Vitrectomy is an intraocular surgery in which the vitreous is removed. It is performed either because it is opacified (e.g. due to hemorrhage), or to take samples of it for analysis (e.g. in case of infection, inflammation or intraocular tumors), or to allow access to the retina for surgical intervention.
It is usually performed by entering the eye through three small ways. Through one of them, the instrument that allows us to remove the vitreous, known as vitreotome or vitrectome, is introduced; through another, a light probe to visualize the inside of the eye; and through the third, a continuous infusion of serum.
Applications of vitrectomy
Vitrectomy is applied in a wide variety of pathologies; the most frequent are:
- The presence of blood inside the eye, frequent in diabetics and other vascular pathologies, in trauma or retinal tears.
- Retinal detachments. In this case it is usually associated with intraocular injection of some type of gas or silicone oil.
- Treatment of some macular pathologies, such as epimacular membranes, macular holes or tractions on the macula.
- Intraocular infections, to remove the vitreous, to culture it and to facilitate the diffusion of antibiotics inside the eye.
- In case of cataract surgery complications, such as dislocation of the cataract or intraocular lens inside the eye.
- To treat some retinal vascular anomalies.
- To remove vitreous opacities that may seriously impair vision.
- To take vitreous or retinal samples in case of intraocular tumors.
Risks of vitrectomy
There are certain risks, common to all eye surgeries, which, if they occur, can be very serious. For example, intraocular infections, very serious and difficult to control intraocular hemorrhages, important increases or decreases in intraocular pressure, etc… Although these complications are very infrequent.
Among the most frequent complications is the subsequent formation of a cataract, especially in people over 50 years of age. So much so, that in these patients, ophthalmologists warn beforehand that even if the surgery is satisfactory, it is frequent that in a few months or a year the cataract will have to be operated on.
Another complication that may appear is retinal detachment in the postoperative period. However, this complication is becoming less frequent as the surgical technique has improved in recent times; the incisions through which we enter the eye are becoming smaller and the surgery time has shortened significantly compared to a few years ago.
In general, we achieve a satisfactory surgical result without complications in 90-95% of the cases.
Recovery after vitrectomy
Since vitrectomy is used in very diverse pathologies, the time to recover vision and the amount of vision that is recovered is very variable depending on the original cause that forces the vitrectomy.
Generally speaking, and if we forget about very serious and rare pathologies (such as intraocular infections or intraocular tumors, in which vision can be seriously affected), we could say that when we treat pathologies of the macula vision usually recovers quickly, and when we treat retinal detachments it depends on the type of gas or silicone oil we use. We use a type of intraocular gas that takes 3 to 4 weeks to disappear, another type of gas that usually disappears between six and eight weeks and, finally, if we use silicone oil, we would have to think about intervening again to remove it from the eye a few months after the first operation.
Vitrectomy, one and no more?
Vitrectomy can be performed several times on the same eye. Ideally, however, a single operation should solve the patient’s pathology.
In general, the more times the same eye is operated on, the worse the surgical success and final visual prognosis is likely to be.