WHAT IS A VITRECTOMY?
Vitrectomy is a kind of intraocular surgery aiming to treat ocular diseases that affect the retina and vitreous body.
The retina is the sensitive film of the eye coating the inner wall of the eye. Outside the retina, there is the choroid which is a vascular layer located beneath the cornea and the sclera.
The vitreous humor is a clear jelly like liquid that fills most of the eye, located behind the crystalline lens and in touch with the inner part of the retina. It can sometimes shrink, get cloudy and interfere in the light rays onto the retina. Vitrectomy is a surgical procedure by which the unhealthy or altered vitreous humor is removed.
WHAT ARE THE INDICATIONS OF VITRECTOMY?
There are many diseases that require a vitrectomy, mainly diabetic retinopathy, especially when there is bleeding into the eye or foreign membranes over the retina's surface or in cases of retinal detachment. Also, many other circumstances may lead to a vitrectomy, to name a few: eye injuries or trauma, in diseases of the macula, especially related to neoformation of membranes, macular holes or macular degeneration with neovascularization. Some other secondary problems like inflammation of the eye or occasionally after cataract surgery where there have been complications.
Vitrectomy, as surgical procedure, improves patient's vision because it removes the altered or unhealthy material stored in the vitreous body. Furthermore, this surgery acts directly onto the retina to restore disturbed areas and improve vision, like removing redundant membranes, tractions, displacements or bleeding.
WHAT TESTS ARE REQUIRED BEFORE A VITRECTOMY?
When your ophthalmologist has decided to perform a vitrectomy, eye examinations should be performed to determine the surgical maneuvers during vitrectomy. Also, general examinations may be required, such as a blood test to get ready for surgery and general anesthesia, if necessary, even if most cases are currently done under local anesthesia without hospitalization.
WHAT HAPPENS DURING SURGERY?
Vitrectomy lasts one to two hours, depending on the pathology suffered by the eye. Sometimes the ophthalmologist has to repair other tissues, such as removing a cataract or doing a corneal transplant.
During surgery, the ophthalmologist looks at the eye through a surgical microscope. Several instruments are placed into the eye through small incisions in the sclera, the white area of the eye.
The first thing is the removal of the vitreous humor to access directly the retina. Retina may be reapplied using liquid or gas, and breaks may be sealed by laser photocoagulation. At the end of the surgery, the vitreous humor, filling the vitreous body will be replaced by polymers or silicones that resemble much the vitreous jelly (humor). Sometimes gas is introduced to help keep the retina in place. Also during vitrectomy, proliferative tissue can be removed, especially in diabetic retinopathy or foreign bodies that occasionally reached the eye secondary to trauma.
After surgery, the patient may experience some pain in the eye, in which case, the ophthalmologist will prescribe drops and ointment to relieve symptoms and inflammation within the eye. If by any chance a gas bubble is stuck within the eye, the patient will have to keep the proper position until the gas is absorbed and disappears. It is very important to remember that if a gas bubble was used during surgery, the patient cannot take a plane or go to places over 1000 meters high, since the atmospheric pressure decreases and the bubble can expand into the eye and cause a quick increased eye pressure that can be harmful to the eye.
WHAT ARE THE POTENTIAL RISKS OF VITREOUS SURGERY?
Any intraocular surgery has some risk, but the risks are less than the benefits that are usually obtained with regard to vision. Some of the risks of vitrectomy are intraocular infection, postoperative bleeding, which can occur in cases of diabetic vascular disease, retinal detachment, increased eye pressure and cataracts, especially in elderly patients.
The visual improvement after vitrectomy occurs within several weeks or even months after surgery. The final visual acuity (the final vision of the eye) will be consistent with the harm previously received by tissues, with the eye disease itself or with previous ocular surgeries.
HOW ARE EYE DROPS INSTILLED?
Tilt your head back, pull the lower lid down and apply a drop without touching the eye.
HOW IS AN OINTMENT APPLIED?
Tilt your head back, pull the lower lid down and place a little ointment "as a grain of rice." The first portion should be discarded each time the tube is opened.