Until the late 1960s, doctors did not perform surgical procedures on the vitreous body. Vitrectomy was also not used at that time. The reason was the numerous complications associated with vitreous aspiration.
At that time, doctors relied on a swab vitrectomy. In this procedure, doctors removed the vitreous humor from the eyeball using a swab. With today’s vitrectomy, which uses modern suction and cutting devices, doctors do not need to apply traction to the entire vitreous humor. This reduces the incidence of complications.
Experts also refer to vitrectomy as pars plana vitrectomy (PPV for short). A continuous infusion into the eyeball ensures that the eyeball does not collapse during vitreous removal.
This procedure minimizes risks and is possible even in difficult cases. As a result, vitrectomy has become increasingly common when medically necessary, replacing other vitrectomy techniques. Thanks to these new possibilities, doctors can treat many eye conditions and diseases in a more targeted and low-risk manner.
Many patients are initially hesitant about undergoing a vitrectomy. They believe that the vitreous is an important part of the eye. They equate the loss of the vitreous with the loss of vision. In fact, the vitreous substance is only important during the eye’s developmental phase.
Later on, it simply fills the eyeball and gives it its shape. Other substances can easily take over this function.
In most cases, doctors inject air or gas into the eye, which is subsequently reabsorbed. They then replace it with the body’s own fluid. Difficult retinal detachments require the injection of silicone oil.
The eye is very sensitive for the first few days after the procedure, but the procedure itself is not painful @ Pepermpron /AdobeStock
Vitrectomy may be necessary under various circumstances. An eye injury caused by an accident can often lead to bleeding into the vitreous humor or contamination by foreign bodies.
If the eye cannot naturally clear foreign substances, doctors must remove the vitreous humor. They replace it with a neutral solution.
Other common reasons for a vitrectomy include retinal detachment or diabetic retinopathy. If fluid leaks from the vitreous humor, it can cause permanent damage to the retina and lead to severe vision problems. A vitrectomy can significantly improve vision. It can be performed for diagnostic purposes or to administer antibiotics to the eye.
Because eye surgery always carries risks, doctors rarely perform a vitrectomy for mild symptoms. In cases of severe eye problems, doctors perform a vitrectomy promptly to prevent vision loss or blindness.
The treating physician can determine whether a vitrectomy is necessary to treat an eye condition after a comprehensive examination.
In doing so, they consider:
- The individual diagnosis
- The condition of the eye
- The patient’s condition
If any of the above factors indicate that a vitrectomy is not advisable, the doctor should consider alternative treatments. The doctor will determine in advance whether a complete or partial vitrectomy is necessary.
A vitrectomy is a well-established surgical procedure that is always performed inside the eye. During the procedure, doctors simply suction out the gel-like mass.
Since vitrectomy does not exert any traction on the eye, intraocular pressure remains largely stable during the procedure.
Vitreous removal is usually performed under local anesthesia. Anesthesia prevents the eye from moving during the procedure.
Only in rare cases (children, anxious patients, or those with specific risk factors) do doctors perform vitrectomy under general anesthesia.
The procedure is as follows:
- First, the surgeon makes three small incisions that serve as access points for the necessary instruments.
- Through these access points, doctors insert a suction-cutting instrument, an irrigation-drainage tube (to maintain intraocular pressure), and a light source.
- They then remove the diseased or damaged parts of the vitreous body or the entire vitreous mass. To prevent the eye from collapsing due to the removal of the vitreous body, doctors inject fluid into the eye. This is done through a minimal (smaller than 1 mm) opening.
The three incisions are so tiny that doctors do not need to suture them after the vitrectomy. As a rule, patients experience only mild pain, if any. Patients who undergo a vitrectomy are hospitalized for two to five days. Depending on the severity of the condition, the procedure takes between 30 and 60 minutes.
Complications and Risks
Like any surgical procedure, vitrectomy carries a number of risks and side effects. Patients should discuss these with their treating physician during the preoperative consultations. Overall, however, the risks are relatively low. In most cases, the benefits outweigh the risks of the surgery.
Infection is the greatest risk during and after the surgery. To reduce the risk of infection, patients are admitted to the hospital for treatment.
Only in very rare cases do doctors perform a vitrectomy on an outpatient basis.
Other complications include:
Cataract viewed under a slit lamp @ Zarina Lukash /AdobeStock
After being discharged from the hospital, the patient should take it easy for a few days and weeks. The patient’s treating physician will explain how to maintain proper eye hygiene, what physical activity limits to observe, and how to position the head.
An individualized approach is important because not every vitrectomy requires the same guidelines. As a general rule, however, the patient should avoid physical exertion, sports, direct sunlight, rubbing the eyes, and wearing makeup.
In summary, vitrectomy is a highly advanced procedure in retinal and vitreous surgery and is now routinely performed by an experienced specialist. Vitrectomy is a surgical procedure in which removal of the vitreous body is necessary to effectively treat certain conditions. The vitreous body can be removed either completely or partially, particularly in cases of retinal detachment or macular diseases. Modern techniques such as pars plana vitrectomy or 27-gauge vitrectomy enable highly precise, minimally invasive vitrectomy procedures.
Vitreous removal is performed as part of specialized eye procedures, often at a modern eye center staffed by experienced ophthalmologists. After the vitreous is removed, it is replaced with the eye’s own fluid, or a special gas is injected into the interior of the eye. This special gas serves to stabilize the retina and temporarily affects intraocular pressure. Vitrectomy is an option when conservative therapies are insufficient or when it is the only reasonable treatment.
Thanks to continuous advancements in retinal surgery, vitrectomies are now particularly gentle and safe. The procedure is usually performed under local anesthesia and is characterized by high quality and safety. Nevertheless, follow-up examinations and careful monitoring are crucial for the healing process. Antibacterial eye drops support healing and prevent infections. Overall, minimally invasive vitrectomy offers an effective treatment option with good prospects of success for many patients.
What is a vitrectomy?
A vitrectomy is a surgical procedure in which the vitreous body in the eye is completely or partially removed. This vitreous surgery is often performed for retinal diseases. The goal is to improve vision and prevent complications.
When is a vitrectomy necessary?
A vitrectomy is used to treat various conditions, including retinal detachment, macular holes, or severe vitreous opacities. Bleeding in the vitreous can also be an indication for this procedure.
How is the surgery performed?
The surgery is usually performed using a minimally invasive technique through small incisions in the eye. The vitreous is removed and replaced with a fluid, gas, or silicone oil. The procedure can be performed under local or general anesthesia.
What are the risks?
Like any surgery, vitrectomy carries a risk of complications such as infection, bleeding, or increased intraocular pressure. Overall, however, the procedure is considered safe and is frequently performed successfully.
What is the follow-up care like?
Regular follow-up exams are important after a vitrectomy. Eye drops support the healing process and help prevent infections. Depending on the treatment, a specific head position may be necessary.
