Treatments & Surgery - Vitrectomy
Vitrectomy is literally the removal of the vitreous gel from the eye. The eye is filled with a protein and water based gel, about 4mls of it. One might think that removal of the gel would cause collapse of the eye or other problems but in fact this is not the case. The eye secretes fluid (aqueous humour) to replace the removed vitreous.
Above: The left macula affected by a white fibrotic membrane causing distortion and thickening of the retina
Vitrectomy is done for many reasons including retinal detachment, macular hole, premacular fibrosis, diabetic retinopathy, and trauma. It is done with either 20 gauge instruments or the newer 23 gauge instruments. The latter have
To do a vitrectomy requires a trip to the operating theatre and anaesthesia to put the eye to sleep. Small cuts are made in the white part of the eye and small suction and cutting instruments are used to remove the gel. Once this is done, often membranes on the retinal surface can then also be removed using tiny grasping forceps.
Left: An actual surgical image taken during vitrectomy. It shows the internal limiting membrane being peeled by microforceps, after staining with a blue dye.
Sometimes ancillary chemicals and dyes are used to enhance this process. We typically use Membrane Blue, Brilliant Peel, and triamcinolone to do this. During the vitrectomy the eye is kept “inflated” by the constant infusion of high tech saline. At the conclusion of surgery we sometimes put gas or other chemicals into the eye to aid in recovery.
Above: A cross section of the retina in the lower half, the internal limiting membrane stained bright yellow in the middle, and the adherent vitreous gel in the upper half. The vitreous gel and the membrane are peeled away during the operation
Vitrectomy is generally a very safe operation and is now very commonly done. The main problems with vitrectomy include a risk of causing cataract, risk of retinal detachment, risk of high pressure related to the use of gas, and a small risk of infection.
