Vitrectomy

What is a vitrectomy?

A vitrectomy is an eye surgery that is used to remove the vitreous humour, which is the name given to the clear, gel-like substance that takes up about 80% of the space within your eyeball.

Its purpose is to maintain the shape of your eye, and it’s clear so that light can pass directly through it and reach the back of your eye, where it’s converted into messages that tell your brain what you can see.

Surgery to remove the vitreous humour may be needed for a variety of reasons, from clearing cloudy fluid that is affecting the quality of your vision, to repairing structural damage that could result in permanent vision loss.

What else is a vitrectomy known as?

You may also hear of a vitrectomy called vitreous surgery or pars plana vitrectomy. It’s also sometimes generally referred to as retina surgery, since in many cases, the procedure is used to repair problems with the retina.

What are the different types of vitrectomies?

You may hear that there are different types of vitrectomies, but this isn’t entirely true. There are primarily two names used to describe them, but these refer to the specific surgical technique used to perform them. Essentially, the procedure itself, which is to remove the vitreous jelly, remains the same.

Pars plana vitrectomy (PPV)

The most common surgical technique used in a vitrectomy, it’s used to treat problems occurring at the back of your eye, such as diabetic retinopathy (a complication of diabetes) and retinal detachment. Today, almost all vitrectomy surgeries are performed using the PPV method.

Anterior vitrectomy

In contrast, anterior vitrectomy focuses on removing only vitreous humour from the space between the cornea and iris at the front of the eye. It’s usually the preferred technique if there’s a problem with the lens of your eye.

What conditions can a vitrectomy treat?

A vitrectomy can be used to treat a variety of eye conditions.

• Diabetic retinopathy: A vitrectomy may be recommended to treat advanced diabetic retinopathy – a complication of diabetes that occurs when persistently high blood sugar levels cause damage to the blood vessels at the back of your eye.
• Retinal detachment: This is where the retina, which is the light-sensitive area of cells at the back of your eye, comes away from its blood supply. It’s serious and requires immediate surgery to repair it; otherwise, you could experience permanent vision loss.
• Vitreous haemorrhage: As its name suggests, a vitreous haemorrhage occurs when blood leaks into the vitreous humour. It’s also classed as a medical emergency and needs immediate treatment.
• Floaters: Used to treat severe floaters which haven’t improved with any other treatment, a vitrectomy may be recommended as a last resort.
• Macular holes: The macula is the central part of the retina that is responsible for seeing fine detail. A macular hole is a small opening that can develop in the macula, usually as part of the ageing process, but they are relatively rare.
• Epiretinal membranes: An epiretinal membrane is a layer of scar tissue that forms on your retina, either because of age or trauma. Vitrectomy surgery can be used to relieve traction on the retina, while also being an opportunity to remove the membrane itself.

How serious are vitreoretinal conditions?

It depends on the condition. Some, like floaters, can be harmless but inconvenient. Others, such as retinal detachment, are classed as an emergency because left untreated they could cause irreversible vision loss.

How do I know if I need a vitrectomy?

Your consultant ophthalmologist will be able to advise you if you need a vitrectomy, but first you’ll need to have a physical examination and several tests to confirm your diagnosis and ensure that it’s the most suitable treatment for you.

Who is suitable for a vitrectomy?

You may be a good candidate for a vitrectomy if you have:

• retinal detachment
• a vitreous haemorrhage
• a macular hole
• an epiretinal haemorrhage
• signs of diabetic retinopathy
• suffered a severe eye injury that has damaged either the vitreous humour or your retina
• infection of the vitreous humour.

Who is not suitable for a vitrectomy?

You may not be suitable for a vitrectomy if you have:

• an uncontrolled medical condition that could make using anaesthesia too risky
• uncontrolled diabetes as this could affect your ability to heal
• severe glaucoma
• an active eye infection
• general poor health or fitness

You may also not be a good candidate if your consultant feels that the risks of surgery outweigh the benefits, or if you’re unable or unwilling to follow post-operative instructions.

What are the alternatives to vitrectomy surgery?

If you’re not a good candidate for the treatment, or you would prefer to try a less-invasive therapy, there may be some alternatives to vitrectomy surgery. However, it will depend on the specific condition being treated and how severely you are affected.

Some of the options that you may be offered could include:

• scleral buckling to repair a detached retina
• pneumatic retinopexy, also to repair a detached retina
• intravitreal injections for diabetic retinopathy
• gas injections for macular holes.

Your consultant can explain these in more detail.

How does a vitrectomy differ from other vitreoretinal surgery techniques?

A vitrectomy is different from other vitreoretinal surgeries because it is specifically carried out to remove the vitreous humour from your eye. Other vitreoretinal surgeries are then performed to treat the underlying problem, such as retinal detachment.

How can I prepare for a vitrectomy?

Preparing for any surgery is important as it will help ensure that everything goes as smoothly as possible on the day, reduce your risk of complications and optimise the outcome of your treatment.

You’ll be given some specific advice to follow in the days and weeks before your vitrectomy procedure. This may include:

• fasting, as your surgery will be carried out under anaesthetic
• keeping your face and eyes free from cosmetics on the day of your procedure
• stopping smoking, as smoking has been proven to increase complications and delay healing and recovery
• arrange for someone to drive you home from your appointment.

