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Vitrectomy

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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 from the outside of the eye is called 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 in order 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 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 off the other layers. The blood supply to the retinal detachment area decreases and stops over the 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. If you recognize such symptoms, you should see an ophthalmologist to recover visual functions.

The known risk factors of the retinal detachment include age above 50 years, diabetes mellitus, hypertension and family history of retinal detachment.

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

This stage of the eye examination is followed by retinal examination by an ophthalmologist who is specialized 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 an option of surgical treatment that is reserved for retinal diseases, such as large retinal tears and retinal detachment.

For vitrectomy, small incisions are made on the eye and the vitreus humor located at the posterior part of the eye are suctioned out of the eye. After various conditions are treated that include, but 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 in order to prevent collapse.

The removal of the gel-like vitreous humor provides your ophthalmologist with the better access to the posterior part of the eye. Vitrectomy is carried out by an ophthalmologist who receives special education on retinal problems.

Risks

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 occurrence of risks, it is no means possible to warrant that the risks will be completely 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 the cataract is associated by other eye disorders or not. Such evaluations aim maximizing the postoperative visual accuracy and eliminating possible visual field disorders.

Although vitrectomy is carried out at outpatient basis, after it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase 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 to use antibiotic eye drops or tablets before and after the surgery in order to eliminate the risk of postoperative infection.

You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.


Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.


Surgery and early postoperative period

Vitrectomy is an ocular surgery that is carried out under local or general anesthesia.

Vitrectomy device, a high-end technological device, is used for the vitrectomy. Small incisions are made on the sclera of the eye. One of those incisions is used to insert a tiny camera into the eye, while other incisions serve advancing surgical instruments into the vitreous.  The vitreous humor is partially or completely emptied to make the ophthalmologist clearly see the retina and access the retinal pathologies. Vitrectomy can be used to correct various pathologies, such as removal of intraocular foreign bodies, repair of retinal tear with laser, cleaning the retinal infection and repair of the retinal detachment. The space created when vitreous humor is suctioned, depending on the type and the severity of the condition, is filled in by air or intraocular silicone. The gas or the air is absorbed by the body over the time and the space is filled in by the vitreous humor that is 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 major surgeries in the field of ophthalmology and it requires maximum attention for the postoperative care.

You may feel itching, irritation, pain, tenderness and mild discomfort in the early postoperative period. Such symptoms will spontaneously disappear without need to a treatment. If necessary, you will be prescribed medications in order 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 advices of your doctor in order to prevent or minimize postoperative complications.

You should necessarily keep your eyes clean, avoid rubbing and/or scratching your eyes and follow wound care advices of your doctor or 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 major factor that influences postoperative visual results is the location and the severity of the retinal damage.

Moreover, the risks of retinal detachment and bleeding are probable, if gas or silicone gel is used.

You should necessarily present for follow-up visits that your doctor will inform you in order to prevent and sustain surgical results after the vitrectomy.