Vitrectomy

What is a vitrectomy?

A vitrectomy is a surgery to remove the vitreous humor (the vitreous) of your eye. The vitreous humor is a gel-like substance that fills the center of your eyeball.

During a vitrectomy, your surgeon removes the vitreous. They may then do repairs on your retina, which is at the back of your eye. Your retina is the part of your eye that converts light into electrical signals that it sends to your brain.

Your surgeon may replace the vitreous humor with sterile salt water, silicone oil or a gas bubble. This step helps your eye keep its shape and your retina stay in position.

What does a vitrectomy treat?

You may need a vitrectomy if you have an eye condition that:

• Causes your vitreous to become cloudy. This is often due to vitreous hemorrhage or bleeding in your eye.
• Causes pulling on or damage to your retina.
• Isn’t easy to diagnose.
• Needs a drug delivery or therapeutic device.

What retinal and macular conditions do surgeons treat with vitrectomy?

• Retinal detachment: Your retina pulls away from its supporting tissue.
• Posterior vitreous detachment: Your vitreous gel pulls away from your retina.
• Diabetes-related retinopathy: The blood vessels in your retina leak and grow abnormally.
• Macular hole: You have a hole in the center of your macula, which is the center of your retina.
• Macular pucker: Your macula develops a wrinkle or a crease.
• Retinopathy of prematurity: Scar tissue forms from blood vessel growth in the eyes of premature babies.

What non-retinal conditions do surgeons treat with vitrectomy?

• Eye injury: Damage to your eye, including from scratches or punctures.
• Endophthalmitis: An infection inside your eye.
• Tumors: Vitrectomy can be a way to biopsy a tumor in your eye.
• Lens issues: Providers sometimes use vitrectomy to address cataracts and dislocated lenses.
• Drug delivery: Your healthcare provider can use a vitrectomy to place drug delivery devices. These drugs may be steroids, gene therapy and antiviral drugs.

What are the types of vitrectomy?

The type of vitrectomy you have will depend on the diseased part of your eye.

Anterior vitrectomy

You may need an anterior vitrectomy if you have vitreous leakage in the front part of your eye. The anterior chamber (the front part of your eye) contains your iris and lens. An ophthalmologist can perform an anterior vitrectomy. You may need a retina specialist to do a pars plana vitrectomy on the posterior chamber of your eye.

Posterior pars plana vitrectomy

A posterior pars plana vitrectomy treats conditions that affect the back (posterior) part of your eye. The pars plana is the flat part of the ciliary body of your eye. The posterior contains your retina, retinal pigment epithelium, choroid and sclera. It also contains the vitreous cavity, which holds the vitreous.

How common is vitrectomy surgery?

In the United States, surgeons do about 225,000 vitrectomies each year. The number is likely to continue to grow as eye care providers find more uses for vitrectomy.

What happens before a vitrectomy?

Usually, your provider will tell you when to stop eating and drinking on the day before the surgery. They’ll also tell you when and if you should stop taking your usual medications.

You’ll need a driver to take you home after the procedure. Most people go home on the same day.

You may have an ultrasound before surgery to help with placing instruments during the surgery.

What happens during a vitrectomy?

Your healthcare team will track your vital signs during the procedure.

You’ll have local anesthesia to numb your eye. You may also have intravenous (IV) sedation or general anesthesia to make you sleep.

A provider will dilate your eye. An instrument called an eye speculum will hold your eye open for the procedure.

Your surgeon will make a cut in your eye and use very small tools to take out the vitreous. They may use a laser for blood vessels that are leaking or growing out of control.

When your surgeon finishes the repair, they’ll replace the vitreous humor with sterile salt water, a gas bubble or silicone oil.

The time that you’re in surgery depends on what repairs your eye needs. Simpler surgeries could last an hour, while procedures that are more complicated take longer.

What happens after a vitrectomy?

After a vitrectomy, you’ll spend time in the recovery area until you’re ready to go home with instructions from your surgeon.

If you have a gas bubble or silicone oil, you may have to spend most of your time in a face-down position. Your provider will give you detailed instructions after surgery.

You’ll leave with a patch and medications like eye drops and instructions on how to use them. Providers tell you when you can take any medicines you stopped before the vitrectomy.

You’ll need a driver for your next appointment after the surgery, which is usually the next day.

Following the take-home instructions is key to helping your eye heal correctly.

What are the advantages of a vitrectomy?

A vitrectomy can treat eye conditions that can cause vision loss or even blindness. It can also help your provider give an accurate diagnosis and better treatment.

What are the risks or complications of a vitrectomy?

Any surgery carries risks. Possible risks or complications of vitrectomy include:

• Getting an infection.
• Bleeding.
• Retinal tearing or detachment.
• Developing a new cataract or having an existing cataract grow more quickly.
• Having either low or high pressure in your eye.
• Needing repeat eye surgery.
• Rarely, vision loss or blindness.

What is the recovery time for vitrectomy?

You’ll need to take off or stay away from work or school for about two to four weeks. It may be days or weeks until you can drive because you’ll want to wait until you know you can drive safely.

Your healthcare team will tell you how to hold your head when you’re awake and how to sleep correctly. You might find it helpful to use a neck pillow to help you keep your head in the correct position.

Your eye may feel puffy or slightly irritated. You may have some redness and bruising. It’s important to use your medicated eye drops as prescribed.

You might have imperfect vision for a few days, but it will keep getting better over time.

If you have silicone oil in your eye, you may need another surgery later to remove it. With saline or gas, your eye will begin producing vitreous that will replace the salt water or gas.

However, it may take several weeks for the gas bubble to go away. At first, it can block most of your vision, but it begins to clear from the top down. The edges may appear dark.

If you have any questions about what you’re seeing, call your provider.

When should I see my healthcare provider?

Call your provider if you have:

• Severe pain.
• Signs of infection (including severe swelling or discharge).
• Worsening vision.
• Any other concerning symptoms.

A note from Cleveland Clinic

A vitrectomy is a way to treat eye conditions that were untreatable earlier. It can be scary, but you may feel that keeping your vision is worth it. Your eye care providers are your partners in keeping your eyes healthy. Following your at-home instructions is your way of making the surgery a success. Always ask questions before and after so you know what you need to do and expect.