What Is Retina Surgery (Vitrectomy)?
Vitrectomy surgery is performed to repair many diseases that affect the back of the eye including the retina, vitreous and macula. This procedure requires the removal of the liquid gel, located in the back of the eye, called the vitreous.
The lack of vitreous gel does not affect the functioning of the eye. Instruments are placed in three tiny incisions near the front of the eye. The first incision is used to introduce a fiberoptic light to illuminate the inside of the eye. The second incision is used to remove the vitreous gel with a miniature handheld cutting device. The third incision is used to infuse a saline solution into the eye as the vitreous gel is removed. The body replaces the saline with its own fluid within a few days.
In some cases, a gas or silicone oil bubble is placed in the eye. The gas bubble is gradually absorbed and is replaced by the eye’s own fluid. This gas may stay in the eye for up to eight weeks. While the bubble is present, patients are not permitted to travel by air or go to high altitudes, as changes in air pressure may cause the bubble to expand, increasing pressure inside the eye.
Conversely, when Silicone Oil is used, the eye is unable to absorb it on its own. It has to be removed from the eye after several months, with a second operation. Your surgeon will discuss with you whether silicone oil or a gas bubble is most suitable. If either substance is placed in the eye, you will most likely be required to lay face down (prone) for several days. This insures that the gas or oil is able to float upwards, toward the back of the eye, for proper healing of the retina. Our physicians use the latest technologies. In fact, they helped pioneer some of the most advanced surgical techniques, including 23 and 25 gauge suture instruments, which allow smaller incisions and faster vision rehabilitation.
The procedure is performed in an operating room, under local or, in rare cases, general anesthesia. The anesthesiologist will administer medication through an IV, which will make you feel relaxed and sleepy. The Anesthesiologist will regulate the anesthesia levels, throughout the procedure, to keep you comfortable until your retina surgery is complete.
What Are The Risks Of Surgery?
The most common risk following Retina surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment. Either can occur during surgery or afterward, but both can be treated immediately.
Special Techniques During Vitrectomy Surgery
Vitrectomy surgery involves many steps when used to repair complex conditions – conditions, which can cause blindness and vision loss in our patients. Here are some of the special techniques used to achieve the best outcome:
Membrane peeling: This step involves the removal of fine membranes from the retinal surface, using micro forceps. A special diamond-dusted silicone scraper may also be used in select patients. Membrane peeling is commonly used in the repair of macular puckers, macular holes, retinal detachments, and diabetic retinopathy.
Endophotocoagulation: This is the application of laser inside the eye at the time of vitrectomy. Endo laser may be used to treat an unhealthy retina, affected by diabetic retinopathy. More specifically, it can treat a thinning retina, retinal holes and retina tears or set (mend) a retinal detachment. Endo-laser is often used to treat leaking blood vessels inside the eye, a secondary affect of vein occlusions and other retinal disorders.
Intraocular Gases: “The Bubble on the Trouble”: In some vitrectomy procedures a gas bubble must be placed inside the eye as part of the procedure. This involves exchanging the fluid inside the eye for air or a mixture of air with gas – termed “air-fluid exchange”. This maneuver introduces a gas bubble, which can hold the retina in place as it heals. This is commonly required in the repair of a macular hole or retinal detachment. When a gas bubble is in the eye, the patient must position their body to keep the “bubble on the trouble.” In the case of a macular hole, for example, honoring the rule requires face down positioning for a period of time, ranging from several days to 2 weeks. The length of time is dependent on the nature of the hole. When a gas bubble is in the eye, vision can be blurry for as long as a month, depending on the type of gas used and the speed of absorption. (See above for high altitude warnings).
Silicone Oil: An alternative to gas is silicone oil, which is also used to keep the retina in place. Silicone oil is used in more complex cases, such as trauma and retina detachment repair, when there is scar tissue (proliferative vitreo-retinopathy). In rare cases, it is used in macular hole patients whose first surgery failed or who are unable to position themselves facedown. It may also be used when more rapid vision rehabilitation is required (eg, one eyed or “monocular” patients) or when patients must travel to high altitude – something prohibited when a gas bubble in place. Silicone oil may need to be removed at a later date and this is a potential disadvantage when managing uncomplicated cases.
Scleral Buckling: A scleral buckle is either a piece of silicone sponge, rubber, or semi-hard plastic. The retina specialist will sew this material onto the white part of the eye, called the sclera. The buckling element is usually left in place permanently.
Lensectomy: This refers to the removal of the eye’s crystalline lens, during a vitrectomy procedure. This is sometimes performed when there is a cataract, as a cataract prevents the surgeon from adequately visualizing the internal structures. A lensectomy may also be necessary to gain access to and remove scar tissue, during complicated retinal detachment or diabetic retinopathy procedures.