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What is Vitrectomy?
Vitreous is a viscous substance that fills the middle part of the eye. Vitrectomy is a type of surgery that is used to treat various conditions in the vitreous and retina. Typically, the vitreous is transparent and allows the light to pass through it and reach the retina. In some instances, blood and debris block the light. The scar tissue in the vitreous can tear or displace your retina and can impair your vision. Therefore, a vitrectomy can be performed, where your ophthalmologist uses a small instrument to remove the debris and repair your retina.
What are the Benefits of Vitrectomy?
- Vitrectomy helps to flush out the blood from vitreous humour that cannot be cleared out by the eye itself.
- It prevents traction retinal detachment and progression of subsequent detachment.
- Helps in restoring the lost vision caused by the bleeding of the vitreous humour.
- Repairs retinal tears
Who needs Vitrectomy?
Individuals suffering from the following conditions require vitrectomy:
- Retinal detachment
- Diabetic retinopathy (a complication of diabetes that damages the blood vessels in the tissue of the retina)
- Severe eye injury
- Infection inside the eye
- Vitreous haemorrhage (blood in the vitreous cavity)
- A wrinkle in the retina’s central part
- A hole in the macula (central part of the retina)
- Specific problems after the surgery of cataract
- To clear the cloudy vitreous humour causing blurry vision
If these conditions are not treated, they can cause vision loss and, in some cases, lead to blindness. In some instances, vitrectomy gives excellent results as it can even restore the lost vision.
How is Vitrectomy performed?
- To keep the eye open, an eyelid speculum will be placed.
- The ophthalmologist (a doctor who specialises in treating eye diseases) will visualise the eye by using a microscope or intraocular (administered through the eyes) instrumentation. They will also use lenses to see the fundus (back surface) with indirect ophthalmoscopy (to check the inside of the back of the eye using a hand-held lens or beam of light).
- Medical devices like trocar and cannula will be inserted via conjunctiva, sclera and inferotemporal (below the side area of the head) regions.
- To start with, the core vitreous will be removed.
- The entire retina will be checked to find any holes, breaks, detachment, or tears.
- For non-clearing vitreous haemorrhage or vitreous haemorrhage that does not get resolved), Pars plana vitrectomy (PPV) is commonly used.In PPV, the blood blocking the visual axis will be removed.
- After correcting the retina from any holes, detachment, tears, or breaks, the PPV will finally be over.
What to Expect Before Vitrectomy?
- Your ophthalmologist will conduct a physical examination and will evaluate your eye thoroughly.
- An ultrasound or blood test may be done.
- You must inform your doctor if you take any medication, supplements, or herbs.
- You will be told to stop taking medications for up to one week prior to the surgery.
What to Expect During Vitrectomy?
Your doctor will:
- Put you on general anaesthesia or local anaesthesia (you will be awake during the surgery, and the doctor will put eye drops and injections so that you don’t feel the pain)
- Expose your eye and make an incision (cut) in the eye’s outer layer
- Make a small cut in the sclera
- Remove the foreign matter or vitreous and any scar tissue (caused by debris and blood)
- Do other repairs in your eye if required
- Replace the vitreous with certain fluids like saline or silicone oil
- Stitch the incision part
- Put an antibiotic ointment in your eye to prevent any infection
- Cover your eyes with a patch.
What to Expect After Vitrectomy?
The recovery process in the hospital:
- You can go home on the same day of surgery (in most cases)
- If a gas bubble is placed in your eye, you will have to follow certain instructions regarding the positioning of your head after the surgery. You may have to keep your head in a side-facing or facedown position for a certain period. The exact duration, like how long you will have to stay in that position, will be directed by your ophthalmologist.
The recovery process at home:
- You will have to put antibiotic eye drops to prevent infection or any painkiller
- Wear an eye patch for a day
- Avoid air travelling for a certain period of time.
First Follow up Appointment
You may have an appointment scheduled for the next day after your surgery. You will require a close follow-up with your doctor to know whether the surgery was effective.
What are Risks and Complications of Vitrectomy?
Contact your ophthalmologist if your recovery is not as expected or you develop any complications like:
- Worsening of vision like black spots, blurring, or cloudiness
- Signs and symptoms of infection (chills and fever)
- Pain even after taking any medicine.
Risk and Complications of the Surgery
The risk and complications of the surgery are rare, but there are chances of some complications occurring, including:
- Damage to the other eye structures like cornea or lens
- Increased pressure in the eye
- Development of cataracts
- Tear or detachment of the retina
- Vision problems
- Excess bleeding
- Issues with the eye movement after the surgery
- Also, there are chances that the surgery may not repair all your problems; in such cases, you might need to have another surgery