Vitrectomy surgery

Vitrectomy surgery may be performed for multiple conditions including:

• Vitreous haemorrhage
• Vitreous dense floaters or inflammatory membranes
• Retinal detachment
• Diabetic tractional retinal detachment
• Proliferative vitreoretinopathy (PVR); scarring of the retina
• Macular hole
• Vitreomacular traction
• Epiretinal membrane
• Giant retinal tears
• Complicated cataract surgery
• Malignant glaucoma
• Trauma
• Eye infection (endophthalmitis)

• Food: We advise that you fast for 6 hours before surgery.
• Medicine: Regardless of the timing of surgery please be sure you take all your medications in the morning as usual. The exception would if you are on anticoagulant or diabetic medication, please read the following paragraphs.
• Diabetic patients:
  • Tablets: If you usually take tablets for diabetes in the morning, do not take them on the morning of surgery, but bring them with you to the hospital.
  • Insulin: If your surgery is planned for the morning, please take only a third of your usual dose of insulin and do not have breakfast. Take your other medications with a sip of water in the morning as usual. It is advised that you check your blood glucose level and take sweets such as sugar if you are hypo (low glucose level below 5).
    If your surgery is planned in the afternoon, have breakfast as normal then fast for 6 hours before admission. Take a third of your normal morning insulin dose.
• Anticoagulants
  • Aspirin; you can continue taking the Aspirin as usual.
  • Warfarin; if you are on Warfarin, we advise that you consult with your blood lab to adjust your INR to be below 3.0. Please do a blood test on the Friday before surgery and fax the results to the day surgery.
  • Plavix (Iscover), Xarelto; It is preferable if you can stop these tablets for a week before surgery. You need to get permission to stop from your family doctor or treating heart specialist.
• Smoking: Please stop smoking because the longer you stop smoking prior to surgery, the greater the benefit. Please inform your anaesthetist if you have frequent coughing, emphysema or chronic bronchitis.

Vitrectomy surgery is usually performed in a day surgery centre under local anaesthetic. Some patients may require general anaesthesia. You will be discharged on the same day after an hour or so from the operation. If you live alone or came from a long distance you may elect to spend a night at the hospital.

Before surgery you will receive multiple eye drops to dilate your pupil. Our anaesthetist will give you some sedative medications in the vein to calm you and make you sleepy. We cover the other eye so you will not see us but you may hear our conversation.

The procedure is performed under an operating microscope and with special lenses to allow us to see the inside of the eye. After sterilising the eye, a speculum is used to keep the eye open. Three tiny self-sealing (no-stitch) incisions are made in the white of the eye (sclera) a few millimetres behind the cornea. An infusion line is used to maintain the eye pressure during surgery. A tiny light pipe is inserted to illuminate the inside of the eye. A special instrument called a vitrectomy probe is used to cut the vitreous and delicately remove it. Other instruments may be used depending on the case.

At the conclusion of surgery, the eye may be filled with saline, air, gas bubble or silicone oil depending on the indication for surgery. If gas is used, you cannot fly until it disappears. Silicone oil will need to be surgically removed a few weeks after surgery. Eventually the eye is filled with aqueous fluid which is the clear nourishing fluid usually present in the front of the eye.

Because vitrectomy is performed for many different problems, the recovery period varies with the individual. If the eye is filled with gas, the vision is very poor. You can sometimes see better, though, while looking straight downward and holding an object just a couple of inches from the eye. As the gas bubble becomes smaller, you will see it shrinking towards the bottom of the field of vision. It may cause glare and double vision, especially when it is about halfway reabsorbed. When the bubble becomes rather small, it tends to break up into a few smaller bubbles before disappearing altogether.

Cataract development after vitrectomy is quite common. It occurs more commonly in older patients. Best visual outcome therefore is achieved after cataract surgery is performed months after vitrectomy surgery.

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

1. You will be using drops after surgery for three to four weeks
2. Avoid lifting heavy objects or any strenuous activity for at least a week (unless otherwise directed by your doctor).
3. Certain precautions should be observed when there is a gas bubble in the eye. First of all, you must maintain the head position recommended. In most cases, this means looking straight downward, or lying on one side. You should avoid lying on your back for any significant period of time. Finally, patients must avoid flying with an air or gas bubble in the eye. The reduced atmospheric pressure causes the gas bubble to expand, which can raise the pressure in the eye to dangerous levels. We will tell you when it is safe to fly.

Silicone oil is a clear, viscous fluid which is used in some patients instead of a gas bubble. It has some advantages over long-acting gas: quicker visual recovery, no restriction on air travel, less need for head positioning after surgery, and longer duration of effect. Unlike gas, however, silicone oil is not removed from the eye by your body; it must be removed in a second surgery, which is usually very similar to the initial vitrectomy. Certain complications are also more frequently associated with the use of silicone oil.

Vitrectomies have been commonly performed and perfected for over 30 years. Latest advances in instrumentation, technique and understanding of various diseases have made the operation safer and more comfortable.

Severe complications are rare and anatomic success for many conditions is over 90%. However, certain risks do still exist although at a much lower percentage. These may include: retinal detachment, glaucoma, bleeding, swelling of the macula, swelling of the deeper choroid layer, epiretinal membrane formation and infection. Cataract development after vitrectomy is quite common in older patients and is not considered as a complication. The risk of blindness from vitrectomy surgery is very rare.