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Vitrectomy (Vitreous / Retinal Surgery)

What is Vitrectomy?

A Vitrectomy is a micro-incisional eye surgery performed by a Vitreoretinal (VR) specialist to remove the gel-like vitreous humor inside the eye. It provides access to repair the retina for severe conditions like Retinal Detachment, Macular Holes, Epiretinal Membranes, and Vitreous Hemorrhages.Modern Microincision Vitrectomy Surgery (MIVS) is sutureless, enabling rapid recovery.

Vitrectomy Surgery explained by Dr Kenneth Fong Choong Sian

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

Vitrectomy Tamponade Comparison: Gas vs. Silicone Oil vs. Air

Tamponade Type Duration in Eye Flying / Altitude Travel Removal Requirement Typical Indications
Gas Bubble (C3F8 / SF6) Dissipates naturally in 2 to 8 weeks Strictly prohibited until gas dissolves No second surgery needed (body replaces it with fluid) Macular holes, uncomplicated retinal detachments
Silicone Oil Remains in eye until removed Permitted (oil does not expand with pressure) Requires a second minor surgery to remove (2 to 8 months) Complex retinal detachments, severe diabetic eye disease
Air / Fluid Absorbs within 1 to 3 days Prohibited for 24–48 hours until air reabsorbs No second surgery needed Minor retinal tear repairs, vitreous

Vitreoretinal Specialists at OasisEye Specialists

OasisEye Specialists provides advanced surgical vitreoretinal services across Malaysia. Our fellowship-trained vitreoretinal surgeons diagnose and treat complex diseases of the retina and vitreous humor, including retinal detachment, macular hole, epiretinal membrane, diabetic retinopathy, age-related macular degeneration (AMD), vitreous hemorrhage, and retinopathy of prematurity (ROP). Services are available at our Kuala Lumpur, Cheras, Penang, Seremban, Johor Bahru, and regional centres through Dr. Kenneth Fong Choong Sian, Dr. Manoharan Shunmugam, Dr. Wilson Wong Jun Jie, Dr. Teh Wee Min, Dr. Ling Kiet Phang, and Dato’ Dr. Haslina Binti Mohd Ali.

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.

FREQUENTLY ASKED QUESTIONS

A vitrectomy is a specialized microsurgical procedure where an eye surgeon removes the vitreous gel filling the eye cavity. It is performed to treat retinal detachments, macular holes, epiretinal membranes, diabetic retinopathy, and vitreous hemorrhages.

If a gas bubble is placed in your eye during vitrectomy, reduced cabin pressure during air travel causes the gas bubble to expand rapidly. This can cause dangerously high intraocular pressure, severe pain, and permanent blindness. You must not fly until the gas has completely absorbed.

Face-down posturing requires keeping your head facing downwards so that the buoyancy of the intraocular gas or oil bubble presses directly against the repaired retina or macular hole. This holds the tissue in place while it heals.

Gas bubbles dissolve on their own over 2 to 8 weeks, but restrict flying and high-altitude travel. Silicone oil stays in the eye indefinitely to provide continuous support and requires a minor second operation to remove, but allows safe air travel.

Almost all adult patients who undergo vitrectomy develop a cataract in that eye within 1 to 2 years. For this reason, vitreoretinal surgeons often perform combined cataract surgery and vitrectomy during the same session.

Vitrectomy is commonly performed under local anesthesia with conscious sedation. Local numbing injections ensure you feel no pain, and sedation keeps you relaxed while awake. General anesthesia is reserved for specific cases or anxious patients.

Initial recovery takes about 1 to 2 weeks, during which eye drops must be used and strenuous activity avoided. Full visual improvement stabilizes over 1 to 3 months, especially after a gas bubble completely dissipates.

Modern vitrectomy uses small-gauge instruments (23G, 25G, or 27G) passed through micro-incisions that self-seal. Stitches are rarely required, resulting in faster recovery and minimal post-operative discomfort.

Increasing severe pain, worsening vision, increasing eye redness, or sudden flashes/shadows are urgent red flags. You should contact your retinal specialist or visit OasisEye Specialists immediately.

At OasisEye Specialists, the cost of vitrectomy surgery per eye typically ranges from RM12,000 to RM20,000, depending on the complexity of the case. International patients are subjected to an additional 6% SST.