Your consultant will provide you with information about exactly what you should do on the day of your surgery, including what you should bring with you.

What happens during a vitrectomy?

A vitrectomy is a fairly straightforward procedure that’s carried out under anaesthetic. In some cases, this may be a general anaesthetic (which means you’ll be asleep during your surgery), but in most cases you'll receive local anaesthetic, which numbs your eye and the surrounding area. This is often combined with sedation which will help keep you calm and comfortable for the duration of the procedure.

Once your eye is numb, your consultant will make several small incisions into your eye, through which tiny instruments will be placed to perform the surgery. This involves keeping your eye pressurised while sucking out the vitreous gel using a micro-vacuum. This will enable your consultant to see and access the retina to perform any required treatment.

The space previously filled with the vitreous humour is then refilled with either a clear fluid, gas bubble or silicone oil, depending on the type of repair you’ve had carried out. In many cases, the incisions are so tiny that they are left to heal naturally, but if stitches are needed, they will be dissolvable. Your eyes will be dressed, and you’ll be taken into a recovery room and given post-surgery instructions to follow.

How long does a vitrectomy take?

It depends on the complexity of the reason for your surgery, but most vitrectomies can be performed in under two hours.

How long does it take to recover from a vitrectomy?

You should allow between six and eight weeks to recover from vitrectomy surgery. Your recovery can be broken down into stages.

The first 24 hours
You’ll be given a patch to wear over your affected eye to protect it, and you should remove it as advised. It’s normal for your eyes to feel sore, gritty and uncomfortable and you may notice blood-tinged tears. You can take over-the-counter pain medication if you need it.

The first week after vitrectomy
You’ll be given eye drops and should use these exactly as prescribed. You’ll need to avoid driving, bending, heavy lifting, strenuous exercise, swimming and wearing eye makeup. You’ll be shown how to keep your eyes clean and should follow these instructions carefully. If your surgery included a gas bubble being used to replace the vitreous gel, you’ll also be given instructions regarding your posture that will be essential to follow. Your vision may still be blurred and so you’ll need to avoid driving until you can reach the minimum visual standard for driving and get the permission of your consultant.

Weeks two to five
You should be able to return to many of your usual activities, including work if you have a desk job or other physically undemanding role. You shouldn’t need pain medication at this point, and your vision will continue to improve during this time so you may be able to return to driving.

Six weeks after vitrectomy surgery
If you have a more physical job, you should be able to go back to work by this time. You should also be able to get back to more intense exercise. You may still experience some visual disturbances, but your eyesight should continue to improve, stabilising between six and 12 weeks after your vitrectomy surgery.

Do I need to lie face down (posturing) after a vitrectomy?

If the vitreous gel has been replaced with a gas or oil bubble during your surgery, you will need to lie face down immediately after. This is to make sure that the bubble floats into the correct position, to hold your retina in place while it heals.

After the initial recovery period, you’ll need to remain posturing for anywhere from three to 14 days after surgery, depending on your individual circumstances. Typically, this involves lying face down for at least 50 minutes out of every hour. This is obviously a huge commitment, and your surgeon will want to ensure that you understand it is importance and are prepared to strictly adhere to the post-operative posturing programme before you undergo surgery.

If you fail to follow this, your surgery could fail, your retina could become detached again, and you could experience worsening vision and even permanent vision loss.

When can I fly after a vitrectomy?

You’ll be advised not to fly for at least one to four weeks after vitrectomy surgery, depending on the specific details of your procedure. Always get the permission of your consultant before scheduling to fly.

When can I swim after a vitrectomy?

Similarly, you’ll also be advised not to swim for at least four to eight weeks after vitrectomy surgery. This is to give your eyes time to heal and reduce the risk of infection.

What are the risks and complications of a vitrectomy?

Despite vitrectomy being considered a safe and effective surgery, as with any medical procedure, there are some risks and complications that you should be aware of. Your consultant will go through these with you, but they could include:

• formation of cataracts: vitrectomy surgery is associated with accelerated development of cataracts
• increased intraocular pressure
• risk of infection
• failure to improve vision
• inflammation inside the eye/uveitis.

Your consultant will take the time to explain all potential risks and complications to you ahead of your surgery, and answer any questions that you may have.

What are the signs of infection or raised pressure after a vitrectomy?

Symptoms of an infection after vitrectomy surgery include:

• severe or worsening eye pain
• sudden loss of vision
• thick yellow or green discharge from your eye
• fever
• swelling of your eyelid that is getting worse
• sensitivity to light.

Symptoms of raised intraocular pressure after a vitrectomy include:

• severe headaches
• nausea and vomiting
• seeing halos or rainbow-style rings around lights
• hazy vision
• a dark/blind spot in your vision

If you notice any of these symptoms, get in touch with your medical team straight away.

What are the signs of retinal detachment after a vitrectomy?

Symptoms of a retinal detachment following vitrectomy surgery include:

• bright flashing lights in your vision
• sudden appearance of a large number of visual floaters
• a dark shadow spreading over your field of vision

Retinal detachment is classed as a medical emergency, so if you experience any of these symptoms, contact your medical team immediately. If they are unavailable, go straight to your nearest emergency department.

What is the success rate of vitrectomy surgery?

Vitrectomy surgery has a very high success rate, with studies suggesting figures of around 94.9%.

How much does vitrectomy surgery cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.