Vitrectomy - Purpose, Procedure, and Indications

Introduction

Vitrectomy is surgically removing the eye's vitreous humor either partially or wholly. Then, the removed vitreous humor is replaced with another solution, normal saline. It is primarily advised in patients with retinal damage.

What Are Vitreous Humor and Retina?

Vitreous humor is a gel-like substance present between the retina and the crystalline lens of the eye. The retina is a bundle of nervous tissue present at the posterior-most part of the eye. It primarily helps sense the light from the eye lens to the brain. The retina is a multilayered tissue that receives blood supply from the branches of internal carotid arteries.

How Does Vitreous Humor Removal Help in Correcting Pathologies?

The removal of the vitreous humor from the vitreous cavity helps provide clear-cut access to the underlying obstruction in the retina.

Access to the vitreous cavity is best achieved through the pars plana area of the eye. Pars plana is a part of the middle layer of the eye present near the junction of the colored part of the eye (iris) and the opaque sclera. Pars plana vitrectomy helps in reducing the damage caused to the nerves during the procedure and provides convenient access.

What Are the Conditions That Require the Procedure of Vitrectomy?

Several conditions of the eye necessitate the procedure of vitrectomy. These conditions include:

• Cloudy vitreous humor.

• Retinal tears.

• Mechanical traction of the eye. Conditions causing tractions include macular holes, diabetic retinopathy, and sickle cell anemia.

• Macular bleeding. Age-related macular degeneration causes bleeding in the macula.

• Foreign body presence.

• Traumatic pathologies.

• Endophthalmitis (inflammatory condition of the vitreous humor).

• Conditions that increase the pressure inside the eye (intraocular pressure), like bacterial infections (endophthalmitis) of the eye.

• Vitrectomy is indicated as a diagnostic procedure after laboratory testing in prolonged intraocular pressure conditions of the eye.

• Vitrectomy is used to retrieve fragments of the retained lens.

• Biopsy of tumors present inside the eyes.

What Are the Situations When It Is Best to Avoid Going for Vitrectomy?

Usually, there are no specific situations where vitrectomy is inadvisable. However, vitrectomy is avoided in a few general conditions like:

• Patients with severe systemic diseases.

• Diagnosis of poorly adhesive tumors. In patients with poorly defined tumors, vitrectomy should be performed with caution. Vitrectomy in these conditions can spread cancer further.

• Blunt traumas involving the eye and surrounding structures like the orbit and face an interdisciplinary approach.

Where Is the Vitrectomy Procedure Carried Out?

The vitrectomy procedure is carried out in a standard operating room with standard equipment. The American Academy of Ophthalmology recommends the equipment.

Who Performs the Vitrectomy Procedure?

A vitreoretinal surgeon performs vitrectomy surgery. In case of trauma and increased ocular pressure, ophthalmologists and glaucoma specialists are also consulted.

What Are the Procedures Performed Before the Actual Surgical Procedure?

• Before the vitrectomy procedure, the internal structures of the eye are entirely examined by indirect ophthalmoscopy.

• Ultrasonography is used to view the retinal and vitreal tears distinctly.

After the Vitrectomy Procedure:

• Eye Patch: It is mandatory to wear an eye patch for a day or longer to protect the eye.

• Vision Changes: Initially, the vision may be blurry, and it may take several weeks to months for the vision to stabilize. Some patients may experience improved vision, while others might need further treatment or adjustments in their prescription lenses.

• Activity Restrictions: Avoid strenuous activities, heavy lifting, and bending over to prevent pressure changes in the eye.

How Is the Vitrectomy Technique Performed?

Vitrectomy can be performed under general anesthesia or by providing a nerve block. The surgery is performed in one to three hours.

• The ophthalmologist removes the vitreous humor by making an incision in the white portion of the eye (sclera) with the help of specialized instruments and a microscope.

• Apart from the vitreous humor, the surgeon may also remove -

  • Scar tissue.

  • Cataract.

  • Foreign body.

• The surgeon places air, gas, or silicone oil bubbles inside the eye, which helps the retina establish its position. The air bubble goes away by itself.

• A second surgery removes the silicone oil bubble.

• In the case of subretinal fluid accumulation, the fluid is removed to flatten the retina.

• Lasers are used to treat torn retinal detachments.

• Intravitreal injections of antibiotics like Vancomycin follow vitrectomy biopsies for bacterial infections.

• In case of difficult pathological conditions like perforations in the cornea (transparent, outermost layer of the eye) and blunt trauma, an interprofessional approach is required.

• Diagnostic vitrectomy for the intraocular tumor is performed with caution to avoid spread.

Will There Be Any Side Effects After Surgery?

There are no severe side effects related to vitrectomy surgery.

• Patients may feel foreign body sensations in the eye for some time. After that, it will go by itself.

• There is swelling and redness of the eye.

• Usually, the patients recover entirely in two to four weeks.

What Are the Postoperative Measures to Be Followed After Vitrectomy Surgery?

• Patients are advised to keep their eyes closed, and a caregiver should be present while going home.

• Patients are advised to bandage their eyes or wear a patch for a few days. Also, keeping the face down or sideways is recommended if a gas bubble is placed.

• Avoid vigorous activities and traveling on planes.

• Patients are kept under follow-up at regular intervals of one week, four weeks, and three months after the operation.

• Patients are advised to use pressure-reducing eye drops to reduce post-surgical intraocular pressure.

• Eye drops are also recommended to reduce the swelling.

Is There Any Complication Linked to the Vitrectomy Procedure?

Vitrectomy usually carries a shallow risk. However, several serious complications are linked to the vitrectomy technique, sometimes even causing blindness.

• Early Complications of Vitrectomy Include -

  • Increase in the intraocular pressure.

  • Corneal defects of the eye lead to blurry vision.

  • Central retinal vein block.

  • Macular edema.

  • Retinal break.

  • Endophthalmitis.

  • Reduced vision.

  • Blood vessel formation in the iris.

  • Neovascular glaucoma.

• Late Complications of Vitrectomy Include -

  • Cataract.

  • Secondary glaucoma.

What Is Clinical Significance And Overall Outlook of the Surgery?

Vitrectomy is an essential surgical procedure to prevent or revert vision loss. The vitrectomy procedure overall has a good prognosis with lower risks.

• Visual Prognosis: The success and visual outcome of vitrectomy largely depend on the initial condition being treated and the overall health of the eye.

• Ongoing Care: Continued monitoring and regular eye check-ups are essential to ensure the long-term health of the eye.

Conclusion

Vitrectomy is an essential surgical procedure to correct mainly the retinal defects leading to vision loss. The procedure is usually performed in a single day with minimal side effects and complications. Experience and recovery process can vary from person to person, so it is important to follow the ophthalmologist’s specific advice and instructions throughout the preoperative and postoperative periods.