Vitrectomy is the procedure of removing or replacing the jelly-like fluid called vitreous in your eye. In the past, many eye diseases could not be treated without vitrectomy surgery and could lead to permanent vision loss. Today, thanks to this surgical intervention, serious conditions such as retinal problems, vitreous hemorrhage, and intraocular infections can be successfully treated.
In this article, we will discuss in detail what vitrectomy surgery is, in which cases it is applied, the surgical process, and the recovery period.
What is Vitrectomy Surgery?
The transparent gel structure filling the inner part of your eye is called the vitreous. This substance is located between the lens and the retina and constitutes approximately 80% of the eye's volume. Being completely transparent, this structure allows light to reach the retina unhindered and maintains the shape of the eyeball.
The Role of Vitreous Fluid in the Eye
The vitreous is an important structure that preserves the anatomical integrity of the eye. By providing support on the retina, it helps balance the intraocular pressure. It remains largely constant from birth and contains no blood vessels.
Changes occur in the vitreous structure with age. While vitreous liquefaction is observed in 25% of individuals aged 40-49, this rate rises up to 62% in the 80-89 age group. This condition, called vitreous detachment, is seen at a rate of 53% over the age of 50, and 66% between the ages of 65 and 85.
This natural aging process usually does not cause problems. However, in some cases, the vitreous may become clouded, bleeding may occur, or it may damage the retina. At this point, vitrectomy surgery comes into play.
The Purpose of Vitrectomy Surgery
Vitrectomy is the surgical removal of the vitreous gel inside the eye. The clouded or blood-filled vitreous is cleared with special devices, and intraocular fluid or gas is injected in its place.
The main goal of the surgery is to remove the damaged or problematic vitreous fluid from the eye. When the vitreous becomes clouded or when there is bleeding, severe blurred vision occurs. In this case, damage may occur in the retinal tissue and your visual functions are negatively affected.
Thanks to vitrectomy, repair on the retina can be performed and the vision problem can be eliminated. Significant improvement in visual functions is achieved in a large proportion of patients after surgery. If left untreated, blindness and complete loss of the eye may occur.
Performed with microsurgical techniques, this procedure ensures the clearance of intraocular hemorrhages, foreign bodies, or infection. When scar tissues and inflammatory cells prevent light from reaching the retina where images are perceived, vitrectomy is required to correct this. It can prevent permanent vision loss in emergencies such as retinal detachment.
In Which Cases Is Vitrectomy Surgery Applied?
Vitrectomy surgery is applied for many diseases that affect the retina and cause vision loss. Your ophthalmologist decides on this surgery based on the extent of retinal damage and the loss in your visual functions.
Retinal Detachment and Tears
Retinal detachment is a serious condition that occurs when the retina separates from the eye wall. It usually starts with retinal tears and can spread to the entire retina if left untreated. High myopia, advanced age, and eye trauma are among the risk factors.
Vitrectomy surgery is required once the retina is detached. In this procedure, the vitreous gel is cleared and the retina is put back into place. Laser and gas tamponade methods are also used in the repair of large tears. The success rate of vitrectomy operations ranges between 63% and 100%.
Diabetic Retinopathy
Diabetes causes damage to the eye vessels and creates bleeding in the retina. Approximately 50% of intraocular hemorrhages in diabetic patients are due to diabetic retinopathy. If the disease progresses uncontrolled, it can result in vision loss and blindness.
When bleeding occurs inside the eye and does not clear on its own, vitrectomy surgery is applied. During the surgery, the hemorrhage and structures causing the hemorrhage are cleared from the eye. Silicone oil or air is left inside the eye to prevent re-bleeding.
Vitreous Hemorrhage
Sudden vision loss develops in hemorrhages into the vitreous. Symptoms ranging from mild blurring to complete vision loss may be observed. Approximately 20% of all intraocular hemorrhages are due to retinal tears and detachment.
If the hemorrhage is severe or if the patient's job requires binocular vision, surgery is performed immediately. Emergency vitrectomy is required if the hemorrhage is due to causes such as retinal detachment. In mild hemorrhages, up to 3 months can be waited, but if it does not clear, surgery is planned.
Macular Hole
The macula is the central region of the retina and is responsible for detailed vision functions such as reading and driving. Generally, after the age of 50, tractions and holes form during the separation of the vitreous gel from the retina. The probability of developing in the other eye of patients with a hole in one eye is 10-15%.
The only treatment for a macular hole is vitrectomy surgery. The surgery takes 50-60 minutes and the success rate is around 90%. In Stage 1 and Stage 2 holes, the success rate is almost 100%. After the surgery, the patient is asked to lie face down for 5 days.
Epiretinal Membrane
Epiretinal membrane is a tissue that forms on the surface of the macula and causes a decrease in vision. Its incidence after the age of 40 is between 4-12%. The annual incidence in the community is 1%.
If the vision level drops below 70%, vitrectomy surgery is required. In experienced hands, the anatomical success rate is close to 100%. Post-surgical recovery may continue up to 6 months.
