Other than cataract surgery, retinal surgery is another type of eye surgery that takes place relatively common and is rather critical for our vision.
Why? Mainly because the retina houses all of our photoreceptors – vital cells that are responsible for our sight. Naturally, it seems important enough for us to know more about retinal surgery, especially if our relatives or ourselves would need it someday.
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When would we need a vitrectomy or retinal surgery?
Retinal specialists perform a vitrectomy when there are problems with our vitreous (the jelly-like substance within our eyeball) or our retina. Typically, the vitreous and retina are very inter-related, and they tend to affect each other closely. Examples of various vitreoretinal conditions requiring surgery may broadly include:
- Vitreous bleeding
- Vitreous degeneration/detachment that causes retinal problems
- Retinal bleeding
- Retinal tears or detachment
- Specific retinal diseases for example diabetic retinopathy
- Macular degeneration such as age-related macular degeneration (AMD), epiretinal membrane, macular hole, myopic macular degeneration
Very often, retinal bleeding will lead to vitreous bleeding. And vitreous detachment can lead to retinal detachment. Hence, problems with the vitreous/retina are often taken care of together with a vitrectomy/retinal surgery.
The term vitrectomy simply means removal of the vitreous jelly. This is critical because a lot of the time, degenerating vitreous pulls on the retina, causes retinal traction, and lead to multiple retinal problems. Removal of vitreous is a key step in treating retinal conditions.
How is vitrectomy performed?
No, we do not remove your eyeball to perform retinal surgery. The procedure is done under full sedation, which means patients are usually very comfortable.
3 small microincisions are made (each only 0.5mm in size) at the white part of the eye called sclera. Very much like key-hole surgery, each of the incisions holds a port, which in turn holds an instrument:
- Infusion which fills the eyeball with fluid
- Light pipe which illuminates the inside of the eye
- Vitrector which is responsible for cutting and removing the vitreous jelly
During the vitrectomy, many things can take place:
- We can remove all blood or abnormal tissue in the vitreous or retina
- We can fix retina detachments
- We can seal retina tears with endolaser
- We can dissolve blood clots
- We can stop blood vessel bleeding by cauterising
And that’s just to name a few. Essentially, retinal surgeons can choose to perform a whole array of procedures during a vitrectomy, depending on what is needed for each patient. That is why a vitrectomy is so complex and very customised to each patient. In my opinion, no two patients would receive the same surgery and no two surgeons would perform the surgery in exactly the same way.
What is the recovery like after vitrectomy?
After a vitrectomy surgery, it is normal for the eye to have slight swelling and redness, which lasts transiently for 1 week.
Sometimes, it is necessary for certain patients to assume a certain posture after vitrectomy. This is especially so for the patients with macular hole and gas bubble placed in the eye to facilitate macular hole closure. These patients would have to posture face down for about 3 days to 1 week, depending on the size of the hole.
After any eye surgery, patients will have to use antibiotic and anti-inflammatory eyedrops that are gradually tapered down each week.
Complete recovery after vitrectomy takes 1 month; however, patients can start to feel almost back to normal by 1-2 weeks.
Can I travel after vitrectomy?
This depends on whether any gas was placed into the eye during vitrectomy. If any form of gas was used, it is generally not advisable to travel by air until the gas has completed dissipated or disappeared. The gas takes approximately 1 week to 1 month to disappear completely. Patients are free to travel by land (eg. car, bus, train, boat etc) regardless of whether there is air in the eye.
If patients are in a great need to travel by air soon after surgery, silicone oil can be used in place of the gas. A person with silicone oil is safe to travel by air. However, having silicone oil in the eye poses its own set of issues, so this option should be discussed in detail with the eye surgeon prior to surgery.
What are the risks of vitrectomy?
As with any eye surgery, the risks of surgery are very low and includes mainly bleeding, infection, and retinal detachment. With the advent of micro-incisional vitrectomy, operative risks have been further lowered to make standard vitrectomy under the right hands fairly straightforward.
If you have a vitreoretinal condition that requires a vitrectomy, do have a detailed discussion with your retinal specialist to fully understand what you will be going through before surgery. In some cases, your surgeon will be able to address your cataract issue at the setting as your retinal issue in a combined cataract and vitrectomy surgery. Ask your doctor for more details.
References:
- Shaheeda Mohamed et al. Review of Small Gauge Vitrectomy: Progress and Innovations. J Ophthalmol. 2017; 2017: 6285869.
- Khan MA et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016 Jan;161:36-43.e1-2.
- Khan MA et al. Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease. Ophthalmology. 2018 Mar;125(3):423-431.
- Omari A, Mahmoud TH. Vitrectomy.Treasure Island (FL): StatPearls Publishing; 2019 Jan-2019 Nov 23.
- Sizmaz S et al. Outcome and Complications of Combined Phacoemulsification and 23-Gauge Pars Plana Vitrectomy. J Ophthalmol. 2019 Mar 17;2019:7918237.