Vitrectomy

The vitreous is normally a clear, jelly-like fluid that fills the inside of the eye. Various disease states can cause the vitreous to cloud, fill with blood or even harden so that light entering the eye will be misdirected and not reach the retina properly.

Definition

A vitrectomy is a surgical procedure that removes the vitreous in the central cavity of the eye so that vision can be corrected. It is beneficial in many disease states including diabetic eye disease (diabetic retinopathy), retinal detachments, macular holes, macular pucker and vitreous hemorrhage.

Procedure

The vitrectomy procedure is usually performed as an outpatient procedure. Rarely, an overnight stay in the hospital is required. Local or general (while you are asleep) anesthesia may be used. The eye will be held opened using a special speculum and the eye that is not being operated on will be covered. The procedure begins with Dr. Deupree making a small (less than 2mm) slit in the side of the eye and inserting an infusion line to maintain constant eye pressure. Next, a microscopic cutting device is inserted which will aspirate (suck out) the vitreous fluid.

A microscopic light source is also inserted to illuminate the inside of the eye through the procedure. Additional instruments may also be used to perform additional maneuvers such as cauterizing blood vessel leaks or removing scar tissue. Dr. Deupree will look through a microscope while performing the procedure. The surgeon may also use special lenses to help see the anatomy of the eye.

After the vitreous is removed, the surgeon will refill the eye with a special saline solution that closely resembles the natural vitreous fluid in your eye. Tiny absorbable stitches are used to close the three small openings and antibiotic injections to prevent infection will be instilled at the end of the procedure.

Vitrectomy Risks

Vitrectomies have been commonly performed and perfected for over 30 years. However, certain risks do exist. They include:

• retinal detachment
• development of glaucoma (increased pressure in eye)
• cataract formation or progression
• bleeding and/or infection inside or outside of eye
• red or painful eye
• loss of depth perception, blurring of vision, double vision, or blindness
• swelling of layer under the retina (choroidal effusion)
• change in focus, requiring new spectacle lenses (refractive changes)
• wrinkling of retina (macular pucker)
• swelling of the center of retina (cystoid macular edema)
• loss of night vision or distortion of vision
• loss of eye (extremely rare)
• need for additional treatment and/or surgery

Retinal detachment during or after the procedure is the most common risk. Dr. Deupree is prepared for this to happen and can repair the detachment by inserting gas that applies pressure on the retina before completing the case. The retinal detachment will heal during the normal vitrectomy healing time, which is between 4 to 6 weeks. Normal restoration of vision can take several weeks. Physical activity will be restricted during this time to prevent complications.

Postoperative Instructions

Since vitrectomy is often performed along with other procedures, postoperative instructions may vary. Some general guidelines are provided; however, please consult with your surgeon for specific instructions.

• Begin using any anti-inflammatory and antibiotic drops prescribed by your physician immediately after your eye patch has been removed.
• Wear the plastic eye shield when sleeping for the first 7 days following surgery. The shield should be worn for the first 3 days following surgery when showering.
• Avoid bending, stooping, lifting objects over 5 pounds, or any strenuous activity for one week (unless directed otherwise by your physician).
• Take Tylenol E.S. or gently apply ice compresses to the eye to relieve mild discomfort.
• Follow any special instructions given by your physician for head positioning (this is not necessary in all cases).

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