Intraocular Infections and Traumas
Intraocular infections require urgent intervention. Infected tissues are cleared with vitrectomy and the infection is brought under control. Vitrectomy is also applied in case of foreign bodies entering the eye as a result of an accident or injury. Traumatic injuries are the most common cause of vitreous hemorrhage in individuals under 40.
How Is Vitrectomy Surgery Performed?
Performed in an operating room environment under a special microscope, vitrectomy surgery is a delicate procedure. Your eye surgeon determines the appropriate anesthesia method according to the severity of your disease.
Anesthesia Options
Local anesthesia is usually preferred. Anesthetic drugs are injected around the eye to eliminate any pain sensation that may occur in the eye. In this method, you are expected to lie flat on your back and stay without moving your head during the surgery.
General anesthesia is required in some cases. This method is applied especially when the surgery is anticipated to take a long time, in individuals with claustrophobia, in pediatric patients, or in individuals with compliance difficulties. Patients who receive general anesthesia need to stay in the hospital for one night.
Surgical Process
The surgeon makes 3 small incisions of approximately 0.5 mm in diameter into the eye wall. These incisions are so small that stitches are usually not required. In recent years, 23, 25, and 27 gauge microsurgical instruments have been used.
Continuous fluid is infused into the eye from the first incision. The interior of the eye is illuminated by inserting a light source from the second incision. From the third incision, a cutting-suction instrument called a vitrector is placed. This device works with a special system consisting of 10,000 cuts per minute.
The vitreous gel is cleared by being divided into small pieces. During the surgery, blood cells, inflammation-causing microorganisms, and foreign bodies are also removed from the eye. Membranes or abnormal tissues on the retina are removed.
The duration of the surgery varies between 30 minutes and 2 hours depending on the severity of the disease. It takes an average of 45 to 90 minutes.
Substances Placed in the Eye After Surgery
At the end of the surgery, different substances may be left inside the eye to stabilize the retina. Depending on the situation, liquid, air, gas, or silicone oil is used.
If sterile saline is given, it does not impair your vision and the eye's own fluid is produced over time. If air is placed, it is absorbed within 1 week; if gas is placed, it is absorbed within 2-8 weeks. SF6 gas completely disappears in 2 weeks, and C3F8 gas in 6-8 weeks.
Gas tamponade resorbs on its own over time and a second surgery is not required. However, as long as gas is present, the vision will be blurry. A person who has had gas placed in their eye can definitely not board an airplane and cannot go to high altitudes.
Since silicone oil is transparent, it does not impair vision and does not require a head position. It is usually left in the eye for 3-6 months. Since silicone may deteriorate after a while and potentially harm the eye, it must be removed. A second surgery is performed for its removal.
Points to Consider Before Vitrectomy Surgery
Preparations that need to be made beforehand are of great importance for a successful vitrectomy surgery. Your ophthalmologist will give you various instructions before the surgery and ask you to undergo the necessary examinations.
Required Tests and Examinations
Your ophthalmologist performs a detailed examination of your eye before the surgery. These examinations are performed using methods such as OCT, retinal ultrasound, slit lamp examination, and fluorescein angiography. Detailed vision tests and visual acuity measurement are also part of the evaluation process.
Intraocular pressure check is performed and retinal photographs are taken. If the operation will also cover the anterior region of the eye, additional tests may be required. If damage has occurred as a result of eye trauma, CT scanning or MRI imaging must be performed to fully understand the level of the injury.
Your general health status is also meticulously evaluated before the surgery. Your medical history is reviewed for the presence of systemic diseases such as hypertension or diabetes. Your cardiovascular and respiratory systems are evaluated in detail and your suitability for surgery is confirmed.
Laboratory tests such as a complete blood count and coagulation profile are performed. The anesthesiologist performs a detailed evaluation to prevent possible risks during the surgery. It is aimed to stabilize all medical conditions if possible before the surgery.
Pre-Surgery Preparation Instructions
You are asked not to eat or drink anything 8 hours before the surgery. This rule reduces the probability of stomach contents escaping into the windpipe and reaching the lung in case of vomiting. You must follow this rule even if your surgery is later in the day.
Coming fasting on the morning of the surgery and leaving your facial area free of makeup reduces the risk of infection. Since driving is prohibited after the surgery, you need to plan your transportation in advance.
Particular attention is paid to blood sugar regulation in diabetic patients. Keeping fasting blood sugar at an appropriate level is protective against hypoglycemia. Blood pressure control is ensured in hypertensive patients.
Coming early rather than late for surgery is more correct. If other surgeries take longer than anticipated, you may need to wait, but rather than rushing and panicking, it is better to arrive early and rest.
Information Regarding Medications Used
Aspirin or blood-thinning medications that you use regularly are temporarily discontinued if necessary. Your doctor and anesthesia team will tell you whether or not to continue your medications on the day of the surgery.
Patients who usually use eye drops can continue their medications even on the day of the surgery. However, special guidance needs to be given for oral medications.
Medications of critical importance regarding the heart, respiration, blood pressure, or anxiety will most likely be continued to be taken with a teaspoon of water. Other medications such as vitamins, cholesterol-lowering drugs, or birth control pills can continue to be taken after the surgery.
The surgeon may prescribe pre-surgery eye drops to reduce the risk of infection and explains their correct use.
