Don't you Need Your Vitreous?
Vitrectomy Surgery allows the Retina Surgeon to work inside of the eye and repair damage caused by a variety of diseases. The vitreous is the jelly inside the eye and is removed during the vitrectomy. YOU DO NOT NEED YOUR VITREOUS. The vitreous is important when the eye forms as a fetus grows into a baby. There is theoretical evidence that the vitreous absorbs oxygen and protects the natural lens. That may be why most pateints who have not yet had cataract surgery develop cataracts after vitrectomy surgery. The vitreous is replaced with a salt solution or gas or oil and your body replaces the salt solution or gas in the vitreous cavity over a week or two. Some vitrectomies can be performed using very small instruments. Once the vitreous is removed, instruments like picks, forceps, lasers, and cautery can be used inside the eye to help fix problems like macular pucker, macular hole, retinal detachment, vitreous hemorrhage, diabetic retinal disease, infection, retained lens fragments and so on.
How is a Vitrectomy Done?
Vitrectomy surgery in our practice is usually done with local anesthesia and sedation. Since you will be sedated, YOU CANNOT EAT the morning of surgery. You will be sedated and your eye will be anesthetized. You will be monitored by an anesthesiologist or nurse anesthetist. After surgery you will have to wear a patch and shield over the eye until your appointment the following day.
If you have a retinal detachment and your doctor puts a gas or oil to hold your retina in place, you will have to hold your head in a certain position and also look in a certain position for the surgery to work. This is also true of surgery for macular holes which requires face down positioning.
After your patch is removed during your post-operative visit, you will need to take eye drops. If during the week after surgery, your eye starts to hurt more or vision starts to decline, you should call our office since that can indicate a problem with infection or elevated intraocular pressure. If you see a new shadow after surgery you need to call so we can check to make sure you do not have a retinal detachment.
Using modern microsurgical techniques, your retinal surgeon is able to repair many macular and retinal problems that were once thought unfixable. Your physician can tell you what the success rates are for your surgery including the possibility of some vision improvement and the possibility of a lot of vision improvement.
After any eye surgery there is a risk of infection, bleeding, and retinal detachment. Also, the intraocular pressure in the eye can sometimes rise necessitating extra post-operative eye drops. Make sure to call our office if you are having any problems.
Why is Positioning Sometimes Required?
Since a gas bubble or oil in the eye does not know where it is supposed to go, it is very very important that patients who are treated with vitrectomy and gas (or oil) position their head properly during the days and weeks following treatment.
A patient with a gas bubble in his eye cannot fly until the gas bubble re-absorbs. Most airplanes are pressurized to about 1/2 atmosphere, so a bubble in an airplane will double in size. In the case of gas filled eye, this causes an abrupt rise in intraocular pressure that can be blinding if the pressure in the eye is high enough to cut off the circulation to the eye.
Video Macular Pucker Surgery
This 65 year old woman has had decreasing vision for 6 months from a macular pucker. The visual acuity is 20/200. The patient had cataract surgery 6 months ago and the vision is still hazy and distorted from the macular pucker. Vision improved to 20/30 6 months after surgery.
Video Macular Hole Surgery with ILM Peel
Macular hole surgery in a patient with a stage 2 macular hole. The internal limiting membrane is peeled. A short acting gas was used (sulfur hexafluoride) and vision was 20/50 1 week after surgery. This surgery was done 1 month ago. Vision at 1 month visit was 20/40.
Video Diabetic Vitreous Hemorrhage Vitrectomy
This 63 year old man has had full pan retinal laser and multiple injections of anti-VEGF medications into his eye and still has recurrent vitreous hemorrhages. He has bled about once very 1-2 months for the past year. The bleeds are dense and he is having trouble with work. His other eye has proliferative retinopathy and also needs treatment.
This surgery shows a fairly typical vitrectomy for proliferative diabetic retinopathy with vitreoretinal traction and extramacular tractional retinal detachment. The small, 25 gauge, instruments allow for controlled trimming of the membranes in the back of the eye which removes the traction and prevents recurrent bleeding.