding in the eye)
- Dropped nucleus (a complication of cataract surgery)
- Macular Hole
- Epiretinal Membrane
- Diabetic tractional detachment (TRD) and many others
If you’ve never had cataract surgery, your doctor may recommend that you have a combined vitrectomy and cataract operation at the same time. This may be because:
- You have a cataract which will obstruct the surgeon’s view during surgery
- Your lens / cataract will get in the way of certain manoeuvers during surgery
- You are at high risk of developing a cataract after a vitrectomy and so doing it both at once will save you another operation
- In some conditions (especially macular holes), performing a cataract surgery later on can affect your retina adversely so doing it together ameliorates this risk
Preparing for Surgery
At the time of your booking for surgery, measurements of your eye will be taken to help us decide which lens strength is right for you if you’re having a combined vitrectomy and removal of cataract.
On the day of surgery, do ensure you give yourself ample time to get into hospital. You do not want to be rushing or getting stressed prior to surgery as this can raise your blood pressure. This is why we frequently ask patients to stay in hospital the day before surgery. Please do not bring any valuable items to the hospital and ensure you have made arrangements to be escorted home after surgery.
We cannot tell you in advance exactly what time your operation will be, as this depends on numerous factors on the day. Please allow a half day attendance in our unit if your operation is under a local anaesthetic, and a full day if your operation is under a general anaesthetic.
If you are having your operation under local anaesthetic (LA), you will need to be able to lie flat for approximately 90 minutes. You will also need to be able to keep your head still during the surgery. If you are unable to do this, please discuss this with your doctor. If you opt for a general anaesthetic (GA), you will be asleep for the duration of surgery and will therefore usually have to stay in the hospital overnight. Having a LA involves injections around the eye to numb the area. You will be awake during the operation but will not be able to see what the surgeon is doing. The advantage of LA is that you do not usually need to stay overnight in the hospital. Sedation may be given to relax you during the LA. Complications from LA are rare. They include haemorrhage (bleeding) and injury to the eye from the needle. Some operations are considered too long for a local anaesthetic and therefore GA will be performed.
How is a Vitrectomy Performed?
Modern vitrectomies require sophisticated machinery and are performed through 3 needle-sized incisions made in the white part of your eye. These are so small they frequently do not even need stitches after. 1 incision is used to inject fluid into the eye to keep it inflated. The other 2 openings are used for the instruments, namely a light-pipe (fibre-optic illumination) and a high-speed cutter which cuts and sucks the jelly out simultaneously.
After performing all required surgical manoeuvers, the eye may be filled with a tamponade. The tamponade may be air, gas or oil. Air and gas dissipates into the blood with time and can take days to weeks depending on the type of gas used. Oil however remains in the eye until it is removed at another sitting. The choice of tamponade depends on your surgeon, the severity of your condition and circumstances.
Don’t I need my Vitreous?
Your vitreous get plays a very important role in the development of your eye during pregnancy. After birth, the vitreous can cause more problems than benefits such as floaters, retinal tears and detachments in later years. Once the vitreous is removed at surgery, the body refills the eye with its own natural aqueos fluid. In the event air or gas is used, the body replaces this with time, as the gas dissipates. With oil however, this does not happen until the oil is removed surgically.
The tamponade (gas or oil) in your eye works by keeping your retina attached after surgery until it ‘heals’. Having gas in your eye will make your vision very blurred until it dissipates. This can take up to 4 – 8 weeks after surgery and while it is there, you should not fly or go up hills. This is because the change in altitude will cause the gas in your eye to expand and raise your eye pressure which will cause a lot of pain and injury to your eye. Going up to your apartment however will be fine.
Having a tamponade in your eye may require you to adopt a certain posture for a specific number of hours per day. In general, you should not face the ceiling while you’re asleep at night. Your surgeon will give you specific details of how you should posture.
What should I do after my Vitrectomy?
After your operation, you will have an eye pad and/or shield over your eye (Fig. 1), depending on your surgeon. Once you have recovered from the anaesthetic, you will receive your eye drops, instructions about caring for your eye, and details of your next appointment. You should not drive until your doctor says it is safe to do so. The amount of time that you will need to take off work depends on the nature of your job.
Here are some DOs after surgery:
- DO put your drops in as instructed
- DO follow your posturing instructions if you have any
- DO clean your eye daily as instructed
- You CAN continue reading / watching TV as usual
- There are NO dietary restrictions after surgery.
Here are some DON’Ts after surgery:
- DO NOT fly or go up hills while you have gas in your eye (oil is fine)
- DO NOT allow any water into your eye for 2 weeks (ie. when showering etc.)
- DO NOT rub your eye – if you really need to wipe it, gently dab the skin around your eye with a clean tissue.
- DO NOT strain or carry anything heavy after surgery
- DO NOT perform any ‘major’ cooking – you do not want anything splashing into your eye
- DO NOT play any sports for a few weeks after surgery
- DO NOT do any gardening for 6 weeks after surgery
- DO NOT sleep on your eye – if you have a tendency to do this, then wear a plastic eyeshield when you sleep at night.
What should I do if I have a problem?
Please contact your doctor if you have any problems or concerns. It is important to do so URGENTLY if you have any of the following:
- Severe pain after surgery
- Increasing redness, pain and blurring of the vision in the days or weeks after surgery
- Worsening vision – especially if you find that your vision initially improves after surgery, but then starts to decline.