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Vitrectomy

What is vitrectomy?
Vitrectomy is a microsurgical procedure in which specialized instruments and techniques are used to repair retinal disorders.

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 fiberoptic 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.

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. Entering the eye through this location avoids damage to the retina and the crystalline lens.

Instruments entering the eye through the pars plana (brown area). Vitreous gel is being removed.

What are diseases requiring Vitrectomy?
Trans pars plana vitrectomy (TPPV) is used to treat many different retinal disorders including those listed below

Surgeon’s view during vitrectomy surgery
During vitrectomy surgery, the retinal surgeon may use a variety of special techniques to achieve the desired results, including:

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. 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
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.
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.