Vitrectomy refers to the surgical removal of part or all of the vitreous body from the eye. The vitreous body forms the central part of the human eye and consists mainly of a gel-like substance. This fills the back of the eye and keeps the eye stable. If the vitreous body becomes diseased, this can entail considerable risks. There are many medical and health reasons that require a vitrectomy.
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Until the late sixties of the 20th century, doctors did not perform surgical procedures on the vitreous body. Vitrectomy was also not used. The reason for this was the numerous complications associated with vitrectomy.
At that time, doctors relied on a swab vitrectomy. This involved doctors sucking the vitreous out of the eyeball with a swab.
With today's vitrectomy using modern suction and cutting devices, doctors do not have to apply traction to the entire vitreous body. This reduces the frequency 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 when the vitreous is removed.
This procedure minimizes the risks and is also possible in difficult cases. As a result, vitrectomy became more and more fashionable and replaced other vitrectomy procedures.
The new options allow doctors to treat many eye complaints and diseases more specifically and with less risk.
Many patients are initially reluctant to have a vitrectomy. They believe that the vitreous body is an important part of the eye. They equate the loss of the vitreous body with the loss of vision. In fact, the vitreous body substance is only important during the developmental phase of the eye.
Later, it merely fills the eyeball and gives it shape. Other substances can also do this without any problems.
Doctors usually inject air or gas into the eye, which is absorbed during the process. They then replace the body's own fluid. Difficult retinal detachments require the injection of silicone oil.
After the procedure, the eye is very sensitive for the first few days, but the procedure itself is not painful @ Pepermpron /AdobeStock
Aspiration of the vitreous humor may be necessary under various circumstances.
An eye injury caused by an accident can often lead to bleeding into the vitreous body or contamination by foreign bodies.
If the body cannot break down foreign substances from the eye, doctors must remove the vitreous body. They replace it with a neutral solution.
Other common reasons for a vitrectomy are retinal detachment or diabetic retinopathy. If fluid leaks from the vitreous, this can permanently damage the retina and lead to severe difficulties.
A vitrectomy can significantly improve vision. It can be used for diagnosis or to treat the eye with antibiotics.
Because eye surgery always involves risks, doctors rarely perform a vitrectomy for mild symptoms. In the case of severe eye complaints, doctors perform a vitrectomy quickly in order to avoid visual impairment or blindness.
The treating doctor can determine whether a vitrectomy is necessary to treat an eye disease after a comprehensive examination.
He will take this into account:
If any aspect of the above speaks against a vitrectomy, the doctor should consider alternatives.
The doctor will check in advance whether a complete or partial vitrectomy is necessary.
Vitrectomy is a tried and tested operation that is always performed inside the eye. Doctors only aspirate or remove the jelly-like mass.
As vitrectomy does not exert any tension on the eye, the pressure in the eye remains largely stable during the procedure.
Vitrectomy is usually performed under local anesthesia. It is not possible to move the eye during the procedure due to anesthetics.
Only in rare cases (children, anxious patients or special risk factors) do doctors perform vitrectomy under general anesthesia.
The procedure is as follows:
The three incisions are so tiny that doctors do not need to stitch them after the vitrectomy. As a rule, there is only slight pain, if any at all. Patients who have a vitrectomy remain in hospital for two to five days.
The procedure takes between 30 and 60 minutes, depending on the severity.
Like any surgical procedure, vitrectomy carries a whole range of risks and side effects. The patient should clarify these with the attending doctor during the preliminary consultation. Overall, however, the risks are relatively low. In most cases, the benefits outweigh the risks of the operation.
Inflammation is the greatest risk during and after the operation. To reduce the risk of infection, patients remain in hospital for treatment.
Only in very rare cases do doctors perform vitrectomy on an outpatient basis.
Other complications include
Cataract in the light of a slit lamp @ Zarina Lukash /AdobeStock
After hospitalization, the patient should be careful for a few days and weeks. The patient's attending physician will tell them how they should behave in terms of eye hygiene, stress limits and head posture.
Individual consideration is important because not every vitrectomy requires the same rules of conduct. As a rule, however, patients should avoid physical exertion, sport, direct sunlight, rubbing their eyes and make-up.
The decision as to whether a vitrectomy is necessary must be made by the ophthalmologist depending on the disease and the prognosis. This is because vitrectomy cannot eliminate all symptoms.
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