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Vitrectomy

Last updated April 5, 2018

Vitrectomy is a microsurgical procedure that involves the removal of the vitreous fluid.


Background Information:

What are the other Names for the Procedure?

  • Anterior Vitrectomy
  • Pars Plana Vitrectomy

Both these names are based on the region of the eye, where the procedure is performed.

What is the Vitrectomy surgical procedure?

  • Vitrectomy is a microsurgical procedure that involves the removal of the vitreous fluid
  • The vitreous fluid is a clear gel-like fluid present in the center of the eye. It is responsible for giving shape to the eye and maintaining eye pressure
  • Anterior Vitrectomy refers to the procedure where only small portions of the vitreous are removed, from the front structures of the eye. This procedure is performed in case of a traumatic cataract removal and secondary intraocular lens placement
  • The Pars Plana Vitrectomy refers to a group of procedures that involve the deeper end of the eye. During this procedure, almost all of the vitreous fluid is removed. It is carried out in cases of various retinal disorders, eye injuries, hemorrhage, etc.

What part of the Body does the Procedure involve?

A Vitrectomy procedure involves the eye and eye parts.

Why is the Vitrectomy surgical procedure Performed?

  • The vitreous fluid is removed in order to cure or prevent continued vision loss resulting from retinal damage, cause by bleeding, injury, or infection, inside the eyeball
  • Such conditions could arise due to sickle cell disease, complications of cataract surgery, glaucoma and various retinal disorders like macular hole, eye floaters, proliferative diabetic retinopathy, traumatic eye injuries, retinal detachment, macular pucker, and vitreous hemorrhage

What are some Alternative Choices for the Procedure?

This procedure is only carried out in extreme cases, when no other therapy or surgery can be helpful.

What are the Recent Advances in the Procedure?

There has been some advancement in the field of technology, including the micro instruments involved, and various materials used to replace the vitreous fluid; all meant to get best results, while enabling a quicker recovery.

What is the Cost of performing the Vitrectomy surgical procedure?

The cost of Vitrectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Vitrectomy procedure and on what needs to be done.
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.allaboutvision.com/conditions/vitreoretinal-procedures.htm

http://www.maculacenter.com/EyeSurgery/vitrectomy.htm

Prior to Vitrectomy surgical procedure:

How is the Vitrectomy surgical procedure Performed?

  • During a Vitrectomy procedure, the eye is held open and in place with the help of a special speculum. Incisions are generally made through the pars plana
  • Pars plana is a region of the eye that has no specific function in a fully-developed (post-fetal) eye. It is thus considered to be a safe place for incisions
  • Three incisions are made to enable three instruments to enter the eye
  • One incision is used to insert a tube, an infusion line that supplies a fluid that replaces the vitreous fluid being removed, in order to maintain constant eye pressure
  • The second incision is used to insert a microscopic cutting device, which cuts the vitreous fluid into tiny bits and aspirates (sucks out) the vitreous
  • The third incision is used to insert a microscopic illuminator, a high intensity fiber optic light source, which will light up the interior of the eye, in order to give a clear view
  • The surgeon then uses a special operating microscope with contact lenses, to get a clear view of the inner eye, at varying magnifications
  • The fluid used for replacing the aspirated fluid, closely resembles the natural vitreous fluid and contains certain factors that promote the development of the vitreous
  • Small, self-absorbing stitches are then used to close the incisions
  • Depending upon the condition to be treated, other procedures are carried out. Other instruments like forceps, scissors, pics, or lasers can be used for cauterizing blood vessel leaks, removing scar tissue or foreign bodies. In case of macular holes and retinal detachments, various substances like sterile air, gas, or silicone oil, are inserted as a replacement to the vitreous to flatten the detached retina, thereby allowing its reattachment and to close up macular holes, allowing it to heal.

Where is the Procedure Performed?

A Vitrectomy procedure is usually performed in an out-patient surgery center facility or at a hospital’s surgery facility, depending on the need for hospitalization

Who Performs the Procedure?

The surgical procedure is performed by an ophthalmologist, who is specialized in vitreoretinal surgery.

How long will the Procedure take?

The length of the surgery is generally 1-3 hours. However, the time period varies, and it is dependent upon the complications and other surgical procedures (if any) involved.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Local anesthesia may not be used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Vitrectomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Vitrectomy surgical procedure?

Routine blood tests and urine tests are required along with eye examinations, before Vitrectomy procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Vitrectomy procedure?
  • Why is this procedure necessary?  
  • What does the procedure involve?
  • How will this procedure help?
  • Will I need adjunct treatments after the surgery? 
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Is there any life style restrictions needed after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Are there any life-long medications that need to be taken after the procedure?
  • How many procedures have you (the physician) performed? 
  • What are the costs involved?

During the Vitrectomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered local anesthesia, either with or without sedation. However, in some cases, general anesthesia may be administered, depending on the procedures performed (if any), along with Vitrectomy.

How much Blood will you lose, during the Procedure?

There is no significant blood loss during the procedure.

What are the possible Risks and Complications during the Vitrectomy surgical procedure?

The possible risks and complications during the surgery are:

  • Accidental damage to other parts of the eye
  • Infection
  • Bleeding

What Post-Operative Care is needed at the Healthcare Facility after the Vitrectomy surgical procedure?

  • Generally, no post-operative care is required at the healthcare facility
  • Once the surgery is performed, the patient may go home and return later, to get the eye patch removed. Apart from that, routine check-ups will be necessary, till recovery is complete
  • In case of retinal detachments, where silicone oil has been used; a second surgery may be required to remove the oil and replace it with a more natural fluid that can be easily replaced by vitreous fluid

After the Vitrectomy surgical procedure:

What are the possible Risks and Complications after the Vitrectomy surgical procedure?

Post Vitrectomy surgical procedure, the following complications may arise:

  • Infections
  • Cataract
  • Development of glaucoma
  • Vision loss (extremely rare)
  • Recurrent retinal detachment
  • Loss of depth perception, blurred vision or double vision
  • Loss of night vision
  • Refractive changes
  • Choroidal effusion (swelling of layer under the retina due to fluid build-up)
  • Macular pucker (wrinkling of retina)
  • Cystoid macular edema (fluid in the macula, leading to swelling)

What is the Prognosis after the Surgery?

The prognosis of the surgery is dependent upon the nature of the eye disorder and the ability of the eye to heal

  • A surgery is termed successful, if the vision returns back to normal, or is greatly improved

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Decrease in vision
  • Increasing pain
  • Increasing redness
  • Swelling around the eye
  • Discharge from the eye
  • Any new floaters, flashes of light or changes, in the field of vision

What Post-Operative Care is needed at Home after the Vitrectomy surgical procedure?

Vitrectomy is often performed along with other procedures; thus, the post-operative instructions may vary from patient to patient. Some of these instructions include:

  • Regular use or application of the prescribed anti-inflammatory and antibiotic drops, once the eye patch has been removed
  • A plastic eye shield should be worn, to avoid any water from entering the eye
  • Avoid bending, stooping, lifting heavy objects, or performing any other strenuous activity
  • Follow the special instructions given by the physician, regarding positioning of the head
  • Avoid air travel
  • Use warm compress over the eyes to relieve discomfort

How long does it normally take to fully recover, from the Procedure?

A complete healing (if no complications develop), takes about 5-6 weeks, after the surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient

Who will you receive a Bill from, after the Vitrectomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from

  • The outpatient facility
  • An ophthalmologist
  • An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before the Vitrectomy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 4, 2013
Last updated: April 5, 2018

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