Recovery Process After Vitrectomy Surgery
The recovery process varies from person to person and depends on the complexity of the surgery. While most patients return home on the day of the surgery, overnight observation may be required in some cases.
Symptoms That May Be Experienced in the First Days
It is normal to experience discomfort, stinging, pain, and redness in your eye in the first days after surgery. These symptoms are expected conditions and decrease over time. Having mild stinging and watering is natural.
Redness and bloodshot appearance may be observed in the white part of your eye. A certain amount of pain responding to painkillers is at an acceptable level. However, in case of severe pain not responding to painkillers, sudden worsening of vision, or intense redness, you must immediately consult an eye physician. Your eye pressure may have risen or you may have contracted an infection.
It is quite difficult to predict when visual acuity will improve after surgery. Vision recovery is directly related to how much the retina was affected before the surgery. If the retina was mildly affected, vision increase is rapid. If there is severe retinal damage, recovery can take 6 months or even 1 year.
Position and Activity Restrictions
If gas was given to your eye, head position is of vital importance. Make sure to learn from your doctor how and for how long you need to lie down. A face-down lying position is generally recommended for the first 3-5 days. It is normal to feel a black shadow in front of your eye.
Traveling by plane is strictly prohibited in patients who have undergone gas tamponade. You should prefer other means of transportation until the gas is completely absorbed. This period varies between 2-6 weeks.
If silicone oil was used, head positioning needs to be applied for the first 2 weeks. Since silicone is transparent, vision begins, albeit blurry, after a few days. Heavy lifting, bending forward for a long time, and entering a swimming pool are prohibited for the first 3 weeks.
Eye Care and Medication Use
Your eye should remain closed for 3 days after the surgery. You can buy clean patch cotton and tapes from the pharmacy and change them daily. Do not let water touch your eye for a week. Wash your head from the back and clean your torso separately.
The eye drops prescribed by your doctor prevent infection and edema. Make sure to learn how many times a day you should instill the drops and do not skip them. Antibiotic and steroid drops are generally used for one month.
Do not wipe your eye with an unclean tissue or paper towel. Do not press on your eye and protect it from traumas. Strictly avoid rubbing.
Control Examinations
Control examinations need to be performed at intervals of 10-15 days until the gas is completely absorbed. At the first check-up, the doctor and patient jointly determine the frequency of subsequent appointments. Regular check-ups are indispensable to monitor the recovery process.
Risks After Surgery
Among early-stage complications, low intraocular pressure is seen at 13.9%, increased intraocular pressure at 12.36%, corneal edema at 13.9%, intraocular hemorrhage at 7.52%, and inflammation at 2.15%. If these complications are detected and treated early, long-term success is increased.
The retina may tear again or detachment may develop. It should be kept in mind that there is a risk of recurrence of retinal detachment after the silicone is removed. The probability of developing a cataract increases with age.
Vitrectomy Surgery in Summary
Vitrectomy surgery is an effective surgical method that treats your retinal problems. Many eye diseases leading to vision loss can be successfully treated thanks to this surgery. It is the best way to preserve your visual functions in conditions such as retinal detachment, diabetic retinopathy, or macular hole.
You must completely follow the instructions given by your doctor before the surgery. After the surgery, you should patiently follow the recovery process. Regular check-ups and medication use ensure that you obtain successful results. When your eye health is concerned, consult a specialist eye physician without delay.
Frequently Asked Questions
Patients ask various questions about vitrectomy. Let us answer what you are curious about regarding the surgical process.
Is vitrectomy surgery painful?
You do not feel pain during the surgery. Local anesthesia numbs your eye and you do not experience discomfort. There may be mild pain or stinging sensation in the first days after surgery, but it passes in a short time.
A certain amount of discomfort responding to painkillers is normal. However, in case of severe pain not responding to painkillers, you should consult your doctor immediately. An increase in pressure or infection may have developed in your eye.
How long does the surgery take?
Vitrectomy surgery takes an average of 1-2 hours. The duration may vary depending on the condition of the disease. It is completed in an average of 45 to 90 minutes.
While 30 minutes is sufficient in simple cases, the surgery can extend up to 2 hours in complex retinal problems. Your surgeon will inform you of the estimated duration before the surgery.
When can I return to normal after surgery?
Recovery usually takes place within a few weeks. Full recovery varies depending on the condition of the retina. It can take an average of 3 to 6 months.
You should pay attention to eye care in the first weeks. Avoid heavy lifting and strenuous activities. Following regular check-ups, your doctor will inform you when you can return to your normal life.
When does vision occur after vitrectomy surgery?
Vision varies depending on the type of surgery and the condition of the eye. In most people, vision begins to improve within the first few weeks. If gas was given to your eye, you will see blurry for 2-6 weeks.
Your pre-surgery vision level and disease duration affect the outcome. Vision levels of 80-100% can be reached in patients operated on early. In late applications, even 5-10% vision is considered a success. Full recovery can take 6 months.
Vitrectomy is the surgical removal of the vitreous fluid in the eye. It is used in the treatment of serious conditions such as retinal problems, vitreous hemorrhage, and intraocular infections.
