Vitreoretinal Surgery

Vitreoretinal surgery includes a set of procedures performed inside the eye using lasers or conventional surgical instruments to operate on the retina, the light-sensitive part of the eye, and the jelly-like vitreous surrounding it. 

These procedures can preserve, enhance or even restore deteriorated vision in many eye conditions. For example, a vitrectomy can be used to treat various problems affecting the retina and vitreous such as replacing the naturally-occurring vitreous if it becomes damaged and cloudy, impairing vision. A vitrectomy can also be performed to treat small tears in the retina or retinal detachment. By removing the vitreous, the ophthalmologist can access the retina more easily to repair it while relieving any excess pressure on it.

A vitrectomy may be needed if you have one of the following eye problems:

• Diabetic retinopathy
• Retinal tears
• Retinal detachment
• Vitreous haemorrhage
• Eye infections
• Severe eye injury
• Complications after eye surgery

Retinal tears

A retinal tear or hole can lead to detachment and vitreoretinal surgery may be suggested to prevent this outcome and preserve vision. The ophthalmologist uses laser surgery (photocoagulation) involving a laser beam that is directed through the pupil to burn around the retinal tear, creating tiny scars that re-attach the retina to the underlying tissue.

Retinal detachment

Retinal detachment is an emergency condition in which the retina separates from its normal position at the back of the eye, reducing its ability to receive oxygen and nourishment from the surrounding blood vessels. 

If not treated urgently, retinal detachment may lead to permanent vision loss in the affected eye. Even though retinal detachment is itself painless, some symptoms of this condition may include:

• Appearance of floaters — tiny specks drifting in your field of vision
• Sudden flashes of light (photopsia)
• Blurred vision
• Reduced peripheral vision

Before surgery

The ophthalmologist will tell you what you need to do to prepare for vitrectomy surgery. This includes stopping any medicines before the procedure and not eating anything after the midnight in the case of general anaesthetic. 

Before the operation, the ophthalmologist will perform an eye exam during which special drops may be used that will dilate your eye to make it easier to view the retina.

During surgery

In general, patients will be awake during vitrectomy surgery and will be given medicine to help them relax. Anaesthetic eye drops or injections are used to ensure you won’t feel anything during the procedure. In other cases, you may receive a general anaesthetic to put you completely to sleep.

The ophthalmologist will first expose your eye and make an incision in the outer layer. This is followed by a small cut in the sclera—the white part of the eye—to gain access to the gel-like vitreous body, which is suctioned out to reveal the retina. A liquid or gas bubble is used to flatten the retina and fix it in place, the surgeon will then do any repairs needed to fix or re-attach the retina. 

When the operation is completed, the vitreous is replaced with another fluid, usually silicone oil or saline solution, and stitches may be used to close surgical incisions but this is often not necessary. Eye drops with antibiotics are used to help prevent infection and your eye may be covered with a patch.

After surgery

In most cases, patients will be able to return home on the same day as the procedure. It is advisable to arrange with someone to drive you back home after the surgery. 

The ophthalmologist may prescribe you eye drops and antibiotics to prevent infection. If your eye feels sore, you may be given pain-killers as well. Patients may have to wear an eye patch for a day or two after surgery to assist recovery.

Your eye doctor will set a follow-up appointment to see whether the procedure was effective and monitor recovery. Make sure to inform your doctor if you notice decreasing vision, increasing pain or swelling.