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is a microsurgical procedure in which specialized instruments and techniques are
used to repair retinal disorders, many of which were previously considered
inoperable. The initial step in this procedure is usually the removal of the
vitreous gel through very small (1.4mm) incisions in the eye wall, hence the
name "vitrectomy". The vitreous is removed with a miniature handheld
cutting device and replaced with a special saline solution similar to the liquid
being removed from the eye. A high intensity fiber optic light source is used to
illuminate the inside of the eye while the surgeon works. The surgeon uses a
specialized operating microscope and contact lenses, which allow a clear view of
the vitreous cavity and retina at various magnifications. The procedure is
performed in an operating room under local or (occasionally) general anesthesia.
It can often be done as an ambulatory procedure.
Although vitrectomy procedures are sometimes
performed through incisions made near the front of the eye, most vitreoretinal
surgeons enter the globe through a part of the eye known as the pars plana. This
is why the procedure is often referred to as a trans pars plana vitrectomy
(TPPV). Entering the eye through this location avoids damage to the retina
and the crystalline lens, see figure below.
entering the eye through sclera and the Vitreous gel is being removed.
Trans pars plana vitrectomy (TPPV) is used to treat many
different retinal disorders including those listed below (more information on
some of these topics can be found elsewhere in our patient information section):
During vitrectomy surgery, the retinal surgeon
may use a variety of special techniques to achieve the desired results,
- Intraocular gases (usually either
perfluropropane (C3F8) or sulfur hexafluoride (SF6))
when mixed with sterile air have the property of remaining in the eye for
extended periods of time (up to two months). They are eventually
replaced by the eyes own natural fluid. Gas is useful for flattening a
detached retina and keeping it attached while healing occurs. Gas injection
is also used to close macular holes. It is frequently necessary to
maintain a certain head position following surgery when gas is used (see Macular
Hole page). Vision in a gas filled eye is usually rather poor until at
least 50% of the gas is absorbed. Possible complications of intraocular gas
include progression of cataracts and elevated eye pressure (glaucoma). It is
unsafe to fly in a plane while gas remains in the eye.
- Silicone oil is sometimes used instead of
gas to keep the retina attached postoperatively. Silicone remains in
the eye until it is removed (often necessitating a second surgery at a later
date). This technique is advantageous when long term support
("tamponade") of the retina is required, for instance in the
repair of very complicated retinal detachments. Unlike gas, patients
are still able to see through clear silicone oil. Positioning is less
critical with silicone oil, therefore, it may be used in patients
unable to position postoperatively (i.e. children). Like gas, silicone
oil can promote cataracts, cause glaucoma, and may damage the cornea.
- Endophotocoagulation is the use of laser
to treat intraocular structures. This modality is often used to treat
retina tears in the setting of retinal detachment.
Endophotocoagulation is frequently used to treat proliferative diabetic retinopathy
- Microsurgical instruments such as forceps,
scissors and picks may be used to
manipulate intraocular structures such as in the removal of scar tissue and
foreign bodies. Literally hundreds of vitrectomy instruments are available
to assist in different surgical maneuvers. Most of these vitreoretinal
tools have a diameter of less than 1mm, making them some of the most precise
and finely crafted instruments in the world today.
- Endoscopy allows the surgeon to view the
inside of the eye on a television monitor while treating intraocular
structures. It is a helpful technique when the cornea or lens are
cloudy and do not allow a clear view through the operating microscope.
- Scleral buckling is sometimes combined
with a vitrectomy procedure to add additional support to the re-attached
retina (see Retinal Detachment page).
- Lensectomy is the removal of the eye's
crystalline lens during a vitrectomy procedure. This is sometimes
performed when there is a cataract
(clouding of the lens) which 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.
The natural lens can be replaced with a clear lens implant at a later
date or during the same surgical procedure. Lensectomy is usually
performed using high frequency ultrasound (phacoemulsification) similar to
routine cataract surgery.
Vitrectomy surgery is a major medical advance which allows us
to treat retinal diseases and prevent vision loss for patients who, in previous
years, may have gone blind without this technique. A vitrectomy procedure
usually takes about 1-2 hours but may take longer in complex cases or when
combined with a scleral buckle or lensectomy. Risks of surgery include
infection, bleeding, cataract, glaucoma, and detachment or re-detachment of the
retina. Any of these complications can result in severe visual loss or
even loss of the eye itself. It is important that you discuss the
potential risks and benefits of this procedure with your surgeon before making a
decision regarding treatment.
Please note that much of the above content was
provided compliments of: Vitreous-Retina-Macular
Consultants New York
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