Vitrectomy is a type of eye surgery, whereby a structure known as the vitreous humour or gel is removed. The term ‘vitrectomy’, is derived from it, meaning vitreous, and -ectomy, meaning to remove in Greek. It is delicate, highly specialised microsurgery that should only be done by a vitreoretinal or retina surgeon.
The vitreous humour or gel is a structure at the back of the eye that occupies about 80% of the total eye volume. At birth, the vitreous is completely clear and transparent. It starts life being fully attached to the retina, the delicate layer of cells at the back of the eye that captures external light, sending it to the brain, enabling sight. The macula is the centre of the retina responsible for detailed vision. Aging and certain diseases can alter the structure of your vitreous, retina and macula, affecting vision, which may require vitrectomy surgery.
Vitrectomy enables both the removal of the vitreous gel and safe surgeon’s access to the retina and macula for additional procedures. You may require vitrectomy surgery for the following conditions to improve eyesight or prevent blindness:
This depends on the reason for the vitrectomy. Retinal detachment surgery is often urgent. Further details on this can be found on our retinal detachment page.
The first time you meet your retinal surgeon will be in the clinic, prior to the vitrectomy surgery. A thorough assessment of your symptoms and a detailed examination of the eye and retina is carried out. Specialised imaging tests of the retina, such as colour photos and optical coherence tomography (OCT), are often required. Your surgeon will explain your vitreous and retina findings, the potential diagnoses and discuss treatment options, including vitrectomy surgery, if appropriate.
Anaesthesia during vitrectomy should enable pain-free surgery and rapid recovery. Vitrectomy is usually carried out with you awake, lying on your back, under local anaesthesia with sedation to help you relax. Patients often doze off during surgery. You can expect to be in our surgical centre for several hours and be able to return home that same day.
You will meet your retinal surgeon prior to surgery to review the risks and benefits of vitrectomy and ask any questions. The correct side is confirmed with you and marked, in line with UK and World Health Organisation surgical safety checklist.
The surgery begins with sedation to help you relax while lying on your back. Local anaesthesia is then applied to numb your eye. Your surgeon places a sterile drape or sheet over your eye. Sutureless microincisions are made on the white of the eye and vitrectomy surgery is carried out. The surgeon can easily manage the position of your eye during surgery and you are free to doze off.
During the procedure, you may see some coloured lights, hear background noise or voices and feel cool water running down the side of your face. You will not see the details of the surgery. Surgery typically lasts 30-60 minutes, sometimes a little longer, depending on your eye condition.
A bubble of gas or oil may be placed in your eye to help the retina heal. Vitrectomy is sutureless. Stitches are occasionally required, which dissolve over several weeks. Following application of antibiotic to your eye, the eye is covered with a white gauze pad and a clear plastic eye shield. Your eye will remain numb for several hours thereafter.
You will start to awaken from the sedation as soon as your surgery is completed. You can sit up and have a drink and will feel ready to get on your feet in a relatively short period of time. Occasionally patients require general anaesthesia, in which case it can take additional time for you to be fully awake.
Vitrectomy is day-case surgery, meaning you can head home very shortly thereafter, often within an hour, if carried out at our surgical centre.
The gauze pad and eye shield can be removed the next morning, after which eye drops can commence, usually prescribed for 4 weeks. The eye shield should be worn at night for 1 week.
Your surgeon may recommend posturing, depending on your eye condition. Posturing involves positioning your head a certain way during the day and/or night for a few days, to help with the healing of your retina. Your surgeon will specify additional details if required. A posturing pillow can be helpful for this.
Your vision after surgery will be very blurry for at least a week. If a gas or oil bubble has been used, the blurriness can last several weeks. Your eye will be red for a couple of weeks, and can feel dry, gritty and sore for a few days. Feel free to use your normal over-the-counter pain medication, if needed. Your eye should not be painful.
Driving: You should avoid driving for 1-2 weeks after surgery
Flying: If a gas bubble has been used, it is important to avoid flying for several weeks until this has completely resorbed. The lower atmospheric pressure in an aeroplane allows the gas bubble to expand, which increases the pressure in the eye, and can lead to interruption of blood to the retina and cause irreversible blindness. Your eye surgeon will be able to confirm when you can fly.
Exercise: You should be able to resume light exercise 1 week following surgery, and avoid swimming for 4 weeks after.
After surgery, you may be asked to posture, which means to position your head a certain way to help the retina heal better. This may be required when there is a gas or oil bubble in the eye. Posturing uses gravity to help the gas or oil bubble float against the part of the retina where this may be helpful.
1. Is posturing required for everyone having vitrectomy surgery?
No. It depends on the condition for which you are having vitrectomy surgery. Surgery for retinal detachment and macular hole are the most common conditions for which posturing may be required.
2. How long do I need to posture for?
If you are asked to posture, this typically ranges from 3 to 7 days. Your surgeon will be able to confirm during your consultation or immediately after surgery what the exact length required is.
3. What position do I need to be in when I posture?
This depends on where the problem in the retina is, and where we want to try and position the bubble in the eye. During the day, it can vary from being face-down, to lying or leaning on one side. During the night, you may be asked to sleep on one side.
4. Are there any devices or aids that can help me posture better?
Yes. There are various devices that can be loaned for a short period to help with posturing. This is particularly helpful for those that need to posture face-down, e.g. after surgery for a large macular hole. Our team can help with this.
Devices or aids increase convenience and ease of posturing, but aren’t absolutely necessary. Creative use of pillows also works well.
5. Do I need to posture 24 hours a day?
No. Even if you are asked to posture throughout the day, you can rest and be free of any posture for 10 minutes out of every hour, to enable you to do any necessary tasks and also to stretch and move around.
6. Does posturing affect the success of surgery?
Potentially. It depends on the condition. For example, there is some scientific data to suggest that face-down posturing for large macular hole may increase the chance of successful hole closure.
The vitrectomy success rate depends on the reason for surgery. For example, the success rate is over 90% after surgery for retinal detachment and epiretinal membrane, and over 95% after surgery for eye floaters.
The risks of vitrectomy surgery are low, particularly in the hands of experienced, highly skilled surgeons.
Risks include retinal tear, retinal detachment, severe infection and bleeding to cause blindness, and high eye pressure. A significant proportion of patients will develop cataract following vitrectomy, particularly, in patients aged 50 or over.
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