Vitrectomy

Overview

Our eyeball consists of cornea, the foremost transparent layer of the eyeballs; the anterior chamber located behind the cornea, in which the aqueous humor is found; the iris and the pupil forming the rear border of the anterior chamber; the lens located in a capsule in the posterior chamber; the fluid, called vitreous humor, filling the eye globe in the posterior chamber; and the optic disc, the optic nerve and the retina at the rearmost part of the eyeballs. The white part seen outside the eye is called the sclera.

Vitrues body is the clear gel that fills the cavity at the posterior part of the eyeballs. The retina is the first layer that confines the vitreous humor in the eyeball.
The retina hosts photoreceptor cells of the eye, and the layer is located adjacent to the arterial and venous network (choroid plexus) of the eyeball; the macula – the layer that transmits light signals to the brain to sense the light and create the image-, the foveola, the optic disc, and the optic nerve are located in the retina.

If a hole occurs in this layer of the eye (the innermost layer at the posterior part of the eye) that is so important for healthy vision due to various reasons, including but not limited to aging, trauma, diabetes mellitus, and hypertension as well as a brain tumor, the gel-like fluid that fills the posterior portion of the eyeball may leak through the hole. The vitreous humor advances through the hole and strips this layer of the eyeball of the other layers. The blood supply to the retinal detachment area decreases and stops over time, and the detached retinal segment may not fulfill the visual functions.

The detachment of the retina is manifested by various symptoms, such as loss of visual accuracy, blurred vision, flashes in front of the eye, loss of peripheral visual field, total loss of the visual field, and floaters in one or both eyes. You should see an ophthalmologist to recover visual functions if you recognize such symptoms.
The known risk factors for retinal detachment include age above 50, diabetes mellitus, hypertension, and family history of retinal detachment.

A detailed eye examination will be made when you see an ophthalmologist due to the symptoms mentioned above. The anterior chamber, which consists of the cornea, the iris, the pupil, and the lens, is examined.

This stage of the eye examination is followed by a retinal examination by an ophthalmologist specializing in retinal diseases. At this phase, advanced imaging methods, such as fundus fluorescein angiography, optic coherence tomography, and eye ultrasound, can be ordered to evaluate retinal vessels and retinal topography in detail and to image the eye. Here, the aim is to determine the location and the severity of the retinal detachment if the retinal detachment is diagnosed.

Retinal detachment is a medical emergency, and possible treatment options include vitrectomy.

Why is this procedure done?

Vitrectomy is a surgical option for retinal diseases, such as large retinal tears and retinal detachment.
Small incisions are made on the eye for vitrectomy, and the vitreous humor located at the posterior part of the eye is suctioned out of the eye. After various conditions are treated that include, but are not limited to, bleeding, intraocular foreign body, infection, macular hole, and retinal tear as well as retinal detachment, air is insufflated to or silicone is placed in the cavity filled by the vitreous humor to prevent collapse.

Removing the gel-like vitreous humor gives your ophthalmologist better access to the posterior part of the eye. Vitrectomy is carried out by an ophthalmologist who receives special education on retinal problems. The following complications can be faced during and after vitrectomy:
•    Cataract
•    Bleeding
•    High intra-ocular pressure
•    Blindness

Although all possible measures that modern medicine allows are taken to prevent the occurrence of risks, it is by no means likely to warrant that the risks will be eliminated. Our specialists will employ all practices to minimize the risk of complications, and our ophthalmologists will preoperatively inform you about the risks listed above and all other potential complications.

Preparation

Your ophthalmologist will first evaluate your visual accuracy and the visual field. At this stage, a comprehensive examination is made to determine whether other eye disorders are associated with the cataract. Such evaluations maximize postoperative visual accuracy and eliminate possible visual field disorders.
Although a vitrectomy is carried out on an outpatient basis after it is verified that the surgery does not pose a risk, you will be asked to quit smoking if you are a smoker and to stop taking certain medications that increase the risk of bleeding. All other prescribed and over-the-counter medications, herbal products, and supplements will also be questioned, and you will be informed to continue or stop taking them.

You may need antibiotic eye drops or tablets before and after the surgery to eliminate the risk of postoperative infection.
You will also be instructed to stop eating and drinking at a particular time before the surgery. You should strictly follow this instruction to undergo the surgery as scheduled.

Moreover, it is reasonable to plan discharge, post-discharge accommodation, and travel at this phase to manage the postoperative period better.
Surgery and early postoperative period: Vitrectomy is an ocular surgery carried out under local or general anesthesia.

A high-end technological device is used for vitrectomy. Small incisions are made on the sclera of the eye. One of those incisions inserts a tiny camera into the eye, while other incisions advance surgical instruments into the vitreous. The vitreous humor is wholly or partially emptied, allowing the ophthalmologist to see the retina clearly and access the retinal pathologies.

Vitrectomy can correct various pathologies, such as removing intraocular foreign bodies, repairing the retinal tear with a laser, cleaning the retinal infection, and repairing the retinal detachment. Depending on the type and severity of the condition, the space created when vitreous humor is suctioned is filled in by air or intraocular silicone. The body absorbs the gas or the air over time, and the space is filled in by the vitreous humor produced by the healthy retina. If silicone gel or silicone oil is used, it should be removed in the future.

Finally, the devices used for the vitrectomy are removed, and small incisions are stitched. The eye is closed with bandages. Vitrectomy is one of the major surgeries in the field of ophthalmology, and it requires maximum attention for postoperative care. You may feel itching, irritation, pain, tenderness, and mild discomfort in the early postoperative period. Such symptoms will spontaneously disappear without the need for treatment. If necessary, you will be prescribed medications to manage those symptoms. Your doctor may ask you to use antibiotics, anti-inflammatory tablets, and eye drops as a precaution. You should closely follow all advice of your doctor to prevent or minimize postoperative complications. You should keep your eyes clean, avoid rubbing and scratching your eyes, and follow the wound care advice of your doctor or be present for wound dressing visits after the surgery.

Therefore, you should see your doctor at follow-up visits that will be informed to you, and you should also be ready to visit your doctor at particular intervals.

Result

Retinal damages are, unfortunately, irreversible, as retinal cells cannot regenerate.
The primary factor influencing postoperative visual results is the retinal damage's location and severity.
Moreover, if gas or silicone gel is used, the risks of retinal detachment and bleeding are probable. You should be present for follow-up visits that your doctor will inform you of to prevent and sustain surgical results after the vitrectomy.