Vitrectomy

Vitrectomy is a group of ophthalmological procedures regarding deep structures of the eye i.e. located behind the lens. Vitrectomy literally means excision of the vitreous humour, but it is primarily used in the treatment of numerous diseases of the retina, a delicate tissue responsible for vision. This surgery is used in the treatment of e.g. retinal detachment, advanced diabetic retinopathy, intraocular haemorrhage of various origin, macular diseases – epimacular membranes, macular holes. Vitrectomy is a vision and eye-saving procedure in the case of severe endophthalmitis and serious eye injuries. In such cases, the surgery should be performed as soon as possible, since the time that elapsed since the beginning of infection or injury to the implementation of treatment decides of its success.

It is a combined procedure, including not only vitrectomy, but also removal of the patient’s own lens. The lens is removed with the method of phacoemulsification (see FAQ – cataract). This stage of the procedure precedes the vitrectomy as such. The combined surgery is performed usually when the patient’s own lens is opacified (cataract) and makes it difficult to visualise the posterior eye segment structures.

Vitrectomy, i.e. excision of the vitreous humour: and removal of abnormalities from the retinal surface (membranes, tractions, blood, etc.) is performed with the use of a pneumatic knife (vitrectom) combined with a specialist device used to perform microincisions. In this type of surgery, we also use an ophthalmological laser, but as an accessory device for the treatment of retina only, e.g. in diabetic retinopathy or to strengthen the retina after its attachment – laser treatment of peripheral retinal tears or degenerative areas.

Duration of the procedure depends on the type of medical problem that is dealt with. In the event of removal or epimacular membrane or closure of the macular hole, the time usually does not exceed 1 hour. However, if we deal with retinal detachment or proliferative diabetic retinopathy, the time of the surgery may be longer

Most vitrectomy/phakovitrectomy surgeries do not require general anaesthesia. We usually use regional anaesthesia: we administer an anaesthetic agent around the operated eye, and additionally intravenous sedative and analgesic agents. Sometimes, especially if we deal with a complex situation in the eye itself (e.g. post-traumatic lesions, tractional retinal detachment), or we expect a non-cooperative patient (children, persons with intellectual disability, diseases with head or whole body twitching), we use general anaesthesia.

The procedure is not painful. The surgery is performed under local anaesthesia with additional support of an anaesthesiologist who administers sedative, and, as prophylaxis, analgesic agents. Before the procedure, we give an injection into the eye area with a mixture of topical anaesthetic agents, in order to eliminate pain sensation at the surgical site. When the injection is administered, the patient may have a pricking sensation and slight spreading force around the eye, but then, during the whole procedure and up to 3 hours after that, sensation is eliminated.

Every surgical intervention is associated with a potential risk of both intra- and postoperative complications. Such complications, fortunately, are very rare in ophthalmological surgery, and, if early diagnosed, may be effectively treated.

They are usually mild and transient – conjunctival edema, subconjunctival haemorrhage, slight bleeding into the eye interior, retinal edema after macular peeling, corneal edema after phacovitrectomy. All of them regress spontaneously. Serious complications after the surgery are very rare, but they may be effectively treated. These include: retinal detachment, haemorrhage into the eye interior, infective endophthalmitis. All require urgent reoperation; therefore, the information card contains the following warning: In the event of sudden pain or loss of vision, you must immediately contact the Centre.

We usually request the patient to restrict his/her usual activity up to a month after the procedure. This primarily refers to excessive muscular exercise (lifting heavy objects, doing competitive sport, physical work, especially in dusting conditions – construction, car workshops). In patients to whose eye gas was introduced, it is important to keep the head in a determined position (most frequently, face down) for a few days, which additionally limits their normal activity. Moreover, the gas left in the eye initially obstructs vision, which excludes driving a car or watching TV. In addition, after gas administration, the patient is requested not to fly planes or go to high mountains for about a month, since at larger heights, gas may excessively expand and cause painful increase of ocular pressure.

The optimal time of the surgery depends on what kind of disease is treated. In the case of retinal detachment, especially when the macula is attached, the surgery must be performed as emergency. Similarly, in a post-traumatic eye or in the event of infection. Macular diseases – epimacular membranes, edema with traction or macular hole do not require immediate surgery. However, protracting the procedure for too long may limit the effect of the surgery, despite its correct performance. If the ocular pathology lasts for too long, a significant and permanent limitation of the retinal function may develop, even if the pathology is finally removed.

The surgery is performed as a one-day procedure. After the surgery, the patient is under the care of the medical facility personnel. The duration of the patient’s stay depends on his/her general feeling. After he/she receives a hospital discharge summary, the patient may leave the hospital.