Vitrectomy

Surgery Overview

Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye. It may be done when there is a retinal detachment, since removing the vitreous gel gives your eye doctor (ophthalmologist) better access to the back of the eye. The vitreous gel may also be removed if blood in the vitreous gel (vitreous hemorrhage) does not clear on its own.

During a vitrectomy, the surgeon inserts small instruments into the eye, cuts the vitreous gel, and suctions it out. After removing the vitreous gel, the surgeon may treat the retina with a laser (photocoagulation), cut or remove fibrous or scar tissue from the retina, flatten areas where the retina has become detached, or repair tears or holes in the retina or macula.

At the end of the surgery, silicone oil or a gas (perfluropropane) is injected into the eye to replace the vitreous gel and restore normal pressure in the eye.

Vitrectomy is always done by an eye doctor who has special training in treating problems of the retina.

What To Expect After Surgery

Vitrectomy may require an overnight hospital stay, but it may sometimes be done as outpatient surgery. The surgery lasts 2 to 3 hours. Your eye doctor will determine if the surgery can be done with local or general anesthesia.

Why It Is Done

Vitrectomy may be done to:

• Repair or prevent traction retinal detachment, especially when it threatens to affect the macula.
• Repair very large tears in the retina.
• Reduce vision loss caused by bleeding in the vitreous gel (vitreous hemorrhage) when bleeding is severe or when the blood does not clear on its own after several months.
• Treat severe proliferative retinopathy that causes severe scar tissue formation or when growth of new blood vessels on the retina (neovascularization) continues despite repeated laser treatment.

How Well It Works

Vitrectomy has been shown to greatly improve visual acuity in many people who have severe vitreous hemorrhage that has not cleared on its own. A vitrectomy can decrease the risk of severe bleeding in people who have begun to have bleeding into the vitreous gel. It can also reduce the risk of severe bleeding in people with severe growth of abnormal blood vessels in the iris if the retina is not severely damaged because of scar tissue.

In general, surgery can restore some vision lost as a result of traction retinal detachment and may help prevent further detachment. But the results tend to be better when the detachment has not affected the centre of the retina (macula) and the central vision it provides.

Risks

Vitrectomy may cause elevated pressure inside the eye (intraocular pressure, or IOP), especially in people who have glaucoma.

There are several other serious, vision-threatening risks associated with vitrectomy. These include:

• Further bleeding into the vitreous gel.
• Retinal detachment.
• Fluid buildup in the clear covering of the eye (corneal edema).
• Growth of new blood vessels on the surface of the iris (rubeosis iridis), which can eventually cause a form of severe glaucoma (neovascular glaucoma). This can lead to permanent eye pain or loss of the eye.

What To Think About

One of the main uses of vitrectomy is to remove blood from the middle of the eye, a condition called vitreous hemorrhage. When vitreous hemorrhage occurs, some doctors may recommend waiting several months to a year to see whether the vitreous gel will clear on its own before they perform a surgery that can have serious complications.

But if the hemorrhage is causing severe vision loss or is preventing treatment of severe retinopathy, surgery may be performed sooner rather than later. Some studies have shown that long-term results are better with early vitrectomy.

For more information, see the topic Retinal Detachment.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Jeannette Curtis Maureen Shea	Last Updated: October 31, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Anne C. Poinier, MD - Internal Medicine Christopher J. Rudnisky, MD, FRCSC - Ophthalmology
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