From the Guidelines
Vitrectomy is a surgical procedure used to treat several eye conditions, including diabetic retinopathy with vitreous hemorrhage, retinal detachment, macular hole, epiretinal membrane, endophthalmitis, and certain cases of eye trauma with foreign bodies or severe injury. The procedure involves removing the vitreous gel from the eye and replacing it with a saline solution, gas bubble, or silicone oil depending on the specific condition being treated 1. Patients undergoing vitrectomy typically receive local or general anesthesia, and the surgery takes 1-3 hours depending on complexity. Recovery involves specific positioning (particularly face-down positioning for macular holes), activity restrictions, and use of prescribed eye drops (typically antibiotic and anti-inflammatory medications) for several weeks.
Some of the key indications for vitrectomy include:
- Nonclearing vitreous hemorrhage
- Tractional retinal detachment threatening the macula
- Combined rhegmatogenous and tractional retinal detachment
- Dense pre-macular subhyaloid hemorrhage 1
- Epiretinal membrane and vitreomacular traction, especially in patients with significant symptoms and decreased visual acuity 1
- Macular hole, particularly in cases where the hole is large or has caused significant visual impairment 1
Vitrectomy works by clearing cloudy vitreous, removing scar tissue that pulls on the retina, repairing retinal tears or detachments, and providing better access to treat retinal diseases. While generally successful, potential complications include cataract formation, retinal detachment, infection, and increased intraocular pressure, making it important for patients to follow post-operative instructions carefully and attend all follow-up appointments 1. The decision to perform vitrectomy should be based on the severity of the patient's symptoms and the potential benefits and risks of the procedure.
From the Research
Conditions Treated by Vitrectomy
Vitrectomy is a surgical procedure that involves the removal of the vitreous gel from the eye. It is used to treat various conditions, including:
- Macular pucker and vitreomacular traction syndrome, as vitrectomy is generally agreed to be the most appropriate treatment for these clinical situations 2
- Idiopathic epimacular membrane, vitreomacular traction syndrome, and macular hole, which are all characterized by a pathological vitreomacular adhesion 3
- Rhegmatogenous retinal detachment, where vitrectomy is used to eliminate dynamic traction on the retina 4
- Penetrating trauma, hemorrhage, retinal detachment, intra-ocular foreign bodies, and infection endophthalmitis, which are all indications for vitreous surgery in the posterior segment 5
- Macula-off rhegmatogenous retinal detachment, where primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases with poor preoperative vision, ocular hypotony, and prolonged macular detachment 6
Specific Conditions and Vitrectomy
Some specific conditions that may be treated with vitrectomy include:
- Idiopathic macular holes
- Retinal detachment associated with optic pit
- Evacuation of submacular hemorrhage
- Excision of choroidal neovascular membranes
- Proliferative diabetic retinopathy
- Macular hole surgery
- Submacular surgery
These conditions often involve abnormalities in the vitreous gel or the retina, and vitrectomy may be used to repair or remove damaged tissue and restore vision. 2, 3, 4, 5, 6