Vitrectomy

Anterior vitrectomy involves removing small portions of the vitreous humor from the front structures of the eye.

The anterior vitreous humor often is tangled in an intraocular lens or other structures.

Pars plana vitrectomy is a general term for a group of procedures in the deeper part of the eye.

Pars plana vitrectomy involves removing some or all of the vitreous humor.

Its original purpose was to remove clouded vitreous humor, usually containing blood.

Procedures developed subsequently to remove clouding and also to peel scar tissue off the retina, and to provide space for materials injected in the eye to reattach the retina such as gases or liquid silicone, and to increase the efficacy of other surgical steps such as scleral buckle.

Advances include smaller and more refined instruments to allow injection of medications at the time of surgery, to manipulate a detached retina into its proper position and mark the location of tissue layers to allow their removal, and for long term protection against scar tissue formation.

Additional surgical procedures involved as part of modern vitrectomy surgeries may include:

Membranectomy-the removal of layers of unhealthy tissue from the retina, fluid/air exchange – injection of air into the eye to remove the intraocular fluid from the posterior segment of the globe while maintaining intraocular pressure to temporarily hold the retina in place or seal off holes in the retina.

Air/gas exchange, the injection of gas, or more typically mixed gas and air, into the posterior segment of the globe, to provide for a retinal tamponade.

The retinal tamponade holds the retina in place or temporarily seal off holes in the retina.

The mixed gases eventually disappear and the posterior segment re-fills with fluid.

Silicone oil injection can be injected to hold the retina in place.

Photocoagulation with laser treatment to seal off holes in the retina or to shrink unhealthy, damaging blood vessels which grow in some diseases such as diabetes.

Scleral buckling – placement of a support to maintain the retina in a proper, attached position.

Lensectomy – removal of the lens in the eye when it has a cataract or if it is attached to scar tissue.

Vitrectomy usefulness includes:

Retinal detachment –to reattach the retina may include vitrectomy to clear the inner jelly, scleral buckling to create a support for the reattached retina, membranectomy to remove scar tissue, injection of dense liquids to smooth the retina into place, photocoagulation to bond the retina back against the wall of the eye, and injection of a gas or silicone oil to secure the retina in place as it heals.

Macular pucker also called epiretinal membrane uses vitrectomy to remove the vitreous gel, while membranectomy is undertaken to peel away the tissue.

Diabetic retinopathy complicated by bleeding or retinal detachment, vitrectomy is employed to clear the blood, membranectomy removes scar tissue, and injection of gas or silicone with scleral buckle may be needed to return sight.

Macular holes – the normal shrinking of the vitreous humor with aging can occasionally tear the central retina causing a macular hole with a blind spot blocking sight.

Vitreous hemorrhage – bleeding in the eye from injuries, retinal tears, subarachnoidal bleedings, or blocked blood vessels.

Vitreous floaters – deposits of various size, shape, consistency, refractive index, and motility within the eye’s normally transparent vitreous humor which can obstruct vision.

Vitrectomy can result in retinal detachment.

The most frequent complication of vitrectomy surgery is high intraocular pressure, bleeding and cataract.

Cataract can develop within the first few years after surgery.

Following vitrectomy eye drops are used to allow the surface of the eye to heal, heavy lifting is avoided and a gas bubble may be placed inside the eye to keep the retina in place.

When a gas bubble is used, a certain head positioning has to be maintained until it dissolves over several weeks, and air travel should be avoided during its presence.

The return of eyesight after vitrectomy related to underlying condition which prompted the procedure.