VITREOUS SURGERY (VITRECTOMY)
Vitreous surgery is performed in the operating room and the substantial majority of cases are accomplished on an outpatient basis. Every vitreous surgical procedure involves entering the large space inside the eye (the vitreous cavity) and removing vitreous – hence the synonymous term “vitrectomy”. The volume previously occupied by the vitreous gel is replaced either with a saline solution, a gas bubble or a liquid material called silicone oil. Removal of vitreous is only the initial part of any such procedure however, and permits the retinal surgeon to perform a variety of other surgical interventions.
Common indications for vitreous surgery include:
Many retinal detachments are repaired utilizing vitrectomy techniques. In such cases, following removal of the vitreous gel, the fluid which has accumulated beneath the retina is removed and the retina reattached. Laser photocoagulation or cryotherapy is performed to seal any retinal tears. At the conclusion of such a procedure, the vitreous cavity is temporarily filled by a gas bubble or less commonly, silicone oil to maintain reattachment of the retina. As described previously in the case of pneumatic retinopexy, proper positioning of the patient’s head is particularly important when a gas bubble is utilized. Air travel is similarly prohibited until the gas bubble has dissolved into the bloodstream and dissipated.
PROLIFERATIVE DIABETIC RETINOPATHY OR
OTHER VASCULAR DISORDERS OF THE RETINA
In the situation of proliferative diabetic retinopathy (PDR) or other vascular disorders of the retina leading to similar complications, a number of goals can be achieved at the time of vitreous surgery. These include removal of blood (vitreous hemorrhage), dissection and removal of scar tissue, removal of areas of abnormal blood vessel growth, and/or repair of regions of retinal detachment. Retinal laser photocoagulation can also be performed as necessary at the time of such a procedure.
Vitreous Surgery (Vitrectomy)
EPIRETINAL MEMBRANE / MACULAR PUCKER
Epiretinal Membrane Peel
As mentioned in the Clinical Conditions section, an epiretinal membrane is a thin film of tissue which may form overlying the surface of the macula. Contraction of such a membrane can cause distortion of the macular tissue resulting in blurred and/or distorted vision. At the time of vitrectomy surgery, the epiretinal membrane is “peeled” from the surface of the macula.
Macular hole repair is another common indication for vitreous surgery. Typically, a thin film of vitreous is adherent over the surface of the macula resulting in the formation of the macular hole. At the time of surgery, this is carefully removed. At the conclusion of the operation, the vitreous cavity is filled with a large gas bubble and postoperatively, face downward positioning is necessary on a short-term basis in order to attempt to achieve closure of the macular hole and recovery of better central vision.
POSTOPERATIVE PROBLEMS FOLLOWING CATARACT SURGERY
Displaced intraocular lens implant
A variety of problems can occur following cataract surgery which may necessitate vitreous surgery. These include infection (endophthalmitis), retained fragments of the cataract which have become displaced into the vitreous cavity, or dislocation of the intraocular lens implant. The best approach and timing for the surgical management of these difficulties will vary considerably based upon the individual patient’s characteristics.
SEVERE EYE INJURIES
Retinal specialists frequently deal with serious eye injuries. In many situations, vitreous surgery may be necessary to address retinal detachment, bleeding or fragments of metal or other materials (called “intraocular foreign bodies”) which have penetrated the eye.