Removal of vitreous fluid from
the eye is called vitrectomy. It is done to treat several conditions such as
retinal detachment, vitreous hemorrhage, endophthalmitis, macula hole, and intraocular
foreign body. The decision to perform vitrectomy is decided by an
ophthalmologist after considering the symptoms, examination findings and
investigation findings. The patient is counseled regarding the importance of
performing the surgery. The doctor will also briefly explain the procedure and
risks of the surgery. It is important to relieve anxiety.
Surgical Procedure
Briefly, the surgery involves
cutting the vitreous gel, sucking it out and repairing the retina. At the end,
a silicon oil or gas is injected to replace the vitreous gel. This might look
very simple. But, it is not. Eye is a small and very sensitive organ. All
measures should be taken to minimize damage to other parts of the eye. If the
lens of the eye gets damaged during the procedure, cataract can develop.
Therefore, performing vitrectomy requires good surgical skills and
patience.
The surgery is started by anesthetizing
and positioning the patient. Propofol is given to sedate the patient. Then the
patient is anesthetized by retrobulbar block . Therefore, the patient is
conscious throughout the surgery. General anesthesia is used for children
because they might not corporate during the surgery. The surgical area is
cleaned thoroughly with 5% solution of povidone iodine. Then an eyelid speculum
is placed to gain access to the eye. After these initial steps, vitrectomy is
performed by creating sclerotomies. The sclera is incised and the instruments are
inserted in to the eye. Some of these instruments illuminate the eye while some
maintain the shape of the eye. The system used to perform vitrectomy could be
either 20 gauge, 23 gauge or 25 gauge. The
procedure differs according to the system used. During the procedure, all the
precautions are taken to prevent incarceration. After removing the vitreous the
surgeon will take additional measures to treat the disease. These steps vary
according to the type of the disease. Posterior vitreous detachments, removal
of posterior hyaloids, shaving of the vitrous base are examples of such
additional steps. Finally, the sclerotomies are closed by suturing. Measures
are taken to make the closure water tight.
Recovery
Recovery is fast because it is
done under local anesthesia. Some patients can develop post operative
discomfort of the eye. The patient should be reassured because it is normal.
Initially, the patient may not be able to see clearly. But, the vision will
improve slowly and steadily over several months. After recovery, the commonest
complications that the patient can develop are bleeding, infection and retinal
detachment. So, the patient is monitored to detect these complications. Topical
or subconjunctival antibiotics are given immediately after the surgery to
prevent infections.
On Discharge
The patient is discharged with instructions.
The patient is advised to avoid exercises, watching television and reading. He
should rest as much as possible. Every movement should be done slowly and
steadily. Patient should restrain from
straining because it can increase intraocular pressure. He is advised to apply
topical antibiotics for one week. Following these instructions is very
important for fast recovery.
Post Operative Follow Up
The patient is followed up at the
ophthalmology clinic. During the clinic visits the eye is examined for improvement.
The ophthalmologist will also look for complications of the surgery such as
cataract. Cataract is a common complication of vitrectomy surgery. The patient
might have to undergo another surgery if cataract develops.
Vitrectomy surgery is a common
surgery performed by ophthalmologist everyday. The techniques and instruments
used for the surgery are also advancing with time. Therefore, the outcome of
the surgery is also improving.
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