Vitrectomy is a surgical procedure to remove the vitreous humor, the gel-like substance that fills the back cavity of the eye. As one of the most important microsurgical techniques in the treatment of retinal diseases, vitrectomy is successfully applied in the treatment of many serious conditions such as diabetic retinopathy, retinal detachment, macular hole, and intraocular hemorrhages. Thanks to modern technology, this surgery can be performed with sub-millimeter incisions, providing promising results for many diseases that could otherwise lead to vision loss. Many retinal diseases that were considered untreatable in the past can now be successfully treated with vitrectomy, making it possible to preserve or improve patients' vision. With the development of heads-up 3D surgical systems and smaller gauge instruments, the practice of vitrectomy is constantly being renewed.
What is Vitrectomy and How Does It Work?
Vitrectomy is based on the principle of fragmenting and aspirating the vitreous gel located in the posterior two-thirds of the eye using specialized surgical instruments, and performing therapeutic procedures on the retina when necessary. Unlike traditional open surgery, only three small entry ports of approximately 0.5 mm are created in the eye. Through these openings, a vitrectome (cutting-suction instrument), an illuminating probe, and an infusion cannula are inserted into the eye. The vitrectome breaks the vitreous into microscopic particles and simultaneously aspirates them out of the eye. A balanced salt solution is continuously infused to replace the removed vitreous, thereby maintaining intraocular pressure. At the end of the procedure, the bloody vitreous is completely cleared, tractional membranes on the retina are peeled, and necessary treatments are applied.
Working Principle
The basic steps of vitrectomy surgery are as follows:
- Creating micro-ports: Three ports of 23, 25, or 27 gauge size are opened in the sclera (white of the eye).
- Inserting the infusion cannula: One port is dedicated to infusion for continuous fluid balance.
- Vitreous aspiration: The vitreous fluid is fragmented and aspirated using the vitrectome.
- Intraoperative imaging: The retina is examined in detail using endoscopic illumination.
- Membrane peeling: Epiretinal membranes on the retina are removed using forceps.
- Treatment applications: Procedures such as laser, cryotherapy, or membrane peeling are performed.
- Tamponade application: The eye is filled with gas, air, or silicone oil when necessary.
- Closing the ports: In most cases, no sutures are required; they close spontaneously.
Which Diseases Is It Used For?
Vitrectomy is applied in a very wide range of diseases:
- Retinal detachment: Separation of the retina from its underlying tissue.
- Diabetic retinopathy: Advanced proliferative diabetic retinopathy and intraocular hemorrhage.
- Vitreous hemorrhage: Bleeding into the eye due to various causes.
- Macular hole: Formation of a hole in the center of the macula.
- Epiretinal membrane: Formation of a fibrous membrane on the retinal surface.
- Vitreomacular traction: The vitreous pulling on the macula.
- Endophthalmitis: Treatment of intraocular infections.
- Traumatic eye injuries: Removal of foreign bodies that have entered the eye.
- Complex cataract: Dislocation of lens fragments into the posterior segment.
- Age-related macular degeneration: Cases with submacular hemorrhage.
- Retinopathy of prematurity: Applied in advanced stages.
- Uveitis complications: Vitreous opacities occurring in chronic intraocular inflammation.
- Post-traumatic complications: Retinal problems developing after eye trauma.
Advantages of Vitrectomy
The clinical benefits provided by this advanced retinal surgery are significant:
- Prevention of vision loss: Preserves vision in diseases that could lead to blindness if left untreated.
- Minimally invasive approach: Surgery is performed through very small incisions, eliminating the need for sutures.
- Rapid recovery process: Recovery time has been significantly shortened with modern techniques.
- Versatile treatment in a single session: Multiple retinal problems can be addressed in the same surgery.
- High success rate: Successful results are achieved in the vast majority of cases with the correct indication.
- Local anesthesia option: Most surgeries can be performed without the need for general anesthesia.
- Ambulatory surgery: Can be performed as a day-case surgery in many instances.
- Continuous technological advancement: Results are improving with heads-up 3D systems and smaller gauge instruments.
- Combined procedure option: Can be combined with cataract surgery.
- Detailed retinal examination: The retinal surface can be evaluated in detail during the procedure.
Treatment Process
Before a vitrectomy, the patient undergoes a detailed eye examination. The type and stage of the disease are determined through tests such as optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasonography. Systemic diseases (diabetes, hypertension) are brought under control, and blood-thinning medications are adjusted if necessary. The surgery takes approximately 30-90 minutes under local anesthesia; it may extend to 2-3 hours in complex cases. The procedure is performed under an operating microscope, and real-time retinal imaging is conducted via intraoperative OCT if needed. After surgery, gas or silicone oil may be placed inside the eye in some patients; in this case, the patient may need to remain in a specific position (usually face-down). The face-down position is important in cases of macular hole and retinal detachment and may last from a few days to a few weeks. There may be redness, mild pain, and blurred vision in the eye for the first few days. Antibiotic and anti-inflammatory drops are used regularly. Full visual recovery may vary from weeks to months depending on the disease. Regular check-ups are important to monitor the success of the disease and treatment. In patients with silicone oil, the oil is removed via a second minor operation after 3-6 months.
Points to Consider
Patients who have had gas placed in their eye after vitrectomy surgery must avoid air travel for a certain period because pressure changes can lead to serious complications. For patients advised to maintain a face-down position, compliance with this rule directly affects the success of the treatment. Post-operative increases in intraocular pressure, cataract development, and rarely, recurrence of retinal detachment may occur. Regular control of diabetes, blood pressure, and other chronic diseases is critical for long-term success. In case of sudden vision loss, severe pain, or redness after surgery, an ophthalmologist should be consulted immediately. Regular follow-up appointments should never be missed. In diabetic patients, blood sugar control must be ensured both before and after surgery. After the procedure, contact with water, rubbing the eye, and heavy labor should be avoided during the first week. It should be remembered that since cataract development is common after surgery, cataract surgery may be required in the future.
As Koru Hospital, in our ophthalmology department, we successfully treat the most complex retinal diseases with our team of physicians specialized in retinal surgery and our state-of-the-art vitrectomy devices. With our 23, 25, and 27 gauge minimally invasive systems, modern endoscopic illumination technology, and multidisciplinary approach, we are committed to providing our patients with the highest standards of service in retinal health. You can apply to our center for a detailed examination and treatment options for diabetic retinopathy, retinal detachment, macular hole, and other retinal diseases from our expert team.
