A vitrectomy is a surgical procedure undertaken by a specialist where the vitreous humor gel that fills the eye cavity is cleared to provide better access to the retina.
The vitreous humor serves as a framework or support for the eye. In normal eyes, the vitreous is crystal clear and fills the eye from behind the iris and lens till the optic nerve. This area comprises two-thirds of the volume of the eye and is called the vitreous cavity. The vitreous cavity lies in front of the retina and choroid.
Removal of this vitreous allows for the ease of a variety of retinal procedures.
In rare cases, following complex cataract/cornea/glaucoma surgeries, the vitreous gel comes through the pupil into the front portion of the eye. This must be cleared to reduce inflammation and to prevent the cornea from decompensating and to reduce the risk of future retinal problems.
A vitrectomy performed by a retina specialist for diseases of the posterior segment is called a posterior or pars plana vitrectomy. Three self-sealing openings or ports are created in the eyeball to access the vitreous which is removed using high speed cutters with a light source providing illumination inside the eye.
Once a pars plana vitrectomy is complete, saline, a gas bubble or silicone oil may be injected into the vitreous gel to help hold the retina in position.
When such a vitreous substitute is used, a period of post-operative positioning (typically face-down) by the patient helps the retina heal.
Preoperatively, after a thorough examination by your retinal specialist, you will be asked to do a few scans. These scans involve:
A clinical photograph of your retina.
An aid to assess the back portion of your eye through ultrasound imaging in case the retinal view is hazy (ocular ultrasound)
A detailed pictorial representation of the layers of your macula (OCT macula).
Once your procedure is planned, your treating doctor will inform you whether additional procedures will be combined with the vitrectomy, such as cataract surgery, or placement of an encirclage buckle (to straddle the vitreous base), depending on the indication of surgery.
Our physician and anaesthesiology team will evaluate you for fitness after a basic assessment. They will advise you on whether to continue with your regular medications if any on the day of surgery, which is done as a daycare procedure.
On the day of surgery, anesthesia is achieved with an injection near the eye to prevent pain sensation and eye movement during the surgery. The eye is painted externally and irrigated with povidone iodine solution of optimum strength and a sterile drape is applied to ensure asepsis. The surgery typically takes 60 to 120 minutes depending on the complexity of surgery.
Post operatively the eye is patched to protect from injury. Your surgeon will give you instructions on how to do any required head positioning (such as face-down), and how long you should continue it. Post operative drops and oral medication are usually prescribed before discharge.
Remember your compliance with the postoperative instructions is the key to the success of this procedure!!!
Written by: Dr. Santosh Balasubramaniam – Consultant Ophthalmologist, TTK Road
1st & 3rd Floor, Buhari Towers, No.4, Moores Road, Off Greams Road, Near Asan Memorial School, Chennai – 600006, Tamilnadu