What is Vitreoretinal Surgery?
Vitreoretinal surgery refers to a group of procedures performed deep inside the eye where the retina (light-sensitive membrane) and vitreous (gel-like substance) are located using microscopic surgical instruments or lasers to treat problems involving the vitreous field and the retina.
Vitrectomy is one of the more common vitreoretinal procedures employed for the treatment of vitreoretinal conditions in order to restore, preserve, and enhance vision.
Indications for Vitreoretinal Surgery
Vitreoretinal surgery is indicated for the treatment of various vitreous and retinal disorders, such as:
- Macular hole
- Epiretinal membrane
- Floaters
- Vitreomacular traction
- Diabetic retinopathy
- Proliferative vitreoretinopathy
- Endophthalmitis
- Retinal detachment
- Diabetic vitreous haemorrhage
- CMV retinitis
- Perforating and penetrating injuries of the eye
Preparation for Vitreoretinal Surgery
In general, the preparation for vitreoretinal surgery involves the following:
- A complete eye exam is performed to evaluate the overall health of your eyes.
- Do not apply eye makeup for at least 2 days prior to surgery.
- Refrain from using contact lenses at least 2 days prior to surgery.
- A general health assessment is done to look for any active health conditions.
- A review of all the medications and supplements you may be taking is conducted. You may need to refrain from taking some medications a few days prior to surgery.
- Do not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for a friend or family member to drive you home after surgery.
- A written consent is obtained after the surgical process has been explained in detail.
Procedure for Vitreoretinal Surgery
Vitrectomy procedure is performed by surgeons to treat various vitreoretinal disorders by enabling surgeons to access the back of the eye to repair any vitreoretinal abnormalities. In general, the procedure involves:
- The eye is numbed with ophthalmic anaesthetics and dilated.
- Antiseptic solution is used to cleanse the eye, and a sterile covering is used to drape the eye.
- An eye speculum is used to keep the eyelids apart to enable surgery.
- Your surgeon will make a tiny surgical cut in the outermost membrane of the eye.
- The eye is then accessed through the pars plana, the white part of the eye.
- Forceps are used to open the surgical cut.
- A fibreoptic light and a microscope are used to visualise the eye clearly.
- Your surgeon then employs a vitrectomy probe or vitrector to incise the vitreous gel and a suction device to drain the broken down fluid.
- Based on the specific condition, your surgeon will then:
- Microscopic scissors, cutters, or forceps to remove scar tissue from the retina
- Use a silicone-coated needle tip to drain cloudy, bloody, or infected fluid
- Probe with a laser to treat abnormal clots, blood vessels, and to seal retinal injuries
- Your surgeon then fills the eye with a vitreous alternative, such as a saline solution or a bubble of self dissolving gas.
- An antibiotic ointment is applied to the eye to avert infection, and the eye is covered to complete the operation.
Postoperative Care and Recovery
Postoperative care and instructions will include the following:
- You should wear an eye shield for several nights to protect your eyes from rubbing.
- Anti-inflammatory and antibiotic eye drops are prescribed to minimise the risk of infection, dry eye, or inflammation.
- You must avoid dusty environments or wearing eye makeup for at least a week.
- Contact sports, bathtubs, and swimming should be avoided for at least a week.
- Do not drive until cleared by your ophthalmologist.
- Avoid strenuous activities and heavy lifting for a week to prevent stress on the eye as it heals.
- Call your doctor immediately if you experience pain, discharge, or redness in the eye or any other problems.
- The full recovery process may take anywhere between 4 to 6 weeks.
- Strictly adhere to the scheduled follow-up appointments to monitor your progress.
Risks and Complications
Vitreoretinal surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as:
- Elevated intraocular pressure
- Corneal oedema
- Continued bleeding into the vitreous
- Eye infection
- Retinal detachment
